Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
PADILLA, DENNYS DIAZ (5)
• • N-2026-135' JUN 1 'I 2026 RECREATION SERVICES AGREEMENT WITH DENNYS DIAZ PADILLA FOR FOLKLORICO DANCE CLASSES D:W (ii) THIS AGREEMENT is made and entered into on this 7th day of May, 2026 by and 0014t SOW 44) between Dennys Diaz Padilla,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 may be 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 Folklorico dance classes in its recreation class program. B. Provider represents that it is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Provider represents that 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 COVID-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. Page 1of8 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-I9 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. COMPENSATION a. In consideration for the provision of the programs set forth in Exhibit A, City agrees to pay, and Provider agrees to accept as total payment for their services for the City, seventy percent (70%) of all gross revenue received from program participants. Total annual revenue to Provider shall not exceed Twenty-Five Thousand Dollars and Zero cents($25,000). 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-year period upona 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 Page 2 of 8 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 indemnify, defend and hold harmless the City, its officers, agents,employees,consultants,special counsel, and representatives from liability: (1)for personal injury, damages,just compensation,restitution,judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Provider or its contractors,subcontractors, agents,employees, or other persons acting on their behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages,just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement, to the extent that the injury, damages,just compensation,restitution,judicial or equitable relief is caused by the negligence of the Provider. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of,or effects,arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. In no case will Provider be required to indemnify or hold harmless the City from injury, damages,just compensation,restitution,judicial or equitable relief caused by the negligence of the City. 7. CONFIDENTIALITY If Provider receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary,Provider agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information, including but not limited to student records. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either Party by any subsidiary and/or agent of the other Party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a)has been disclosed in publicly available sources; (b) is, through no fault of the Provider disclosed in a publicly available source; (c)is in rightful possession of the Provider without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or(e)is independently developed by the Provider without reference to information disclosed by the City. Page 3 of 8 8. COVID-19 ASSUMPTION OF RISK AND WAIVER Provider acknowledges that Provider could be exposed to persons that may have COVID- 19 providing services pursuant to this Agreement. Provider understands that interacting with any person currently comes with the inherent risk of exposure to COVID-19 and that COVID-19 is highly contagious. Provider assumes the risks associated with providing services pursuant to this Agreement, namely potential exposure to COVID-19. Provider acknowledges that while some people have no symptoms or mild symptoms from COVID-19,some people have become seriously 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 City'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 CaIPERS 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 Page 4 of 8 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 funds 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 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, 288.2,288.3,288.4,288.5,288.7,289,290,311,1,311,2,311.3,311.4,311.10,311.1 I,314, 347(a),368,417(b),451(a),518 with 186.22, 647.6, 653f(c),664 and 187, 667.5(c), 18745, 18750, or 18755, 12022.53, 11418(b)(1)or(b)(2);Business and Professions Code Section 729. 11. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail,postage prepaid, or sent by'fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: City Clerk City of Santa Ana 20 Civic Center Plaza(M-30) P.O. Box 1988 Santa Ma, CA 92702-1988 Fax (714) 647-6956 Page 5 of 8 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) 571-4211 To Provider: Dennys Diaz Padilla 2295 Lime Ave.Apt. B Long Beach, CA 90806 dennysdiaz052@gmail.com A Party may change its address by giving notice in writing to the other Party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four(24)hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames,weekends, federal, state, County or City holidays shall be excluded. 12. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Provider regarding the subject matter herein, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This.Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Provider. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Provider or the City. Each Party to this Agreement acknowledges that no representations, inducements,promises or agreements,orally or otherwise,have been made by any Party,or anyone acting on behalf of any Party, which is not embodied herein. 13. ASSIGNMENT The experience, knowledge, capability and reputation of Provider were a substantial inducement for City to enter into this Agreement. Therefore, 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. Page 6 of 8 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. 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. 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. 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. SEVERABILITY In the event that one or more of the phrases, sentences, clauses, paragraphs or sections contained in this Agreement shall be declared invalid or unenforceable by valid judgment or decree , Page 7 of 8 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: CITY OF S NTA ANA 41111111 nni er LTAl. lvaro Nunez City Cler City Manager APPROVED AS TO FORM: SONIA R. CARVALHO PROVIDER: City Attorney Dennys az adilla(May 24,2026 13:26:28 PDT) Jonathan T. Martinez Dennys Diaz Padilla Assistant City Attorney RECOMMENDED FOR APPROVAL: 41/4 a Scott400 Yecutive Director o Parks, Recre. - -•e + unity Services Agency Page 8 of 8 EXHIBIT A SCOPE OF SERVICES SCOPE OF SERVICES Program Overview: This Scope of Services outlines the responsibilities and expectations for engagement of Provider (or instructor")to provide Folkloric° dance classes for ages 4 years and older at City recreation facilities and parks, as defined below. The aim is to promote health and wellness in the community by offering affordable recreation opportunities that encourage 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: I. Danza Folklorico 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. Provider and City agree that class locations and/or scheduling are subject to change due to unforeseen events or needs beneficial to the class participants. The Parties agree that changes to scheduling or location of classes shall be agreed upon, in writing, prior to the allowance of said change(s). iii. Class Size i, 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 set for each class to 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. 1 iv. Class Fees i. Class pricing is dependent on session length per season and subject to City staff approval. Class pricing is limited to no more than a 5% increase annually. ii. Each participant shall pay class registration fees as established by City. Instructor may not waive class participation/registration fees. Only 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: I. Planning and delivering engaging and age-appropriate Folklorico dance classes as defined by class curriculum and description to be approved by City staff. ii. Ensuring the safety and well-being of all participants during class sessions. • 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 needs, facility availability, and alignment with City goals, iv. Adhering to all City policies and procedures related to the use of facilities and interaction with participants. v. Adhering to all City deadlines for required documentation. vi. The 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. 2 viii. Instructor shall provide all materials, supplies, equipment, records and personnel. Instructor shall be responsible for repairing and maintaining all equipment and supplies, and ensuring that it is in good working condition. Instructor shall ensure clean-up of the facilities and materials to ensure the safety and effectiveness of instruction. The City will not responsible for any damage, repairs, misplaced, or stolen supplies or equipment, and will not be responsible for storing supplies or equipment. C. City Responsibilities: i. City shall manage participant registration and class information through registration software. Instructor shall be granted access to the class roster on the City registration system and is responsible for tracking attendance. ii. City shall collect all enrollment fees through the registration software. 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 class(es) seasonally, in writing. The City will confirm the class(es) schedule seasonally: Location selection is based on need, size of class, type of activity and availability, and is reserved at the discretion of the City. v. City shall provide refunds to participants when: • The participant formally requests to drop the class before the second schedule class meeting. • The class is canceled by City or Instructor. 3 EXHIBIT B INSURANCE REQUIREMENTS 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. MINIMUM SCOPE AND LIMIT OF INSURANCE 1. Commercial General Liability(CGL):Insurance Services Office Form CG 00 Olcovering 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. Required policy limits can be met with primary and umbrella/excess insurance policies. 2. Automobile Liability(AL):Insurance Services Office Form CA 00 01 covering Code 1 (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 umbrella/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, and the CGL 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. 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. 5. 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 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 Aim,Attention: Parks, Recreation, and Community 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:VII, unless otherwise acceptable to City. Verification of Coverage Provider shall furnish City with original Certificates of Insurance including all required amendatory endorsements(or copies of the applicable policy language effecting coverage required by this clause) and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive Provider's obligation to provide them. City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. Special Events Coverage Special events coverage is available and can be purchased by Provider. Use this link to learn more: littps://www.theeventhelper,cointiymilia. 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. A`.---- OB/13/2025VVY) Ro® CERTIFICATE OF LIABILITY INSURANCE DATE (M /2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Maguire Insurance Agency,Inc.FWI NAME: 1 Bale Plz Ste 100 PHONE FAX Bala Cynwyd,PA 19004.1401 (AIC,No,Ext): (A/C,No): 610,617.7900 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC it INSURER A: Philadelphia Indemnity Insurance Company 18058 INSURED INSURER B: Dennys Diaz INSURER C: 7143 Fulton Way Stanton,CA 90680 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDIYYYY) (MMIDOIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X PHPK2457612-003 09101(202S 08101/2026 EACH OCCURRENCE $1,000,000 CLAIMSMADE OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 X PROFESSIONAL LIABILITY MED EXP(Any one person) $2,500 PERSONAL&ADV INJURY $1,000,000 GENT.AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY ®PROJECT ❑LOC R PRODUCTS-COMP/OP AGG $6,000,000 SAM AGGREGATE $30Q000 OTHER SAM OCCURENCE $100,000 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) $ — ANY AUTO BODILY INJURY(Per person) $ ®OWNED AUTOS SCHEDULED AUTOS ONLY BODILY INJURY(Per accident) $— HIRED AUTOS NON-OWNED PROPERTY DAMAGE ONLY _ AUTOS ONLY (Per accident) $ $ _UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTHER AND EMPLOYERS'LIABILITY YIN STATUTE ANYPROPRIETOR/PARTNEWEXECUTIVE r NIA OFF10ER/MEMBER EXCLUDED? I E.L.EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) It is understood and agreed that the following entity is added as an additional insured but only with respect(s)to the operations of the named Insured except that liability resulting from the additional insured's sole negligence. Additional Insureds:City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers CERTIFICATE HOLDER CANCELLATION City of Smite Ana,Attention:Parke,Recreation,and Community Services Agency SHOULDANY OFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 20 Civic Center Plaza,CA 92701,M-23 EXPIRATION DATE THEREOF,NOTICE W ILL BE DELIVERED IN ACCORDANCE WITH Santa Ana,CA 92701 Dlgltally stoned by Tu Tran Tu Van Nguyen THE POLICY PROVISIONS. Nguyen p ,n-aroo.` AUTHORIZED REPRESENTATIVE tit.„,s. • APPROVED • By Pt.Trgn Nguysn at7;e3 10,Avg 14 702$, ©1988-2015 ACORD CORPORATION.All rights reserved. • ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY CHANGE DOCUMENT POLICY NO: CHANGE # 3 CHANGE EFFECTIVE: 09/01/2025 PHPK2457612-003 Philadelphia Indemnity Insurance Company PRODUCER: Maguire Insurance Agency, Inc. FWI NAMED INSURED: Dennys Diaz MAILING ADDRESS 7143 Fulton Way Stanton, CA 90680- POLICY PERIOD: FROM 09/01/2025 TO 09/01/2026 at 12:01 A.M. Standard Time at your mailing address shown above. DESCRIPTION: In consideration of the premium reflected,the policy is amended as indicated below: Added Additional Insured with WOS PNC Special WordingCity of Santa Ana,Attention: Parks, Recreation, and Community Services Agency20 Civic Center Plaza, CA 92701, M-23Santa Ana, CA 92701 Total Annual Total Prorate Additional/Return Premium $0.00 Additional/Return Premium $0.00 Total Annual Total Prorate Additional/Return Additional/Return Tax/Surcharge/Fee $0.00 Tax/Surcharge/Fee $0.00 Page 1 of 1 POLICY NUMBER: PHPK2457612-003 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 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 Person(s)Or Organization(s): City of Santa Ana, its City Council, officers, officials, employees,agents,and volunteers Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section li — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III—Limits Of Insurance: with respect to liability for"bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury" caused, in whole or in part, by your acts or required ony a behalf contract ther agreement,i the most we omissions or the acts or omissions of those acting will payofinsurance:of additional insured is the on your behalf: amount 1. In the performance of your ongoing operations; 1. Required by the contract.or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in the Declarations. insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a 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. CG 20 26 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: PHPK2457612-003 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers 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. ISO Properties, Inc. CG 24 04 05 09 ©Insurance Services Office, Inc.,2008 Page 1 of 1 CI PHPK2457612-003 PI-GL-005(07/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization (Additional Insured): City of Santa Ana,its City Council,officers, officials, employees,agents, and volunteers Effective Date: 09/01/2025 Agency SECTION II—WHO IS AN INSURED is amended to include as an additional insured the person(s)or organization(s)shown in the endorsement Schedule, but only with respect to liability for"bodily injury," "property damage"or"personal and advertising injury" arising out of or relating to your negligence in the performance of"your work"for such person(s)or organization(s)that occurs on or after the effective date shown in the endorsement Schedule. This insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured), except for loss resulting from the sole negligence of that person or organization. This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or"occurrence"we cover for this Additional Insured. The Additional Insured's limits of insurance do not increase our limits of insurance, as described in SECTION III—LIMITS OF INSURANCE, All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Safeway Insurance Company . . Fna cialSfenglhRnling P.O.BOX 5004 SAFEWAY INSURANCE ® v Monrovia,CA 91 0 1 7-71 04 �� (0 N F-N r N to_O Private Passenger Auto Application aco Policy Information Transaction Date: 02/20/2026 41.F- ce Carrier: Safeway Insurance Company NAIC: 12521 Phone:800-807-2339 Agent/Broker: ID#2129 A-MAX INSURANCE SERVICES 11330 FIRESTONE BLVD NORWALK CA 90650 Phone:866-603-9905 Applicant: DENNYS DIAZPADILLA 2295 LIME AVE APT B LONG BEACH,CA 90806 I- Cell Phone:714-809-8979 V Home Phone: 2 Bus Phone: 2 Effective Date/Time: 02/20/2026 10:40 AM ,expiring 08/20/2026 12:01 AM standard time 0_Tr Policy Term: 6 Month ti ni Pay Plan: Pay in Full et N r N Drivers uo c List all drivers(licensed or not)15 years of age and older. o Name(as it appears on license) Date of Birth Sex Marital Status Relationship CNII N DENNYS DIAZPADILLA 02/13/1966 Male Single Self N Years/Months Experience:44/0 Date of License: 02/13/1982 Driver Lic.No./State:Y2391856/CA CV Good Student: No Mature Driver: Good Driver: Yes o ZO Occupation: SALES Employer: O CI Driving History CI W Accidents and Minor Convictions--last 3 years;Major Convictions--last 10 years.(Note:Your driving record is � Z verified with state motor vehicle department(s)and other insurers.) Z Driver and Description Date Amount of Property Damage Z 2DENNYS DIAZPADILLA Points:0 0- LU At fault FINANCIAL RESPONSIBILITY ACCIDENT 12/07/2024 $0.00 Lu Coverages/Premiums Total Number of Vehicles in Household: 2 Z 2004 INFINITI FX35 Garaging Address: 2295 LIME AVE APT B, LONG BEACH, CA 90806 z 3 VIN Registered State Odometer Reading Annual Mileage Mileage One Way 3 JNRASO8U74X100633 CA 10000 5 fY O Cost New _Symbol Comprehensive/Collision Territory Mufti Car Vehicle Usage O Li. 17/17 H164 Yes Pleasure LI- O Type Salvaged Restraint System ARS.Brakes AntiTheftlDevice O 15 No No System Not Equipped ALARM ONLY } Limits Premium a O Bodily Injury Liability $30,000 each person$60,000 each accident $ 74.00 0 0 Property Damage Liability $15,000 each accident $ 56.00 0 Comprehensive $1,000 deductible from actual cash value $ 48.00 Collision $1,000 deductible from actual cash value $ 175.00 Discounts:Anti-Theft,Good Driver and Multi-Car Total for 2004 INFINITI FX35 $ 353.00 APPROVED By Charlene R. Muro at 10:20 am, Mar 05, 2026 .to co O .d Rev.01/01/2025 Policy Package for 4340849-CA-PP-001 Return signed document di▪c 66 (Page 2 of 17) to your agent/broker o ¢va Safeway Insurance Company41 P.O.BOX 5004,Monrovia, CA 91017-7104 Auto Application (cont.) M a ,p N Coverages/Premiums N 2013 CHEVROLET TRAVERSE LTZ AW Garaging Address: 2295 LIME AVE APT B,LONG BEACH,CA 90806 0i o VIN Registered State Odometer Reading Annual Mileage Mileage One Way N N 1 GNKVLKD8DJ255806 CA 10000 5 CO o Cost New Symbol Comprehensive/Collision Territory Multi Car Uehicfe Usage 26/20 H164 Yes Pleasure ix I'm Salvaged Restraint System ABS Brakes Anti-Theft Device 15 No No System Not Equipped ALARM ONLY Limits Premium Bodily Injury Liability $30,000 each person$60,000 each accident $ 112.00 Property Damage Liability $15,000 each accident $ 84.00 Comprehensive $1,000 deductible from actual cash value $ 58.00 Collision $1,000 deductible from actual cash value $ 191.00 Discounts:Anti-Theft,Good Driver and Multi-Car Total for 2013 CHEVROLET TRAVERSE LTZ AW $ 445.00 Subtotal Policy Premium $ 798.00 0 Fees U Policy Fee $ 32.00 12. Fraud Fee $ 1.76 a. Total Fees $ 33.76 d' Total Policy Premium $ 831.76 er r Additional Interest r to Only Lessees are accepted as Additional Interests N NVehicle and Additional Interest Loan Number N NPrior Insurance Coverage o N Prior Carrier and Years with Company Prior Policy Number and Expiration Date N 0 0 Z Z O O IW— H Z Z d: e2 a I1 W W ix De Z_ Z l O Q u_ ® O a. a ® p U U .o ••a aQ Rev.01/01/2025 Policy Package for 4340849-CA-PP-001 Return signed document N o 66 (Page 3 of 17) to your agent/broker R o aaii • 6....anwermemosateway Insurance Company P.O.BOX 5004, Monrovia, CA 91017-7104 Safeway Insurance Comp an... _ ..... .. NA.. . ..C, 1252.,.. . ..1.. ........ . ................... ...... PO.BOX 5004 ; `Monrovia, CA 91017.7104 •800-807-2339 • :California Auto Liability Insurance ID Card In case of accident: DENNYS D! 1.Remain at the scene,do not admit fault. DIAZPADILLA 2.Find a safe location, call the police arid exchange driver and :Folic vehicle information. y Number:4306543-CA-PP-001 To report a claim:call 888-203-5129 or go to www.MySafeway.com ?Effective Date: 11/19/2025 05:03 PM To 05/19/2026 12:01 AM Evidence of financial responsibility shall at all times be carried in ;Standard Time the vehicle.This policy provides at least the minimum amounts of :Agent/Broker: A-MAX INSURANCE SERVICES liability insurance required by law. Phone; 714-706-3723 This policy complies with Sections 16056 or 16500.5 of the • `Vehicle: 2004 INFINITI FX35 California Vehicle Code. VIN; JNRAS08U74X100633 Insurance information has already been submitted directly to the `Additional Driver(s): • DMV electronically.Submit this document to DMV only if specifically requested by DMV. Safeway Insurance Company NAIC 12521 • P.O.BOX 5004 • `Monrovia, CA 91017-7104 •800-807-2339 In case of accident: 1.Remain at the scene, do not admit fault.California Auto Liability Insurance ID Card DENNYS DIAZPADILLA 2.Find a safe location, call the police and exchange driver and vehicle information. Policy Number:4306543 CA-PP-001 To report a claim:call 888-203-5129 or go to www.MySafeway.com Effective Date: 11/19/2025 05:03 PM To 05/19/2026 12:01 AM Evidence of financial responsibility shall at all times be carried in Standard Time the vehicle.This policy provides at least the minimum amounts of Agent/Broker: A-MAX INSURANCE SERVICES liability insurance required by law. _Phone: 714-706-3723 This policy complies with Sections 16056 or 16500.5 of the ?Vehicle: 2013 CHEVROLET TRAVERSE LTZ AW California Vehicle Code. :YIN: 1GNKVLKD8DJ255806 Insurance information has already been submitted directly to the :Additional Driver(s): DMV electronically.Submit this document to DMV only if specifically requested by DMV. • • • • • CITY OF SANTA ANA Risk Management a division of Human Resources Managing Risk through Awareness and Action AFFIDAVIT OF EXEMPTION FOR WORKERS' COMPENSATION INSURANCE I. lzfl ("Representative"),attest that I am an authorized (Name and Title of Vendor Representative) representative of aitermy S Diaz P°a illta ("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 acrinfifF61114tsitltly ("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 wil be fully liable for any and all damages. 6/3/26 Signal ae \ Date y s[ z''.41III Print Name l Flftf I Fligttxatt t Title 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