HomeMy WebLinkAboutSUPREME PARKING SERVICE 2 - 2015kNf'41G ANt li ON
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Gi. FtK t)F COUNCIL
VALET PARKING MANAGEMENT SERVICES
AND LICENSE AGREEMENT WITH SUPREME PARKING SERVICE
THIS VALET PARKING MANAGEMENT SERVICES AND LICENSE
AGREEMENT ( "Agreement ") is effective as of the I" day of January, 2015, by and
between the City of Santa Ana, a charter city and municipal corporation ( "City ") and
Supreme Parking, Inc., a California corporation, doing business as "Supreme Parking
Service ", located at 7144 Dinwiddie Street, Downey, CA 90241 ("Operator"),
RECITALS
A. City desires to provide, or cause a third -party contractor to provide valet
parking service in the City's downtown area.
B. City is the owner of a public parking lot located at 309 N. Bush Santa Ana,
California (the "Property ").
T'i
C. City desires that a portion of the Property be used for valet parking for the
general public on specific days and at specific times to support the users of
businesses located within the downtown area, The specific parking spaces
designated for valet parking are depicted in Exhibit A, attached hereto and
incorporated herein by reference.
D. Operator warrants that it possesses specialized skill and experience in
providing valet parking and facilitation of traffic movement to provide such
service and is willing to provide valet parking services to the City, as further
defined in this Agreement.
NOW, THEREFORE, in consideration of the terms and conditions of this Agreement, the
parties agree as follows:
AGREEMENT
Location. This Agrecaicrrt pertains to the public parking lot owned by the City and
located at 309 N. Bush Street, Santa Ana, California (the "Valet Lot "). The Valet Lot
is shown on Exhibit A, which is attached hereto and incorporated herein.
2. Term. The Term of this Agreement shall commence on the date stated above and
continue for a one (1) year period through December 31, 2015 (the "Term "). The
Agreement shall have two (2) one -year options to renew, exercisable by the City
Manager. Other than for the reasons enumerated in Section 10 that shall cause
immediate termination of this Agreement, either party may terminate this Agreement
at any time for any reason by giving thirty (30) days written notice to the other party.
Grant of License. City hereby grants to Operator a revocable, non - exclusive, non-
transferable License for the sole purpose of staging and parking up to 25 vehicles
on the Valet Lot during the Tenn.
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4. Relationship of Parties. This Agreement is made solely for the purpose of authorizing
Operator to manage and operate the Valet Lot at 309 N. Bush. City and Operator are
not partners or joint ventures, and the services to be rendered by Operator are as an
independent contractor. All personnel for the parking operation shall be employees of
Operator and shall not be considered employees of City.
Obligations of the Operator.
a. Use. Operator shall use the Valet Lot for the sole purpose of providing valet
parking services for automobiles and motorcycles. The Valet Lot shall be
used for vehicle parking and related purposes, and for no other use or
purpose.
b. Compliance with Laws. Operator shall perform each duty and obligation
imposed herein in full compliance with the Santa Ana Municipal Code,
including procuring a business license from the City of Santa Ana, and other
ordinances of the City, and all applicable laws of the State of California and
the United States of America.
C. Standard of Service and Performance. Operator agrees to provide a high
standard of performance in the execution of all obligations and duties as
hereinafter provided, particularly with respect to service given directly to the
public utilizing the Valet Lot. The City reserves the right, through the office
of the City Manager or his designee, to instruct the Operator as to the
standard of performance when deemed necessary.
d. Personnel. For the performance of any duties required by this Agreement,
Operator shall employ, engage and retain only persons who are competent,
efficient, qualified and of honest reputation. Operator shall maintain close
supervision over all personnel to insure the integrity and maintenance of an
honest and high standard of service to the public, as well as to insure that said
persons discharge their duties in a courteous and efficient manner. In
addition to parking attendants, Operator shall provide one on -site Parking
Manager or Supervisor who shall monitor staff at the Valet Lot during all
such hours the Valet Lot is open to patrons.
C. Condition of the Valet Lot; Custodial Services. Operator accepts the Valet
Lot in its "As -Is" state of repair and condition, and Operator expressly agrees
that City has made no representations to Operator regarding the condition of
the Valet Lot. No alterations to the Valet Lot shall be made by Operator
without first obtaining City's written consent, which City may grant or
withhold in City's sole and absolute discretion. Operator shall keep the Valet
Lot free from any liens arising out of any work performed, materials
furnished or obligations incurred by Operator, and shall indemnify City to the
fullest extent provided by Paragraph 6 below in connection with any such
liens. Operator shall maintain the Valet Lot in a neat, clean and safe condition
during the Tern, Without limiting the generality of the foregoing sentence,
Operator shall not permit any vehicles to remain in the Valet Lot overnight,
nor perform any repair work to any vehicles in the Valet Lot, nor permit any
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patrons to perform any repair work to any vehicles in the Valet Lot. Any
vehicles violating the foregoing restrictions shall be towed at Operator's
expense. Operator shall not permit patrons to access the Valet Lot or vehicles
parked thereon but stall instead require parking attendants to retrieve vehicles
for patrons from parking spaces within the Valet Lot. Operator shall be
responsible for removing any trash or debris from the Valet Lot at the
conclusion of each day of the Term.
Operator also agrees to promptly notify City of the need for maintenance or
equipment repair that is the City's responsibility under the terms of this
Agreement. Operator shall provide copies of daily maintenance performed by
Operator at the Valet Lot at the City's request.
Traffic Control. Operator agrees to implement any necessary traffic control
plans specified or approved by the Executive Director of Public Works or
designee to ensure the smooth flow of traffic in and out of the Valet Lot.
g. Safekeeping of Valet Lot. During all hours of operation, and whenever
Operator is performing any obligation of this Agreement at the Valet Lot,
Operator shall provide for the safekeeping of the Valet Lot. During hours of
operation, Operator shall promptly report any suspicious or illegal activity, or
the presence of unauthorized persons to the Santa Ana Police Department.
h. Payment to City; Accounting Records. In consideration for City's granting
the aforesaid license, Operator shall remit to City, a License Fee of Five
Hundred Dollars ($500.00) per month. Said fee shall be issued in the name of
the City of Santa Ana and is due to the City on or before the 5"' day of each
month.
All fees, and any other monies collected at the Valet Lot by Operator
shall be collected in the manner prescribed by City.
2. Operator shall maintain full and complete accounting records, in
conformity with generally accepted accounting principles applied on a
consistent basis, and Operator shall deliver to City a copy thereof, in
such form and providing such information as the City may require
within five (5) days upon written request from the City.
Operator shall maintain all accounting records generated as a result of
this Agreement for no less than six (6) months after the end of the
Term.
Si nape; Marketing /Promotional Materials. With the exception of removable
signage (which may be in the form of one or more "sandwich board" signs)
indicating the availability and cost of Operator's valet parking service and
any directional signs in connection with the foregoing, Operator shall not be
permitted to install any signage or advertising at the Valet Lot without
obtaining the prior written consent of the City, which consent may be granted
or withheld in the City's sole and absolute discretion. Any marketing or
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promotional materials, activities, or other similar type of documents must be
submitted and approved by the City prior to publication or dissemination to
the public. Material cost to be paid for by the City.
6. Indemnification and Hold Harmless. Operator shall indemnify, defend, and hold
harmless the City and its officers, officials, agents, employees and volunteers against
any and all liability, claims, actions, causes of action or demands whatsoever against
any of them, including any injury to or death of any person or damage to property or
other liability of any nature, arising out of or in any way connected with the
performance of this Agreement by Operator or Operator's employees, officers,
officials, agents or independent contractors, except for the sole negligence or willful
misconduct of City.
Insurance. Operator shall procure and maintain at its sole cost for the duration of this
agreement the following insurance:
a. Minimum Scope of Insurance.
Coverage shall be at least as broad as:
Insurance Services Office Commercial General Liability coverage
( "occurrence" form CG 0001);
2. Insurance Services Office form number CA 0001 (Ed. 1/87) covering
automobile Liability, code 1 "any auto";
Workers' Compensation insurance as required by the Labor Code of
the State of California and Employers Liability insurance.
4. Garage Keepers Liability: $1,000,000
Minimum Limits of Insurance.
Operator shall maintain policy limits of no less than:
General Liability: $2,000,000 combined single limit per occurrence
for bodily injury, personal injury and property damage. If
Commercial General Liability Insurance or other form with a general
aggregate limit is used, either the general aggregate limit shall apply
separately to this project /location or the general aggregate limit shall
be twice the required occurrence limit;
2. Automobile Liability: $1,000,000 combined single limit per accident
for bodily injury and property damage;
Worker's Compensation and Employers Liability: Worker's
compensation limits as required by the labor code and employers
liability limits of $1,000,000 per accident.
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4. Garage Keepers Legal Liability: Minimum amount of $250,000
per Location, per occurrence, with a maximum deductible of $1,000
to provide collision and comprehensive coverage for vehicles.
C. Deductibles and Self - Insured Retentions. Any deductibles or self- insured
retentions must be declared to and approved by the City. At the option of the
City, either: the insurer shall reduce or eliminate such deductibles or self -
insured retentions as respects the City, its officers, officials, employees and
volunteers; or operator shall procure a bond guaranteeing payment of losses
and related investigations, claim administration and defense expenses.
d. Other Insurance Provisions:
The policies shall contain, or be endorsed to contain, the following
provisions:
1. General Liability and Automobile Liability Coverage:
a. The City, its officers, officials, employees, agents and
volunteers are to be covered as Insured with respect to
liability arising out of activities performed by or on behalf of
Operator; products and completed operations of Operator;
premises owned, occupied or used by Operator; or
automobiles owned, leased, hired or borrowed by Operator.
The coverage shall contain no special limitations on the scope
of protection afforded to the City, its officers, officials,
employees, agents or volunteers;
b. Operator's insurance coverage shall be primary insurance as
respects the City, officers, officials, employees and
volunteers. Any insurance or self - insurance maintained by the
City, its officers, officials, employees, agents or volunteers
shall be excess of Operator's insurance and shall not
contribute with it;
C. Any failure to comply with reporting provisions of the
policies shall not affect coverage provided to the City, its
officers, officials, employees, agents or volunteers;
d. Operator's insurance shall apply separately to each insured
against whom claim is made or suit is brought, except with
respect to the limits of the insurer's liability.
2. Worker's Comnensation and Employers Liability Coverage: The
insurer shall agree to waive all rights of subrogation against the City,
its officers, officials, employees and volunteers for losses arising from
work performed by Operator for the City.
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All Coverages: Each insurance policy required by this clause shall be
endorsed to state that coverage shall not be suspended, voided,
canceled by either party, reduced in coverage or in limits except after
thirty (30) days' prior written notice by certified mail, return receipt
requested, has been given to the City.
e. Acceptability of Insurers. Insurance is to be placed with insurers with a Best's
rating of no less than A: VII.
f. Verification of Coverage: Operator shall furnish the City with certificates of
insurance and with original endorsements effecting coverage required by this
clause. The certificates and endorsements for each insurance policy are to be
signed by a person authorized by that insurer to bind coverage on its behalf.
All certificates and endorsements are to be received and approved by the City
before the commencement of the Term. The City reserves the right to require
complete certified copies of all required insurance policies at any time.
8. Safety and Accidents. Operator shall comply with all laws and industrial safety
standards. If a death, serious personal injury or substantial property damage occurs in
connection with the performance of this Agreement, Operator shall immediately
notify the City's Risk Management Office by telephone. Any reports prepared by
Operator shall also be promptly submitted to the City's Risk Management Office.
9. Assignment. City has entered into this Agreement in part because of the
qualifications of Operator. Accordingly, Operator shall not assign or transfer this
Agreement or any of the rights or privileges herein agreed without the express written
consent of City, which consent may be withheld with or without cause.
10. Termination. City reserves the right to immediately terminate this Agreement and
revoke the License granted hereby in the event any one of the following
circumstances occurs during the term of this Agreement:
a. The failure of Operator to maintain the quality and conditions of service
imposed under the terms of this Agreement, upon two (2) clays written notice
to correct the condition(s) objected to;
b. The failure of the Operator to keep in full force and effect at any time the
policies and amounts of Insurance required in this Agreement upon five (5)
days written notice to Operator to correct the condition(s);
C. The happening of any act which results in the suspension or revocation of the
rights, power, licenses, permits and authorities necessary for the conduct and
operation of the City's parking facilities as herein authorized;
d. Any substantial change in the ownership or proprietorship of Operator that, in
the opinion of the City, is not in the best interest of the City or of the public;
e. A petition under any part of the federal bankruptcy uptcy laws, or an action under
any present or future solvency law or statute shall be filed by or against
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Operator and shall not be dropped or dismissed within thirty (30) days after
the filing thereof;
£ Operator voluntarily discontinues its obligations under this Agreement for a
period of two (2) days or more;
g. Operator agrees that if this Agreement is terminated, Operator agrees to
cooperate in every way possible with any succeeding Operator, so that the
public shall not be inconvenienced by the change of Operators.
1 t. Operator's Duties Upon Expiration of Term. Operator agrees that if upon City's
request, at expiration date of the term of thus Agreement, or at the earlier tennination
thereof, Operator shall move its personnel and equipment from the Valet Lot, leaving
the Valet Lot in good condition, reasonable wear and tear and acts of God excepted.
The City's equipment and equipment purchased by Operator and reimbursed by the
City shall be left in good working order and appearance. Operator also agrees that at
the expiration date of this Agreement or at the earlier termination hereof, Operator
shall provide City with current, accurate financial records pertaining to the Valet Lot.
12. Possessory Interest Tax. Pursuant to section 107.6 of the Revenue and Taxation
Code, City hereby advises, and Operator recognizes and understands, that this
Agreement may create a possessory interest subject to property taxation and that
Operator may be subject to the payment of property taxes levied on such interest.
Operator shall pay, prior to delinquency, all taxes assessed against and levied upon
Operator's possessory interest, if any.
13. Miscellaneous Obligations:
a. Right of City �pect. City shall have the right, at any and all reasonable
times, to inspect, examine and investigate any and all operations and activities
of Operator and of its officers and employees, connected or related to the
operation or maintenance of the Valet Lot or to the doing of any of the actions
required by Operator under this Agreement, including the unlimited right to
enter the Valet Lot at any time to inspect the Valet Lot and to determine
whether the Operator is complying with all its obligations under this
Agreement;
b. Rates; Schedules; Locations of Valet Stands. Parking rates, methods of
operation, discounts and allowances, and the locations of valet parking stands
shall be approved in writing by City to Operator prior to implementation;
Hours of O ern ation. Operator shall offer the valet parking services
contemplated by this Agreement during the following hours (the "Operating
Hours ") during the Term: Thursday through Saturday from 8:00 PM to 2:00
AM.
Operator may access the Valet Lot within one (1) horn prior to the start time
noted above and continue to access the Valet Lot for one (1) hour after the
end time noted above to complete any necessary maintenance or perform any
Page 7 of 10
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other duty required of Operator by this Agreement other than accepting
patrons' vehicles.
d. City's Right to Operate, In the event Operator fails to perform its obligations
set forth in this Agreement, as an additional remedy and prior to taking
formal action authorized in Section 10, City shall have the right to
immediately assume operational control of the Valet Lot in whatever manner
is necessary to continue smooth operation of the Valet Lot. This right shall
include, but not be limited to, and only to the extent necessary, the right to
collect parking fees from users of the Valet Lot;
e. Uniforms. Operator agrees to have all parking personnel outfitted in uniforms
acceptable to the City. Uniforms must be such that Valet Lot employees are
readily recognizable as Valet personnel and which are easily visible at
nighttime. City reserves the right to determine what identification will appear
on the uniforms;
Alterations /Additions. Operator shall not make any alterations, changes, or
additions to the Valet Lot, or to any fixtures or equipment owned by City
without first having obtained written consent of City;
g. Nuisance or Waste. Operator shall not commit, permit or allow any nuisance
or waste in, or damage to the Valet Lot, or permit the use of the Valet Lot for
any illegal or immoral purposes.
14. Conditions and Covenants. Each covenant herein is a condition, and each condition
herein is as well a covenant by the parties bound thereby, unless waived in writing by
the parties hereto.
15. Fair Meaning Construction. The language of this Agreement shall be construed
according to its fair meaning, and not strictly for or against either City or Operator.
16. Notices. Any action, notice or request required to be taken, given or made by City
hereunder may be taken, given or made by the City Manager, or such other person or
persons as he may authorize for the purpose. All notices, requests, or other papers
required to be given or delivered to Operator shall be deemed to be duty and properly
given or made if mailed to City, postage prepaid, addressed to:
Supreme Holdings, Inc.
dba Supreme Parking Set-vice
7144 Dinwiddie St,
Downey, CA 90241
or personally delivered to Operator at such address, or at such other address as
Operator may designate in writing to City.
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All notices, requests, or other papers required to be given or delivered to City shall be
deemed to be duty and properly given or made if mailed to City, postage prepaid
addressed to:
City Manager
City of Santa Ana
20 Civic Center Plaza
P.O. Box 1988
Santa Ana, CA 92702
or personally delivered to the City Manager at the City, or at such other address as
City may designate in writing to Operator.
17. Entire Agreement. This Agreement is the entire Agreement between the parties and
supersedes all prior negotiations, representations, or agreements, whether written or
oral. This Agreement may be amended only by written agreement signed by both
parties.
IN WITNESS WHEREOF the parties hereto have caused this Agreement to be executed by
and through their duly authorized officers and representatives as of the date first above
written.
ATTEST:
;D
Maria D. Huizar
Cleric of the Council
APPROVED AS TO FORM:
Sonia R. Carvalho
City Attorney
By: Lisa Storck
Assistant City Attorney
CITY OF S1 NA:
David Cavazos
City Manager
OPERATOR
Supreme Parking Service
In
Title: ��ry
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EXHIBIT `A'
Page 10 of l0
L2/2/L4
All...� ��)\ �®
l-/ CERTIFICATE OF
LIABILITY INSURANCE
DATE (IdM /DD/YYYV)
5/29/2014
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.
ADDL
INSD
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policypes) must 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).
POLICY BOB
MMrDD/YYYV
PRODUCER
D ZONE INSURANCE SERVICES
17208 Saticoy Street
Van Nuys, CA 91406
License #:Ca license 0GO5828
CONTACT
NAME. GEORGE W DIAZ
HONED. EM. (818)609 -8691 rvc,nlok(818) 609 -8684
E-RAL Gdiaz @dzoneinsurance.com
ADDRESS.
NeuRER(9) AFFORDING DevERADR
INSURERA:Western Heritage Insurance Cam
37150
INSURED Supreme Parking
EACH OCCURRENCE
INSURER B., State Compensa .ion Ins Fund
35076
INSURER C
CLAIMS -MADE D OCCUR
7 918 De Palma
INSURER D
Downey, CA 90241
$
INSURER E..
RED FAR (Any one pereen)
(310) 505 -0125
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.
lNe
LTR
TYPE OF INSURANCE
ADDL
INSD
SUER
ME
POLICY NUMBER
POLICY EFF
(MMIDDIVYYV
POLICY BOB
MMrDD/YYYV
LIMITS
X
COMMERCIAL GENERAL LIAEILITY
EACH OCCURRENCE
$ 2,000 , 000
CLAIMS -MADE D OCCUR
UPARAUL 10 TEN f ED
PREMISES (Ee occur coca)
$
RED FAR (Any one pereen)
$ 5,000
A
agpO814478
05/15/201405/15
/2015
PERSONAL A ADV INJURY
s 2,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER
GENERAL AGGREGATE
$ 2,000 r 000
POLICY [::I PRO,
JEC CI LOO
PRODUCTS - COMP /OP AGG
$ 2,000,000
$
OTHER
I
I
AurowoBlLE
UABwTV
- LIM I
Ea accident
$ 1,000,000
_
X
BODILY INJURY (Per person)
$
ANYAUTO
A
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Per accident)
$
_
NON-OWNEO
HIRED AUTOS AUTOS
R PERTYE
(Per accident)
$
_
6
UMBRELLA HAB
OCCUR
EACH OCCURRENCE
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
PER RETENTION $
$
I
jB
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETORIPARTNEDEXECUrrvE
Mandator, le H) EXCLUDED? C
(Mandatory In NHI
DESCRIPTION OFdOPERATIONS below
N /A'
9072632 -2013
09/21/201309/21
/2014
}i STAT UTE ER
E 1. EACH ACCIDENT
$ 1x000,000
E.L. DISEASE - EA EP4PLOVEE
$ 1 , 000 , 000
E.L. DISEASE- POLICY LIMIT
$ 1,000,000
A
Garage Liability
agp0814478
0571-57014-05715T2015
1,000,000
Per Vehicle /ded /1000
A
Garagelceepers Legal- Liability
agp081.4478
05/15/201405/15
/2015
per Lot $35,000/$250,000
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attache l It more apace Is required)
Valet Parking operations Master Parking Operator
CERTIFICATE HOLDER
CANCELLATION
City of Santa Ana
20 Civic Center Plaza,
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Santa Ana, CA 92701
ACCORDANCE WITH THE POLICY PROVISIONS.
714.647.5400
AUTHORIZED REPRESENTATIVE
— T
O 1988 -2013 ACORD CORPORATION. All rights reserved.
ACORD25(2013/04) The ACORD name and logo are registered marks of ACORD /,/,,. rLC)
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company
WESTERN HERITAGE INSURANCE COMPANY
This endorsement modifies such insurance as is afforded by the provisions of Policy
# agp0814401 relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its
officers, employees, agents, volunteers and representatives are named as additional insureds
( "additional insureds ") with regard to liability and defense of suits arising from the operations
and uses performed by or on behalf of the named insured.
2. With respect to claims arising out of the operations and uses performed by or on
behalf of the named insured, such insurance as is afforded by this policy is primary and is not
additional to or contributing with any other insurance carried by or for the benefit of the
additional insureds.
3. This insurance applies separately to each insured against whom claim is made or
suit is brought except with respect to the company's limits of liability. The inclusion of any
person or organization as an insured shall not affect any right which such person or organization
would have as a claimant if not so included.
4. With respect to the additional insureds, this insurance shall not be cancelled, or
materially reduced in coverage or limits except after thirty (30) days written notice has been
given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701.
(Completion of the following, including countersignature, is required to make this endorsement
effective.)
Effective 05/05/2014 this endorsement form as a part of
Policy# agp0814401
Issued to 6upreme HarKing
Named Insured
Countersigned by k
Authorized Representative