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HomeMy WebLinkAboutRUFFIN, DON A. AND ARLENE B. 3 - 2015City of Santa Ana ems,, Clerk of the Council AGREEMENT TERMINATION FORM Please complete this form when the attached agreement and all amendments (if any) are no longer in effect. Return form to the Clerk of the Council Office (M-30). Call 647-6520 if you have any questions. The agreement with Use 7z(9 AUG ?I FM 4! 19 CITY OF SANTA ANA CLERK OF COUNCIL No N-2016-113 was completed on © p and final payment has been made. (List all amendments. Use space below if needed.) Department: Rc- s A Phone/Ext.: '-ta (a Signature: Date: Oita §on Revised 08-23-10 INSURANCE ON FILE YiORK: MAY PROCEED UNTIL INSURANCE EXPIRES CLERK OF COUNCIL, DATE, JUL7 415 RECREATION SERVICES AGREEMENT O: PRCSI(f) Silvia Cuevas THIS AGREEMENT made and entered into this 30th of June of 2015, by and between Don Ruffin and Arlene Ruffin (hereinafter "Provider") and the City of Santa Ana, a charter city and municipal corporation organized and existing tinder the Constitution and laws of the State of California (hereinafter "City). i RECITALS A. The City desires to retain a recreation service provider having special skills, resources and knowledge to conduct tennis classes in its leisure class program. 8, Provider represents that Provider is able and wilting to provide such services to the City, C. In undertaking the performance of this Agreement, Provider represents that it is knowledgeable in its field and that any services performed by Provider under this Agreement will be performed in compliance with such standards as may reasonably be expected. NOW TI3EREFORE, in consideration of the mutual raid respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: I. SCOPE OF SERVICES Provider shall perform those services as set forth in Exhibit A. to tlris Agreement. 1 COMPENSATION In consideration for the right to provide the programs set forth in Exhibit A, City agrees to pay the Provider seventy percent (70%) of all gross revenue received from program participants. Anticipated revenue from this class shall not exceed $25,000 annually. Payment to Provider shall be made within thirty (30) days following completion of the last class taught by Provider that month. 3. TERTNI This Agreement shall commence on July 1, 2015 and terminate on June 30, 2017, unless terminated earlier in accordance with Section 12, below. The term of this Agreement may be extended upon a writing executed by the City Manager and the City Attorney, 4INDEPENDENT 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 not shall it be construed to create an employer-omployee 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 allsalaries and wages, employer's social security taxes, - unemployment insurance and similar taxes relating to employees and shall be responsible for all 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, 3. INSURANCE Prior to undertaking performance of work under this Agreement, Provider shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Provider shall maintain commercial general liability insurance which shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Provider's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1,000,000 per occurrence and $2,000,000 in the aggregate. Such insurance shall (a) name the City, its officers, employees, agents, volunteers and representatives as additional insured(s); (b) be primary and not contributory with respect to insurance or self-insurance programs maintained by the City; and (c) contain standard separation of insured's provisions. b. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the Labor Code, Provider, if Provider has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance, Prior to commencing the performance of the work under this Agreement, Provider agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. Q. The following requirements apply to the insurance to be provided by Provider pursuant to this section: (i) Provider shall maintain all insurance required above in full forme and effect for the entire period covered by this Agreement. Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved in form by the City Attorney. (6) Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. d. If .Provider fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the City with required proof that insurance has been procured and is in force and paid for, the City shall have the right, at the City's election, to forthwith terminate ibis Agreement, Such termination shall not affect Provider's right to be paid for its time and materials expended prior to notification of termination. Provider waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 6. INDEMNIFICATION Provider agrees to and shall indemnify and hold harmless the City, its officers, agents, employees, Providers, special counsel, and representatives from liability for personal injury, darnages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including health, and claims for property damage, which may arise from the direct of indirect operations of the Provider or its contractors, subcontractors, agents, employees, or other persons acting on their behalf which relates to the set -vices described in section 1 of this Agreement. The Provider further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including tees and costs for special counsel to be selected by the City, regarding any action by a third party asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may snake all reasonable decisions with respect to its representation in any legal proceeding. 7. CONFLICT OF INTEREST Provider covenants that it presently has no interests and shall riot have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 8. LIVE SCAN BACKGROUND CHECK Providers, and any employees, subcontractors or substitutes, in contact with minors under eighteen (18) years of age shall arrange for and submit to a Live Scan electronic background check for criminal history available through the California Department of Justice as a condition of this Agreement and provide proof of compliance prior to performing services hereunder. 9. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be property given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by facsimile or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of the Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Facsimile (714) 647-6956 With copy to: Executive Director of Parks, Recreation and Community Services City of Santa Ana 26 Civic Center Plaza (M-75) P.O. Box 1988 Santa Ana, California 92702 Facsimile (714)571-4211 To Provider: Don Ruffin and Arlene Ruffin 28 Grant Irvine, CA 92620 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 facsimile, 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. 10. EXCLUSIVITY AND ANIENDMENT I'his Agreement represents the complete and exclusive statement between the City and Provider, 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 teens or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shrill 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. 11. ASSIGNMENT/SUBSTITUTES a. 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. Provider must personally teach at least seventy-five percent (750/u) of its offered classes. b. Substitutes. In the event Provider is not able to teach a class due to illness or some other cause beyond Provider's reasonable control, Provider must procure, at its sole expense, a qualified substitute instructor to teach the class at its regular time and place. Provider shall ensure that substitute instructors comply with the City's insurance and live scan requirements contained herein. Provider must immediately notify the City of the substitute instructor's name, qualifications, address and phone number. If Provider cannot procure a qualified substitute and the City is unable to assist in this regard, then the class shall be canceled and a make-up class must be added to the session. Provide- must notify participants as soon as possible of any class cancellation and make-up class. 12. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. Termination or cancellation of classes by the Provider must be given to the City 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 and will result in the City's retention of ten (10%) percent of the final payment to Provider. 13. DISCRIIMINATION Provider shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, tern ination or other employment related activities, Provider affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 14. 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 farther 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. 15. LICENSES Provider shall, throughout the tern 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. 16. 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 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. 17. EXITIBITS All Exhibits referenced herein and attached hereto shall be incorporated as if {illy set forth in the body of this Agreement. 18. 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 patties and that be so executing this Agreement, the parties hereto are formally bound to the provisions of this Agreement. Signature Page to Follow IN WITNESS WHF,REOF, the parties hereto have executed this Aknecmaut the date and year first above written. ATTES"C: _ _ G qV(/ G NIAA IA D. HU1ZAR Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALIIO City Attorney i -' By: tI<_ - 6r,)_ C Lisa Storck Assistant City Attorney RECOMMENDED FQR APPROVAL: OERARDO MOUET Executive Director of Parks. Recreation and COul nullity Service CITY OF SANT/ ANA �. DAVI CAVAZOS City Manager PROVIDER Don Ruffin: Arlene RufYi Exhibit A SCOPE OF SERVICES -Tennis (Arlene & Don Ruffin) A. Provider will teach a variety of Classes on Tennis for children aged 3-17 years. B. Tots Tennis class is Saturday, per week, 45 minutes per day - $25/monthly, ages 3-5 yrs old C. Beginner's Tennis class is offered (3) Three days per week, 1 hour per day - $75/monthly, 6-17yrs old D. Beginner's Tennis class is offered (2) Two days per week, 1 hour per day - $50/monthly, 6-17 yrs old E. Beginner's Tennis class is offered (1) One day per week, 1 hour per day - $25/monthly, 6-17 yrs old F. Intermediate Tennis class is offered (3) Three days per week, 1 hour per day - $105/monthly, 6-17yrs old G. Intermediate Tennis class is offered (2) Two days per week, 1 hour per day - $70/monthly, 6-17 yrs old H. Intermediate Tennis class is offered (1) One day per week, 1 hour per day - $35/monthly, 6-17 yrs old I. Advanced Tennis class is offered (3) Three days per week, 1 hour per day - $135/monthly, 6-17yrs old J. Advanced Tennis class is offered (2) Two days per week, 1 hour per day - $90/monthly, 6-17 yrs old K. Advanced Tennis class is offered (1) One day per week, 1 hour per day - $45/monthly, 6-17 yrs old L. Private and Semi -Private class lessons $25 per''/: hour and $45 per hour M. Tennis Summer Camp is offered weekly during the summer, 2Yx hours, AM/PM - $100/weekly, 6-17 yrs old N. Provider shall work with City staff in setting a schedule for classes, including the location, specific days and hours when class will be held and holidays to be observed. O. Provider shall provide materials, supplies, equipment, records and personnel. Provider shall be responsible for cleanup of the facilities and materials and shall ensure the safety and effectiveness of instruction. P. If Provider allows others to teach his/her class, those teachers must be over 18, have obtained and maintain an instructor rating, and be covered by Provider's insurance. Provider shall provide City with documentation to verify instructor and insurance requirements. CLASS SIZE A. Class level (beg., Int., etc.) must have a minimum of 4 paid students and no more than a maximum of 32. B. In the event the minimum number of enrollees is not met by the class meeting (per level) excluding Semi/Private lessons the class shall be canceled. Provider will be under no obligation to provide services and the City will have no obligations to pay Provider compensation CLASS FEES 410 owl A. Each participant shall pay the set class registration fee per session. A material fee of $35,payable to instructor on the first day of class B. No refunds will be made to participants after the second class meeting unless the class is cancelled by the City. C. The City shall collect registration fees from each participant during the registration period. Provider shall not collect fees, but shall refer all interested participants to City for registration. D. Provider shall receive seventy per cent (70%) of the total fees collected each month. City and Provider agree that City shall retain thirty per cent (30%) of the fees collected as an administration fee. E. Payment to provider shall be made within fifteen (30) days following completion of each class. F. Provider agrees that City is entitled to audit Provider's records and classes to insure compliance with this Agreement. G. Provider may not waive class participation/registration fees. H. City shall prepare class rosters and provide a copy to Provider. Only registered participants may participate in class. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TFI 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, 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 Lauren Kachadorian Edgowood Partners Insurance Center PAfoNN 617.398 5560 -- PAx� _ 27 School Street, Suite 404l I Fx) �' — `._ -- -.._-� luc hFvTATL ""` ...____ Boston, MA 02108 10 Christopher M. Price - INSUREgJE AFFORDING COVERAGE NAIL N - _._._..__. 1 INSURER Philadelphia Indemnity Ins Camp 118058 ,- ._ ' RED United States Professional }3 �a7Gl � I� � 1.INSURER- 13:---------- M_ Tennis Association Inc. I INSURERc 1-1___..._...... _._._._....._... 3635 Briarpark Drive, Suite 1 1INSURER D: Houston, TX 77013 INSURER E: CnHCa An PQ nah Tlc,r ATO I,, ml. nn.n THIS E TO CERTIFY THAT THE POLJCIES'OF INSURA146E LISTED BELUOV HAVE BEEN ISSUED fO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY PEOUIREMENT, TERRI OR CONDITION OF ANY CONTRACTOR 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. !NSA..—._.._._. .______. i�UgL B-1(—BP_._.._... ...__.__.. Pi CY EFF PoucYEXP.._ .. ...._._._...... .._......_._. ....�...___.____ L'R TYPE Or INSURANCE .INSR WVO' POLICY NUMBS@ MMIOUIYYYY MMIDUIYYYY LIMITS A ceNeRALLIABILTY 1 !PHPK1269427 12/311201412(31120'15'_pEpAC��l1HoccciuRRENCE s1,0000go X I COMMERCIAL GENERAL LIABILITY PRCMhF yojE(RENTED ocN a cal 5100,000 DLAIbI&MADE OCCUR MER EXP(A ranepe sonl 6 _ T_ ( PERSONAL AADb'INJURY 51,000 0�...0d .._ _ I OENERALAGGREGAM SZ 009,000 ;PRODUCTS- COMPIOR AGO s2,000,000 GEN'LAGGREGATE LIMITAP(_ PPLIES PER. j hoU 6 0.Ul OM11oBILE LIABILITY I ?COMBINED SINGLE LIMIT ANY AUTO ! BODILY INJURY (Pa, Banner)A.LO P11 SCHEDULED AUTOS LIED AU HIRED AUTOS NDTDS N Dw+lEO OS �! 'BODILY INJURY (Per cu Nta DAMAGE I A X UMBRELLAOAe X CCCUR PHU 6483468 �_ 12131120141 ��ROPERTV EACH OOCURREnIGE 2/3112015 E OCCURRENCE S8000,000 EXCESS LIAR _ CLAIMe-M1IAOE `AGCREGATE _ A$ 000,000 _ g I, DEO RfiTEMTIONS - WORKERANO EMPS COMPENSATION OMPEN AeTL01TY YIN Review � ad ^_. —I III- �/ _,�-'PC' AATU- _.,OT - _ — ANYPROPMETOR/PARTNMbEXECUTiVE— OFFICPRRPR90ER EXCLUDED'? I NIA EL EACH ACCIDENT e B (Mentlamc, In NH) Ir YYes, desr to ndcr OESCRIPTIO J OF OPERATIONS. helm, - �- ^ "'� E L. DISEASE -EA EMPLOYE.€ 5 - E.L DISEASE -POLICY LIMIT S — —via uevas DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLE e (Attach ACORD RI, Additional Remarks Schedele, V omm space is required) USPTA Members are Insured for General Liability for playing, teaching or officiating in tennis, pickleball and platform tennis or operating a tennis ball machine for practicing or teaching. Arlene Ruffin 54144 City of Santa Ana, its officers, Employees, agents, volunteers and representatives, is included as an additional insured in respects to General Liability when required by written contract City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AU'HOPILED REPRESENTATIVE. 0 ACORD 25 (2010f)5) 1 Oil[ The ACORD name and logo are registered marks of ACORD #$3602401M356236 CMAR2 All Inhtd macro—i POLICY NUMBER: PHPK1269427 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 Person(s) Or Organizatlon(s)_ _ City of Santa Ana, it's officers, employees, agents, volunteers and representatives With respects 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. 20 Civic Center Plaza Santa Ana, CA 92701 Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or or- ganization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property dam- age" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. Reviewed by: evas d_1of1 11 Client#: 19406 USPROFES TE I m DDIYYYY) I ACORD,. CERTIFICATE OF LIABILITY INSURANCE , =21m, 2 0 16 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 INSURERI AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) 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 andorsement(s). PRODUCER NAONTACT ME' Edgewood Partners Insurance Center PHONE FAX Ext): (AIC, No): 27 School Street, Suite 404 E Boston. MA 02108 INSURED, United States Professional Tennis Association Inc 3535 Briarpark Drive, Suite 202 Houston, TX 77013 INSURER(S) AFFORDING COVERAGE NAC # INSURERA . Phill "dip'hia-lindemnity Ins Comp 118058 INSURER B: INSURER ­.C: - - --- ---- - -------- INSURER 0: INSURER 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 LTR TYPE OF INSURANCE ADDILtUBR INSR WVD POLICY NUMBER POLICYIEFF POLicYtX0 LDIYYYYJ �IMLQ­ _JMMIC LIMITS A GENERAL LIABILITY PHPK1417813 12131/2015 1213112010EAcHcccURRENCE X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx1OCCUR PREMISES TQ 11FI ES (Ea occurrencpi 5100000 M .. E - D - EXP (Any one person) S PERSONAL& ADV INJURY ­­ ..... . .... GENERAL AGGREGATE S1,000,000 s2,000,,000 PRODUCTS - COMPICIP AGG S1,000,000 GENL AGGREGATE LIMIT APPLIES PER V� POLICY F PI LOC AUTOMOBILE LIABILITY ANY AUTO \,Jw (Ea aI S S BODILY INJURY QPar person) S ALL CANNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) S I NON -OWNED JI HIREDAUTOS AUTOS PROPERTY-15AWAGE _(Per arxidenn A . . . .... ....... XI MEIRELLA LIAS U 7, OCCUR PHUBS21030 1213112015 12/3112016 EACH OCCURRENCE S5,000,000 EXCESS LAB CLAIMSMADE AGGREGATE $5,000,000 DED RETENTION S $ WORKERS COMPENSATION- WC STATIJ-�CTH- AND EMPLOYERS' LIABILITY YIN ANY I ETORIPARTNERiEXECUTIVE ­--� OFFICER/MEMBER EXCLUDED? ❑NIA —.T.1.QFY,.UMJI . I E L. EACH ACCIDENT $ . ........ — E.L. DISEASE - EA EMPLOYEE I $ (Mandatory in I If yes, describe under DESCRIPTION OF OPERATIONS low be . . .......... . ..... . E L. DISEASE - POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) USPTA Members are insured for General Liability for playing, teaching or officiating in tennis, pickleball and platform tennis or operating a tennis ball machine for practicing or teaching. Arlene Ruffin #54144 City of Santa Ana, its officers, employees, agents, volunteers, and representatives with respects 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. City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE @ 1988-20110 ACORD CORPORATION. All rights reserved.. ACORD 25 (2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S4421321M421902 CMAR2 POLICY NUMBER: PHPK1417813 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name OfAdditional KnsurmdPersmn(s) OrOrganization (m): City of Santa Ana, its officers, employees, agents, volunteers, and representatives with respects ooclaims arising out ufthe operaflons 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. 2OCivic Center Plaza Santa Ana, CA 92701 � Information required to complete this Schedule, if not shown above, will be shown in the Declarations. -1 A. Section U —VVbu Is An Insured is amended to include as an additional insured the (m) or organization(s) nhcmxn in the Sohedu|e, but only with respect to |iabifity for "bodily injury^. "property damage" or "personal and advertising injury" caumed, in whole or in part by your acts or omissions mrthe acts oromissions ofthose acting onyour behalf: 1. |nthe performance ofyour ongoing operatione� or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies tothe extent permitted by law; and 2. |fcoverage 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. B.With respect to the insurance afforded to these additional imoun*da, the following is added to SeoUonU|—L|mbs Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the mostme vv|8 pay on behalf ofthe additional insured is the amount of�nsunance: 1. Required bythe contract oragreement; or 2. Available under the applicable Limits of Insurance shown inthe Deolanationa� whichever ialess. This endorsement shall not increase the applicable Limits of Insurance shown in the CG 20 26n413 CInsurance Services Office, Inc., 2012 Page of I EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 2017-27 CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY (ADDITIONAL INSURED) Alliant Insurance Services, Inc. in conjunction with City of Santa Ana Apex Insurance Services 20 Civic Center Plaza P, O. Box 6450 Santa Ana, CA 92701 Newport Beach, CA 92658 License No: OC 36861 NAMED INSURED (EVENT HOLDER): EVENT INFORMATION: Arlene Ruffin TYPE: Tennis 28 Grant DATE(S): 01/26/2017 — 12/31/2017 Irvine, CA 92620 LOCATION: Neal Machander Tennis Center *Liquor Liability Yes [-] No Z "Liquor Liability after 12 am ends before 2 am E] This is to certify that the insurance policy listed below has been issued to the above insured named (event holder) for the policy period indicated. The insurance described herein is subject to all the terms, exclusions and conditions Of SLICII POIiCy(iCS) unless amended as described in Special Conditions. INSURANCE CARRIER: Evanston Insurance Company MASTER POLICY NUMBER: SEP41023 MASTER POLICY DATES:: EFFECTIVE: JANUARY 1, 2017 EXPIRATION: JANUARY 1, 2018 COMMERCIAL GENERAL LIABILITY OCCURRENCE FORM DEDUCTIBLE: NONE General Aggregate Limit $2,000,000 Products & Completed Operations 1,000,0w SPECIAL CONDITIONS: Personal & Advertising 111JUly 1,000,000 The following endorsements attached to Each Occurrence Limit 1,000,000 the Master Pohey do not apply to this Damage To Premises Renled'fo You (Any One Premises) 100,000 Certificate Of Insurance! Medical Payments (Any Ou Person) 5,000 Liquor Liability (If purchased) 1,000,000 Optional Limits Purchased $1,000,000/$3,000,000 $2,000,000/$2,000,000 Damage To Property (If purchased) as The Unlits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has be' OTHER ADDITIONAL INSUREDS Don Ruffin CANCELLATION: ShOUld the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions. AUTHORIZED REPRESENTATIVE: DATE ISSUED: January 26, 2017 by Stella Fajardo WQg&El� �LLQNLPLjj,�Ajj OH.IjEg_LA �LN hereby affirm under penalty of perjury, the following declaration: I certify on behalf of that during the -term of my Consult n0mpany Name) with the City o J) "c , " I , . I . _ contract for & �` / . , services f Santa n Aa, I will not employ any person in any mahner so as to become subject to the workers' compensation laws of California, and agree that if I should becoine subjec:t to the Nvorkers' compensation provisions of" Section 3700 of the Labor Cody-,, I shall forthwith comply vOth those provisionswid provide proof of workers' compensation r coverage. DATE: By Name: Title: Telephone: ... qjq:j_C,2' _Ig" ..... .. ... ... c + e WOR.KER.S'(,'QMPE'NSA`FlQN DECLARATION FV&I/ hereby affimi under penalty of perjury, the (NameiTid(,,) following declaration — I certify on behalf of that during the term of my - xl-�—Eu (comotanucompany Name) contract for —<--5 services with the City of Santa Ana, I will not employ any person in any manner so as to become suject to the workers' corqpensadon laws of Califomia,and agree that ifl should become subject to the workers' compensation, provisions of Section 3700 of the Labor Cor de, I shall florthwith co� ljply with those provisions and provide proof of workers' compensation coverage. DATE: 7 By: Nwne: 7S- Tho elep ne: -C . WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND STIALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ()NE HUNDRED THOUSAND DOLLARS ($100,000). IN 2 .DDITION TO THF COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.