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Home My WebLink AboutARCHILLA, ILLARY-2015City of Santa Ana Clerk of the Council COTC Office Use Only AGREEMENT TERMINATION FORM Please complete this form when the attached agreement and all amendments (if any) are no longer in effect. ZV9 A_UG ?1 PM 4 nq Note: If your agreement is grant related, please ensure that all grant retention requirements hMvc been satisfied prior to signing the termination form. C' TY OF SA N TA ANA CLERK OF COUNCIL Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. i The agreement with �1 x: �Gck Ylnf �A"V,1 � V N � No. -o2OJ a -60o 0 was completed on ��3t l 1 to and final payment has been made. (List all amendments. Use space below if needed.) Department: V, "Is tor Phone/Ext.: �S Signature: Date: Revised. 01-07-16 INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES CLERK OF COUNCIL, DATE: FED 10 2016 ®• �C,s Cry + + + RECREATION SERVICES AGREEMENT THIS AGREEMENT is made and entered into this 17rx day of December 2015, by and between Illary Archilla ("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"). RECITALS A. The City desires to retain a recreation set -vice provider having special skills, resources and knowledge to provide Yoga classes in Espanol in its leisure 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 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 THEREFORE, in consideration of the mutual and respective promises, and subject to the terns and conditions hereinafter set forth, the parties agree as follows: SCOPE OF SERVICES Provider shall perfora those services as set forth in Exhibit A. to this Agreement. 2. COMPENSATION In consideration for the provision of the programs set forth in Exhibit A, City agrees to pay the Provider seventy percent (70%) of all gross revenue received from program participants. Total revenue to Provider shall not exceed $25,000 annually. 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 January 1, 2016 and end on December 31, 2016, 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. 4. INDEPENDENT CONTRACTOR Provider shall, during the entire tern of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended. nor Page 1 of 8 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 applicable withholding taxes. Provider is not an agent, representative or employee of City acid Provider shall have no authority to act on behalf of the City. 5. 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 negligent 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 armount 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 insureds provisions. b. Worker's Compensation Insurance. In accordance with California State law, 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. c. 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 force 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. (ii) 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 Page 2 of 8 and is in force and paid for, the City shall have the right, at the City's election, to terninate this 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, 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 direct or indirect operations of 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. 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 tennis of, or effects, arising from this Agreement. Provider further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party challenging the validity of this Agreement, or 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 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 for injury, damages, just compensation, restitution, judicial or equitable relief caused by the sole negligence of the City. 7. CONFLICT OF INTEREST Provider covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with perforniance of services specified under this Agreement. 8. LIVE SCAN BACKGROUND CHECK Provider, 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 properly given if delivered in person or Page 3 of 8 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: Cleric of the Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax (714) 647-6956 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: Illary Archilla 1 Dover Street Trabuco Canyon, CA 92679 ilaryPhotrnail.corn 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 effeetive 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. Forpurposes of calculating these time frames, weekends, federal, state„ County or City holidays shall be excluded. 10. 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 airy 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 terns or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the ternis 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. Page 4 of 8 It. 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 assigmnent, transfer, delegation or subcontract without the City's prior written consent shall be considered mill and void. b. S ubstitutes. 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 are at least twenty-one (21) years of age and comply with the City's insurance and live scan requirements contained herein, Evidence of compliance with City's insurance and live scan requirements shall be provided upon request. Provider must immediately notify the City of the substitute instructor's name, qualifications, address and phone number. If Provider carmot 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. Provider must notify participants as soon as possible of any class cancellation and make-up class. Provider must personally teach at least seventy -live percent (75%) of its offered classes. 12. TERMINATION a. 'Phis Agreement maybe terminated by the City upon thirty (30) days written notice of termination. In such event, Provider shall be entitled to receive, and City shall pay Provider, compensation for all services rendered prior to the effective date of termination. b. Termination or cancellation of classes by the Provider outside of Section 11 b. 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. 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. 14. NON-DISCRIMINATION 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, termination or other employment related activities or in connection with any activities related to Page 5 of 8 this Agreement. Provider affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 15. 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. 16. 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. 17. SE'VERABILITY 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. 18. EXHIBITS All Exhibits referenced herein and attached hereto shall be incorporated as if firlly set fbrdr in the body of this Agreement. 19. AUTHORITY The porson(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 thus Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: MARIA, ri, FILJIZAR Cleric of the Council CITY OF SANTA ANA DAV�I CA .AZOS City Manager Page 6 of 8 APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By:vU Vl�-vr—(C JJ NNM,FU K Assistant City Attorney RECOMMENDED FOR APPROVAL: -2-� - jtv -- GERARDO MOUET #�* ILLAR C ILLP Executive Director of Parks, Tax ID# 6-61-8231 Recreation and Community Services Agency Page 7 of 8 Exhibit A SCOPE OF SERVICES —Yoga Classes in Espanol A. Provider shall conduct Yoga classes in Espanol for ages 18 and up. B. Provider shall teach such or similar classes (1) at the times below at facilities to be designated by the City or (2) on a schedule agreed upon by the parties 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. Yoga classes in Espanol will consist of monthly sessions, held 1 day per week, 1 hour per day C. Provider will provide and be responsible for equipment, records, and personnel and clean-up of the facilities and materials necessary to ensure the safety and effectiveness of said instruction. CLASS SIZE / REGISTRATION A. Each class must have a minimrun of 5 paid students and no more than 30 students. B. No registration will be accepted after the second meeting of class. C. If the minimum registration has not been reached by the second class, the class may be cancelled by mutual agreement of Provider and City. Provider will be under no obligation to provide services for the cancelled classes, and the City will have no further obligations to pay Provider compensation for the remaining classes that were cancelled in that session, CLASSINEES A. Each participant shall pay class registration fee as established by City. B. Provider may not waive class participation/registration fees. C. Only registered participants may participate in class, D. Any refunds to participants will be made in accordance with City policy. E. Any material fee shall be established by mutual agreement of City and Provider and shall be payable directly to Provider. Page 8 of 8 q� p01 CERTIFICATE OF LIABILITY INSURANCE HI E 1M8H20t YYYY, a/aa/zais PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION Maguire Sees me Aged, l"` v101 Pretty Fred Ed, mR Mission Vlelo, CA 92691 8)] 938.)459 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAICIf INSURED INSURER A. Philadelphia lndmenlly Ing, ranw Company 1R02H Blery Archedle 1 Dover Trebure ConyOry CA 92679 INSURER B: INSURER C. INSURER U: INSURER E: COVERAGES 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 CERIFICATION MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'NIB LTR ADD'L INSRO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE GATE IMM/DD{YYW) POLICY EXPIRATION DATE(MMJDD/YYYY) LIMITS A % GENEIALLIAOILITY MMEaCIAI GENERALLIABIIIfY CWIMSMADE FAOCCUR FESSIONAL LIABI LITY TC AGGREGATE LIMITAPPLIES PER: POLICY PROJECT TOO PHPKI362709 000 09/06/2VE 07/06/2016 FACHOCCUPENC6 $2,000,000 PREMISES E11 a arourreneef $100,000 MED EXP Any one person) $2,500 GEN'L %. PERSONAL&ADVINIURY $2,000,000 GENERAL AGGREGATE $4,000,000 PRODUCTS-COMP/OPAGG $4,000,000 AUTOM0814E UABIUTY ANYAUTO ALL OWNEDAUTO5 SCHEDULED AUTOS HIRED AUTOS NO&OWNED AIIIDS COMPUTER SINGLC LIMIT (EAso ident) BODILY INJURY (Pet wre,r) BODILY INJURY (Pera[[dent) PROPPRTYOAMAGE (Per gmdent) GARAGE LIABILITY ANYAUTO 51� VV �� AUTO ONLY - EA ACCIDENT OTHERTHAN - CA ACC AUTO ONLY: AGG' EXCESS / UMBRELLA LIABILITY OCCUR1:1 CLAIMS MADE OfOULTIOIE HECOMPENS TIO k, fj/ I /y EACH OCCURENCE AGGREGATE EMPLOYERS' LIABILITY Y/N OFFICER/MEMBER EXTENDED?E%ENi1Vf )'""', L_7 MYandtles nin NHI be antler SPECIAL PROV151ONS below p S"` \\ �Yj'+ .gNy[o- j�l d \ I y,aY T)� iJ9 y� &y B+ 9a.. TORY LIMITS FR f.l.fACH ACCIDENT E,L. DISEASE -CA AMPLOYEE E.L. DISEASE -POLICY UMIi OTHER DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS It is understood and agreed [bat the delowing entity Is added as sn additbnal made d but only with m,mct(s) to the opeudl"ns of the "timed Insured except that IIeblllty nalea ing from the additional Inure 'sole The Dry of Serb And 20 CiVICCenter Ph, Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEILED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 36 DAY$ WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL IMPOSE NO OBLIGATION OR ACORD 25 (2009/01) © 1988-2009 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. Reviewed by Carmen Acosta PRCSNRecreation ACORD 25 (2009/01) POLICY NUMBER: PHPK1362709-000 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 1 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Oryanization(s) The City of Santa Ana 20 Civic Center Piz Santa Ana CA 92701- Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II - Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zations) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. m Carmen Acosta nr± on oa n7 nn I.... �nnv o--- I ..r n rti PI-APG-CA-1 (01/07) (6) If we have made a written offer to you, in accordance with the timeframes shown in Paragraph 4.a, above, to renew the Certificate of Insurance under changed terms or conditions or at an increased premium rate, when the Increase exceeds 25%. c. The transfer of a Certificate of Insurance between companies with the same insurance group or changes in Deductible, premium, Limit of Insurance or coverage are not refusal to renew. 6. Conditional Renewal If we elect to renew this Master Policy or Certificate of Insurance, and the renewal is subject to any of the following: a. Increase in Deductible; b.Reduction in Limit of Insurance; c. Elimination of coverages; or d. 25% or more rate increase, We shall mail or deliver written notice of the change(s) to the Members of the Fitness and Wellness Group at the mailing address shown in the Master Policy Declarations or the first Named Certificate Holder at the mailing address shown in the Certificate of Insurance and to the producer of record, if any, at least 60 days, but not more than 120 days, before the expiration date. 6. Mailing time must be added to the notice periods as follows: a. Add 5 days if the place of address and place of mailing is in California; b. Add 10 days if the place of address or place of mailing is outside of California; or c. Add 20 days if the place of address or place of mailing is outside the United States. Reviewed by carmen ACOSW F°IRCSAI ec;reatiort A .A PI-APG-CA-1 (01/07) (3) If the Members of the Fitness and Wellness Group have obtained replacement coverage, or have agreed, in writing, within 60 days of the termination of the Master Policy, to obtain that coverage. (4) If the Master Policy is for a period of no more than 60 days and you are notified at the time of issuance that it will not be renewed. (6)If the Members of the Fitness and Wellness Group request a change in the terms or conditions or risks covered by the Master Policy within 60 days of the end of the policy period. (6)lf we have made a written offer to the Members of the Fitness and Wellness Group in accordance with the timeframes shown in Paragraph 3.a above, to renew the policy under changed terms or conditions or at an increased premium rate, when the increase exceeds 25% c. The transfer of a Master Policy between companies with the same insurance group or changes in Deductible, premium, Limit of Insurance or coverage are not refusal to renew. 4. Nonrenewal of the Certificate of Insurance a. If we elect not to renew this Certificate of Insurance, we will mail or deliver written notice stating the reason for nonrenewal to the first Named Certificate Holder at the mailing address shown in the Certificate of Insurance and to the producer of record, if any, at least 60 days, but not more than 120 days, before the expiration date. If we fail to provide timely written notice required by the paragraph above, the coverage provided to the first Named Certificate Holder shall remain in effect with no change in Its terms and conditions, for a period of 60 days. b. We are not required to send notice of nonrenewal in the following situations: (1) If the transfer or renewal of a Certificate of Insurance, without any changes in terms, conditions or rates, is between us and a member of our insurance group. (2) If the Certificate of Insurance has been extended for 90 days or less, provided that notice has been given in accordance with Paragraph 4.a. above. (3) If you have obtained replacement coverage, or have agreed, in writing, within 60 days of the termination of the Certificate of Insurance, to obtain that coverage. (4) If the Certificate of Insurance is for a period of no more than 60 days and you are notified at the time of issuance that it will not be renewed. (6) If you request a change in the terms or conditions or risks covered by th G�edificaatfe�off Insurance within 60 days of the end of the policy period. y Carmen) Acosta PRCSAJ ecre;ation h ,A PI-APG-CA-1 (01107) laws or regulations establishing safety standards, by the Named Certificate Holder or his or her representative, which materially increase any of the risks insured against; (5) Failure by the Named Certificate Holder or his or her representative to implement reasonable loss control requirements which were agreed by the insured as a condition of policy issuance or which were conditions precedent to the use by us of a particular rate or rating plan, if the failure materially increases any of the risks insured against; (6) A determination by the commissioner that the loss of, or changes in, our reinsurance covering all or part of the risk would threaten our financial integrity or solvency. A certification made under penalty of perjury to the commissioner by one of our officers of the loss of, or change in, reinsurance and that the loss or change will threaten our financial integrity or solvency if the cancellation of the Certificate of Insurance is not permitted shall constitute such a determination unless disapproved by the commissioner within 30 days of the filing, There shall be no extension to this 30 day period; (7) A determination by the commissioner that the continuation of the Certificate of Insurance would place us in violation of the laws of this state or the state of its domicile or that the continuation of coverage would threaten our solvency; or (8) A change by the Named Certificate Holder or his or her representative in the activities or property of the commercial or industrial enterprise which results in a material added risk, a materially Increased risk or a materially changed risk, unless the added, increased, or changed risk is included in the Certificate of Insurance. If we cancel subjects to Paragraphs c,(1) through c.(8) above, we shall mail by certified mail to the first Named Certificate Holder at the address shown in the Certificate of Insurance, and mail to the producer of record, if any. Written notice of cancellation shall take effect: (1) 10 days from the date of mailing for the reasons set forth In Paragraph c.(1) and c.(2); and (if) 30 days from the date of mailing for the reasons set forth in Paragraph c.(3) through c.(8). d. If the Certificate of Insurance is canceled by us, the earned premium shall be computed pro-rata. Premium adjustment may be made at the time cancellation is effected or as soon as practicable thereafter. Failure to pay any premium adjustment at, on, or around the time of the effective date of cancellation shall not alter the effectiveness of cancellation. 3. Nonrenewal of the Master Policy a, If we elect not to renew this Master Policy, we will mail or deliver written notice stating the reason for nonrenewai to the Members of the Fitness and Wellness Group at the mailing address shown in the Master Policy Declarations, and to the producer of record, at least 60 days, but not more than 120 days, before the expiration date. If we fail to provide timely written notice required by the paragraph above, the coverage provided to the Members of the Fitness and Wellness Group shall remain in effect with no change in its terms and conditions, for a period of 60 days, b. We are not required to send notice of nonrenewal in the following situations: (1)If the transfer or renewal of a Master Policy, without any cRV# 66 igdsbynditions or rates, is between us and a member of our insurance group. (2)lf the Master Policy has been extended for 90 days .., provident that no e has been given in accordance with Paragraph 3,a, above Carmen Acosta PRCSA/Recreation PI-APG-CA-1 (01/07) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES — CANCELLATION, NONRENEWAL AND CONDITIONAL RENEWAL This endorsement modifies insurance provided under the following: COMMERICAL GENERAL LIABILITY COVERAGE PART SECTION IV- COMMERICAL GENERAL LIABILITY CONDITIONS, Paragraph S. When We Do Not Renew is deleted and replaced with the following.: I. Cancellation of Master Policy a. The Master Policy may be canceled by the Members of the Fitness and Wellness Purchasing Group by surrender of the policy to us or by mailing written notice to us stating when such cancellation shall take effect, If canceled by the Members of the Fitness and Wellness Purchasing Group, we shall retain the customary short -rate proportion of the premium. In no event may the requested date of cancellation be greater than 10 days prior to the date the request is received by us. b. The Master Policy may be canceled by us by written notice mailed by certified mail to the Members of the Fitness and Wellness Purchasing Group at the address shown in the Master Policy Declarations. Such cancellation shall be no fewer than 30 days from the date the notice is mailed. 2. Cancellation of the Certificate of Insurance a. The Certificate of Insurance may be canceled by the first Named Certificate Holder shown in Item 1, of the Certificate of Insurance by surrender of the Certificate of Insurance to us or by mailing written notice to us stating when such cancellation shall take effect. If canceled by the first Named Certificate Holder shown in Item 1. of the Certificate of Insurance, we shall retain the customary short -rate proportion of the premium. In no event may the requested date of cancellation be greater than 10 days prior to the date the request is received by us. b. If this Certificate of Insurance has been in effect 60 days or less, the Certificate of Insurance may be canceled by us by written notice mailed by certified mail to the first Named Certificate Holder at the address shown in the Certificate of Insurance. Such cancellation shall be no fewer than 30 days from the date the notice is mailed unless the Certificate of Insurance is canceled because the first Named Certificate Holder has failed to pay a premium when due or has committed fraud. In that event, such cancellation shall take effect no fewer than 10 days from the date the notice is mailed. c. If this Certificate of Insurance has been in effect for more than 60 days, the Certificate of Insurance may be canceled by us only for the following reasons: Reviewed by (1) Nonpayment of premium;; .. (2) Discovery of fraud or material misrepresentation by either of , `, ,Ip g: } (a) The Named Certificate Holder or his or her representatl 'n� kit 40 iniu (b) The Named Certificate Holder or his or her representative i uing a claim the Certificate of Insurance; [[�� {{�� (3) A judgment by a courtor an administrative tribunel that the Na�r�CatQ oldeas Violated any law of the state of California or of the United 1 f7a ,jn Qor6a-6111 O necessary elements, an act which materially increases any of the risk insured against; (4) Discovery of willful or grossly negligent acts or omissions, or of any violations of state POLICY NO: PHPK1362709-000 POLICY CHANGE DOCUMENT CHANGE # 4 CHANGE EFFECTIVE: 12/07/2015 Philadelphia Indemnity Insurance Company I PRODUCER: Maguire Insurance Agency, Inc. NAMED INSURED: Illary Archilla MAILING ADDRESS 1 Dover Trabuco Canyon, CA 92679- POLICY PERIOD: FROM 07/06/2015 TO 07/06/2016 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: 30 day cancellation. 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 Reviewed by Carmen Acosta Page 1 of 1 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY IN!SU'RANCE 0811012016 I PRODUCER THIS CERTIFICATION 15 ISSUED AS A MATTER OF INFORMATION Mao ' Agerry, III,, rPeul C a nec. el ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Ii 2 7 1 Puerto Site 200 1 Mission Viejo, CA 92691 877A38 7459 HOLDER. THIS CERTIFICATE DOES NOT AIMMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED 111aly AICII I Do: �,J Frabuco Canyon, CA 92679 INSURER A: Philadelphia Indemnity Insurance Company 18058 . . .. ...... ....... INSURER B INSURER C: INSURER D: INSURER F: L COVERAGES 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 CERIFICATION 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR" ADD-L POLICYEFFECTIVE POLICY EXPIRATION . . ........ . LTR JNSRD TYPE OF INSURANCE POLICY NUMBER E ATE (MM/DD/YYYYI 11 DATE IM M/DD/YYYYJ LIMITS A X GENERAL LIABILITY PHPK1362709- 07/06/201c, u7/o6/2017 EACH OCCURENCE $2,000,000 -11AMAG9 r(�NT� COMMERCIAL GINFRALLIASILPREMISES 001 JITY 11 $100,000 ".I_, MADE F-1 OCCUR MED EXP (Any one person) $2,500 X LIABILITY PERSONAL & ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000 GENT. A6GHE6AFE ]AMITAPPLIFS PFR: PRODUCTS-COMPJUPA6G 54,000,000 r7- POLICYPROJECT LOC AUTOMOBILE LIABILITY COMBINED 11ING11 LIMIT ANYAUTO (EA accident) .... .. . . ......... ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS �Pe, person) e ... rT BODILY INJURY HIRED AUTOS IAu ros (Per accident) PROPERTY DAMAGE as (Per accident) GARAGE LIABILITY AUl 0 oNlry -- EA ACCIDII r OTHER THAN LAACC ANYAUTO AUTO ONLY: AGG EXCESS / UMBRELLA LIABILITY EACH OCCURENCE AGGREGATE OCCUR CLAIMS -ADE dw ............ DEDUCTIBLE - RETENTION Ode WORXERS COMPENSATION AND 'H EMPLOYERS' LIABILITY Y/N ANYPROPRIE] CRJP ARFN ER/E x"cu" F 70RYIIMITS ER OFFICER/MEMBER EXCLUDED. E.L. EACH ACCIDENT E.L. DISEASE - FAAMPLOYEE (Mandatory in NH) IUF, describeunder F.L. DISEASE- POLICY LIMIT SPECIAL PROVISIONS IONS b.1— OTHER DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS It is mI(Je,,ipod1 and agreed that the F.11—ing entity is added as an iidditi.—I m-o,d but only writh —ip-lh,) to the operations oY the named Insured except that liability res.ring from the additional insured's sole neglig—ce. This insurance is Primary, with any insurance or self-insurance Program maintained by the name of person or cnganizdtlort listed being, non-contribe ling excepting loss fesolmig from the sole negligence of the name of person or organization listed CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE Th. City of Santa An. THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE 20 Civic CerAer Piz CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR Santa Ana, CA 92 , /01-4058 LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/01) 0 1988-2009 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD IMPORTANT |fthe certificate holder isaoADDITIONAL INSURED, the po|iq4ies must beendorsed. Astatement onthis certificate does not confer r�ghts to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. Astatement on this certificate does not confer rights to the certificate holder in Qeu of suchendorsementW. DISCLAIMER This Certificate of Insurance does not constitute v contract between the issuing inxurer(s), authorized representative or producer, and the certificate holder, nor doe: it affirmatively or negatively amend' extend oralter the coverage afforded bythe policies listed thereon, POLICY NUMBER: PHPK13627O8-0Q1 COMMERCIAL GENERAL LIABILITY i WIN Mw i we AN I This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations The City of Santa Ana, it's officers, employees, agents, and representatives Information requi,red to com lete this Schedule, if not shown above, will be shown in the Declarations. A. Section O —VVho Is An Insured is amended to include asan additional insured the person(a) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" ..property damage" or "personal and advertising injury" caused, imwhole orin part, by: 1. Your acts oronnissiowor 2. The acts oromissions ofthose acting onyour behalf-, in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to theme additional insureds, the following additional exclusions apply: This insurance does not apply to~bodi|yinjurypor "property damage" occurring after: 1. All work, including memtfumiahed in connection with such work, on the project (other than mewioe, maintenance orrepairs) tvbeperformed byor on behakfofthe additional insured(s) at the location of the covered operations has been completed; or 2. That out of which the injury damage arises has been put tmits in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as e part of the same project. THIS ENDORSEMENT CHANGES THE POLICY., PLEASE READ IT'CAREFUILLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name ofPerson orOrganization (Additional bnwored)�:The City of Santa Ana, it's officers, employees, agents, and representatives. Effective Date: 07/0x612016 SECTION H—WHO kSANINSURED is amended to include amanadditional insured the person(s)or organizahon(s)shown inthe endorsement Schedule, but only with respect bzliability for "bodily injmg/^^ .'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 inthe 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 aloss or^noourrenoe~vvecover for this Additional Insured. The Additional |msured's limits of insurance do not increase our limits of insurance, an described in SECTION III —LIMITS OF INSURANCE. All other terms, conditions, and exclusions under the policy are applicable to this endorsementand remain unchanged. Page 1of11 -, Me my I•I CHANGE #4 CHANGE EFFECTIVE: 07/06/2016 Philadeiphia Indemnity Insurance Company I PRODUCER: Maguire Insurance Agency, Inc. NAMED INSURED: Illary Archilla MAILING ADDRESS 1 Dover Trabuco Canyon, CA 92679- POLICY PERIOD: FROM 07/06/2016 TO 07/06/2017 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: Endorse to add primary and non-contributory wording in favor of the following entity. The City of Santa Ana, it's officers, employees, agents, and representative. Total Annual Total Prorate Additional/Return Premium $0.00 Additional/Return Premium $0.00 Total Annual Additional/Return Tax/Surcharge/Fee Total Prorate Additional/Return $0.00 Tax/Surcharge/Fee Page 1 of 1 ME DATE(MM/DDJYYYY) 06/27/2016 PRODUCER Maguire Insurance Agency, Inc. 27101 Puerta Real Suite 200 Mission Viejo, CA92691- 8774387459 THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW INSURERS AFFORDING COVERAGE NAIC # ... ........ INSURED INSURER A Philadelphia Indemnity Insurance Cornpany 18058 INSURER 8� Cowrie McGuire c, 539 F Washington Ave INSURER C Orange, CA 92866- INSURER D: ....... .. . . INSURER E: COVERAGES 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 CERIFICATION 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTH INSRD TYPE OF INSURANCE POLICY NUMBER DATE (MMIDD/YYYY) DATE (MM/ D D 1Y YYY) LIMITS A X GENERAL LIABILITY PHPK1473665- 0313112016 03/3112017 EACH OCCURENCE $2,000,000 M M11CIALGINERALLIABILITY COMMERCIAL 2mm coo DAMAG E T N 5 PREMISES'`Ea cccurrani;�., LA VS MADE ["I OCCUR CLAIMS MED EXP Wry one person) PER50NAL IS, ADV INJURY 52 DOD X PROFESSIONAL LIABILITY GENERAL AGGREGATE $4,000,000 PRODUCTS - COMPIOP AGG GIN"LAG GREGAIlTimirAPPLI SPER: POLICY F—] PROJECT F1 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMP ANY AUTO (EA accident) ALL OWNED AUTOS BODILY INJURY SCHEUU LED AUTOS Per person) BODILY INJURY HIRED AUTOS NON -OWNED AIUTOS (Per accoent) PROPERTY DAMAGE 71 (Per accldentN GARAGE LIABILITY AUTO ONLY - EA ACCIDENT OTHER THAN EAACC HANYAUTO AUTO ON LY: AGG EXCESS / UMBRELLA LARIUIN EACH OCCURLINCL OCCUR L1 CLAIMS MADE AGGREGATE DEDUCTIBLE RETENTION W =RKEI S COMPENSATION AND LIABILITY EMPLOYERS' ABILITY Y/N OTI WC ' TAT1l - TOBY LIMITSER ANY PROPRIETOR/PARTNER/EXECUTIVE 7-1 orriuk/mcwi:R EXCl.UOED. E.L EACH ACCIDENT_.______ (Mandatory in NIT) E.L. DISEASE -EA AMPLOYEE If Yes, describe u ride, SPECIAL PROVISIONS held, E.L. DISEASE - POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS It Is understood and agreed that the following entity City of Santa Ana its officers, employees, agent,, representatives & wclunteem is added as an additional insured but only with rospectls) to, the operations of the named insured except that liability resulting from the additional d's,.I. negligence. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE City of Santa Ana THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE 1825 W Civic Center Dr CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 50 SHALL IMPOSE NO OBLIGATION OR Santa Ana, CA 92703-2821 LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTAnVLS. - C AUTHORIZED REPRESENTATIVE , N" A0 e I to lv� e C ACORD 25 (2009/01) 1988-2009 ACORD rights 4 d, The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed, A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION ISWAIVED, subject tothe terms and conditions ofthe policy, certain policies may require an endorsement. A statement on th� certificate does not confer rights to the certificate holder in lieu of suchandmmement(y). DISCLAIMER This Certificate of Insurance does not oonsUtute a contract between the issuing iosu*er(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend' extend oralter the coverage afforded bythe policies listed thereon. PI -SE-O07(11M1) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CARE,FUILLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization (Additional |nsured):The City ofSanta Ana, it's officers, employees, agents, and representatives. Effective Date: 09/20/2016 SECTION 11 —WHO IS AN INSURED is amended to include as an addftional insured the pers,on(s) or orgen�zokom(e)shown inthe endorsement 8ohedw|e,but only with respect boliability for "bodily irjury." `pruperty damage" or "personal and advertising injury" arising out nfmrrelating 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 inthe endorsement SrheduI*. This insurance ieprimary tnand non-contributory with any other insurance maintained bythe 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 OFINSURANCE. All other 8enmm.00ndbiuma.andoxo|uoionnunderthepn|ioymnamppkoabkatodh�mendorsamerdand remain unchanged. Page1of1 POLICY NUMBER: PHPK14738O5'ODO PkSE-O07(11M1) A@§ I W.Wk Ths endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE, PART SCHEDULE Name ofPerson orOrganization (Additional |m»ured):The City ofSanta Ana, it's officers, employees, agents, and representatives. Effective Date: 0g/20/2016 SECTION |U—WHO |SANINSURED is amended boinclude esanadditional insured the pemon(s)cx organization(o)shown inthe endorsement Schedule, but only with respect toliability for "bodily irjury." "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 inthe endorsement Schedule. This insurance is primary to and non-contributory with any other insurance ma�ntainecl 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 coflectible insurance is available to the AddifionalInsured 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. AIIother terms, conditions, and exclusions under the policy are applicable tothis endorsement and remain unchanged. Page 1cf1 PI-APG-CA-1 (01/07) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES, — CANCELLATION, NONRENEWAL AND CONDITIONAL RENEWAL This endorsement modifies insurance provided under the following: COMMERICAL GENERAL LIABILITY COVERAGE PART SECTION IV- COMMERICAL GENERAL LIABILITY CONDITIONS, Paragraph 9. When We Do Not Renew is deleted and replaced with the following.: 1. Cancellation of Master Policy a. The Master Policy may be canceled by the Members of the Fitness and Wellness Purchasing Group by surrender of the policy to us or by mailing written notice to us stating when such cancellation shall take effect. If canceled by the Members of the Fitness and Wellness Purchasing Group, we shall retain the customary short -rate proportion of the premium. In no event may the requested date of cancellation be greater than 10 days prior to the date the request is received by us. b. The Master Policy may be canceled by us by written notice mailed by certified mail to the Members of the Fitness and Wellness Purchasing Group at the address shown in the Master Policy Declarations, Such cancellation shall be no fewer than 30 days from the date the notice is mailed. 2. Cancellation of the Certificate of Insurance a. The Certificate of Insurance may be canceled by the first Named Certificate Holder shown in Item 1. of the Certificate of Insurance by surrender of the Certificate of Insurance to us or by mailing written notice to us stating when such cancellation shall take effect. If canceled by the first Named Certificate Holder shown in Item 1. of the Certificate of Insurance, we shall retain the customary short -rate proportion of the premium. In no event may the requested date of cancellation be greater than 10 days prior to the date the request is received by us. b. If this Certificate of Insurance has been in effect 60 days or less, the Certificate of Insurance may be canceled by us by written notice mailed by certified mail to the first Named Certificate Holder at the address shown in the Certificate of Insurance. Such cancellation shall be no fewer than 30 days from the date the notice is mailed unless the Certificate of Insurance is canceled because the first Named Certificate Holder has failed to pay a premium when due or has committed fraud. In that event, such cancellation shall take effect no fewer than 10 days from the date the notice is mailed. c. If this Certificate of Insurance has been in effect for more than 60 days, the Certificate of Insurance may be canceled by us only for the following reasons: (1) Nonpayment of premium-, (2) Discovery of fraud or material misrepresentation by either of the following: (a) The Named Certificate Holder or his or her representative in obtaining the insurance-, (b) The Named Certificate Holder or his or her representative in pursuing a claim under the Certificate of Insurance; (3) A judgment by a court or an administrative tribunal that the Named Certificate holder has violated any law of the state of California or of the United States, having as one of its necessary elements, an act which materially increases any of the risk insured ;R a ? P i st; 6 (4) Discovery of willful or grossly negligent acts or omissions, or 0 *eAaetions of state I �a' Page 1 of 4 laws orregulations establishing safety standards, bythe Named Certificate Holder orhis or her representative, which materially increase any of the risks insured against; (5) Failure by the Named Certificate Holder or his or her representative to implement reasonable loss control requirements which were agreed by the insured as o condition of policy issuance or which were conditions precedent to the use by us of a particular rate or rating p|mn, if the failure materially increases any of the risks insured againnt (6) A determination by the commissioner that the loss of, or changes in, our reinsurance covering: all or part of the risk would thnmeh*n our fimanc�a| integrity or solvency. A certification made under penalty of perjury to the commissioner by one ofour officers of the loss of, or change in, reinsurance and that the |men or change will threaten our f|nemoim| integrity or solvency if the cancellation of the Certificate of |muunsnue is not permitted shall constitute such m determination unless disapproved bythe commissioner within 3Odays ofthe filing. There shall bemoextension tothis 3Oday period; (7) A determination by the commissioner that the continuation of the Certificate of Insurance would place us in violation of the laws of this state or the state of its domicile or that the continuation cfcoverage would threaten our solvency; mr (B)}\change bythe Named Certificate Holder urhis orher representative in the activities or property of the commercial or industrial enterprise which results in a material added risk, a materially increased risk or a materially changed huk, on|eom the added, [nuneuaed, or changed risk isincluded inthe Certificate ofInsurance. |fwecancel subjects tnParagraphs c.(1)through o.(B)above, weehaIlmail bycertified mail to the first Named Certificate Holder atthe address shown in the Certificate of Insurance, and mail to the producer of record, if any. Written notice of cancellation shall take effect: (i) 1Qdays from the date ofmailing for the reasons set forth inParagraph c.(1)and c.(2); and ([i) 30 days from the date cfmailing for the meeaomm set forth in Paragraph c.(3) through c.(8). d.If the Certificate of Insurance is canceled by us, the earned premium shall becomputed pm-rato. Premium adjustment maybe made atthe bnne cancellation is effected ores soon as practicable thereafter. Failure to pay any premium adjustment at on, or around the time of the effective date of cancellation shall not alter the effectiveness of cancellation. 3^ NonremoxwmU of the Master Policy a. If we elect not to renew this Master Poicy, we will mail or deliver written notice stating the reason for nmnnenewa| to the Members of the Fitness and Wm|nomm Group at the maiOng address shown in the UNamhar Policy Declarations, and to the producer ofrecord, at [east 00 doys, but not more than 128daya. before the expiration date. If we fail to provide timely written notice required by the paragraph above' the coverage provided to the Members of the Fitness and VVe||neoa Group shall remain in effect with no change in its toono and conditions, for aperiod of6Odays. lb. VVeare not required hosend notice ofnonrenewalinthe following situations: (1)|fthe transfer orrenewal ofaMaster Policy, without any changes in terms, conditions or rates, is between us and a member of our insurance group. (2)|fthe Master Policy has been extended for 90days or less, provided that notice has been given bnaccordance with Paragraph 3.m.above ��' �� PI,4PG'CA-1 (0107) (3)If the Members of the Fitness and Wellness Group have obtained replacement coverage, or have agnaed, in vvhting. wiftn 60 days of the termination of the Master Pu|ioy, to obtain that coverage. (4)|fthe Master Policy is for operiod of no more than 60days and you are notified at the time of issuance that it will not be renewed. (5)}fthe Members of the Fitness and Wellness Group request a change in the terms or conditions o/ haha covered by the Master Policy within GO days of the end of the policy (6)Kwe have made a written offer to the Members of the Fitness and VVe|nwao Group in accordance with the timeframes shown in Paragraph 3.a above, to renew the policy under changed terms or conditions or at an increased premium nate, when the increase exceeds o. The transfer ofaMaster Po4uybetween companies with the same insurance group orchanges in Deductible, premium, Limit of Insurance or coverage are not refusal to renew. 4.Numnenewva|ofthe Certificate ofInsurance a� If we elect not hnrenew this Certificate mfInsurance, wewill mail ordeliver written notice stating the reason for nomnenewo| to the first Named Certificate Holder etthe mailing, address shown in the Certificate of Insurance and to the producer of record, if any. at least GO deye, but not more than 12Odays, before the expiration date. If we fail to provide timely written notice required bythe paragraph above, the coverage provided to the first Named Certificate Holder shall remain in effect with no change in its terms and nonditione, for aperiod ofGOdays. b.VVe are not required to send notice ofmomranewa| in the following eduetioms.- (1) If the transfer or renewal of a Certificate of |msorunce, without any changes in termm, conditions or rates, is between us and a member of our insurance group. (2) If the Certificate of Insurance has been extended for 90 days or |ema, provided that notice has been given in accordance with Paragraph 4.a, above, (3) If you have obtained replacement coverage, urhave agreed, in writing, vvithinSO days of the termination of the Certificate of Insurance, to obtain that coverage. (4) If the Certificate of Insurance is for a period of no more than 60 days and you are notified at the time ofissuance that itwill not berenewed. (6) |fyou request achange imthe terms orconditions orrisks covered bythe Certificate of Insurance within 8Qdays ofthe end cf the policy period. (G) If we have made a written offer to you, in eoomndanoe wfth the tinnefrannea shown in Paragraph 4.o. above, to renew the Certificate of Insurance under changed bamns or conditions or at an increased premium rate, when the increase exceeds 25%. o. The transfer ofa Certificate of Insurance between companies with the same insurance group or changes in Deductible, premium, Limit of Insurance or coverage are not refusal to renew. 5. Conditional Renewal If we elect to renew this Master Policy or Certificate of Insurance, and the renewal is subjecttnany of the following: a. Increase in Oedactibke� b. Reduction in Limit of lnsurance� c. Elimination pfcoverages; mr d. 25% or more rate increase, We ohmU mail ordeliver written notice of the change(s) to the Members of the Fitness and VVe||neaa Group at the mailing address shown in the Master Policy Declarations or the first Named Certificate Holder at the mailing address shown in the, Certificate of Insurance and to the producer of raoord, if any, mtleast GOdays, but not more than 12Odays, before the expiration date. 6. Mailing time must be added to the notice periods as follows: a. Add 5days if the place ofaddress and place ufmailing hainCa|ifomk� b. Add 10 days if the place of address or place of mailing is outside of California; or C. Add 20 days if the place of address or place of mailing �S Outside the I.-Inited States. Page 4of4 CAREFULLY.THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT ADDITIONAL CONDITIONS This endorsement modifies insurance pnov�dedunder the: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to Section IV — Commercial General Liability Conditions: 1. Changes The Certificate of Insurance contains all the agreements between you and us concerning the insurance afforded. The first Named Certificate Holder shown in the Certificate of Insurance is authorized to make changes in the terms of the Certificate of Insurance with our consent. The Certificate of insurance Wmcmm can be amended or waived only by endorsement issued by us and made apart ofthe Certificate cfInsurance. Transfer ofYour Rights and Duties Under The Certificate ufInsurance: Your rights and duties under the Certificate of Insurance may not be transferred without our written consent except in the case of death of an individual Named Certificate Holder. If you die, your rights and duties will be transferred toyour legal napmeeenhsfive but only while acting within the scope of duties as your |e0e| representative. Until your legal representative is appointed, anyone having proper temporary custody of your property will have your rights and duties but only with respect tothat property. Page 1 of 1 POLICY NO: PHPK1473005-000 POLICY CHANGE DOCUMENT CHANGE#5 CHANGE EFFECTIVE: 04/11/2016 Philadelphia Indemnity Insurance Company I PRODUCER: Maguire Insurance Agency, Inc. NAMED INSURED� Connie McGuire MAILING ADDRESS 53AEWashington Ave Orange, CA928GG- POL[CYPERIOD: FROM 03/31/2016 TO 03C31/2017 at 12:01 A.M. Standard Time atyour mailing oddnaoa shown above. |noonnderatiommfthe premium reflected, the policy iaamended asindicated below: Anlendiingadditional insured: Addition boread City ofSanta Ana timofficer, employees, agents, Total Annual Total Prorate Total Annual Total Prorate AddidonaVRet m Addi6unmKRetum Tax/Surcharge/Fee $000 Tax/Surcharge/Fee $0.00 Page 1 of 1 POLICY NO: CHANGE # 5 CHANGE EFFECTIVE: 04/11/2016 PHPK1473,665-000 Philadelphia Indemnity Insurance Company PRODUCER,- Maguire Insurance Agency, Inc. NAMED INSURED: Connie McGuire MAILING ADDRESS 539 E Washington Ave Orange, CA 92866- POLICY PERIOD: FROM 03/31/2016 TO 03131/2017 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: Amending additional insured: Addition to read City of Santa Ana tis officer, employees, agents, representatives & volunteers. Plus 30 NOC 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 Page 1 of 1 M