HomeMy WebLinkAboutUNION ARMY OF THE WEST, INC.-2016City of Santa Ana
1 Clerk of the Council core office use only
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AGREEMENT TERMINATION FORM
Please complete this form when the attached agreement and all
amendments (if any) are no longer in effect.
Note: If your agreement is grant related, please ensure that all grant retention requirements
have been satisfied prior to signing the termination form. CLERK OF THE B
ALIG 2'21, pm, :27
Return form to the Clerk of the Council Office (M-30).
Call 647-1520 if you have any questions.
The agreement with
No.
N-2016-085 t'
was completed on (1 and final payment has been made.
(List all amendments. Use space below if needed.)
Revised: 01-07-16
Department: r �GA
Phone/Ext.: gdtok
Signature: (naOrQ�2�
Date: ! 11r zw
NSURANCE ON FILE
WORK MAY PROCEED
NTIL INSURANCE EXPIRES
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CLERK OF COUNCIL;':-
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Union Army of the West, Inc. ("Perfonmer")
39266 Calle de Companero
Murieta, CA 92562
Attn: Dave Richman
Re: Performer Eneaeement Agreement
N-2016-085
This letter represents your agreement with the City of Santa Ana ("City") as entered into on the above date for the
engagement described below:
I . Event Description: 2 canons for City -Sponsored July 4 program; canons to be operated and fired by Performer, each
canon to be fired 7 times
1 Date(s); Monday, July 4, 2016
3. Event Tone(s): 4:00 p.nz. to 9:30 p.m.
4. Location: Centennial .Park, 3000 W. Edinger Ave, Santa Ana ("Property")
5. Compensation: $800 (payable by check within 30 calendar days of event); Performer must provide IRS form W-9
before payment can be made; if only I canon is provided, compensation shall be $600; remit payment to Perfenuer
at following address: 1509 T'etela Heights, Escondido, CA 92026
6. Equipment provided by City: none
Equipment provided by Performer: 2 canons and all related supplies and equipment, including technical crew for
each canon demonstration. Performer shall follow all applicable safety procedures in the tiring of canons.
S. City Contact Person (for coordinating purposes only): Sonia Batres
Independent Contractor: Performer shall, during the entire term of this Agreement, be construed to be an
independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed
to create an employer -employee relationship, a joint venture relationship, or to rdlow the City to exercise discretion
or control over the professional marmer in which Performer performs the services that are the subject matter of this
Agreement; however, the services to be provided by Performer shall be provided in a manner consistent with all
applicable standards and regulations. Performer 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.
to. Indemnification: Performer, his or her agents, or employees (if applicable) agrees to and shall indetrinify, defend,
and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives from
and against all loss, expenses, or liability (including costs and attorney's fees) arising from the negligence or willfttl
misconduct of Performer, his or her agents, or employees.
It. Release: Performer accepts the Properly and any City -provided equipment used in connection with the performance
in their "as -is" condition, with all faults. Performer fully releases, waives and discharges forever any and all claims,
demands, rights, and causes of action of any kind or nature against, and covenants not to sue., City, its elected
Letter Agreement — Union Anny of the West
Page 2
officials, officers, employees, agents and volunteers, and all persons acting on behalf of, by, through or under each
of them, under any present or future laws, statutes, or regulations for any claim or event relating to the condition of
the Property or City -provided equipment or Performer's use thereof.
12. Commercial General Liability Insurance. Performer shall maintain commercial general liability insurance narning
the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and 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 Performer's operations in the
performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance
shalt 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, with $2,000,000 in the
aggregate. Such insurance shall: (1) name the City, its officers, employees, agents, volunteers, and representatives
as additional insureds; (2) be primary and not contributory with respect to insurance or self-insurance programs
maintained by the City; and (3) contain standard separation of insured provisions.
13. Worker's Compensation Insurance. In accordance with the California Labor Code, Performer, if Performer has any
employees, is required to be insured against liability for worker's compensation or to undertake self-insurance.
14. The City shall have the right and royalty -free license to simulcast or produce and show a tape -delayed broadcast of
Performer's presentation to the City conununity or general public, through webeast or any other means. This license
shall be non-exclusive and the copyright shall remain with the Performer. Copies of Performer's presentation may
be maintained by the City, and Performer consents to use of such recordings.
15. Performer shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age,
national origin, ancestry,, disability, or any other basis protected by applicable law in connection with any activities
related to this Agreement.
16, This Agreement shall in all respects shall be interpreted, enforced, and governed exclusively by and under the laws
of the state of California. Both parties 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.
17. This Agreement represents the complete and exclusive statement between the City and Performer regarding the
subject matter herein and supersedes any and all other agreements, oral or written, between the parties. This
Agreement may not be modified except by written instrument signed by the City and by an authorized representative
of Performer.
Please execute this letter to reflect your agreement to the terms and conditions set forth herein.
CITY IOF SANTA AN.
_ 1
DAVID CAVAZOS
City Manager
ATTEST:
f9v' r
ARIA D, HUI'LAR
Clerk of the Council
PERFORMER
By: �),4vt? Qletkfr�,A,
Title: cAP"VA rr
APPROVED AS TO FORM(:
By:ilk
JOWM. FUNK
Assistant City Attorney
R�MMMFNDEp FOA,,y3PTROVAL
GERARDO MOUET, Executive Director, Parks, Recreation, and Community Services Agency
ALCM& CERTIFICATE OF LIABILITY INSURANCE
11"11
DATE(MMIDDIYYYV)
06/10/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT
NAME, Lockton A££inity, LLC
Lockton Affinity, LLC
AIONNo Eot1877-487-5407 A10 Na: 913-652-7599
P.O. Box 874952
E-MAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC#
Kansas City, MO 64187-4952
INSURER A: Certain underwmiter's st Lloyd's, London
AM122000
INSURED
INSURER B:
1st Pennsylvania Light Artillery,
Battery 'I'll39266 Calla De Companero
INSURER C:
INSURER D
INSURER E:
Murrieta, CA 92562
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.
IL TR
TYPE OFINSURANCE
ADDLSUBR
INSDMID
55 CYEFF
MMIDDIYYYY
POLICYEXP
MMIDDIYYYYI
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
Y
Y
L201519110
11/02/2015
11/02/2016
EACHOCCURRENCE
11,000,000
CLAIMS -MADE OCCUR
DAMAGE IUKrNIED
PREMISES Ea occurrence
S 300,000
MED EXP (Any one person)
$ 5,000
PERSONAL B ADV INJURY
A1,000,000
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$1,000,000
GEN'L
X
POLICY n JECT1:1 LOC
PRODUCTS-COMP/OP AGO
$ 1,000,000
$
OTHER.
I
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
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$
BODILY INJURY 'Per parson)
$
ANY AUTO
ALL OWNED SCHEDULED
NON-OWNEDAUTOS AUTOS
HIREDAUTOS ATOS
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BODILY INJURY Peraccideni
$
PR ERTV DAMAGE
accident
$
—
UMBRELLA LIAB
OCCUR
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EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
.6..of,,,G��A%%�
DED
RETENTION$
$
°) \rw°
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WORKERS COMPENSATION
PER OTH-
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
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STATUTE ER
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$
E. L. DISEASE - EA EMPLOYEE
S
(Mandatory In NH)
If yes, describe under
E. L. DISEASE -POLICY LIMIT
--
$
DESCRIPTIONOFOPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required)
The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents
and volunteers are named as additional insureds with regard to liability and defense of suits arising from
the operations and uses performed by or on behalf of the named insured for Event dated July 4, 2016.
This insurance is primary and non-contributory if required by contract.
The NAIC number shown above is the Alien Insurer Identification Number (AIIN)
signed by the National Association of Insurance Commissioners (NAIC)
CANCELLA
City of Santa Ana
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS.
Santa Ana, CA 92701
198B-2014 ACORD CORPORATION. All rights reserved.
e
ACORD 25 (2014101) The ACORD name and logo are registered arks of ACORD
19762046 940960
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED ADDITIONAL INSURED ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
City of Santa Ana
SECTION II — LIABILITY is changed as follows:
A. SECTION II — WHO IS AN INSURED, is amended to include as an additional insured any
person(s) or organization(s) shown in the Schedule or on a Certificate of Insurance issued by the
Company, whom you are required to add as an additional insured to this policy by a written
contract or written agreement that:
1. Is currently in effect, or becoming effective, during the term of this policy; and
2. Was executed by you prior to any "bodily injury," "property damage," "personal and
advertising injury."
B. The insurance provided to the additional insured by this endorsement applies as follows:
1. That person or organization is an additional insured, but only with respect to "bodily injury",
"property damage", or "personal and advertising injury" caused, in whole or part, by your
negligent acts or omissions:
a. In connection with premises you own, rent, lease, or occupy; or
b. In the performance of your ongoing operations.
2. There is no coverage for the additional insured for "bodily injury", "property damage", or
"personal and advertising injury" arising out of the sole negligence of the additional insured
or by those acting on behalf of the additional insured.
3. The limits of insurance applicable to the additional insured are those specified in the written
contract or written agreement or in the Declarations of this policy, whichever is less. These
limits of insurance are inclusive of and not in addition to the limits of insurance shown in the
Declarations.
If a claim involves some conduct on the part of the Named Insured and some on the part of
the Additional Insured, Underwriters will only contribute on a pro r §is, to the extent the
Additional Insured has other responsive insurance coverage-.�,\egl2tam
Includes copyright material from Insurance Services Office, In ~' berm sion
LRS 1927 NRA 07 15��y�"y �� �t�'g ❑ 1 of 3
9�6
C. If the additional insured is a Lessor of Equipment, this insurance does not apply to any
"occurrence" which takes place after the equipment lease expires.
D. If the additional insured is a State or Political Subdivision and has issued a permit in
connection with premises you own, rent, or control, this insurance applies only with respect to the
following hazards for which the state or political subdivision has issued such permit:
1. The existence, maintenance, repair, construction, erection, or removal of advertising signs,
awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away
openings, sidewalk vaults, street banners, or decoration and similar exposures;
2. The construction, erection, or removal of elevators; or
3. The ownership, maintenance, or use of any elevators covered by this insurance.
E. If the additional insured is a State or Political Subdivision that has issued a Permit with
respect to operations performed by you or on your behalf.
This insurance does not apply to:
1. 'Bodily injury", "property damage" or "personal and advertising injury" arising out of
operations performed for the state or municipality; or
2. 'Bodily injury" or "property damage" included within the "products -completed operations
hazard".
F. If the additional insured is a Manager or Lessor of Insured Premises, that person or
organization is only an additional insured with respect to liability arising out of the ownership,
maintenance or use of that part of the premises leased to you.
This insurance does not apply to:
1. Any 'occurrence" that takes place after you cease to lease that premises, or
2. Structural alterations, new construction or demolition operations performed by or for that
person or organization.
G. If the additional insured is an Owner or Other Interest from Whom Land Has Been Leased,
that person or organization is only an additional insured with respect to liability arising out of the
ownership, maintenance or use of that part of the land leased to you and subject to the following
additional exclusions:
This insurance does not apply to:
1. Any 'occurrence" that takes place after you cease to lease that land; or
2. Structural alterations, new construction or demolition operations performed by or for that person
or organization.
H. If the additional insured is a Mortgagee, Assignee, or Receiver, this insurance does not apply to
structural alterations, new construction or demolition operations performed by or for that person or
organization.
I. If the additional insured is Controlling Interest, that person or organization is an additional
insured but only for their liability arising out of:
1. Their financial control of you; or
2. Premises they own, maintain or control while you lease or occupy those premises.
This insurance does not apply to structural alterations, new construction and Mtdii4l operations
performed by or for that person or organization. �VVe
�e�G 6't,.Kt\\�.
Includes copyright material from Insurance Services c�'\,h-rte�46iiss�on
LRS 1927 NRA 07 15 $ Page 2 of 3 ❑
J.
I —
SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 4.
Other Insurance, is amended as follows:
1. The following is added to subparagraph b:
Regardless of whether other insurance is available to an additional insured on a primary basis,
this insurance will be primary and noncontributory, if a written contract or agreement
between you and the additional insured specifically requires that this insurance be primary.
2. Condition 8. Transfer of Rights of Recovery Against Others To Us is amended by adding
the following:
We waive any right of recovery we may have against any person or organization when such
waiver is required by a written contract that you have agreed to prior to loss.
Exclusion:
With respect to the insurance afforded the additional insured by this endorsement, the following
additional exclusion applies:
This insurance does not apply to:
1. "Bodily injury" or "property damage" occurring after:
a. all work, including materials, parts or equipment furnished in connection with such
work, on the project (other than service, maintenance or repairs) to be performed by
or on behalf of the additional insured(s) at the site of the covered operations has been
completed; or
b. that portion of "your work" out of which the injury or damage arises has been put to
its intended use by any person or organization other than another contractor or
subcontractor engaged in performing operations on or at the same project.
2. `Bodily injury," "property damage," "personal and advertising injury" caused by the
rendering of or failure to render any professional services.
3. Any claims, including but not limited to those for "bodily inj ury," "property damage" and/or
"personal and advertising injury," arising under the federal Telephone Consumer Protection
Act (47 U.S.C.A. 227) and/or claims made under any similar, related, and/or equivalent state
law and/or any claims related to telephonic solicitations, electronic solicitations,
telemarketing, automatic dialing systems, artificial voice messages, pre-recorded voice
messages, short message service, texting, and/or use of fax machines.
All other terms and conditions of this policy shall remain unchanged. VN'.
This endorsement forms a part of the policy to which it is attached.
OU
Nwc
Includes copyright material from Insurance Services Office, Inc., with its permission
LRS 1927 NRA 07 15 Page 3 of 3 ❑