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Home My WebLink AboutFIESTA DE CARNIVAL 1ACity of Sang 4na f Clerk of the C incil AGREEMENT TERMINATION FORM ----- —._.-._-_--______.___. COTC Office Use Only i -- Please complete this form when the attached agreement and all amendments (if any) are no longer in effect. CITCL Y �h SaNTA ANC E�RK OF COUNCIL Return form to the Clerk of the Council Office (M-30). Call 647-6520 if you have any questions. j The agreement with V-1 f , l i - CLLY o 1 vao No. -A --,-�C%LS Ci�CA was completed on and final payment has been made. (List all amendments. Use space below if needed.) 4 IS f I Department: Phone/Ext.: Y'r ..52Cb,S7- j s�< OZ rD C IS - I -( Signature: Date: Revised 08-23-10 MAYOR Miguel A. Pulido MAYOR PRO TEM Vincent F. Sarmlento COUNCILMEMBERS Angelica Amezoua P. David Benavides Michele Martinez Roman Reyna Sal Tinajero INSURANCC' XON FILE WORK MAY NQ PROCEEi' CLERK OF COUNCIL ®ATE: CITY OF SANTA ANA PARKS, RECREATION, AND COMMUNITY SERVICES AGENCY 20 Civic Center Plaza M-23 . P.O. Box 19813 M-23 Santa Ana, California 92702 WWW,Santa n .a December 20, 2016 Ted Holcomb Fiesta de Carnival 11278 Los Alamitos Blvd, #101 Los Alamitos, CA 90720 A-2015-188-0 3 CITY MANAGER David Cavazos CITY ATTORNEY Sonia R. Carvalho CLERK OF THE COUNCIL Maria D. HUzar Re: Second Extension of Non-Exchisive Agreement to Provide Carn vals at City Parks Agreement No. A-2015-019 Dear Mr, Holcomb: Pursuant to Section 5 of Agreement No. A-2015-019, entered into by Fiesta de Carnival and the City of Santa Ana, dated February 3, 2015 and as amended by First Amendment No. A-2015-188, and Second Amendment No. A-2015-188-02, the team of the Agreement is hereby extended for an additional one (1) year period, from February 3, 2017 to February 2, 2018, The insurance certificates are required to be extended and/or renewed to cover this extension, The carnival event and fee schedule for this period is attached as Exhibit A. AjI other terms and conditions of the Agreement remain unchanged and in fall force and effect. Sincerely, u I :`ntJ Gerardo Mouet D Executive Director of Parks, Recreation, and Community Services Agency CITY OF SANTA ANA AAA David Cavazos City Manager APPROVED AS TO FORM JX M. Funk, Assistant City Attorney ATTEST Mara D. Huizar Clerk of Council SANTA ANA CITY COUNCIL Miguel A. Pulido Vincent F. Sarmiento Michele Martinez i Angelica Amezcua i P. David Sanavides Raman Reyna i Sal Tinalero Mayor Mayor Pro Tem, Ward 1 Ward 2 Ward 3 Ward 4 I Ward 5 I Ward 8 i PUltdaOsanla-ana,ora l VSarm€enlyCn�santa-ana ora l MMartlnezfiDsanta-ana.oro I A ezcua(29anta-ana.aro DBenavtdaslr�santaana_m�_ora I gRevnafcasanla•ana.or�c I �5,;[lgg r�- i i I i ri li N N N V n n X CL 2 M A W_ fu N 1 n < A O] J m Ln A I w N N a m m o N N 0 1 O fD N O n m z a S o m n � d ci 3 � a 3 0 c c` c` M M "O N .6 c (=D `<< �• n LO N N J S tr h A N p � Fa N (may N A O m N VI N N N Uf N VI D) ❑1 N N D) D) N fD fD fD fD fD fD fD .� n n n n n n n N d D1 N D) D) DJ 0 RL o✓ Dt d d d v -. z m m A 3 N J J N A OD A W C N O O N Lm J In N m to O O W O LM O In O O O O O O O O N H N W FJ N N 01 Vl 01 N AM n n n n n n n 3 N DJ DJ N N N DJ N 3 3 3 3> 3 3 x n<i m — _ rt fD fD fD fD (D (D fD N N N N V n n X CL 2 M A W_ fu N 1 n < A DATE (MWDDfYYYY) A" R" CERTIFICATE OF 'LIABILITY INSURANCE 3r3i2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CON'F'ERS 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 Christine Nidel NAME: Governor Insurance Agency, Inc. .,.IPHO,No,Ext): (330)539-9999 _ (AIC,..Nnj:tS�OI..539-9998. MAIL 972 Youngstown -Kingsville Rd. EACH OCCURRENCE P.O. Box 770 INSURER(S) AFFORDING COVERAGE NAIL # Vienna Oka 44473 _.INSURED.... INSURERA:R-T Specialty LLC '..X VEA457676 5/27/2016 5/27/2017 INSURER B: ...._. ....... -.... ... International Promotions, Inc.A-2015-188-02 INSURER C: Fiesta de Carnival A-2015-188-01 INSURER D: 11278 Los Alamitos Blvd INSURERS : Los Alamitos CA 90720 INSURER F. COVERAGES CERTIFICATE NUMBER:CL166108412 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 TYPE OF INSURANCE ..... .RODE 3UBR.. __.POLICY NUMBER _. MMIDDIYYYY POLICY MMIoDIYYVPN...' LTRIN" LIMITS X COMMERCIAL GENERAL. LIABILITY EACH OCCURRENCE $ 1, 000, 000 A CLAIMS -MADE ! X OCCUR. DAMAGE TO RENTED PREMISES (Ea occurrence) ..... 100, 000... $ '..X VEA457676 5/27/2016 5/27/2017 MED EXP (Any one person) $ FXa17Aded PERSONAL 8 ADV INJURY $ 1, 000, 000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOC PRODUCTS - COMPIOP AGG $ 2,000,000 ',.... OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ _ (Ea accident)_.. ANY AUTO BODILY INJURY (Per persen) S _. _ ALL OWNFU SCHEDULED BODILY INJURY (Per accident) S AUTOS AUTOS NON-OWNED NON -OWNED PROPERTY MAGE $ HIRED AUTOS AUTOS (Per accident)....... ...... ..... UMBRELLA LIAB OCCUR _ , q ,g .� �I EACH OCCURRENCE S EXCESS LIAB CLAVM_ S MADE O W� AGGREGATE $ DED RETENTION$r,,,� ,°' $ WORKERS COMPENSATION '" ,� AND EMPLOYERS` LIABILITY y G n �' ,,. PER OTH- STATUTE:. ER Y 1 N�^f ANY PROPRIETORYPARTNER/EXECUTIVE E L , EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) E L DISEASE - EA EMPLOYEE S If yes, describe under T " ...... DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LpMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 1.01, Additional Remarks Schedule, maybe attached if more space is required) Certificate holder is named as additional insured per the attached CG 2026 form City of Santa Ana 20 Civic Center Dr. Santa Ana, CA 92701 ACORD 25 (2014101) IN 025onuni) L91-20M.RP1111IF11116J9.1 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 Thompson, ,Jr./CNIDEL Q 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: VBA457078OO COMMERCIAL GENERAL LIABILITY CG3U2G0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement nnoddieoinsurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE A. Section UU —Who Is An Insured is emended to include as an additional insured the (a) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "'property damage" or "personal and advertising injury" oaused, in whole or in port, by your acts or omissions or the acts or omissions of those acting onyour beMa|f� 1. |mthe performance nfyour ongoing npemfione� or 2. In connection with your premises owned by or rented bzyou. However: 1.The insurance afforded to such additional insured only applies hzthe extent permitted by law; and 2. If coverage provided tothe additional insured ia vaqu/rmU 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 inaunada, the following is added to Section III — Limits Of Insurance: U coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf ofthe additional insured is the amount ofinsurance: 1. Required bythe contract oragreement; or 2. Available under the applicable Limits of Insurance shown inthe Dao|aratione- . whichever isless. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. ~ CG 20 26 04 13 C Insurance Services Office, Inc., 2012 Page 1 of COVINGTON SPECIALTY INSURANCE COMPANY This Endorsement Changes The Policy. Please Read It Carefully. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - PRIMARY AND NONCONTRIBUTORY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations City of Santa Ana Location(s) as specified in written contract with the 20 Civic Center Dr. Additional Insured shown in the schedule of this endorsement Santa Ana, CA 92801. Information required to com tete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) 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: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted bylaw; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: (1) 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 location of the covered operations has been completed; or (2) 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 for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is addedON III — Limits of Insurance: If coverage provided to the additional insured is required by a contract or agreement the mo t' 41 -0 on behalf of the additional insured is the amount of insurance: 7e'4 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declaration whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Policy No.: VBA457676 GBA 104025 0614 D. If the contract between the additional insured and you requires that the insurance afforded by this policy be primary and noncontributory, this insurance shall be primary and noncontributory but only as to the general liability policy(ies) where that additional insured is listed as the named insured on the declaration page(s) of such policy(ies). All other terms and conditions of this policy remain unchanged. GBA 104025 0614 ADDITIONAL INSURED ENDORSEMENT Insurance Company This endorsement modifies such insurance as Is afforded by the provisions of Policy# Relating to the followidg,: The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; is named as ("additional Insured") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2- With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as Is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by orfor the benefit of the additional insured. & This Insurance applies separately to each Insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so Included. 4, With respect to the additional insured, this insurance shall not be canceled, or miateriall!y reduced in coverage or limits except after thirty (30) days written notice has, been given to the City of Santa Ana, 20 Civic Center Plan, Santa Ana, California 92701. (Completion of the following/ including countersignature, is required tomake thisendorsement effective Effective, this endorsement form, as a part of VbA Policy # h 45-1UM-19 COVINGTON SPECIALTY INSURANCE COMPANY This Endorsement Changes The Policy, Please Read It Carefully. POLICY CHANGES This endorsement modifies insurance provided under the following: ❑ COMMERCIAL GENERAL LIABILITY COVERAGE PART ❑ COMMERCIAL PROFESSIONAL LIABILITY COVERAGE PART ❑ COMMERCIAL INLAND MARINE COVERAGE PART ❑ COMMERCIAL PROPERTY COVERAGE PART ❑ LIQUOR LIABILITY COVERAGE PART ® ALL COVERAGE PARTS APPLICABLE TO THIS POLICY Policy Number: VBA457676 00 Named Insured: International Promotions DBA Fies Endorsement No.: 3 Endorsement Effective Date: 3/2/2017 By: R -T SPECIALTY, LLC It is hereby, understood and agreed that the following additional insured is added to form CG2026: per the attached Premium Fully Earned ❑ No change in premium ® Additional Premium $ 100.00 ❑ Additional taxes and fees $ .00 ❑ Return Premium $ ❑ Return taxes and fees $ ® Total $ 100.00 All other terms and conditions of this policy remain unchanged. Policy No.: VBA457676 GBA 904001 0208 COVINGTON SPECIALTY INSURANCE COMPANY This Endorsement Changes The Policy. Please Read It Carefully. CANCELLATION BY US TO OTHERS This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS It is hereby understood and agreed that if we cancel this policy, written notice of cancellation will be mailed or delivered to the First Named Insured and the following: Schedule City of Santa Ana 20 Civic Center Dr. Santa Ana, CA 92801. Number of Days: 30 COMMON POLICY CONDITIONS, A. Cancellation, 2. is replaced by the following: 2. We may cancel this policy by mailing or delivering to the First Named Insured and the entity shown in the Schedule above written notice of cancellation at least: a. 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or b. The number of days shown in the Schedule above before the effective date of cancellation if we cancel for any other reason. This endorsement does not apply if this policy is cancelled by the Finance Company or the Insured. Policy No.: VBA457676 G BA 904019 0814