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Home My WebLink AboutBLUERAY MANAGEMENT LLC-2017City of Santa Ana 1 Clerk of the Council — AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect.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. Is the agreement(s) a permanent record? Yes No Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with COTC Office Use Only 2g9 AIIC 22 PM u! r CCLERKPOF CQ No. N-2017-022 was completed on Q-?Aand final payment has been made. (List all amendments. Use space below if needed.) Department: : A Phone/Ext.: GniI Signature: t Qy yG�oy) Date: 7 iaie.�`te Revised: 10-18-16 kSBRATWE ON FILE kg&K MAY PROLE D.. N-2017-022 ti TI �[�5�1�Ei'ANGE EXPIRES CLERK tiFpUt s - WEEMENT TO PROVIDE AQUATICS PROGRAMMING DATE; AT SANTA ANA CITY POOLS ®: PRCS (if ) Silvia Cuevas THIS AGREEMENT is made and entered into this __aj day of.-1r_,UtL,toVjA') , 2017, by and between Blucray Management LLC, a California limited liability company ("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 utilize the services of an independent contractor with the requisite skill and expertise to provide seasonal aquatics programs for the Parks, Recreation, and Community Services Agency at City pools, including private and group swim lessons, swim team programming, lifeguard training, and other aquatic programming as mutually agreed upon, as more fully described in the scope of services that is attached as Exhibit A. B. Provider represents that it is fully qualified to perform such services by virtue of its experience and the training, education, and expertise of its principals and employees. C. City desires to retain Provider, and Provider desires to perform these services for the City in accordance with the terms and conditions of this Agreement. The parties therefore agree as follows: 1, PROVIDER'S SERVICES A. Scope of Services. Provider shall perform those services as set forth in Exhibit A. B, Standard of Performance. Provider shall perform all services under this Agreement in accordance with the standard of care generally exercised by like professionals under similar circumstances and in a manner satisfactory to City. C. Personnel. Provider has, or will secure at its own expense, all personnel to perform the services required under this Agreement. All of the services required under this Agreement shall be performed by Provider or under its supervision, and all personnel engaged in the work shall be qualified to perform such services. D. CoMpliance with Laws. Provider shall keep itself informed of all local, state, and/or federal ordinances, statutes, and regulations that in any manner affect those employed by Provider or in any way affect the performance of Provider's services under this Agreement. Provider shall at all times observe and comply with all such ordinances, statutes, and regulations. City and its agents shall not be liable for any noncompliance by Provider. E. Safety Equipment. Provider shall be responsible for providing and maintaining all safety equipment required to carry out Provider's duties under this Agreement. F. Class Cancellation and „Rescheduling, If for any reason Provider must cancel a class or other program, Provider shall give City as much prior notice as possible. Provider shall be responsible for contacting all students. G. Class Enrollment. Classes or programs may be cancelled if enrollment minimums axe not met. Provider shall coordinate with City regarding transfer or withdrawal of participants. H. Attendance Sheets. Provider shall complete an attendance sheet listing participants' names aid shall submit all attendance sheets to the Parks, Recreation, and Community Services Agency at the conclusion of each swim session or program, I. FinjzeWrintinBackgKound Checks. Prior to performing services under this Agreement, and at Provider's sole expense, all personnel shall be fingerprinted through Live Scan for completion of a criminal record check by the California Department of Justice. No personnel convicted of any offense specified in California Public Resources Code section 5164 shall be permitted to perform services this Agreement. If at any time Provider fails to comply with this Section I., City may terminate this Agreement immediately and without penalty, Provider shall also comply with all screening and background check requirements of California Penal Code section 11105.3. Provider warrants and represents that none of its employees, agents, or volunteers will provide services under this Agreement unless the proper screening and any necessary notification to City under the above code sections have taken place. 2. COMPENSATION As total and complete compensation for Provider's services under this Agreement, Provider shall have the right to collect and retain all program fees and revenues stated in Exhibit A. Provider shall be responsible for all program costs, except those facility costs to be assumed by the City. 3. TERM This Agreement shall commence on the date stated above and continue through December 31, 2017, unless terminated earlier in accordance with Section 12, below. The term of this Agreement may be extended for an additional one-year period by a writing executed by the City Manager and the City Attorney. 4. INDEPEA NDENT CONTRACTOR Provider shall, dining 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 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 planner 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 and Provider shall have no authority to act on behalf of the City. 5. INSURANCE Prior to undertaking performance of work under this Agreement, and without limiting the indemnification obligations described in Section 6, 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 fronh bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Provider's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following; single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $2,000,000 per occurrence and $4,000,000 in the aggregate, including coverage of sexual molestation with limits not less than $250,000 per occurrence and $500,000 general aggregate, Such insurance shall (a) name the City, its officers, employees, agents, volunteers and representatives as additional insured(s); (b) be primary and not contributory with respect to insurance or self-insurance programs maintained by the City; and (c) contain standard separation of insured's provisions, B. Worker's Compensation Insurance. In accordance with California State law, Provider 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 and is in force and paid for, the City shall have the right, at the City's election, to terminate 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. INDEMNIFICA.TION Provider agrees to and shall defend, indemnify and hold harmless the City, its officers, agents, employees, attorneys, volunteers, representatives, successors, and assigns from and against any and all damages, costs, expenses, liabilities, claims, demands, causes of action, proceedings, expenses, judgments, penalties, liens, or losses of any nature whatsoever, including costs and attorney's fees, and the payment of all consequential damages, whether actual, alleged, or throateaed, that arise out of, pertain to, or relate to the acts or omissions of Provider, its officers, subcontractors, agents, employees, or other persons acting on Provider's behalf in the performance of 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 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. Provider's indemnifications obligations under this section shall survive expiration or tennination of this Agreement. 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 performance of services specified under this Agreement. 8. 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 mailed by first class or certified mail, postage prepaid, in the manner provided in this Section, to the following persons: To City: Clerk of the Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 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 To Provider: Blueray Management LLC 10661 Ellis Ave, Suite E Fountain Valley, CA 92708 Attn. Abby Pearose, President A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 9. EXCLUSWITY 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 any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Provider. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms 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 trade by any party, or anyone acting on behalf of any party, which is not embodied herein, 10. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in, or granted by the provisions of this Agreement skull be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 11. ASSIGNMENT The experience, knowledge, capability and reputation of Provider were a substantial inducement for City to enter into this Agreement. Therefore, Provider may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. 1.2. TERMINATION This Agreement may be 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. 13. RECORDS Provider shall use attendance sheets to record attendance in each class or session. 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 expiration of this Agreement, 14. NON-DISCRIMINATION Provider shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, ago, 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 any services provided under this Agreement. Provider affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 1.5. 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 fiuther agree that Grange County, C<alitornia, 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 terry of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the servim 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. SEVERABILITY In the event that one or more of the phrases, sentences, clauses, paragraphs or sections contained in this Agreement shall be declared invalid or unenforceable by valid judgment or decree of a court of competent jurisdiction, such, invalidity or unenforceability shall not affect any of the remaining phrases, sentences, clauses, paragraphs or sections of this Agreement which shall be interpreted to carry out the intent of the parties hereunder. 18. EXHM S All Exhibits referenced herein and attached hereto shall be incorporated as ifftrlly set forth in the body of this Agrement. 19. AUTHORIW The persons) exemtmg tlris Agreement on behalf of the parties hereto warrant that they am duly authorized to execute this Agreement on behalf of said parties and that by so executing tlds Agreen=t, the parties hereto are formally bound to the provisions of this Agreement. IN Wr ESS WHEREOF, the parties hereto have exec ated this Agreement the date and year fast above writtean. ATTEST, R;11'AQ Clark of the Council RECOMMENDED FOR APPROVAL: � -5 JET JURADO Acting Executive Director, Parks, Recreation and Cmnmunity Service .Agency Cr1 Y OF SANTA AAA, Ace (41�� i t x,qq O M1�7fE Acting n, 6 APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney Jobfi M. Funk Assistant City Attorney EXHIBIT A SCOPE OF SERVICES PROGRAM DESCRIPTION Blueray Management will continue to offer seasonal aquatic programs at all five (5) City pools and will assume the management of the swimming programs, private lessons and coaching of the city - wide swim teams. Blueray Management will manage all registration for these program activities. Blueray Management may add other programs with the prior approval by the PRCSA. Blueray Management will handle the collection and management of program fees and will retain 100% of the revenue generated by the aquatics programming at all five (5) city pools. SWIM LESSONS Blueray Management will provide swim lesson according to the nationally recognized American Red Cross Learn -to -Swim Program. The programs will operate on a schedule determined by Blueray Management and approved by the City. A maximum of six (6) swim participants are enrolled with the exception of the Parent & Me and Adult swim classes, which in both courses accommodates up to 10 participants; the Parent & Me program, has the support of parent involvement, which is a American Red Cross standard. The Swim lesson fees for a two (2) week, 8 day session will be $ 50.00 for all swim participants. Private lessons will be available at $ 20.00 per 25 minutes lesson; Saturday lessons $25 to $30 per session for four 30 minutes lessons. BLUERAY SWIM TEAM Blueray Management will provide the swim team program, which will be conducted at two (2) city pools for all interested participants, ages 5-17. The swim tearn program will operate on a schedule determined by Blueray Management and approved by the City. Teams will compete in the City's traditional events. All Meets will 'be governed by United States Swimming (USS) rules. and regulations. The swim team fees will be $ 60.00 per month, payable to Blueray Management. BLUERAY WATER POLO Blueray Management will provide a water polo program, which will be conducted at Memorial Pool for all interested participants, ages 9-14. A minimum 20 participants must be registered in, order for the program to be offered. The water polo fees will be S 55.00, payable to Blueray Management. PERSONNEL The proposed program will be managed by experienced Blueray Management staff, and will provide training through the nationally recognized American. Red Cross Health and Safety courses for Lifeguard training, First Aid, and CPR for the Professional rescuer and Learn -to -Swim Program, trainings will be conducted in-house and Blueray will offer CPR/First Aid/Lifeguard certification for a minimal cost to City of Santa Ana employees in need of certification. Blueray will interview and possibly hire current City of Santa Ana Aquatics staff. A onetime in-service training to confirm qualificatiot and required skill perfornnanees and team information meeting will be conducted. CITY COSTS The City shall be responsible for all maintenance, gas, water, electricity and related facility expenses, and recreational swim session at facilities covered by this Agreement. BLUEMANA2 GINHQDEN CERTIFICATE. OF LIABILITY INSURANCE 4ATE(Mzlzz1201YYY) zalr _ THIS CERTIFICATE IS ISSUED A$ A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHT5: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 policyiies) 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 License It OG19762 CONTACT NAME: Momentous Insurance Brokerage Inc PHONE i31i3 933-2700 FAX $18 5990 Sepulveda Blvd., #660 .(ArC, No, Ext): t ) (Arc, Nn): () 933-2701 Van Nuys, CA 91411 E-MAIL y a ADDRESS, INSURER(S) AFFORDING COVERAGE NA1C N INSURERA: Philadelphia Indemnity Insurance! Company 18058 INSURED INSURER B: State Compensation Insurance Fund -MAIN '35076 Blueray Management LLC INSURER C:Sentinel Insurance Company 11000 P.O. Box 12529 INSURER D Newport Beach, CA 92668 INSURER E : COVERAGES CFRTIGICOTF NI InARPR- Dr,11101^wi wnreeocu. 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,. LTR TYPE QP INSURANCE ADPI. SUER. INSD WVD POLICY NUMBER POLICY EFF POLICY EXP MMIDONYYY MMIDDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE X OCCUR PHPK1446088 03/24/2016 03124/2017 DAMAGE TES ERaNTED ccu ence) $ 100,000 - - .. .. MED EXP (Any one person) $ 0 - - - - PCRSONAL&AOV INJURY $ 2,000,000 GEN`LAGGREGA_TELIMITAPPLIHSPER; GENERAL AGGREGATE: $ 4,000,000 POLICY - PRO. JECT _ . LOG PRODUCTS - COMPIOP AGO 5 4,000,000 OTHER: _ $ AUTOMOBILE LIABILITY COMBINED 110LE LIMIT 1,000,000 A X ANYAU70 PHPK1446008 (Ea accident) 03/2412016 03124/2017 BODILY INJURY (Per person) $ ALL OWNED X SCHEDULED - AUTOS AUTOS BODILY INJURY Per accident $ ( 1 X NON -OWNED HIRED AVrOS AUTOS PROPERTY DAMAGE • (Perseddent) $ UMBRELLA LIAO OCCUR EACH OCCURRENCE g EXC698 LIAB CLAIMS -MADE ' AGGREGATE $ _ DEL RETENTION 5 S WORRIERS _ - X PER H AND EMPLOYdttS'LtABILITY YIN ATUTE ER STATUTE B - ANY PROPRIETOWPARTNERIEXECUTIVE 9201107-16 12/23/2016 0510112017 E.L. EACH ACCIDENT s 1,000,000 OFFICERIMEMBt=R EXCLUDED?:NIA (MandatnrylnNH) E.L. DISEASE - EA EMPLOYEE S 1,000,000 Les, describe under - DESCRIPTION OF OPERA71gN5 below E,L• DIt3EASE -POLICY LIMIT $ 1,000,000 C :Property 72SSAAROBSI 03/15/2016 03115/2017 BPP 50,000 C :Property 72SBAAR9861 03/15/2016 0311512017 Deductible 1,000 DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 1D1, Addnlonal Remarks Schedule, may be attached If more space Is required] Certificate holder Is named as additional Insured per the attached endorsements. Primary and non contributory endorseme t attached. e, - '(°d• —•,—• • • •• • �• • • ••• • ••.•�••" • Y1..f�tIYVCLLH i lV3V �� V �— •w City of Santa Ana Parks, Recreation & Community Services Agency 1825 W. Civic Center Santa Ana, CA 92701 SHOULD ANY OFTHE AHOV 3tOIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DAME THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Ls 1attts-ZU14 AGUKV CORPORATION, All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD ..m�.••,,.v�.�.�..�,�,�„�,�,<_ nM,.,-..,�., �.-. w�,. ....•.w., .-��.»�.-m ��.,�.,,�n.v�� ...,.�.on��...�,�w«...._,�,.�..�..,,r,-.,�.��.,�.�,,_m,,,-�.�.,:,,n�,.,.,.�,,,,.a„e,. PI-GILD-HS (10111) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy, if such specific coverage applies, the terms, conditions and limits of that coverage are the sole and exclusive coverage applicable under (his policy, unless otherwise noted on this endorsement, The following is a summary of the limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. Coverage Applicable Limit of Insurance Page # Extended Property Damage Included 2 Limited Rental Lease Agreement Contractual Liability $50,000 limit 2 Non -Owned Watercraft Less than 58 feet 2 Demage to Property You Own, Rent, or Cmupy $30,000 limit 2 Damage to Premises Dented to You $1,000,000 3 HIPAA Clarification 4 Medical Payments $20,000 5 Medical Payments — Extended Reporting Period 3 years 5 Athletic Activities Amended 5 Supptementary Payments —Sall Ponds $5,000 5 Supplementary Payment — Loss of Earnings $1,000 per. day 5 Employee Indemnification Defense Coverage $25,000 5 Key and Lock Replacement — Janitorial Services Client Coverage $90,000 timit 6 Additional Insured — Newly Acquired Time Period Amended 6 Additional Insured — Medical Directors and Administrators Included 7 Additional Insured, Managers and Supervisors (with fellow Employee Coverage) Included 7 Additional Insured — Broadened Named Insured Included 7 Additional Insured — Funding Source Included 7 Additional insured — Home Care Providers Included 7 Additional Insured -- Managers, Landlords, or lessors of Premises Included 7 Additional Insured — Lessor of Leased Equipment Included 7 Additional Insured — Grantor of Permits Included g Additional Insured — Vendor Included 8 Additional Insured — Franchisor Included 9 Additional Insured—WhenRequired by Contract. Included Additional Insured — Owners, Lessees, or Contractors Additional Insured — State or Political Subdivisions • Included Included 10 .. r Page 1 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permissio O 2011 Philadelphia Indemnity Insurance Company C"s �� ' W PI-GLD-HS (1Oil 1) K. Key and Lock Replacement --Janitorial Services Client Coverage SECTION I — COVERAGES, SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended to include the following; We will pay for the cost to replace keys and locks at the "clients" premises due to theft or other loss to keys entrusted to you by your "client," up to a $10,000 limit per occurrence and $10,000 policy aggregate. We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners, members, officers, "employees", "managers", directors, trustees, authorized representatives or any one to whom you entrust the keys of a "client' for any purpose commit, whether acting alone or in collusion with other persons. The following, when used on this coverage, are defined as follows: a. "Client' means an individual, company or organization with whom you. have a written contract or work order for your services for a described premises and have billed for your services. b. "Employee" means: (1) Any natural person: (a) While in your service or for 30 days after termination of service; (b) Who you compensate directly by salary, wages or commissions; and (c) Who you have the right to direct and control while performing services for you; or (2) Any natural person who is furnished temporarily to you: (a) To substitute for a permanent "employee" as defined In Paragraph (1) above, who is on leave; or (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. (3) "Employee" does not mean: (a) Any agent, broker, person leased to you by a labor leasing firm, factor, commission merchant, consignee, independent contractor or representative of the same general character, or (b) Any "manager," director or trustee except while performing acts coming within the scope of the usual duties of an "employee." c. "Manager" means a person serving in a directorial capacity for a limited liability company. L. Additionallnsureds SECTION II �- WHO IS AN INSURER is amended as follows; �� E 1. If coverage for newly acquired or formed organizations is not otherwise excluded f��s P Page 6 of 12 X,f Includes copyrighted material of Insurance Services Office, Inc., with its perQ 2011 Philadelphia Indemnity Insurance Company PI-Gl_D-HS (1Oil 1) Coverage Part, Paragraph 3.a. is deleted in its entirely and replaced by the following: a_ Coverage under this provision is afforded until the end of the policy period. 2. Each of the following is also an insured: a. Medical Directors and Administrators —Your medical directors and administrators, but only while acting within the scope of and during the course of their duties as such. Such duties do not include the furnishing or failure to furnish professional services of any physician or psychiatrist in the treatment of a patient. b. Managers and Supervisors -Your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors. Managers and supervisors who are your "employees" are also insureds for "bodily injury" to a co - "employee" while in the course of his or her employment by you or performing duties related to the conduct of your business, This provision does not change Item 2.a.(1)(a) as it applies to managers of a limited liability company, c. Broadened Named Insured —Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part_ However, coverage does not apply to any organization or subsidiary not named in the Declarations as Named Insured, if they are also insured under another similar policy, but for its termination or the exhaustion of Its limits of insurance. d. Funding Source — Any person or organization with respect to their liability arising out of: (1) Their financial control of you; or (2) Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. e. Home Care Providers m- At the first Named Insured's option, any person or organization under your direct supervision and control while providing for you private home respite or foster home care for the developmentally disabled, f. Managers, Landlords, or lessors of Premises -- Any person or organization with respect to their liability arising out of the ownership, maintenance or use of that part of the premises leased or rented to you subject to the following additional exclusions: This insurance does not apply to: (1) Any "occurrence" which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization. g. Lessor of Leased Equipment— Automatic Status When Required in Lease Agreement With You — Any person or organization from whom you lease equipment when you and su. person or organization have agreed in writing in a contract or agreement that such pers; r organization is to be added as an additional insured on your policy. Such person�o1: p,qj Page 7 of 12 L� Includes copyrighted material of Insurance Services Office, Inc_, with its permission, a 2011 Philadelphia Indemnity Insurance Company Cd ,.mi nnin��., _ rui.ei. .«., uw�rvenmwY2a,�npuwmm.,w.rvw.rmuYnfA"�xgo-vr anv wxrmx,smd4 u�rvd+•wrw+m+�..,y�r�-- s�wm�l��«w ».., r_�-�,w+,...,,� _ .m-.+ .�K of ..w..-.g},w� _ ro n,�� _ �awr�eaww.�..urslnn'a»n .�ra,n._ .- flr��.w�*.�rn�+r_..�rmx,� PI-GLD-HS (1Oil 1) (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (h) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1) The exceptions contalned in Sub -paragraphs (d) or (f); or (ii) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products, (2) This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing. j. Franchiser — Any person or organization with respect to their liability as the grantor of a franchise to you. k. As Required by -Contract —'Any person or organization where required by a written contract executed prior to the occurrence of a loss. Such person or organization is an additional -°� insured for "bodily injury," "property damage" or "personal and advertising injury" but only for liability arising out of the negligence of the named insured. The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement. These limits are included within and not in addition to the limits of insurance shown in the Declarations 1. Owners, Lessees or Contractors — Any person or organization, 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; cr (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured when required by a contract. 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: (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 location of the covered operations has been completed; or M 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. Page 9 of 12 Includes copyrighted material of insurance Services Office, Inc., with its permission. C) 2011 Philadelphia Indemnity Insurance Company 0 PI-MANU-1 (01100) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY Primary & Non -Contributory Wording This insurance is prisriary except when it is excess as provided under part b., below, When this insurance is primary, we will not seek contribVi.or. From other insurance available to the person or organization shows in the schedule of this endorsement except for the gross negligence and or willtal or wanton misconduct of the person or organization shown in Cie s,chadule of Lids endorsement All other terms and conditions of this Policy remain unchanged, page 1ofI C . J �' CO -,w>�n,M>.r,,..ter«�.a:..-.�r..:�..,,�.,a;n... ,�enrrater+.�rrcvmmw»n.....,nv.�m��-„vwr�»!w,M.w«e>w.��.w.,�»,»�.»...,m,.,.�,m.:« �r-ri�x�ow�..�,w.waHww.w�»u�nw.r,.,wi<�.-..w.�i,.v��i..��,.,�.i.,.,�;.,owe��.w>,�,..w,..K,�m.�T,.w�..,-.m>.rn.,,,e�a>wn,.mr-�......•�,m,.m�n».»v�..r,_.�»�.«.e..�.....-a.-a.��....._�,..,rra.,.�..M,>„�,�...�...x.�:, ^"" ^ BLUEMAN-02 GINBODEI [7t/2312017 IM MIDDrYYYY) CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOE'S 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 have ADDITIONAL INSURED provisions or 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 License # DGI9762 CONTACT NAME: Momentous Insurance Brokerage Inc PHONE FAX 5990 Sepulveda Blvd., #550 (Arc, No, Exty (818) 933-2700 (AJC, No):(818) 933-2701 Wan Nuys, CA 91411 E-MAIL INSURER(S) AFFORDING COVERAGE NAIL /r INSURERA:P'hiladelphia Indemnity Insurance Company 18058 INSURED INSURERS: State, Compensation Insurance Fund -MAIN 35076 Blueray Management LLC INSURER c:Sentinel Insurance Company 11000 P.O. Box 12529 INSURER®; Newport Beach, CA 92668 INSURERF: r`.nVPPAf"1'FC rcoraZ=urArc kttrka0CC,. 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 13E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED eY 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' '..ArJDL6UeR LTR TYPE. OF INSURANCE D POLICY NUMBER__JMM1Q12JYYYY1 PCLICYEFF POLIGYEXP IMMIODNYYYl LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAtlMS•MAOE X OCCUR PHPKI608851 03124/2017 ' 03124/2018 DAMAGE To rnrel 5 100,000 MEp EXP (Any one person) $ 0 PERSONAL & ADV INJURY :. $. 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY jEET LOG PRODUCTS -COMPtOPAGG 11 4,000,000 $ A AUTOMOBILE LIABILITY '. : COMBINED SINGLE LIMIT 1,000,000 X ANY AUTO PHPK1608851 (Ea accident) $ 0:112412017 0312412018 BODILY INJURY (Per pe=ri) 8 OWNEAUTOS SCHEDULED X. . AUTOS ONLY AUTOS - BODILYiNJURY(Peraccidenl) $. HIR NpIV'VVNLD. AUT SONLY AUTO PROPERTY DAMAGE ONLY ;.(PeraccudenN) UMBRELLA.LIAB OCCUR EACH OCCURRENCE $' EXCESS LIAR CLAIMS -MADE.. AGGREGATE $ j DED RETENTION$ $ WORKERS COMPENSATION X PER CTH- AND EMPLOYERS' LIABILITY Y IN 9201107-16 ECUTIVE 12/231201 0510112017 STATUTE ER 1,000,000 ;. NIA OFFICER/MEM6 R EXCLNLIDSO? E.L. EACH ACCIDENT $ (MandatorpinNH) -. E.L. DISEASE - EAEMPLOYEE $ 1,000,000 EI yes, describe �T " DESCRIPTION OF OPERATIONS below - E.L. DISEASE -POUOY LIMIT $ 1,000,000 C 'Business Owners Poll 72SBAAR9861 0311512017 03/1512018 BPP 50,000 DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES (ACORn 101, Additional Remarks Sclleduls, may be attached If more space is required) Certificate holder is named as additional insured per the attached endorsements. Primary and non contributory endorsementatta SHOULD ANY OF THE ABOVE DESC BED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana Parks, Recreation $Community Services Agency ACCORDANCE WITH THE POLICY PRDVISI4N9, 1',625 W. Civic Center Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE (P1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PI-GLD-HS (I Oil 1) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, GE NERAL LIABILITY DELUXE ENDORSEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the followinT COMMERCIAL GENERAL LIABILITY COVERAGE It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy. It such specific coverage applies,'the terms, conditions and limits of that coverage are the sale and exclusive coverage applicable under this policy, unless otherwise noted on this endorsement. The following Is a summary of the Limits of Insurance and additional coverages provided by this endorsement. Por complete details on specific coverages, consult the policy contract wording, Coverage Applicable G�mit of insurance Page # Extended Property Damage lnclude_d 2 Limited Rental Lease Agreement Contractual Liability S50,000 limit 2 Non -Owned Watercraft Less than 58 feet 2 Damage to Property You Own, Rent, or Occupy $30,000 limit 2 Damage: to Premises Rented to You $1.000,000 3 HIPAA Clarification 4 Medical Payments S20,000 5 Medical Payments — Extended Deporting Period Athletic Activities u�PPIerne�ntary Payments — Bail Bonds 3 years Amended 35,000__ 5 _5 Supplementary Payment — Loss, of Earnings $1,000 per. day 5 Employee Indemnification C7efense Coverage $25,000 5 Key and Lack Replacement — Janitorial Services Client Coverage $10=0 limit 6 Additional Insured — Newly Acquired Time Period ................ Amended 6 Additional Insured — Medical Directors and �Administrators Included —7 Additional Insured— Managers and Supervisors (with Fellow L Employee Coverage) Included —7 Additional Insured — Broadened Named Insured Included 7 Additional Insured— Funding Source Included 7 Additional Insured — Home Care Providers Additional Insured — Managers, Landlords, or Lessors of Premises Included Included —7 7 Additional Insured — Lessor of Leased Equipment Included 7 Acickttor_jaj �Insured �_Gr@n`torof per .. -its Included 8 .Additional Insured — Vendor j Additional Insured — Franchisor Additional Insured — When Required by Contract. Additional Insured — Owners, Lessees, or Contractors Additional insured — State or Political Subdivisions Included lncludFd--g Included Included Included —8 9 10' Page I of 12 10 14 Includes copyrighted material of Insurance Services Office, Inc., with its permjjS,9i.(0j, e Q 2011 Philadelphia Indemnity Insurance Company PI-GLD-HS (10111) K. Key and Lock Replacement —,Janitorial Services Client Coverage SECTION I — COVERAGES, SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended to include the following: We will pay for the cost to replace keys and locks at the "clients" premises due to theft or other loss to keys entrusted to you by your "client," up to a $10,000 limit per occurrence and $10,000 policy aggregate. We will not pay for loss or damage resulting from theft or any other dishonest nest or criminal act that you or any of your partners, members, officers, "employees", "managers", directors, trustees, authorized representatives or any one to whom you entrust the keys of a "client" for any purpose commit, whether acting alone or in collusion with other persons. The following, when used on this coverage, are defined as follows: a. "Client" means an individual, company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services. b. "Employee" means: (1) Any natural person: (a) While in your service or for 30 days after termination of service; (b) Who you compensate directly by salary, wages or commissions', and (c) Who you have the right to direct and control while performing services for you; or (2) Any natural person who is furnished temporarily to you: (a) To substitute for a Permanent "employee" as defined in Paragraph (1) above, who is an leave; or (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. (3) "Employee" does not mean: (a) Any agent, broker, person leased to you by a labor leasing firm, factor, commission merchant, consignee, independent contractor or representative of the same general character; or (b) Any "manager," director or trustee except while performing acts coming within the scope of the usual duties of an "employee. c. "Manager" means a person serving in a directorial capacity fora limited liability company, L, Additional Insureds SECTION 11 — WHO IS AN INSURED is amended'as follows. 1. If coverage for newly acquired or formed organizations is not otherwise excluded froop Page 6 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 2011 Philadelphia Indemnity Insurance Company G\�e PI-GLD-HS (10111) Coverage Part, Paragraph 3.a_ is deleted in its entirely and' replaced by the following a. Coverage under this provision is afforded until the end of the policy period. 2. Each of the following is also an insured: a. Medical Directors and Administrators — Your medical directors and administrators, but only whileacting within the scope of and during the course of their duties as such. Such duties do not include the furnishing or failure to furnish professional services of any physician or psychiatrist in the treatment of a patient. b. Managers and Supervisors —Your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors. Managers and supervisors who are your "employees" are also insureds for "bodily injury" ury" to a co- 11 employee" while in the course of his or her employment by you or performing duties related to the conduct of your business. This provision does not change Item 2.a.(1)(a) as it applies to managers of a limited liability company. c. Broadened Named Insured — Any organization and subsidiary thereof which you control and actively manage on the effective date of this Coverage Part, However, coverage does not apply to any organization or subsidiary not named in the Declarations as Named Insured, if they are also insured under another similar policy, but for its termination or the exhaustion of its limits of insurance. d. Funding Source — Any person or organization with respect to their liability arising out of: (1) Their financial control of you; or (2) Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization, e. Home Care Providers — At the first Named Insured's option, any person or organization under your direct supervision and control while providing for you private home respite or foster home care for the developmentally disabled. f. Managers, Landlords, or Lessors of Premises — Any person or organization with respect to their liability arising out of the ownership, maintenance, or use of that part of the premises leased or rented to you subject to the following additional exclusions: This insurance does not apply to. (1) Any "Occurrence' which takes place after you cease to be a tenant in that premises: or (2) Structural alterations, new construction or demolition operations performed by or on behalf of that person or organization. 9- Lessor of Leased Equipment --Automatic Status When Required in Lease Agreement With You —Any person or organization from whom you lease equipment when you and such person or organization have agreed in writing in a contract or agreement that such perso organization is to be added as an additional insured on your policy. Such person 110 0 Page 7 of 12 Includes copyrighted material of Insurance Services Office, Inc., with its permission.0 Q 201,1 Philadelphia Indemnity Insurance Company PI-GLD-HS (10/11) (g) Products which, after distribution or sale by you, have been labeled or relabeled Or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (h) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to,, (I) The exceptions contained in Sub -paragraphs (d) or (f); or (ii) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. ' (2) This insurance does not apply to any insured person or organization, from whom you have acquired such Products, or any ingredient, part or container, entering into, accompanying or containing. Franchisor — Any person or organization with respect to their liability as the grantor of a franchise to you, As Required.by Contract — Any person or organization where required by a written contract executed prior to the occurrence of a loss. Such person or organization is an additional insured for "bodily injury," "property damage" or "personal and advertising injury" but only for liability arising out of the negligence of the. named insured. The limits of insurance applicable to these additional insureds are the lesser of the policy limits or those limits specified in a contract or agreement, These limits are included within and not in addition to the limits of insurance shown in the Declarations to Owners, Lessees or Contractors -Any person or organization, 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 when required by a contract. 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. (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 location 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 for a principal as a part of the same ame Page 9 of 12 Includes copyrighted material of insurance Services Office, Inc,, with its permission, @2011 Philadelphia Indemnity Insurance Company PI-MANU-I (0�1/00) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY Primary & Non -Contributory Wording This insurance is Primary e-,..cepz when it is excess as orovidec; uncler part below, V.1hen this inaor4ncz is primary, -.-,e will not saok conwribti tior. from other insurance available to the person or sh�ot.;n in the schedule of ti-is endorsement except fax the gross neg.iiqerice and or 1:,ilifilL or wanton misconduct of the person or organization h.own in the zch�.dule of this endorsement A Ie\ AU other terms and con0ions of this Policy remain unchanged, V page 1 Of I Ate`" CERTIFICATE OF LIABILITY INSURANCE 12(MM/DDNYYY)ATE `64. 0511112017 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 CERTIIFICATE 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. It 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: Automatic Data Processing Insurance Agency, Inc. iAJ�No, Ext): FAX No): 1 Adp Boulevard ADDARILESS: Roseland, NJ 07068 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 CLAIM'S. INSR ..... ......... ............. LTR TYPE OF INSURANCE -ADDL SUBRI _ POLICY EFF I POLICY EXP ....... __. INSD WVD POLICY NUMBER JMMIDDNYYYJ [MMIDDfYYYY)LIMITS __ . COMMERCIAL GENERAL. LIABILITY.EACH OCCURRENCE..... .. DAMAGE. TO RENTED I CLAIMS -MADE OCCUR ..... ! ! PREMISES (Ea occurrence) is _ MED EXP (Anyone person) is ....... -.� PERSONAL &.ADV INJURY GFN"L AGGREGATE LIMIT APPLIES PER: AGGREGATE $ POLICY PRO- LOC JECT r{ PRODUCTS L'4�C✓ '� ;� ODUGYS- GOMPlOPAGO $ _ I OTHER - r� V AUTOMOBILE LIABILITY j l e N , OOM&NED SINGLE LIMIT $ ANY AUTO IEa accident) _'�" '�Ai'°" BODILY INJURY (Per person) $ ALL OS SCHEDULED Autos AUTOS . NON tta�,,� ...... �,fC `41 BODILY INJURY (Per $ �"Irw`"�I ( ? -OWNED HIRED AUTOS , AUTOS ^r,'�"'`` PI2QPFRTY 5AMAGE 4 }'°' (Per accident) 40 ... .... $ � I$ i UMBRELLA LIAR i OCCUR EACH OCCURRENCE i $ EXCESS LIAR CLAMS -MADE.. _.. AGGREGATE 5 DFD RETENTION $ ,....... ........ ....----......... $ WORKERS COMPENSATIONx PER OTH- AND EMPLOYERS' LIABILITY YIN ER. A aFFICEROIM BERIEXCLUa�aa EcuTIVE �, NIA N BLWC811574 05101/2017 05/01/2018 . E.L EACH ACCIDENT $ 1,000,000 -. (Mandatary in NHI ',. ET_ DISEASE - EA EMPLOYEE-.. S 1,600,000 If yes, describe... under ..__............. ........_ _ DESCRIPTION OF OPERATIONS below '... F L. DISEASE - POLICY LIMIT S 1,�000,000 DESCRIPTION OF OPERATIONS I LOCATIONS !VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) UtK 1, Ik-IC A It NULII CANCELLATION City of Santa Ana Parks, Recreation & Community Attn: Services Agency 1825 W. Civic Center Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY (PROVISIONS. AUTHORIZED REPRESENTATIVE, _4 .,...,,-4 -) k— , Pn r"r"MRpnpaTIr3N All rinhtc racarr.rari ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD