HomeMy WebLinkAboutSUPER ANTOJITOS (2) - 2017City of Santa Ana
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amendments (if any) are no longer in effect.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. @;LE
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
No. N-2017-045 was completed on
(List all amendments. Use space below if needed.)
Revised: 10-19-16
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OF THE COUNCIL
2'21 PM3.28
EA /M-1 and final payment has been made.
Department: PRC1A
Phone/Ext.: ya I q
Signature: wz&—
Date:
ON FILL
WORK MAY %1 PRO ED
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N-2017-045
CATERING SERVICES AGREEMENT
Silvia Cuevas THIS AGREEMENT is made and entered into this 18tb day of April, 2017, by and
between Super Antojitos ("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 service provider having special skills, resources and knowledge
to provide food catering for the Fiestas Patrias event.
S. Provider represents that Provider 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 the 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
terms and conditions hereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
Provider shall perform those services as set forth in Exhibit A to this Agreement.
2. COMPENSATION
City agrees to pay, and Consultant agrees to accept as total payment for its services, the
rates and charges identified in Exhibit A. The total sum to be expended under this Agreement
shall not exceed Five Thousand Eight Hundred Ninety Two Dollars ($5,892.00) during the term
of this Agreement. This amount includes a 20% contingency of up to $982.00 for services as
may be provided by Consultant at the sole discretion of City.
3. TERM
This Agreement shall commence on the date first stated above and terminate on May 8,
2017 unless terminated earlier in accordance with Section 11, below. The Term of this
Agreement may be extended by a writing executed by the City Manager and the City Attorney.
4. INDEPENDENT CONTRACTOR
Provider shall, during the entire term of this Agreement, be construed to be an
independent contractor and not an employee of the City. This Agreement is not intended 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
Page 1 of 7
by Provider shall be provided in a marmer 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, Provider shall maintain
and shall require its subcontractors, if any, to obtain and maintain insurance as described below:
a. Commercial General Liability Insurance. Provider shall maintain commercial general
liability insurance which shall include, but not be limited to protection against claims arising
from bodily and personal injury, including death resulting therefrom and damage to property,
resulting from any act or occurrence arising out of Provider's negligent operations in the
performance of this Agreement, including, without limitation, acts involving vehicles. The
amounts of insurance shall be not less than the following: single limit coverage applying to
bodily and personal injury, including death resulting therefrom, and property damage, in the total
amount of $1,000,000 per occurrence and $2,000,000 in the aggregate. Such insurance shall (a)
name the City, its officers, employees, agents, volunteers and representatives as additional
insured(s); (b) be primary and not contributory with respect to insurance or self-insurance
programs maintained by the City; and (c) contain standard separation of insured provisions.
b. Business automobile liability insurance, or equivalent form, with a combined single
limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for
owned, hired and non -owned automobiles.
c. Worker's Compensation Insurance. In accordance with California State law,
Consultant, 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.
d. 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.
(ii) Certificates of insurance shall be furnished to the City upon execution of this
Agreement and shall be approved in form by the City.
(iii) 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.
Page 2 of 7
e. If Provider fails or refuses to produce or maintain the insurance requiredby 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. INDEMNIFICATION
Provider agrees to and shall defend, indemnify 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 negligent operations of the 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 terms
of, or effects, arising from this Agreement. The 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.
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, or sent by fax or other telegraphic
communication in the manner provided in this Section, to the following persons:
To City: Clerk of the Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Fax (714) 647-6956
Page 3 of 7
With copy to: Executive Director of Parks, Recreation and Community Services
City of Santa Ana
26 Civic Center Plaza (M-23)
P.O. Box 1988
Santa Ana, California 92702
Fax (714) 571-4211
To Provider: Super Antojitos
1702 North Bristol
Santa Ana, CA 92703
Phone: (714) 835-3619
A party may change its address by giving notice in writing to the other party. Thereafter,
any communication shall be addressed and transmitted to the new address. If sent by mail,
communication shall be effective or deemed to have been given three (3) days after it has been
deposited in the United States mail, duly registered or certified, with postage prepaid, and
addressed as set forth above. If sent by 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. For purposes of calculating these
time frames, weekends, federal, state, County or City holidays shall be excluded.
9. 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 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 made by
any party, or anyone acting on behalf of any party, which is not embodied herein.
10. ASSIGNMENTS
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.
11. TERMINATION
This Agreement may be terminated by the City at any time upon written or verbal 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.
Page 4 of 7
12. 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 any activities 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.
13. 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.
14. 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.
15. 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.
16. EXHIBITS
All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth
in the body of this Agreement.
17. AUTHORITY
The person(s) executing this Agreement on behalf of the parties hereto warrant that they are
duly authorized to execute this Agreement on behalf of said parties and that be so executing this
Agreement, the parties hereto are formally bound to the provisions of this Agreement.
IlI
Ill
Page 5 of 7
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
MARIA D., BUIZAR
Clerk of the Council
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Attorney
B y:
Lisa E. Stork
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
CITY OF SANTA ANA
ROBERT C. C
DEPUTY CITY M,,N-A-GLH
PROVIDER:
JEANNIE JURADO SUPER ANTOJITOS
Acting Executive Director of Parks, Tax ID:
Recreation. arid Coniniunity Services Agency
Page 6 of 7
EXHIBIT A
Page 7 of 7
EXHIBIT A
Super Antojitos
1702 N. Bristol
Santa Ana CA 92703
(714)835-3619
INVOICE#05773
QUOTE:
CITY OF SAN1"A ANA
Z50 PEOPLE 516117
250 PEOPLH 5/7/17
pczipose of expense: CINCO DE MAYO EVENIT CATERING
500 (250 per day)
PLATES
$9.50
$4,750.00
500 (250 per day)
CUPS
4C}I�ITAINER
RICE
CONTAINER
BEANS
CONTAINER
ORDER OF CHIPS
2 CONTAINERS
ORDEROF SALSA
3 TYPES
Q-RC K ITT, PORK, PASTOR
$9.50
AGUAS ITANMRINDO,
LEMON,
20 VIP 5/7 I ASSORTED W0.00 $I6000
APPETIZERS
TAX INCLUDED 0.00
GRAND TOTAL DUE 1$4,910.00
>RIYI`14. DATE(MM/DD/YYYY)...._.,.....,
CERTIFICATE OF LIABILITY INSURANCE 04/26/2017
- ...._... _..._ _ _ ... .. - - __W........,_,.. _.. _......__........._ ..............._.._..........._ .
THIS CERTIFICATE IS ISSU EO AS A MATTER 01=114FORMATION ONLY AND CONFERS NO RIGIfTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOTAFF€RMATIVELY OR NEGATIVELY
AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NO•rCONSTITUTEACONTRACT iIETWEENTHE ISSUING IN5URER(S),
AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
M.,-. ,,, ,...._,.w_.........._...., ................ ....__...__...._._........,._..._......._....,............_...._..,.,.,.._-._•_....._......,-.__...._.._...,_.,_.._._.._.,..., _..._......._.. _.. - ...
IMPORTANT: Jf the cer tlRcate holder Is an ADDITIONAL INSURED, the policy(tea) must have ADDITIONAL INSURED proY€dons or be endorsed. If SUBROGATION IS WAIVED, subject to the lerrrls and
conditions of the policy, Certain pgRcies may, require an endorsement. A statement an this cerClIcate does not confer rights to the cert€R4ate holder In lieu of wh endarsament(s).
PRODUCER CONTACT
NAME: Wendy Munoz
_._--.._......___.._......_........ ................. ... ........... .... ...... .... _.
Wend....
Y MunGz (97G104A) PHONE FAX
2441 N Tustin Ave Ste E (A/C,NO, EXT): 714-5504100 (A/C,NO):714•-550-7170
E MAIL
Santa Ana GA 92705-1681 ADDRESS: wniunoz@farmersagent.com - ..... -- -------.....,__._..._........,.
INSUFMR(5)AFFORDING COVERAGE NAIC N
.... _.......... .............. ........ —.._._.. . ..... _......_.._. ...... - _ .,.... _... _.,...-- -—.—..._..-----.._—.._._....
INSURED INSURERA: TfUCkInsurance Exchange 21709
N5UR 1ERB. Farmers Insurance Exchange 21652
ELIZALDE, GUILLERMO .. ._.. _.._.
DOA: SUPER ANTOJITOS EXPRESS 1NSURERC: Mild Century Insurance Company _ 21087
1702 N BRISTOL ST STE D INSURER D:
SANTAANA CA 92708 INSURERS:
1N5URERP:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER;
THIS €S TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED. NOTWIT HSTAN DING ANY
REQUIREMENT, TCRM OR CON DITION OF ANY CONTRACT OR OTI 1ER DOCUMENT WITH RESPECT TO W141CH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAfN, THE INSURANCE AFFORDED BY THE
POLICIES DI'SCRIEED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONOITfONS OF SUCH POLICIES. LIMITS SHOWN MAY 14AVE BEEN REDUCED BY PAID C€AIMS.
_. _._... ..._,_ ......... .. ... ........
1NSR ! 'TYPE ADDTL SLIER NUMBER POLECYEFP POLICYEXP LIMITS
LTR INSO WV0 (MM/DD/YYYY) (MM/DD/YYYY)
—..—..___....._. _ ........_ _ _...._......._. _ _ _ _._.._....._...........
COMMERCIAL GENERALLIABILIYY -••_.---_._, EACH OCCURRENCE $ 100a000
....,
-., CLAIMS-MADEI ! OCCUR DAMAGETORENTED $
PREMISES (Ea OcCurrence) 260OOQ
MEDEXP(Anyonepersan) ;$ 5000
A Y Y 605416467 11/0112015 11l0112017 PERSONAL &ADV INJURY $ 1,000,000
....._.
GEN'L AGGREGATE LIM17APPLIES PER: GENERALAGGRFGATE $
.., is 2,000,000
POLICY PROJECT LOC PRODUCTS-COMP/OPAGG 3 2,000,000
OTHER; $
AUTOMOEILELIADtLFTY CQM9INEOSINGLFUMI7 $
{Ea aeddent)
ANYAUTO 60DILY INJURY (Per person) $
OWNED AUTOS - SCHEDULED BODILY INJURY (Poe accldent) S
ONLY AUTOS
HIREDAUTOS NON -OWNED �'' PROPERTY DAMAGE $
ONLY ; AUTOSONLY � (Per accident)
UMBRELLALIAB OCCUR OCCURRENCE s
EXCIESSLIAB CJAIMS-MADE AGGREGATE f-i) � ATE S
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WORKERS COMPENSATION
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ANYOPROPRIETOR/PARTNITY (`- - STATUTE OTHER $
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E.L. EACH ACCIDCNT $
EXECUTIVE DED?(Mandat (Mandatory In
E.LDISEASE•CAENIPLOYEE $
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If yes, dew1be under DESCRIPT101V OF
OPiERATIONSbelgw E.LCISCASE-POLICYLlMIT $
DESCRIPTION OF OPERATIONSAOCATION5/ VEHICLES (ACORD i 01. Addltiona) Rem arks Schedule, may be attached If more space is required)
1702 N BRISTOL ST, SANTA ANA, CA 92706
CERTIFICATE HOLDER CANCELLATION
.._.._,._.__._.W.._...._.._..�,N�CI`P`bFSANTAANA-....-.__.....__.__,____�._._..._..__..._..___..... ..._ .. _....
5HOULDANY OFTHEAROVE OESCRMED POLICIES BE CANCELLED BEFORE THE EXPIRATION
20 CIVIC CENTER PLAZA DATE THEREOF, NOTIC E WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS,
_....._.—....._..._..._..........__..._, ....... ,.,.-
AQ"f rM 6%J1ESENTATIVE
_._....._ ..._-SANTA.ANA ...... ..... CA ..92701
ACORD 25 (2016/03) OO 1988.2015 ACORD CORPORATION. All Rights Reserved
31-t 7S9 1 1.1 S The ACORD name and logo are registered marks Of ACORD
_ CERTIFICATE OF LIABILITY INSURANCE9A04252(}17YYY)
HrS TCERTIFICATE IS ISSUEDASAMATTERpF INFORMATION ONLY AND CONF&RS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES No TAFFIRMA71YELYOR NCGATIVMY
AMEN D. EXTENV OR ALTERTHECOVENAGEAFFORDED BY THE POLICIES BELOW,THIS CERTIFICATE OF INSURANCE DOES NOT CbNSTITUTEA CONTRACT ItETW EEN TIME 1S5UING INSURER(S),
AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: III cortifitato holder Is an ADDITIONAL INSURED, the peiicy(les) must have ADDITIONAL INSURED provlslo rla or ye endorsed, If SUBROGATION 15 WAIVED, subject to thaterma and
conditions of the policy, rcrtalnpollcles may require an endorsement. A statement on *Is cardRcatedoes not confor eights to the cartlRcatollaldCY In Mau of such andcrsermot(s),
PRODUCER
CONTACT
NAMEr QUYEN HOANG
PARKSIDE IWURANCrE SE RVICES, INC
18911 l3rookhUrat 5t
PHONE
(A/C, NO, EXT); 714-705.9453
FAX
(A/c, Nolt 714-939-7301
EMAIL
ABDRESS; PARK8(0EINS0GMAIL,COM
Fountain Valley CA 9770E
INSURIER(S)AFFORDiNGCOVERAGC
NAICd
INSGRHD W�
INSURItiRA: EMPLOYERS PREFERREC INSURANCE CO
'
ELIZALIDE, GUILLERMO
DII SUPER ANTOJ ITOS EXPRESS
INSURER
R ElkE
INSURER D;
1702 N BRISTOL ST STE 0
INSURER E;
SANTA ANA CA 92708
IN5URERF!
CUVHRAGES CERTIFICATFNUMII REVISION NUMBER;
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMFABOVE FOR THE POLICY PERICO )NDICATED. N 07WIT44STANOINO ANY
REQUIREMENT, TERM OR CONDITION OFANYCDNTRACTOR OTHER DOCUMENTWITH RESPECT TOWN ICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE IN5URANCEAFFORDED BYTHR
POLICIES DESCRIBED HEREIN IS SUSJECTTO ALLTHE TERMS, EXCLUSIONSAN1) CONDITIONS OF$UCH PCI.ICII LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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POLICY NUMBER
POLICYEFF
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POLICYRXri
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LIMITS
COMMERCIAL GENERAL LIABILITY
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$
CLAIMS -MARE OCCUR
DAMAGETORENTEDPRCMISE$(FaOccurrence)
$
MEUEXP(Anynneperson)
$
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GEN'I.AGGREGATE L€MITAPPLIESPER:
GENERALAGGREGATIE
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PRODUCTS .COMPMPACGG
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5
AUTOMOBILP LIABILITY
ANYAUTO
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COMBINED SINGLE LIMIT
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$
_
B00110fINJURY (Perperson)
$
OWNEDAUTO5 SCHEDULED
ONLY AUTOS
HIRED AUTOS NON -OWNED'
ONLY AUTOS ONLY
p
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BODILY INJURY (Per accident)$
PROPERTY DAMAGE�
(Pwaccideot)
$
,
$
UMBRkI-LALIAB
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1
EACHOCCURIIENCE
$
EXCE55LIAa
CiAIM5-MADE!
!
AGGREGATE
$
DEp RErEN[ION$�
S
WORKERSCOMPENSATSON
AND EMPLOYERS' LIABILITY
�STATUTE
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$
A
ANY PROPRIETOR/PARTNER/ Y/N
FXKVTIVEOFFICER/MEMBER Y
EXCLUDED? (Mundaturyin NH)
N/A
EIG224134900
11101/2018
11/0112017
E.L,EACHACCIDENT
$ 1.000,000
ELpISEA3H-EAEvIPLOYEC 1,000,000
ifyea,describe under DESUMPTIONOF
OPERATIONS below
E.LDISEA5E-POLICY LIMIT'
$ 1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If nlnrespacC is required)
Certlfioate holdar, its officers, agents, and employees are named as Additional Insured, Should any of the above described policies ba Cancelled before the
expiration date thereof, the Issuing insurer wlll endeavor to mall 30 days written notlas to the Edditlonal interest named below, but failure to mall such notice
shall Impose no obligation or Ilabllity of any kind upon the Insurer, Its agents or representatives,
1p- days nctice of cancellation Tor nonpayment
CERTIFICATE HOLDER CANCELLAMCN
.. City of5antaAna SHOULDANYOFTHEABOVEDESCRIBED POUCIESBECANCELLEDBEFORE THEIEXPIRATION
Attn: r-PCSA DATE THEREOF,NOTICE WILL BE DELIVERED INACCORDANCEWITHTHE POLICY PROVISIONS,
20 Civic Conter Plaza M-23
[ -- - Santa Any
ACORIO 25 (2016/03) (�) 1988-2015 ACORD CORPORATION. All Rights Rotarved
31.1769 11-15The ACORD name and logo aria reglsteredmarks ofACORD
ADDITIONAL IN,SURBD ENDORSEMENT
Insurance Company _-�c�-►!� �-- vt G�.
This endorsement modifles such Insurance as Is afforded by the provisions of PaiiTy
# � _ , 4 �rolating to the tollewing
1, 'The City of Santa Ana, 20 Civic Center plaza, Santa Ana, California 92701; h officers,
employees, agents and representative are named as addltlonai insureds ("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,
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 or for the benefit of the
additional insureds,
3, This insurance, applies separately to each insured against whom claim Is made pr suit €s
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.
With respect the additional lnsurads, this insurance shall riot be cancelied, or materially
roduoed to coverage or limits except after thirty (30) days written notice has been givQn to
the City of Santa Ana, 20 CIVIC Center Plaza, Santa Ana, California 92701.
(Completion Of the fnilawfrtg, including countersignature, is required to make this endorsement effective,)
ftectfue� �' , this endorsement farm as part of
Policy#
Issued to —&Lpr�f�,d,
a
dame �sured
Countersigned b
9