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HomeMy WebLinkAboutALVAREZ, ELENA-2017City of Santa P. na Clerk of the Cou _ d corc -- AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agr(P?@) fE"4 M ti; 2 I amendments (if any) are no longer in effect. Note: If your agreement is grant related, please ensure that all grant retention requliReheMs O F SA N �3A A N A have been satisfied prior to signing the termination form. CLERK OF COUNCIL 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-2017-060 was completed on (List all amendments. Use space below if needed.) Use Only 5/6/ZDII and final payment has been made. Department: NC -SA Phone/Ext.: �d Ic1 Signature: AMa,D AWIw— Date: "L13 hot Revised: 10-18-16 I INSURANCE ON FILE WORK MAY PROCEED INSURANCE EXPIRM, CLERK OF COUNCIL. I)ATE: V,ki 1 V& 0: PRCS ( e) -.Silvia Cuevas ay1,2017 Elena Alvarez ("Speaker/Performer") 1765 W, Ball Road #4 Anaheim, CA 90804 Re: Speaker/Performer Engagement Agreement N-2017-060 This letter represents your agreement with the City of Santa Ana ("City") as entered into on the above date for the engagement described below: Event Description: Salsa and Cha Cha Dance Performance Services at Cinco de Mayo Fiestas 2017 event. 2. Date(s): May 6, 2017 Event Time(s): 6:00 p.m, to 6:45 p.m. 4. Location: the Main Stage located Fourth and French Street, Santa Ana ("Property") Compensation: $825.00 (payable by check within 30 calendar days of event); Speaker/Performer must provide IRS form W-9 before payment can be made 6. Equipment provided by City: None 7. Equipment provided by Speaker/Performer: equipment as needed for the dance performance City Contact Person (for coordinating purposes only): Sonia Batres 9. Independent Contractor: Speaker/Performer shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer -employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Speaker/Performer performs the services that are the subject matter of this Agreement; however, the services to be provided by Speaker/Performer shall be provided in a manner consistent with all applicable standards and regulations. Speaker/Performer shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 10. Indemnification: Speaker/Performer, his or her agents, or employees (if applicable) agrees to and shall indemnify, defend, and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives from and against all loss, expenses, or liability (including costs and attorney's fees) arising from the negligence or willful misconduct of Speaker/Performer, his or her agents, or employees. 11. Release: Speaker/Performer accepts the Property and any City -provided equipment used in connection with the performance in their "as -is" condition, with all faults. Speaker/Performer fully releases, waives and discharges forever any and all claims, demands, rights, and causes of action of any kind or nature against, and covenants not to sue, City, its elected officials, officers, employees, agents and volunteers, and all persons acting on behalf of, by, through or under each of them, under any present or future laws, statutes, or regulations for any claim or event relating to the condition of the Property or City -provided equipment or Speaker/Performer's use thereof. Letter Agreement — Elena Alvarez Page 2 12, Commercial General Liability Insurance. Speaker/Performer shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Speakcr/Performer'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 $1,000,000 per occurrence, with $2,000,000 in the aggregate. Such insurance shall: (1) name the City, its officers, employees, agents, volunteers, and representatives as additional insureds; (2) be primary and not contributory with respect to insurance or self-insurance programs maintained by the City; and (3) contain standard separation of insured provisions. 13. Worker's Compensation Insurance. In accordance with the California Labor Code, Speaker/Performer, if Speaker/Performer has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance. 14, The City shall have the right and royalty -free license to simulcast or produce and show a tape -delayed broadcast of Speaker/Performer's presentation to the City community or general public, through webeast or any other means. This license shall be non-exclusive and the copyright shall remain with the Speaker/Performer, Copies of Speaker/Performer's presentation may be maintained by the City, and Speaker/Performer consents to use of such recordings. 15. Speaker/Performer is solely responsible for payment of royalty fees, performance fees, or similar fees that may be required by unions or similar organizations, Speaket/Performer shall indemnify the City against any liability or damages, including attorney'& fees, that may arise as a result of violation by Speaker/Performer of copyright laws. 16, Speaker/Perf, i r �r.: 1 ot, discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, �E.��;riin, ancestry, disability, or any other basis protected by applicable law in connection with any acti vitiFiEft to this Agreement, 17. This Agreemen all respects shall be interpreted, enforced, and governed exclusively by and under the laws of the,9ta of C . ifo#tiia. Both parties agree that Orange County, California, shall be the venue for any action or pro dc': ling th, -Kay be brought or arise out of, in connection with or by reason of this Agreement, 18. This Agredin t, ,serifs. the complete and exclusive statement between the City and Speaker/Performer regarding the._'stibj t Jriaft& herein and supersedes any and all other agreements, oral or written, between the parties. This A r cfAcrit'rnay not be modified except by written instrument signed by the City and by an authorized representative of Speaker/Performer. CITY OF S TA RO ERT C. Deputy City Manager za]�� MARIA D. HUIZAR. d Clerk of the Council RECOMMENDED FOR APPROVAL SPEAKERIPERFORMER Name: QXoe, Title: k_A,�O APPROVED AS TO FORM: By: J01 FUNK Assistant City Attorney Gerard Mouet, Executive Director, PRCSA A,°'� CERTIFICATE OF LIB IRIS CERTIFICATE iS ISSUED AS A MATTER OF INFORMATION ON CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENI BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITI, REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT; If the certificate holder is an ADDITIONAL INSURED, the terms and conditions of the policy, certain policies may require an ei certificate holder In Ileu of such endorsementls). PRODUCER Eddie Quillares Jr, State Farm Agency 415 N. Broadway Santa Ana, CA 92701 .—J.ru Elena Alvarez 1765 W Sall Rd. Apt 4 Anaheim, CA, 92804 � ILITY INSU ANCE DATE 05l0312017i,)017Y, .Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ITE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED )olicy(fes) must be endorsed. If SUBROGATION IS WAIVED, subject to the idorsement. A statement on this certificate does not confer rights to the NAmE: Eddie Quillares PHONE .7 4. Z.7150. -MAIL uc No : 714.617.715 ADD ss: eddie eddie insurance.com INSURER(& AFFORDING COVffkAr3S NAIC 71 wsuReFtA: State Farm General tnSurenCe 00"n r1 2 951 INSURER B : INSURER G : INSURER D : INSURER E : INSURER F : �- COVERAGES CERTIFICATE NUMBER;75-0450 REVISION NUMBER: THIS I$ 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. NTR TYPE OF INSURANCE POLICY SUBR PDLrCY EFF POLICY E%P POLICY NUMBER MMIDDIYVYY MMfDDlYVYY LIMITS A OENERALLIA6ILITY IFTI❑ 92-CE-0933-8 05/0612017 08106/2817 EACHOCCURRENCE X COMMERCIAL GENERAL LIANUTY $ 1,OC4,000 A P EM S S Ea occu rence $ 300,C00 CLIMB -MADE X OCCUR MED EXP {Any ane perscnl $ 5,CC0 GENT AGGREGATE LIMIT APPLIES PER: 7 PCLICY[71 PRO LOC AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRECAUTOS NON•OWNEn AUTOS UMBRELLA LIAM OCCUR EXCESS LIAR WORKERS COMPENSATION AND EMPLOY€RS` LIAMUTY ANY PROPRIETORIPARTNERIEXECUTIVE Y 1 N OFFICEJMEM9EREXCLUDED7 ❑ NI lMandatory In NH) (ryes, dewjW under PERSONAL & ADV INJURY $ 1. GENERAL AGGREGATE $ 2, PROCUCTS-COMPIOPAGO $ 2, BODILY INJURY (Parperson) $ DGOILY INJURY (Par nm(ianq S $ ® �rt�n �v�v�rtr;CNt;t $ AGGREGATE S E.L. EACH ACCIDENT I $ E.L. DISEASE - FA EM PLCYE s S.L. DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach AC090 101, Additional Ramarke gche4uio, Irl"are space Is requlred) Clnco De Maya Celebration In Downtown Santa Ana, Elena Alvarez will perform at the Main Stage on 4th18ush during the hours of 5.30pm-T.30pm, THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, AND REPRESENTATIVE ARE NAMED AS ADDITIONAL. INSURED IN REGARDS TO GENERAL LIABILITY PER ATTACHED EXHIBIT B ADDITIONAL INSURED FORM. CITY OF SANTA ANA 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 SONIA BATRES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVCRen IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZ&O Q 1988=; 010 ACC)WCq'fi ORATION. All rights reserved. ACORD 26 (2010/05) The ACORO name and loge are registered rna"PtACORI� 1001486 132849.7 03 01-2012 Exhibit B ONAL INSURED ENDORSEMENT F COMMERCIAL GENERAL LIABILITY POLICY Insurance Company: State Farm Insurance This endorsement modifies such insurance as is afforded by the provisions of Policy Number: 92-CEMQ933-0 relating to the following; 1) The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents and representative are named as additional insured ("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 names insured, such insurance as is afforded by this policy is primary and is not additional to or to contributing with any other insurance carried by or for the benefit of the additional insured. 3) This insurance applies separately to each insured against whom claim is or suit is brought except with respect to the company's limit of liability. This inclusion of any person or organization as an insured shall not affect any right which is such person or organization would have as claimant if not so included. 4) With respect to the additional insured, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. Effective May 6, 2017 this endorsement form as a part of Policy Number; 92-CE-Q933-0 Issued to Elena Alvarez eo `x � Cj e R Countersigned by , Authorized Representative WORKERS' COMPENSATION DECLARATION I G Pmw � . - hereby affirm under penalty of perjury, the (N—ofride) following declaration : I certify on behalf of ,%w?_- that during the terra of my (Consultant/Company Name) contract for q„ �,g ,l it :R,Fc�oAAc� a.lc�. services with the City of Santa Ana., I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with those provisions and provide proof of workers' compensation coverage. DATE: GW Lon I: Name: - FAjD4,9,, &AWx. Title: kAIAJ Telephone: WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($ 100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEYS FEES.