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HomeMy WebLinkAboutCONSCIOUS BREAK, INC.-2017City of Santa Ana AA Clerk of the Council -corc oiiice use only - - _ ....... ._. AGREEMENT TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. 70 AUG 22 lair 4: 08 Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form. CITY OF SAN_E; ANA Is the agreement(s)apermanent record? Yes _ No CLq,RK OF COUNCIL Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with c �(i) '5 6 D (1 C 6 y-e K—/ lno No. N-2017-117 was completed on (,'j< and final payment has been made. (List all amendments. Use space below if needed.) oo Department: Phone/Ext.: .- 31s- �a Signature: S- Qy)i!& UK)4ci1.o Date: d3011W Revised: 10-18-16 INS'J�ni�CE UN FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES, CLERI( Of, COUNCIL DATE; UJUN 2 3 2011 Y�fi' O: PRCS ( I I RECREATION SERVICES AGREEMENT N-2017-117 Silvia Cuevas THIS AGREEMENT is made and entered into this l Ith day of May, 2017 by and between Conscious Break, Inc. a Delaware Corporation ("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 recreation service provider having special skills, resources and knowledge to provide Yoga en Espanol classes in its recreation class program. B. Provider represents that he/she/it is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Provider represents that he/she/it is knowledgeable in their 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 In consideration for the provision of the programs set forth in Exhibit A, City agrees to pay the Provider seventy percent (70%) of all gross revenue received from program participants. Total revenue to Provider shall not exceed $25,000.00 annually. Payment to Provider shall be made monthly within thirty (30) days following completion of the last class taught by Provider the prior month. City shall be responsible for collecting all fees from program participants. Provider shall not collect fees but will refer all interested participants to City for registration information. Provider agrees that City shall retain thirty percent (30%) of all gross revenue received from program participants as an administrative fee. 3. TERM This Agreement shall commence on July 1, 2017 and end on June 30, 2018 unless terminated earlier in accordance with Section 12 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 by Provider shall be provided in a manner 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 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 (e) contain standard separation of insured's provisions. b. Worker's Compensation Insurance. In accordance with California State law, Provider. 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. 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. INDEMNIFICATION Provider agrees to and shall indemnify, defend 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, to the extent that the injury, damages, just compensation, restitution, judicial or equitable relief is caused by the negligence of the Provider. 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. City may make all reasonable decisions with respect to its representation in any legal proceeding. In no case will Provider be required to indemnify or hold harmless the City from injury, damages, just compensation, restitution, judicial or equitable relief caused by the negligence of the City. 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. LIVE SCAN BACKGROUND CHECK Provider, and any employees, subcontractors or substitutes, in contact with minors under eighteen (18) years of age shall arrange for and submit to a Live Scan electronic background check for criminal history available through the California Department of Justice as a condition of this Agreement and provide proof of compliance prior to performing services hereunder. 9. 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 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 Fax (714) 571-4211 To Provider: Conscious Break, Inc. Attn: Illary Archilla 1 Dover Street Trabuco Canyon, CA 92679 Phone:714-653-2293 Email: lllaryarchill a gmail.coin 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. 10. 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. 11. ASSIGNMENT/SUBSTITUTES a. 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. b. Substitutes. In the event Provider is not able to teach a class due to illness or some other cause beyond Provider's reasonable control, Provider must procure, at its sole expense, a qualified substitute instructor to teach the class at its regular time and place. Provider shall ensure that substitute instructors are at least twenty-one (21) years of age and comply with the City's insurance and live scan requirements contained herein. Evidence of compliance with City's insurance and live scan requirements shall be provided upon request. Provider must immediately notify the City of the substitute instructor's name, qualifications, address and phone number. If Provider cannot procure a qualified substitute and the City is unable to assist in this regard, then the class shall be canceled and a make-up class must be added to the session. Provider must notify participants as soon as possible of any class cancellation and make-up class. Provider must personally teach at least seventy-five percent (75%) of its offered classes. 12. TERMINATION a. 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. b. Termination or cancellation of classes by the Provider outside of Section 1 l.b. must be given to the City at least thirty (30) days prior to termination/cancellation. Failure to provide adequate cancellation notice to the City may put future contracting of business with the City at risk and will result in the City's retention of ten (10%) percent of the final payment to Provider. 13. RECORDS Provider shall use attendance sheets generated and supplied by the City to record attendance in each class. 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 final payment to Provider under this Agreement. 14. 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 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. 15. 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. 16. 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. 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. EXHIBITS All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 19. 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 by so executing this Agreement, the parties hereto are formally bound to the provisions of this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: CITY OF SANTA ANA ow Maria D. Huizar e —Cy4fthia Kurtz Clerk of the Council Interim City b [signatures continue on next page] APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: Laura Rossini Assistant City Attorney RECOMMENDED FOR APPROVAL: Gerardo Moixet ' I Name: 'y Archilla, hl'&�� � v1 Executive Director of Parks, Consci s13reak, Inc. Recreation and Community Services Agency Exhibit A SCOPE OF SERVICES A. Provider shall conduct Yoga en Espanol classes for ages 16 yrs and up. B. Provider shall teach such or similar classes (1) at the times below at facilities to be designated by the City or (2) on a schedule agreed upon by the parties for each class session or term, including the location, specific days and hours when classes will be held, and holidays to be observed, in accordance with City's needs. Yoga en Espanol classes will be taught for 4 weeks, held 1 day per week, 50 minutes per day C. Provider shall provide all materials, supplies, equipment, records and personnel. Provider shall be responsible for clean-up of the facilities and materials and shall ensure the safety and effectiveness of instruction. CLASS SIZE A. Each class must have a minimum of 5 paid students and no more than 25 students. B. No registration will be accepted after the second meeting of classes. C. If the minimum registration has not been reached by the second class, the class shall be cancelled. Provider will be under no obligation to provide services for the cancelled classes, and the City will have no further obligations to pay Provider compensation for the remaining classes that were cancelled in that session. CLASS FEES A. Each participant shall pay class registration fees as established by City. B. Provider may not waive class participation/registration fees. C. Only registered participants may participate in class. D. Any refunds to participants will be made in accordance with City policy. E. Any materials fee shall be established by mutual agreement of City and Provider and shall be payable directly to ,Provider. AC�O,R'L�® CERTIFICATE OF LIABILITY INSURANCE DAM MM/2017w1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: NMC Insurance Services A,CCNIJo Eat; (949) 206-0929 a,c No: (949) 916-9929 P.O. Box 2159 nooRess, service@nmcins.com INSURERS) AFFORDING COVERAGE NAICR INSURERA: U.S. LIABILITY INSURANCE CO. Laguna Hills CA 92653 INSURED INSURER e: INSURERC: Con SCIOUS Break Inc. INSURER D: 1 Dover INSURER E : INSURERF: Trabuco Canyon CA 92679 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE ADDLSUBR Maawa POLICY NUMBER POLICY EFF (MMIDDMYYI POLICY EXP HMIDDIYYYY)LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X CLAIMS -MADE F—IOCCUR PREMISES Ea recurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 A CL1789714 12/302016 12/30/2017 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 GEN'L X POLICY JECT LOC PRODUCTS - COMPIOP ASS $ Included Professional Liability $ Included OTHER: AUTOMOBILE LIABILITY .01481eDt SINGLE LIMIT $ Included BODILY INJURY (Per person) $ ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS NON-O HIRED AUTOS X AUTOS VNED AUTOS CL1789714 12/302016 12/302017 X BODILY INJURY (Per accident) $ PROPERTYDAMAGEAGE Per accident $ a UMBRELLALIAS H OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS -MADE RED I I RETENTION $ $ WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN Ably PROPRIETOR/PARTNERIEXECUTIVE ❑NIA OFFICERIMEMBER EXCLURED? PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE -EAEMPLOYEE] $ (Mandatory In NH) f yes, deecnbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additl one[ Remarks Schedule, may be attached If more space I required) �J The City of Santa Ana, its officers, employees, agents, and representative are additional insured per attached endorsem G\Y�� .�,\, JGP'dfi The City of Santa Ana 20 Civic Center PIZ 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 [oilLK-I&IIIIII d•7:7.IK•7:71+7:LYi[•Tdwilliff 'Ii�MMI-T.11i ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD CL1789714 UNITED STATES LIABILITY INSURANCE GROUP WAYNE, PENNSYLVANIA This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM BLANKET ADDITIONAL INSURED ENDORSEMENT Section 11 — Who is An Insured is amended to include as an insured any person(s) or organization(s) who you are required to add as an additional insured under written contract(s), . written permit(s) or written agreement(s), that require such person(s) or organization(s) to be added as an additional insured on your policy. Such person(s) or organization(s) is an insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" occurring after the effective date of such written contract(s), written permit(s) or written agreement(s) that is caused, in whole or in part by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; EXCLUSIONS There is no coverage under this endorsement for loss or expense, including but not limited to the cost of defense for "bodily injury", "property damage" or "personal and advertising injury" occurring: (1) After all of "your work", including materials, parts or equipment furnished in connection with "your work" and performed under the above referenced written contract(s), written permit(s) or written agreement(s) has ended; or (2) When that portion of "your work" out of which the "bodily injury", "property damage" or "personal and advertising injury" arises and performed under the above referenced written contract(s), written permit(s) or written agreement(s) has been put to its intended use by any person(s) or organization(s); whichever occurs first. Coverage is not provided for "bodily injury", "property damage" or "personal and advertising injury" arising out of the sole negligence of an additional insured under this endorsement. Coverage provided by this endorsement will be excess over any insurance available to any additional insured under this endorsement unless a written contract(s), written permit(s) or written agreement(s) specifically requires that coverage under this endorsement is primary. All other terms and conditions of this policy remain unchanged. This endorsement is a part of your policy and takes effect on the effective date of your policy ul tW h other eff ctive date is shown. Sle J�. S L 723 (02-09) Q�CiSP` Page I of I WORKERS' COMPENSATION DECLARATION I lllary Archilla hereby affirm under penalty of perjury, the (Name/Title) following declaration 1 certify on behalf of Conscious Break Inc (Conaulmnl/Comrany Name) that during the term of my contract for Yoga en Espanol __ 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: 02/22/17 By: Nam_. Title: President Telephone: 714-653-2293 _ 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 ATTORNEY'S FEES. eda�' GuV - •\� Q�G ACORbe CERTIFICATE OF LIABILITY INSURANCE 14.� DATEIMMIDDNYYY) 02/142018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) 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 Ileu of such endorsement(s). PRODUCER CONMA NMC Insurance Services _NAME:__ q�CEN E.O. : (949) 206-0929_ FAC No: (949) 916'9929 P.O. Box 2159 E-MAIL service nmcins.com AOIXeEs INSURER(S) AFFORDING COVERAGE NAIC* _ INSURERA U.S. LIABILITY INSURANCE CO. Laguna Hills CA 92653 INSURED ,, ��--1T 1 �-7 INSURER C: INSURER Conscious Break Inc. flypp -&4Lon- i INSURERD: 1 Dover INSURERE: INSURERF: Trabuco Canyon CA 92679 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAYHAVE BEEN REDUCED BYPAID CLAIMS. ILTR NSR TYPE OF INSURANCE POLICYNIMSER POLICY EFF PMIODmm, LIMITS A X COMMERCIAL GENERALLMBILITY X CLAIMS -MADE ❑ OCCUR CL 1789714A 12/302017 12/302018 EACH OCCURRENCE $ 1,000,000 MISETr RENTED— PWAGES'EaawRa�ce $ 100,000 GEN'L X MED EIP(My one person) $ 5,000 PERSONAL &ADV IN•.URY $ 1,000,000 _ AGGREGATE LIMIT APPLIES PER POLIC'! '0 1 LOC OTHER- GENERA -AGGREGATE $ 2,000,000 PRODUCTS-CONIPIOPAGG $ Included Professional Liability $ Included AUTOMOBILE X LIABILITY ANYMTO ALLOYrNED SCHEDULED AUTOS AUTOS HIREDAUTOS X NON-OYdiED AUTOS CL 1789714A 12I302017 12/302018 Ea BINae�VJeDISNGLELiMIT $ Included BODILY INJURY (Per Person) $ -- BODILY INJURYIPeraceitlent) $ _ P •I fAG� PgracntlenU S UMBRELLA LIAR EXCESSLIAR OCCUR ClA1NSIMDE - - Qv /`eyv RVV b J EACH OCCURRENCE $ AGGREGATE It F-FO—EI-F71ETENTIONS $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROFPIETORIPARTNEPf ECUTIVE Y] OFICERNENBER EXCLUDES'? (Mandatoryin NH) Ito., &e.be in de, DESCRIP[ION OF OPERAT..:ONS below N/A OTH- STATUTE ER E.L, EACH ACCIDENT $ E.L. DISEASE-EAEMPLOYE $ E.L. DISEASE -POLICY LIMIT $ Ca�me� eG ea m% DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES(ACORD 101, Additional Rem Nle, may be M.hed if mom apace le regplmd) The City of Santa Ana, its officers, employees, agents, and representative are additional insured per attached endorsement. The City of Santa Ana 20 Civic Center Piz Santa Ana, CA 92701 ACORD 25 (2014101) 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 OO 1988-2014 The ACORD name and logo are registered marks of ACORD hts UNITED STATES LIABILITY INSURANCE GROUP WAYNE, PENNSYL.VANIA This cudorsemenl modilics insurance provided under [lie rolloving� COMMERCIAL GENERAL LIABILITY COVERAGE FORM � BLANKET ADDITIONAL INSURED ENDORSEMENT Section H — Who is An Insured is amended to include as an insured any person(s) or organization(s) who you are required to add as an additional insured under written contract(s), written permit(s) or written agreement(s), that require such person(s) or organization(s) to be added as an additional insured on your policy. Such person(s) or organization(s) is an insured only with respect to liability for "bodily injury', "property damage" or "personal and advertising injury' occurring after the effective date of such written contract(s), written permit(s) or written agreement(s) that is caused, in whole or in part by: i . Your acts or omissions, or 2. The acts or omissions of those acting on your behalf; EXCLUSIONS There is no coverage under this endorsement for loss or expense, including but not limited to the cost of defense for "bodily injury", "property damage' or "personal and advertising injury" occurring: (1) After all of "your work", including materials, parts or equipment furnished in connection with "your work" and perforated under the above referenced written contract(s), written permit(s) or written agreement(s) has ended; or (2) When that portion of"your work" out of which the "bodily in' property damage' or "personal and advertising injury" .arises and Ra v%der the above referenced written contract(s), written permit(.) or written agreement(s) has been put to its intended use by any person(s) or organization('s); _ whichever occurs first. Coverage is not provided for "bodily injury", "nd Wgd" qt `pro-&M- it ai {d advertising injury' arising out o£ the sole negligence of an 1 in t fgd! pider his efi2Cbr`sement. _ Coverage provided by this endorsement will be exces �v nv insurance available to any additional insured under this endorsement unless a written contract(s), written permit(s) or written agreement(s) specifically requires that coverage under this endorsement is primary. All other terms and conditions of this policy remain unchanged. This endorsement is a part of your policy and takes effect on the effective date of your policy unless another effective date is shown. L 723 (02-09) Page I of I CL1789714 UNITED STATES LIABILITY INSURANCE GROUP WAYNE, PENNSY-LVANIA This endorsement modifies insurance provided under the following: COMMERCL\L GENERAL LIABILITY COVERAGE FORM Primary And Non -Contributory - Written Contract Schedule: Effective Date: 01/1212017 12:01 AM Name of Person or Organization: 7•hc Ca,, f 1'u>lu,. 1 n L'lce U,r & Apyuu,u, c ❑,.,6r iaTiw,a, A�ouL>, auJ liu,yl�ycw 6W gut; u•hc,c my,d.cJ w Lc added as an additional insured under written conn=t(sj, written permit(s), or witten agreements). Rx)(2miLcuial Way Tiw.in. C'.4 927%) (If no cuts, appears above, the information required to complete this endorsement will be shown in the Declarations as apolicable to this endorsement) SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, Paragraph A. OTHER 1NSlJ1Z.1NCF., a. Primary Insurance is amended with the addition of the folloningo: 'the coverage afforded by this policy to the person(s) or organization(s) listed above is primary and non- contritnnor�• if. 1. This insuruice is required to be primary and non-contributory under a written contract; and 2. The loss to be covered occurs on or after the effective date of the written contract; and 3. 11rc long to be cuvcrcd renultcd nvlcly and c�x*luaivcly front your onguiiag acts yr vuribbivns or the vnnoing acts or omissions of those acting on your behalf in performing "your work" under a written contract referred to above. 4. The person(s) or organization(s) is an additional insured under (his policy. However. the coverage provided by this endorsement does not apply to any coverage provided for an "auto" on a "non -owned auto", "hired auto", uninsured motorists coverage, undetinsured motorists coverage, personal injury protection, property protection or similar no-fault coverage by whatever name callgdatilf or an "auto" coverage of any type. F, All other temps and conditions of this policy remain unchanged. T ' ndc • e is (6 y o icy and takes effect on the effective date of your policy unless another effectiv d, ck rl 1,776 (10-13) pa6c 1 of WORKERS' COMPENSATION DECLARATION I IIIary Archilla hereby affirm under penalty of perjury, the rNams'11Uc� following declaration I certify on behalf of Conscious Break Inc _ that during the term of my ICna�ul4mL'Cumrain} Nazutl contract for Yoga en Espanol services with the Citv 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, [ shall forthwith comply with those provisions and provide proof of workers' compensation coverage. DATE: 02/22/17 By: Nam Title: President Telephone: __714-653_2293 WARNING: FAILURE'I'O SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIN41NAL 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 ATTORNEY'S FEES. ReJ�e� y`I Y0 ON GS P¢