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Home My WebLink AboutNOTEWORTHY PUPPETS, INC. 3City of Santa / a >•p C �r Clerk of the Council OTC Office 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TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect. City of Santa Ana Note: If your agreement is grant related, please ensure that all grant retention requirements have been satisfied prior to signing the termination form.ALIG 0 2 261 Is the agreement(s) a permanent record? Yes No Clerk of the Council Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with C�lac� 1 i� No. N-2017-107 was completed on and final payment has been made. (List all amendments. Use space below if needed.) Department: Phone/Ext.: �,S-L� Signature: 0 r`J��yL �_ )-e-sm Date: % 1d � I�ai Revised: 10-18-16 INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES, 4g --- CLERK OF COUNCIL ,d DATE: JUN 232017 O: PRCS (I ) Silvia Cuevas May 31, 2017 Noteworthy Puppets Inc. ("Speaker/Performer") 438 S. Lincoln Place Monrovia, CA 91016 Re: Speaker/Performer Engagement Agreement N-2017-107 This letter represents your agreement with the City of Santa Ana ("City") as entered into on the above date for the engagements described below: 1. Event Description: Up to three (3) variety -type performances including without limitation storytelling, music, puppetry, magic, animals, mimes, juggling, as further agreed upon by the parties for each performance 2. Date(s): As specifically scheduled by the parties by mutual agreement during the period July 1, 2017 through June 30, 2018 Event Time(s): Each performance will be approximately one hour in length Location: Santa Ana Main Library or Newhope Library Learning Center ("Property") Compensation: $300 for each performance (payable by check within 30 calendar days of event); Speaker/Performer must provide IRS form W-9 before payment can be made; total sum to be expended under this Agreement shall not exceed $900 Equipment provided by City: No equipment, however, the City will be responsible for room set up and advertising the program. Equipment provided by Speaker/Performer: all equipment, materials, supplies, and personnel necessary for each performance City Contact Person (for coordinating purposes only): Michelle Loera or Lupita Arroyo 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, its agents, or its 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, its agents, or its employees. IT. Release: Speaker/Performer, its agents, and employees accept the Property and any City -provided equipment used in connection with the performance in "as -is" condition, with all faults. Speaker/Performer, its agents, and employees, fully release, waive and discharge forever any and all claims, demands, rights, and causes of action of any kind or Letter Agreement — Noteworthy Puppets, Inc. Page 2 nature against, and covenant not to sue, City, its elected officials, of persons acting on behalf of, by, through or under each of them, regulations for any claim or event relating to the condition of the Pro 1.2. Speaker/Performer shall maintain commercial general liability insu agents, volunteers and representatives as additional insured(s) and against claims arising from bodily and personal injury, including de resulting from any act or occurrence arising out of Speaker/Perf Agreement, including, without limitation, acts involving vehicles. ' the following: single limit coverage applying to bodily and personal property damage, in the total amount of $1,000,000 per oceurre insurance shall: (1) name the City, its offices, employees, agent; insureds; (2) be primary and not contributory with respect to insuran City; and (3) contain standard separation of insured provisions. 13. Worker's Compensation Insurance. In accordance with the C Speaker/Performer has any employees, is required to be insured a€ undertake self-insurance. employees, agents and volunteers, a :r any present or future laws, statut, or City -provided equipment. nce naming the City, its officers, empl< trall include, but not be limited to protr i resulting therefrom and damage to pro mer's operations in the performance o e amounts of insurance shall be not le& Jury, including death resulting therefrom e, with $2,000,000 in the aggregate, volunteers, and representatives as addi or self-insurance programs maintained 1 nia Labor Code, Speaker/Perform liability for worker's compensation 14. The City shall have the right and royalty -free license to simulcast or [Produce and show a tape -delayed broade Speaker/Performer's presentation to the City community or genera ;I public, through webcast or any other n This license shall be non-exclusive and the copyright shall remain in with the Speaker/Perfarmer. Copi Speaker/Performer's presentation may be maintained by the City, a' d Speaker/Perfornier consents to use of recar mgs. , 15. Speaker/Performer shall not discriminate because of race, color r creed, religion, sex, marital status, s orientation, age, national origin, ancestry, disability, or any other b sis protected by applicable law in vaunt with any activities related to this Agreement. I 16. This Agreement shall in all respects shall be interpreted, enforced, an the state of California. Both parties agree that Orange County, C proceeding that may be brought or arise out of, in connection with or 17. This Agreement represents the complete and exclusive statement bet the subject matter herein and supersedes any and all other agreeme Agreement may not be modified except by written instrument signed of Speaker/Performer. CI OF S TA ANA SPE C Tfl A KURT 'By: Interim City Manager NM ATTEST: AP By: MAR1A D, HUIZAR JOl Clerk of the Council Acs RECOMMENDED FOR APPROVAL: overned exclusively by and under the la "ornia, shall be the venue for any acti reason of this Agreement. .n the City and Speaker/Performer rega , oral or written, between the parties. the City and by an authorized represen VORTHY PUPPETS, INC. )VED AS TO FORM: . FUN_ it City Attorney 0 AC'C)R" CERTIFICATE OF LIABILITY INSURANCE DATE (MWODNVYY) 03/1012017 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the golicy((les) must have ADDITIONAL INSURED provislons or be endorsed. it SUBROGATION IS WAIVED, subject to the terms and conditions of the poticy, 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 K&K Insurance Group, Inc. 1712 Magnavox Way Fort Wayne IN 46804 CONTACT NAME: MESS MBIChand!sing Aano Exl: i-II 328-2317 qIO Na; 1-260-459-5502 E-MAIL {nfoC�oventinsurance-kk.com ADDRESS: PRODUCER CUSTOMER 10: INSURERS AFFORDING COVERAGE NAIC# INSURED 2000648858 CP# 1581 Kevin Christian Noonchester DBA: NOTEWORTHY PUPPETS INC MONROV A, CA 91016 �11 _32C If U lc.` A Member of the Sports, Leisure & Entertainment RPG INSURER A: Nationwide Mutual Insurance Company 23787 INSURER a: INSURER C: �^ INSURER INSURER o: NSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2000294117 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTA TYPE OF INSURANCE AODL HIED SUBR VIVO POLICY NUMBER POUCYEFF M6VDDIYYY POLICY EXP MMIDD/YYV LIMITS A X COMMERCIAL GENERAL LIABILITY X 68RPG000G005895300 04I16/17 G4116/18 EACH OCCURRENCE $2,000,000 CLAIMSMADE7 OCCUR 12:01 AM 12.01 AM DAMAGE TO -NY2f PREMISES Ea Occurrence _ $300,000 MED EXP(Any am person) — $5,000 PERSONAL &ADV INJU RY u Excluded GEN'L AGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE $5,000,000 POLICY ❑ PROJECT ❑ LOC PRODUCTS-COMPIOP AGO $2,000,000 PROFESSIONAL LIABILITY OTHER: LEGAL LIAR TO PARTICIPANTS $2,000,000 AUTOMOBILE LIABILITY COMBINED amident SINGLE UMIi Ice BODILY INJURY (Per person) AUTO IANY X OWNED SCHEDULED AUTOSONLY eAUTOS. HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Not provided while in Hawaii ''`` ��}j'j. ) 13 \ BODILY INJURY (PeracGtlenp PROPERTY DAAIA E Perea;idenl RELLA LAB OCCUR EXCESSLIAB CLAIM&MADE �Qu 0-pi �l EACHOCCURRENCE AGGREGATE DEO M RETENTION WORKERS COMPENSATION N/A PER STATUTE OTHER ANYY PROPRIETORIPARTNERI YIN ❑ EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatary In NH) +a0 (_� \` (`'LJ {}.il E.L. EACH ACCIDENT EL DISEASE -EA EMPLOYEE It yes, deacrllue under DESCRIPTION OF OPERATIONS below G' E.L. DISEASE -POLICY LIMIT A MEDICAL PAYMENTS FOR PARTICIPANTS 68RPG0000005895300 04/16/17 12:01 AM 04/16/18 12:01 AM PRIMARY MEDICAL $5,000 EXCESS MEDICAL DESCRIPTION OF OPERATIONS I LOCATIONS I VEH CLES CO O10,Adduanal Remarks Schedule, maye aaached R more space is required) Performing as Puppeteer Event Date: 07/25/2017-07/30/2017 City Of Long Beach, its officials, employees and agents are added as an additional Insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured. CERTIFICATE HOLDER CANCELLATION City Of Long Beach 333 West Ocean Boulevard SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH Long Beach, CA 90802 THE POLICY PROVISIONS. Owner/Manager/Lessor of Premises AUTHORIZED REPRESENTATIVE /?'�r/b..�i/( 01908.2015 ACORD CORPORATION. All rights reserved. Coverage is only extended to U.S. events and activities. '" NOTICE TO TEXAS INSUREDS: The Insurer for the purchasing group may not be subject to all the Insurance laws and regulations of the State of Texas. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 6BRPG0000005895300 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organization(s) City of Santa Ana, its officers, agents and employees Attention: Monique Rosales 26 Civic Center Plaza Santa Ana, CA 92701 Insured: Kevin Christian Noonchester DBA: NOTEWORTHY PUPPETS ING Cert # 1581 if A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. in the performance of your ongoing operations; or 2. in connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. a� CG 20 26 0413 0 Insurance Services Office, Inc., 2012 Pagel of f POLICY NUMBER: 6BRPG0000005895300 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4.Other Insurance, a. the following is added: Coverage afforded under this Policy is primary insurance and OTHER INSURANCE shall not apply as respects to the additional insured named below, however this insurance does not apply to the sole negligence of such additional insured. Further, we will have no duty to defend such additional insured against any suit to which this insurance does not apply. Additional Insured: City of Santa Ana, its officers, agents and employees Attention: Monique Rosales 26 Civic Center Plaza Santa Ana, CA 92701 Insured: Kevin Christian Noonchester DBA: NOTEWORTHY PUPPETS INC Cert # 1581 Effective Dates: 04116/2017 — 0411612018 SRPG8010 09/08 POLICY NUMBER: 6BRPG0000005895300 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION This endorsement modifies insurance under the following: COMMON POLICY CONDITIONS, A. Cancellation, 2.b. is deleted and replaced by: 30 days before the effective date of cancellation if we cancel for any other reason. This endorsement applies only to the insureds designated below: Named Insured: Kevin Christian Noonchester DBA: NOTEWORTHY PUPPETS INC Additional Insured: City of Santa Ana, its officers, agents and employees Attention: Monique Rosales 26 Civic Center Plaza Santa Ana, CA 92701 Cert If 1581 Effective Dates: 04/16/2017 — 04/16/2018 SRPG8016 09108 1 POLICY NUMBER: 6BRPG0000005895300 INTERLINE IL 12 0111185 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ai74111fE sENT Policy Change NIImhAr q POLICY NUMBER POLICY CHANGES EFFECTIVE COMPANY 6BRPG0000005895300 04/16/17 Nationwide Mutual Insurance Company NAMED INSURED AUTHORIZED REPRESENTATIVE Kevin Christian Noonchester K&K Insurance Group, Inc. DBA: NOTEWORTHY PUPPETS INC COVERAGE PARTS AFFECTED COMMERCIAL GENERAL LIABILITY COVERAGE CHANGES Form SRPG 8018 is added to the Policy Cert # 1581 14,- vl ��" Authorized Representative Signature IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 Copyright, ISO Commercial Risk Services, Inc., 1983 0 Page 1 of 1 POLICY NUMBER: 6BRPG0000005895300 INTERLINE IL 12 01 11 85 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Number 2 POLICY NUMBER POLICY CHANGES EFFECTIVE COMPANY 68RPG0000005895300 104/16/17 Nationwide Mutual Insurance Company NAMED INSURED AUTHORIZED REPRESENTATIVE Kevin Christian Noonchester K&KInsurance Group, Inc. DBA: NOTEWORTHY PUPPETS INC COVERAGE PARTS AFFECTED Common Policy Conditions CHANGES Form Number: 8016 ❑X Add Form ❑ Delete Form F7 Amend Form as Follows: Cart If 1581 The above amendments result in a change of premium as follows: FT No Change F-1 To be Adjusted at Audit El Additional Premium Return Premium Authorized Representative Signature IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 Copyright, ISO Commercial Risk Services, Inc., 1983 �¢� Page 1 of 1