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HomeMy WebLinkAboutSTORM, GAY 1(a City 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TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect.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. r"`i p: 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-2017-131 was completed on (List all amendments. Use space below if needed.) Revised: 1 Pl & 16 N17 T 41= COUNCIL s2s PN3:29 7v y/,-) (- i_ and final payment has been made. Department: PRS4 Phone/Ext.: Wig Signature: Doan/' Date: Q fi Liz0 tlX-ui AxeE ON FILE VORF MAY PROCEED NTIL INSURANCE EXP_(RM,, CLERK OF COUNCIL DATE: JlR 1 1 2017 O; PRCS (: ) June 22, 2017 Silvia Cuevas Gay Storm ("Speaker/Performer") 15241 Cascade Lane Huntington Beach, California 92647 Re: Speaker/Performer Engagement Agreement A�eement N-2017-131 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: Historical Re-enactment Services, Character: Statue of Liberty 2. Date(s): Tuesday, July 4, 2017 Event Time(s): 4:00 p.m. to 8:00 p.m. 4. Location: Show will be presented at the Centennial Park, Santa Ana CA ("Property") 5. Compensation: $300 (payable by check within 30 calendar days of event) provided agreement is fully executed; 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: all supplies, costumes, and equipment, required for the performance 8. 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. 06/27/2017 15:56 FAX U 002 Letter Agre6munl — Sturm, Gay Page 2 12. Commercial Ocneral Liability Insurance. Speaker/Ferfomtor shall maintain commureial gonelal 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 Speaker/Performer's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts orinsurance 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 S2,000,000 in the aggregate. Such insurance shalt: (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 royally -free license to simulcast or produce and show a tape -delayed broadcast of SpeakerlPerformer's presentation to the City community or general public, through weltcast 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 shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, disability, or any other basis protected by applicable law in connection with any activities related to this Agreement. 16. This Agreement shall in all respects shall be interpreted, enforced, and governed exclusively by and under the laws of the state of California, Both parties 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 tills Agreement. 17. This Agreement represents the complete and exclusive statement between the City and Speaker/Performer regarding the subject matter herein and supersedes any and all other agreements, oral or written, between the parties. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Speaker/Performer. Please execute this letter to reflect your agreement to the terms and conditions set CITY OF SANTA CYNTHiA Interim City Manager A I'EST: MARIA D. HU17AR Clerk of the Council RECOMMENDED FOR APPROVAL GAY STORM APPROVED AS TO FORM: By:-Qd — JOT M, FUNK Assistant City Attorney OERARDO MOUET, Exgcutive Director, Parks, Recreation, and Community Services Agency 06/21/2017 16:49 FAX IQ 002 EXHIBIT A YAT3OK WILL TRAVEL Clay Storktv 15241 Ca4cgdel La► & R aAt-Mgtaw Beach CA 926,47 (714) 309 1646 June 21, 2017 Gay Storm, artist, will appear and perform as T'h&Statu& f LO-vxty at the 71h Annual Fourth of July Celebration to be held Tuesday, July 4, 2017, at Centennial Park in Santa Ana. It is understood that the festivities will be from 4:00 to 8:00. She will perform on stage at a time to be determined for no more .than twenty minutes and will also interact with people from a booth to be supplied by others. Gay Storm will provide costuming and props for her show but will not provide a microphone. Compensation for her work will be $300.00. Enclosed with this invoice is a Vendor Information Form, a Taxpayer Form W-9 and a Workers' Compensation Declaration. ------ ---------------�- Gay Storm AeCN? p® 6 2712017 CERTIFICATE OF LIABILITY INSURANCE on/7/2017 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(ies) 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 Anthony Insurance Services, Inc. P.O. BOX 927 CONTACT NAME: HONE Ext: FAX No: Edwards, CO 81632 www.AnthonyinsuranceServices.com AIL ADDRESS: Caitlyn@anthonyinsuranceservices.com INSURER(S) AFFORDING COVERAGE NAICO INSURERA: U.S. Fire Insurance Company 21113 INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION(PURCHASING GROUP) AND ITS PARTICIPATING MEMBERS: INSURERS: INSURERC: HATBOXWILLTRAVEL.COM INSURER D: GAY STORM 15241 CASCADE LANE INSURER E: INSURERF: HUNTINGTON BEACH, CA 92647 COVERAGES CERTIFICATE NUMBER: USS349743 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE ADDL INSR SUER VIVO pOLICYNUMeER POLICY EFF MMIDDI IDY POLICY UP MMIDDIYYYY LIMITS GENERA -LIABILITY GENERAL AGGREGATE Is 1,000,000 PRODUCTS - COMPIOP AGG S 1,000.000 X COMMERCIALGENERALUABILITY PERSONAL &ADV INJURY $ 1,000,000 A CLAIMS -MADE OCCUR X SRPG-101-0717 217 :01 1:01 AM 12:01 :01 17 AM EACH OCCURRENCE S 1,000,000 FIRE DAMAGE (Any one fire) $ 300,000 GENL AGGREGATE LIMITAPPUES PER: MED EXP(Any one person) $ 5,000 X POLICY PR LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acoldent $ BODILY I NJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AMOS BODILY INJURY (Per accident) S HIREDAUTO NON-OMED AUTOS PROPERTY DAMAGE Per mciE $ IS UMBRELLALIAB EXCESS LIAB OCCUR CWMSMADE eJ�ev� \ EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION 5 $ / WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE EXCLUDED? ❑NIA (MandatoryDENT OFFICERVIVEMBER In NH - 1 �`\J� G�,e`� PAP �. WC STATU- TORY OMITS 0TM $ DSEASECH CI $ E.L EA EMPLOYEE $ Ityea, desmUe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ AD&D MAXIMUM MEDICAL DEDUCTIBLE TERMS OF PAYMENT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required) Covered Performer Type: Costumed character. Certificate Holder is named as additional insured with respect to the operations of the Named Insured. 1lVLUCR CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS,VOLUNTEERS AND REPRESENTATIVES 20 CIVIC CENTER PLAZA 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 AP(>f{n.oUt.J ja�yStiYGLvt.C.Pi SP.{'VtiC.Py ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION Policy Number: SRPG-101-0717/USS349743 Insured: Hatboxwilltravel.com This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS,VOLUNTEERS AND REPRESENTATIVES 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 to Section II - WHO IS AN INSURED is amended to include as an 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 of the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. d,�y. �e�as S\\J�aG P�GgP1 CG 20 26 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 13 06/21/2017 16:49 FAX U 005 WORKERS' COMPENSATIONDECLARATION I A\./ SWWA hereby affirm under penalty of perjury, the (Namt(TW per• orv� f following declaration I certify on behalf of I(F,-xhat during the term of my ( onsnitant/Company Name) contract for �u GO%1n� �0 l�, 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, 1 shall forthwith comply with those provi Iions and provide proof of workers' compensation coverage. DATE: 1 By: Narr Title Telephone: _L O 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. eddy'. �eJ\e� 3�� PEGS