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Home My WebLink AboutUNION ARMY OF THE WEST, INC. 2City 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TERMINATION FORM Please complete this form in its entirety when the attached agreement and all amendments (if any) are no longer in effect.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. Cl E's Is the agreement(s) a permanent record? Yes _ No I Return form to the Clerk of the Council Office (M-30). Call 647-1520 if you have any questions. The agreement with No. 11'2017-13e was completed on (List all amendments. Use space below if needed.) Revised: 10-18-16 OF THE (MUNCP r�9n3 G �a••iV ::7 H andfinalpayment has been made. Department: /It Phone/Ext.: q�llq Signature: tt Date: INSURANCE ON FILE WORK MAY PROCEED TIL iNSORMCE EXPIRE CLERK &F MUM DAiE�1UL 11.E^♦0 O: PRCS June 14, 2017 Silvia Cuevas Union Army of the West, Inc. ("Performer"} 39266 Calle de Companero Murrieta, CA, 92562 Attn: Dave Richman Re: Performer Engagement Agreement N-2017-130 This letter represents your agreement with the City of Santa Ana ("City") as entered into on the above date for the engagement described below: 1. Event Description: 2 canons for City -Sponsored July 4`h program: canons to be operated and fired by Performer; each canon to be fired 7 times. 2. Date(s): July 4, 2017 3. Event Time(s): 4:00 p.m. to 9:30 p.m. 4. Location: Centennial Park, 3000 W. Edinger Ave, Santa Ana ("Property") 5. Compensation: $800 (payable by check within 30 calendar days of event); Speaker/Performer must provide IRS form W-9 before payment can be made; if only one canon is provided, compensation shall be $600. 6. Equipment provided by City: None Equipment provided by Speaker/Performer: 2 canons and all related supplies and equipment, including technical crew for each canon demonstration. Performer shall follow all applicable safety procedures in the firing of canons. 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. l 1. 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, Letter Agreement — Union Army of the West Page 2 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. 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 Speaker/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 webcast 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. Speaker/Performer shall indemnify the City against any liability or damages, including attorney's fees, that may arise as a result of violation by Speaker/Performer of copyright laws. 16. 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. 17. 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 this Agreement. 18. 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, CITY OF ANTA AN CYNTHIA URTZ Interim City Manager ATTEST: cta, J� tK MARIA D. HUIZAR Clerk of the Council RECOMMENDED FOR APPROVAL: SPEAKER/PERFORIMER Name: p4vlp r4ct m,0-� Title: gA-1Ter.,.y APPROVED AS TO FORTH: By: JOHN-M. FUNK Assistant City Attorney Gerardo Mouet,.Executive Director, PRCSA Battery B First Penn Light Artillery UNION ARMY OF THE WEST 39266 Calle de Companero Murrieta, CA 92562 Attn: Dave Richman (714)915-3366 drich26130)msn.com CLIENT City of Santa Ana 20 Civic Center Plaza P.O. Box 1988 Santa Ana, CA 92702 Aft. Ross Annex, Room 1301 (M-23) 714-571-4227 Fax: 714-571-4211 Sbatres@santa-ana.org EVENT DESCRIPTION INVOICE Invoice Number: FJ070417 001 Date: 6/9/17 Amount Due: $800.00 Payment Due:. NET 30 FORM OF PAYMENT Money Check # 2017 FOURTH OF JULY CELEBRATION ON TUESDAY, JULY 4, 2017 1 QUANTITY I DESCRIPTION UNIT PRICE TOTAL 1 TWO CANONS, FIRING 7 TIMES EACH DURING CITY OF SANTA ANA FOURTH OF JULY PROGRAM; INCLUDES TECHNICAL CREW FOR EACH CANON $800.00 $800.00 .IF ONLY ONE CANNON IS PROVIDED, FEE WILL BE REDUCED TO $600.00. SUBTOTAL SALES TAX RATE SALES TAX SHIPPING & HANDLING TOTAL DUE $800.00 $800.00 Please send payments to address above on or before payment due date. Make checks or money orders payable to: UNION ARMY OF THE WEST If you have any questions concerning this invoice, contact DAVE RICHMAN at (714) 915-3366 or email drich2613(a),msn.com. Thank you! ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYW) ��- 06/30/2017 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 CONTACT NAME: Lockton Affinity, LLC Lockton Affinity, LLC NCNNo Ext :877-487-5407 NC No: 913-652-7599 E-MAIL P.O. Box 874952 ADDRESS: INSURERIS) AFFORDING COVERAGE NAIC# Kansas City, MO 64187-4952 INSURERA:Certain Underwriter's at Lloyd's, London AA1122000 INSURED INSURER B 1st Pennsylvania Light Artillery, Battery "B^ Division of Union Army of the West INSURER D: 39266 Calle De Companero INSURER E: Murrieta, CA 92562 INSURER F: 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 POUCIES 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 OF INSURANCE ADDLS INSD BR WVD POLICY NUMBER POLICY EFF (MWDMWYI POLICY EXP MMIDD/YW LIMITS A X COMMERCIAL GENERAL LIABILITY y L201619110 11/02/2016 11/02/2017 EACH OCCURRENCE S1,000,000 DAMAGE 10 HEN HEL, PREMISES Ea occurrence S 300,000 CLAIMS -MADE OCCUR MED EXP(Any one person) S5,000 PERSONAL B ADV INJURY 51, 000, 000 AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $1,000,000 GEN'L X POLICY JERCT 171 LOC PRODUCTS. COMP,OPAGG $1,000,000 IS OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accdent $ BODILY INJURY (Per person) S ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS QJ �� • •I� \ BODILY INJURY (Per amident) S PROPERTY DAMAGE Peraccident S e� UMBRELLA LIAB EXCESS LIAR OCCUR CLAIMS -MADE �� - ` V `QJ •� EACH OCCURRENCE $ AGGREGATE 8 DIED RETENTIONS $ G WORKERS COMPENSATION YIN AND EMPLOYERS' LIABILITY ANY PROPRIEfORIPARTNER/ ECUTIVE OFRCEWMEMBER EXCLUDED? ❑ (Mandatory in NH) NIA �� G� y Q G� I PER STATUTE ERH EL EACH ACCI DENT $ E.L. DISEASE - EA EMPLOY S If Yes, describe under E.L DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached if more space is required) The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents and representatives are named as 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 for Event dated 07/01/17 - 07/08/17. This insurance is primary and non-contributory if required by contract. Notice of Cancellation Initiated by the Company: for non-payment- 10 Days; for other reasons: 30 Days Notice of non -renewal Initiated by the Company: 10 Days. Failure to provide notice will not invalidate the cancellation or non -renewal. no NAIC number an. above is the Alien Insurer Identification Number (AIIN) assigned by the National Association of Insurance Co,®iss s (NAIC) 940960 City of Santa Ana, its officers, employees, agents SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN and volunteers ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza AUTHORIZED PRESENTATIVE Santa And, CA 92701 1988-2014 AIJORDICORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered tarks of ACORD 23514698 940960 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON OR ORGANIZATION City of Santa Ana, its officers, employees, agents and volunteers SECTION II — LIABILITY is changed as follows: A. SECTION II — WHO IS AN INSURED, is amended to include as an additional insured any person(s) or organization(s) shown in the Schedule or on a Certificate of Insurance issued by the Company, whom you are required to add as an additional insured to this policy by a written contract or written agreement that: 1. Is currently in effect, or becoming effective, during the term of this policy; and 2. Was executed by you prior to any "bodily injury," "property damage," "personal and advertising injury." B. The insurance provided to the additional insured by this endorsement applies as follows: 1. That person or organization is an additional insured, but only with respect to "bodily injury", "property damage", or "personal and advertising injury" caused, in whole or part, by your negligent acts or omissions: a. In connection with premises you own, rent, lease, or occupy; or b. In the performance of your ongoing operations. 2. There is no coverage for the additional insured for "bodily injury", "propertyge", or "personal and advertising injury" arising out of the sole negligence of tee; itionalgifr�sin or by those acting on behalf of the additional insured. � �� . 3. The limits of insurance applicable to the additional insured are those spectfi�•� 6n* contract or written agreement or in the Declarations of this policy, whit `�w ccJ hese limits of insurance are inclusive of and not in addition to the limits nsura own in the Declarations. If a claim involves some conduct on the part of the Named Insured and some on the part of the Additional Insured, Underwriters will only contribute on a pro rata basis, to the extent the Additional Insured has other responsive insurance coverage. Includes copyright material from Insurance Services Office, Inc., with its permission LRS 1927 NRA 07 15 Page 1 of 3 ❑ C. If the additional insured is a Lessor of Equipment, this insurance does not apply to any "occurrence" which takes place after the equipment lease expires. D. If the additional insured is a State or Political Subdivision and has issued a permit in connection with premises you own, rent, or control, this insurance applies only with respect to the following hazards for which the state or political subdivision has issued such permit: 1. The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decoration and similar exposures; 2. The construction, erection, or removal of elevators; or 3. The ownership, maintenance, or use of any elevators covered by this insurance. E. If the additional insured is a State or Political Subdivision that has issued a Permit with respect to operations performed by you or on your behalf. This insurance does not apply to: 1. 'Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the state or municipality; or 2. 'Bodily injury" or "property damage" included within the "products -completed operations hazard". F. If the additional insured is a Manager or Lessor of Insured Premises, that person or organization is only an additional insured with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you. This insurance does not apply to: 1. Any 'occurrence" that takes place after you cease to lease that premises, or 2. Structural alterations, new construction or demolition operations performed by or for that person or organization. G. If the additional insured is an Owner or Other Interest from Whom Land Has Been Leased, that person or organization is only an additional insured with respect to liability arising out of the ownership, maintenance or use of that part of the land leased to you and subject to the following additional exclusions: This insurance does not apply to: 1. Any 'occurrence" that takes place after you cease to lease that land; or 2. Structural alterations, new construction or demolition operations performed by or for that person or organization. H. If the additional insured is a Mortgagee, Assignee, or Receiver, this insurance does nQ� ply to structural alterations, new construction or demolition operations performed by or f�,Q-it person or organization. e .1. 11 I. If the additional insured is Controlling Interest, that person or organization is an ad�l`dS insured but only for their liability arising out of: 1. Their financial control of you; or 2. Premises they own, maintain or control while you lease or occupy th pretttr This insurance does not apply to structural alterations, new construction and tion operations performed by or for that person or organization. Includes copyright material from Insurance Services Office, Inc., with its permission LRS 1927 NRA 07 15 Page 2 of 3 ❑ J. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, paragraph 4. Other Insurance, is amended as follows: 1. The following is added to subparagraph b: Regardless of whether other insurance is available to an additional insured on a primary basis, this insurance will be primary and noncontributory, if a written contract or agreement between you and the additional insured specifically requires that this insurance be primary. 2. Condition 8. Transfer of Rights of Recovery Against Others To Us is amended by adding the following: We waive any right of recovery we may have against any person or organization when such waiver is required by a written contract that you have agreed to prior to loss. K. Exclusion: With respect to the insurance afforded the additional insured by this endorsement, the following additional exclusion applies: This insurance does not apply to: 1. "Bodily injury" or "property damage" occurring after: a. all work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or b. that portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations on or at the same project. 2. "Bodily injury," "property damage," "personal and advertising injury" caused by the rendering of or failure to render any professional services. 3. Any claims, including but not limited to those for "bodily injury," "property damage" and/or "personal and advertising injury," arising under the federal Telephone Consumer Protection Act (47 U.S.C.A. 227) and/or claims made under any similar, related, and/or equivalent state law and/or any claims related to telephonic solicitations, electronic solicitations, telemarketing, automatic dialing systems, artificial voice messages, pre-recorded voice messages, short message service, texting, and/or use of fax machines. All other terms and conditions of this policy shall remain unchanged. This endorsement forms a part of the policy to which it is attached. �X GSP�Pafi Q� Includes copyright material from Insurance Services Office, Inc., with its permission LRS 1927 NRA 07 15 Page 3 of 3 ❑ IL12011185 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES Policy Change Numher 1 POLICY NUMBER POLICY CHANGES COMPANY L201619110 EFFECTIVE Certain Underwriter's at Lloyd's, London June 29, 2017 NAMED INSURED AUTHORIZED REPRESENTATIVE 1st Pennsylvania Light Artillery, Battery "B" Division of Union Lockton Affinity, LLC Army of the West (UAOW) P.O. Box 410679 Kansas City, MO 64141-0679 COVERAGE PARTS AFFECTED ReEnactor's Policy CHANGES Endorsement IL9990 12 10 — "Notice Of Cancellation To Designated Person Or Organization" is added per the attached. Amend Additional Insured as follows: City of Santa Ana, its officers, employees, agents and volunteers 20 Civic Center Plaza Santa Ana, CA 92701 No change in premium ,dG^�,Pdfi�� i \\J S CJ Policy Term: From: 11/02/2016 To: 11/02/2017 �G Authorized Representative Signature IL 12 01 1185 Copyright, Insurance Services Office, Inc., 1983 Page 1 of 1 ❑ Copyright, ISO Commercial Risk Services, Inc., 1983 polcychg Acct#940960 POLICYNUMBER L201619110 IL99901210 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION PROVIDED BY US TO DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL PROPERTY COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART SCHEDULE Name and Mailing Address of Designated Person(s) or Organization(2) # Mailing g Address - -- T-.—.. -- _._ _ .................I 1 City of Santa Ana, its officers, employees, 20 Civic Center Plaza, Santa Ana, CA 92701 ;agents and volunteers --...._.-.-.-.- ....................__... ------- : : Cancellation Notice Period for Nonpayment of Premium if other than 10 days: 'Cancellation Notice Period for Other Than Nonpayment of Premium if other than 30 days: Non -Renewal Notice Period if other than 10 days The following is added to Common Policy Conditions, Section A. Cancellation: In addition to any notices that may be required by law: 1. If we cancel this policy, we will endeavor to notify individual(s) or entity(ies) shown in the schedule at least: a. 10 days before the effective date of cancellation if we cancel for nonpayment of premium; or b. 30 days before the effective date of cancellation if we cancel for any other reason; or the number of days shown in the schedule. If we elect not to renew this policy, we will endeavor to notify the individual(s) or entity(ies) shown in the schedule: a. 10 days before the expiration date of this policy; or b. The number of days before the expiration date of this policy shown in the Schedule. 3. At our option, we will endeavor to mail or deliver our notice to each mailing address shown in the schedule or endeavor to send an email to an address provided to us by the individual(s) or organization(s) shown in the Schedule. 4. If notice is mailed, proof of mailing will be sufficient proof of notice Ae e 11 All other terms and conditions remain unchanged. e IL 9990 12 10 Includes copyrighted materials of Insurance Services Office, Inc. with its Page 1 of 1 permission Acct#940960 WORKERS' COMPENSATION DECLARATION I pwyc hereby affirm under penalty of perjury, the (Namemae) following declaration: I certify on behalf of tsc'fO-'O- 6 A rCE�Y B!y Az'-'y that during the term of my (CamultanNCompany Nar contract for F6zig i q >1- Suzy 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 sball forthwith comply with those provisions and provide proof of workers' compensation coverage. DATE: 6 , f Name: lJAv4f- IZLAw.,,AP Title: Telephone: 71 `i ` W'- 336' ,!� 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. d�01'. Vol' QRG