HomeMy WebLinkAboutROMO, JOSE - 2017INSURANGE 0-1 ON FILE
WORK MAY NOT PROCEED
CLERK Of COUNCIL
DATE: W 1 2 ""
O: PROS (1) CONSULTANT AGREEMENT FOR EVENT PRODUCTION SERVICES
Silvia Cuevas FOR FIESTAS SANTA ANA 2017
N-2017-172
THIS AGREEMENT is made and entered into this 28i11 day of August 2017 by and between Jose
L„ Rome, a sole proprietorship ("Consultant"), and tlhe 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 consultant having special skill and knowledge in the
field of event production services for its annual Fiestas Santa Ana Event in
Downtown Santa Ana to be held on September 16-17, 2017 ("Event").
B. Consultant represents that Consultant is able and willing to provide such services
to the City.
C. In undertaking the performance of this Agreement, Consultant represents that he
is knowledgeable in his field and that any services performed by Consultant under
this Agreement will be porforin. ed in compliance with such standards as may
reasonably be expected from a professional consulting firm in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the
terms and conditions bereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
Consultant shall provide event production, cleaning, and related services for the Event, as
more specifically described in the scope of services that is attached as Exhibit A.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for his
services, the rates and charges identified in Exhibit A. The total sum to be
expended under this Agreement shall not exceed $1.2,295,80. This amount
includes (1) the sum of $11,178.00 and (2) a 10% contingency sum of up to
$1,117.80 for services as may be performed by Consultant at the sole discretion
of City.
b, Payment in the amount of $5,000 shall, be made by City upon full execution of
this Agreement_ The remaining compensation shall be paid within thirty (30)
days following receipt of proper invoice evidencing work performed, subject to
City accounting procedures. Payment need not be made for work which fails to
meet the standards of performance set forth in the Recitals which may reasonably
be expected by City.
Page I of 10
3. TERM
This Agreement shall commence on the date stated above and continue through
September 30, 2017, unless terminated earlier in accordance with Section 13 below.
4. INDEPENDENT CONTRACTOR
Consultant 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
Consultant performs the services which are the subject matter of this Agreement; however, the
services to be provided by Consultant shall be provided in a manner consistent with all
applicable standards and regulations governing such services. Consultant 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.
5. INSURANCE
Prior to undertaking performance of work under this Agreement, Consultant shall
maintain and shall require its subcontractors, if any, to obtain and maintain insurance as
described below:
a. Commercial General Liability Insurance. Consultant 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 Consultant'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 (c) contain standard separation of insured provisions.
b. Business automobile liability insurance, or equivalent form, with a combined single
limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for
owned, hired and non -owned automobiles.
c. Worker's Compensation Insurance, In accordance with California State law,
Consultant, if Consultant has any employees, is required to be insured against liability for
workers' 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.
d. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section:
Page 2 of 10
(i) Consultant shall maintain all insurance required above in full force and
effect for the entire period covered by this Agreement.
(ii) Certificates of insurance shall be furnished to the City upon execution of this
Agreement and shall be approved in form by the City.
(iii) 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.
(iv) Consultant shall supply City with fully executed additional insured endorsement.
e. If Consultant 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
Consultant agrees to and shall indemnify 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
direct or indirect operations of the Consultant 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. 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 saffered, by reason of the events referred to in this Section or by reason of the terms
of, or effects, arising from this Agreement. The Consultant farther agrees to indemnify, hold
harmless, and pay all costs for the defense of the City, including fees and costs for special
counsel to be selected by the City, regarding any action by a third party challenging the validity
of this Agreement, or asserting that personal injury, damages, just compensation, restitution,
judicial or equitable relief due to personal or property rights arises 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. Notwithstanding the foregoing, to the extent
Consultant's Services are subject to Civil Code Section 2782.8, the above indemnity shall be
limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain
to, or relate to the negligence, recklessness, or willful misconduct of the Consultant.
Page 3 of 10
7. RECORDS
Consultant shall peep records and invoices in connection with the work to be performed
under this Agreement. Consultant shall maintain complete and accurate records with respect to
the costs incurred under this Agreement and any services, expenditures, and disbursements
charged to the City for a minimum period of three (3) years, or for any longer period required by
law, from the date of final payment to Consultant under this Agreement. All such records and
invoices shall be clearly identifiable. Consultant shall allow a representative of the City to
examine, audit, and make transcripts or copies of such records and any other documents created
pursuant to this Agreement during regular business hours. Consultant shall allow inspection of
all work, data, documents, proceedings, and activities related to this Agreement for a period of
three (3) years from the date of final payment to Consultant ander this Agreement.
8. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Consultant agrees
that it shall not use or disclose such information except in the performance of this Agreement,
and further agrees to exercise the same degree of care it uses to protect its own information of
like importance, but in no event less than reasonable care. "Confidential Information" shall
include all nonpublic information. Confidential information includes not only written
information, but also information transferred orally, visually, electronically, or by other means.
Confidential information disclosed to either party by any subsidiary and/or agent of the other
party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure
shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is,
through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful
possession of the Consultant without an obligation of confidentiality; (d) is required to be
disclosed by operation of law; or (e) is independently developed by the Consultant without
reference to information disclosed by the City.
9. CONFLICT OF INTEREST CLAUSE
Consultant covenants that it presently has no interests and shall not have interests, direct
or indirect, which would conflict in any mariner with performance of services specified under
this Agreement.
10. NOTICE
Any notice, tender, demand, delivery, or other commL nication 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:
Page 4 of 10
To City: Clark of the City 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 courtesy copies to:
Executive Director of Parks, Recreation and Community Services
City of Santa Ana
20 Civic Center Plaza (M-23)
P.O. Box 1988
and
To Consultant:
Santa Ana, CA 92702
Fax 714-571-4211
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, CA 92702
Fax 714-647-6515
.Tose L. Romo
1191 La Limonar Road
Santa Ana, CA 92705
Phone: 714-612-9227
e-mail: romo66@yahoo.com
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.
11. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and
Consultant 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
Page 5 of 10
of Consultant. The parties agree that any terms or conditions of any purchase order or other
instrument that are inconsistent with, or in addition to, the terns and conditions hereof, shall not
bind or obligate Consultant 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 are not embodied herein.
12. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Consultant,
Consultant 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. Nothing in this Agreement
shall be construed to limit the City's ability to have any of the services which are the subject to
this Agreement performed by City personnel or by other consultants retained by City.
13. TERNIINATION
This Agreement may be terminated by the City upon thirty (30) clays written notice of
termination. In such event, Consultant shall be entitled to receive and the City shall pay
Consultant compensation for all services performed by Consultant prior to receipt of such notice
of termination, subject to the following conditions:
a. As a condition of such payment, the Executive Director may require Consultant to
deliver to the City all work product completed as of such date, and in such case such work
product shall be the property of the City unless prohibited by law, and Consultant consents to the
City's use thereof for such purposes as the City deems appropriate.
b. Payment need not be made for work which fails to meet the standard of performance
specified in the Recitals of this Agreement.
14. NON-DISCRIMINATION
Consultant 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, training, utilization, promotion, termination or
other employment related activities or in connection with any activities under this Agreement.
Consultant 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.
Page 6of10
16. PROFESSIONAL LICENSES
Consultant shall, throughout the term of this Agreement, maintain all necessary licenses,
permits, approvals, waivers, and exemptions necessary for the provision of the services
hererurder 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. Consultant shall notify the City
immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals,
waivers, and. exemptions, Said inability shall be cause for termination ofthis Agreement.
17, MISCELLANEOUS PROVISIONS
a, Each undersigned represents and warrants that its signature below has the power,
authority and right to bind their respective parties to each of the terms of this Agreement, and
shall indemnify City fully, including reasonable costs and attorney's fees, for any irl1Luies or
damages to City in the event that such authority or power is not, in fact, held by the signatory or
is withdrawn.
b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully
set forth in the body of this Agreement.
IN tVII NESS WHEREOF, the parties hereto have executed this Agreement on or after the date
and year first above written.
ATTEST
NI. I.[i. D. IIiiIZAR
Clerk of the Council
APPROVED AS TO FORM
SONIA R. CARVALHO
City Attorney
By: 7n,
JW M. FUNI{
Assistant City Attorney
RECOMMENDED FOR APPROVAL
fir.^-�..4 /✓]d�'
GERARDO, MOUET .
Executive Director of Parks,
Recreation and Community Services Agency
Y OF SANTA N.
YNTHIA YXRTZ
Interim Cit Manager
CONSULTF N
JOSE L. ROMT
Page 7 of 10
EXHIBIT A
Scope of Services: Jose Rome
Professional services to help with the production of the 2017 Fiestas Patrias Festival
on Saturday, September 16 through Sunday, September 17, 2017.
Jose Romo brings 20 years of experience coordinating the Downtown Santa Ana
street festivals, He will be able to provide valuable technical assistance to City staff
in planning the 2017 Fiestas Patrias Festival.
He will coordinate the logistics of the event including: ordering all required
equipment, establishing early communication with all participants regarding their
planned activity, preparing event layouts, supervising and coordinating activities of
all subcontractors, providing guidance and festival information to participants and
ensuring that all contractual obligations are met.
Jose Romo will act as liaison between City staff, event participants, Orange County
Health Care Agency, Orange County Fire Authority, Downtown Santa Ana business
community and residents, He will work closely with City staff to ensure the event
location meets all building, health and safety requirements, as well as with the sales
team to ensure participants meet their goals and objectives. Other responsibilities
will include resolving and mitigating all issues during the event and contracting all
personnel needed to provide adequate trash pickup services during and after the
event.
Trash pickup and staffing as detailed below.
Saturday 8 am to 4 pm: 12 staff and 1 supervisor
Saturday 4 pm to 12 mid: 14 staff and 1 supervisor
Sunday 10 am to 6 pm: 14 staff and 1 supervisor
Sunday 6 pm to 2 am: .18 staff and 1 supervisor
Monday 6 am to 2 pm: 4 staff
The cost to provide this coverage will be $6,178.00. Please note this amount covers the
hourly wages of the staff mentioned above at the following rates:
64 staff* at $11 per hour for a total of 518 hours = $5,698
1 supervisor at $15 per hour for a total of 32 hours = $480
The services Include trash pick up for event area on 4th Street, Plaza Santa Ana, backstage
area and food areas on French, Bush and Main Street. *Additional 2 staff included for 5 hrs
on Saturday and 6 hrs on Sunday for cleanup of eating areas only.
Carnival operator provides trash pick up services for the carnival area during the 2 day
festival and after they vacate the carnival area,
Event trash boxes and liners will be provided by Waste Management.
Page 8 of 1.0
$ 5,698.00
518 hours @ $11 per hour (64 staff)
$ 480.00
32 hours @ $15 per hour (1. supervisor)
$ 6,178.00
Total of Trash Pick-up Staff Services
The services include trash pick-up for event area on 4th Street, Plaza Santa Ana,
backstage area and food areas on French, Bush and Main Street.
Cost;
$ 5,000.00 Professional Event Production Services
$ 6.178.00 Trash Pick-up Staff Services (as detailed above)
$11,178.00
$ 1,117.8010% Contingency
$12,295.80 Total Compensation
Payment: $5,000 of the overall professional event production service fee due 10 days after
receipt of invoice and upon fully executed agreement but before the actual event.
There is no profit or other fees added to this amount.
Below is a list of tasks for Jose Romo (JR):
• Vendors - Staff will receive applications and screen applications for approval,
Staff will collect all required documents and payments. Upon receiving this,
staff will approve the vendor and forward to JR. JR will be responsible for
determining the best location for vendors and will assign booths. JR will also
be the point person for any logistical requirements for vendors. This will
ensure that vendors are placed at sites that are not in direct competition with
existing businesses. JR would be responsible for assignment of spaces to
sponsors as well.
• Logistics/ Security - JR will be the responsible for bringing to the attention of
staff any concerns regarding damage prevention to existing buildings. His
location in the downtown area will allow him to be accessible to businesses
and serve as a liaison to staff. Staff will procure the stages and canopies. Staff
will process the agreements and coordinate all payments. Jose will
coordinate delivery and placement of the stages and canopies. Staff will
coordinate street closures for these deliveries.
• Meetings - As part of the production team for this event, JR would
attend meetings regarding logistics, security and street closures.
• Event Layout - Assist Event Coordinator in developing event layout.
• Permits - Secure permit for all food participants (commercial and
non-profit) with OC Health Care Agency.
Page 9 of 10
• Event Notification Letter - Distribute event and street closure
notification letter to all impacted businesses and residents in event
area.
• Downtown Merchant Participation - Secure desired location for
businesses on 4th Street who wish to participate.
• Steam Cleaning - Coordinate steam cleaning services the week
following event.
• Parking Passes - Distribute parking passes to impacted businesses.
• Orange County Health Care Agency (OCHCA) - Secure OCHCA event
permit on day of event.
• Orange County Fire Authority (OCFA) - Secure OCFA event permit on
day of event.
• Mitigation of issues - Assist Event Coordinator in resolving and
mitigating all issues reported by staff, members of the public, event
participants, business owners and residents before, during and
following the two (2) day event,
Page to of 10
Jose L. Rorno EXHIBIT A Invoice
1191 La Urn onar Rd
Santa Ana, CA 92705
X.
City of Santa Ana
20 Civic Center Plaza
Santa Ana, CA 92702
Date nvoice #
8/14/2017 --- tot
P.O. No,
Terms
Project
Dae on receipt
Quantity
...Description
Rate
-:. Amount
2017 Fiestas Pattias Event Production Services
5,000.00
5,000.00.
Total $5,000.00
Jose L. Romo
1191 LaLimonarRd EXHIBIT B
Santa Ana, CA 92705
Hill To
City of Santa Ana
20 Civic Center Plaza
Santa Ana, CA 92702
Invoice
Date Invoice #
8/15/2017 102
P.O. No.
Terms
Project
Due on receipt
Quantity
- Description
Rate
Amount
2017 Fiestas Patties Trash Pick Up Services
6,178.00
6,178.00
Total $6,178.00
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.:
CERTIFICATE OF INSURANCE
SPECIAL EVENT LIABILITY PROGRAM
11 PRODUCER I PUBLIC ENTITY (ADDITIONAL INSURED) 11
Alliant Insurance Services, Inc. in conjunction with
Apex Insurance Services Liquor Liability applies to only September 16, 17, 2017
P. O. Box 6450
Newport Beach, CA 92658
License No: OC 36861
NAMED INSURED (EVENT' HOLDER):
AUTHORIZED
EVENT INFORMATION:
City of Santa Ana
TYPE: Annual Fiestas Patrias
P 0 Box 1.988
DATE(S): September 15, 16, 17, 18, 2017
Santa Ana, CA 92702
LOC.ATIONT Downtown Santa Ana
7 --'7")-
*Liquor Liability Yes F No El
"Liquor Liability after 12 am ends before 2 am
']'his is to certify that the insurance policy listed below has been issued to the above insured narned (event holder) for the policy
period indicated. The insurance described herein is subject to all the terms, exclusions and conditions Of Such pOliCY(ieS) Unless
amended as described in Special Conditions,
INSURANCE CARRIER: Evanston Insurance Company
MAs'rER POLICY NUMBER: SEP41023
MASTER POLICY DATES: EFFECTIVE: JANUARY 1, 2017 EXPIRATION: JANUARY 1, 2018
COMMERCIAL GENLRAL LIABILITY
OCCURRENCE FORM DEDUCTIBLE NONE
General Aggregate Limit $ 2,000,000
PrOdUOS & Completed Operations 1,000,000
SPECIAL CONDHIONS:
PersonaB & Advertising Injury 1,00(),000
The following endorsements attached to
Each Occurrence Limit 1,000,000the
Master Policy (to nor apply to this
Damage To Premises RentcdTo You (Any One Premises) 100,000
Certificate Of IIISLIranCe:
Medical Payments (Any One Person) 5,000
11 1�1, L 161
MEGLl64
ON
Liquor Liability (if purchased) u'000'000
Optional Limits Purchased
F] $1,000,000/$3,000,000
e �Njon
52,000,00052,000,000
J '0
Damage To Property
(If purchased)
The limits Of Insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event,
OTHER ADDITIONAL, INSUREDS
Bobby Nava
Andrea USA Start Computer Repair
Raul Martinez
Pei -feet Smile Dental Dr Sheldon Lu
Jose Manuel Garcias
CA Work Injury Law Center
Santa Aria Business Council
Castulo Ramirez
Jose Romo
Leonel Torres
Mexican Consulate
Sixto Romero
Virgilio Satelite
Novamex-Sergio Buenostro
CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy
pro v i s io ns -
s
AUTHORIZED REPRESENTATIVE:
DATE ISSUED:
W' III .I it o
PROOF OF INSURANCE
VEHICLES ON POLICY
VEHICLES ON POLICY
InterinSUrance Exchange of the Automobile Club
NAIC #: 15598
—rj NAJC #: 15598
11 Dv
YEAR MAKE VEH 11)
2013 HOND 2HGFB2F61DH517470
oStop 1: Get the names and addresses of all persons
2016 TYTA
2016 TYTA JTMYFREV2GJ061493
Named Insured Policy Number: CAA068438943
ROMO, JOSE AND PATRICIA
2011 HYLIN 5NPDH4AE7BH004404
ROMO, JOSE AND PATRICIA
I
2006 TYTA 5TBET381X65500368
Step 5: Safely wait for the tow truck. Our independent senAce
Step 2: Get the driver's license number and insurance
Lu
r
providers' tow trucks always display the AAA emblem
0 JOSE L ROMO
U-
cs
DRIVERS ON POLICY
0
JOSE L ROMO
Effective Date: 05-26-2017 Expiration Date: 05-26-2018
LL
1 :
PATRICIA ROMO
state of registration
VALERIE ROMO
This policy provides at least the minimum amounts of liability insurance
KIMBERLY ROMO
required by the CAVEH CODE SECTION 16056 for the specified vehicles
LOAA0805A
and named insureds and may provide coverage for other persons and
E201 110101
081 81
other vehicles as provided by the insurance policy,
--------------------------------------------------------------------------------------------------------------------
After an accident, follow these 5 easy steps:
Stop 4: Call our AAA Accident Assist Hotline at 1 -800 -67 -CLAIM
(1-800-672-5246) to report the accident and, if necessary, have
Step 1: Get the names and addresses of all persons
your vehicle towed to the repair shop or location of your
involved in the accident, e.g., pedestrians, witnesses, other
preference
passengers, etc.
W
Step 5: Safely wait for the tow truck. Our independent service
Stop 2: Get the driver's license number and insurance
providers" tow trucks always display the AAA emblem
information of the driver(s) of the other vehide(s)
LL
i 1 Do not admit responsibility for or discuss the, circumstances of the accident
Step 3: Write down the vehicle(s) license plate, including with anyone other than the police or an authorized Auto Club ciainis
state of registration representative. Do not disclose your policy limits to anyone
Coverage subject to policy terms and limits.
For questions or changes to your policy, call 1-877-422-2100 Monday through Friday from 7 a.m. to 9 p.m, or Saturday from 8 a.m to 5 p.m.
L-------------------------------------------------------------------------------------------------------------------- i
Place the Proof of insurance in each vehicle insured under your policy. In addition, we suggest that each listed driver
carry a card. Under California law, drivers and owners of a motor vehicle must be able to establish financial responsibifty
at all times. These cards become invalid on the expiration or termination date of the policy.
-----------------------------------------------------------------------------
PROOF OF INSURANCE
VEHICLES ON POLICY
Interinsurance Exchange of the Automobile Club
YEAR MAKE
—rj NAJC #: 15598
11 Dv
2013 HOND
oStop 1: Get the names and addresses of all persons
2016 TYTA
Named Insured Policy Number: CAA068438943
2011 IFYUN
ROMO, JOSE AND PATRICIA
2006 TYTA
passengers, etc.
LU
Step 5: Safely wait for the tow truck. Our independent senAce
Step 2: Get the driver's license number and insurance
DRIVERS ON POLICY
providers' tow trucks always display the AAA emblem
0 JOSE L ROMO
U-
Effective Date: 05-26-2017 Expiration Date: 05-26-2018 PATRICIA ROMO
VALERIE ROMO
This policy provides at least the minimum amounts of liability insurance KIMBERLY ROMO
required bythe CAVEH CODE SECTION 16056 for the specified vehicles
and named insureds and may provide coverage for other persons and
other vehicles as provided by the insurance policy.
i._uY
-------------------------------------
VEH B.D. #
2HGFB2FB1DH517470
JI'MYFREV2GJ061493
5NPDH4AE7BHO04404
5TBET351XGS500368
After an accident, follow these 5 easy steps:
Step 4: Call our AAA Accident Assist Hotline at 1 -800 -67 -CLAIM
(1-800-672-5246) to report the accident and, if necessary, have
oStop 1: Get the names and addresses of all persons
your vehicle towed to the repair shop or location of your
invoWed in the accident, e.g., pedestrians, witnesses, other
preference
passengers, etc.
LU
Step 5: Safely wait for the tow truck. Our independent senAce
Step 2: Get the driver's license number and insurance
0
providers' tow trucks always display the AAA emblem
o information of the driver(s) of the other vehicle(s)
t
1
Do not admit responsibility for or discuss the circumstances of the accident
Step 1 Write down the vehicle(s) license plate, including
with anyone other than the police or an authorized Auto Club claims
state of registration
representative Do not disclose your policy limits to anyone.
Coverage subject to policy terms and limits.
For questions or changes to your policy, call 1-877-422-2100, Monday through Friday from 7 a.m. to 9 p.m. or Saturday from 8 a.171. to 5 p.m.
L------------------------------------------------------------------------------------------------------------------- i
LOAA0805A
E201 110101
081 81
8165 (TI 0)
WORD; ERS" Q'014,IPENSATION DECLARATION
I jose Romo hereby affirm under penalty of perjury, the
(tie)
follov,,in,p, declaration:
I certify on behalf of --- Jose Romo that during the term of my
(Cons u Rant/Company Name)
contract for Fiestas Patrias 2017 services with the City of Santa Aria, I will riot employ
any person in any manner so as to become subject to the workers' compensation laws of
Califcii.riia, 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: -,September 1, 2017
By:
Name: Jose Romo
Title: Consultant
Telephone: (714) 612-9227
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.
. \2k