Loading...
HomeMy WebLinkAbout2020 CON Ultimate Entertainment LLC - Inflatable Movie Screen and Auto Visual EquipmentC 2- SHORT FORM SERVICES AGREEMENT BY AND BETWEEN THE CITY OF NATIONAL CITY AND (ULTIMATE ENTERTAINMENT LLC) THIS AGREEMENT is entered into this 19th day of October, 2020, by and between the CITY OF NATIONAL CITY, a municipal corporation (the "CITY"), and Ultimate Entertainment LLC, a corporation. (the "CONTRACTOR"). NOW, THEREFORE, CITY agrees to engage CONTRACTOR to perform the services set forth herein in accordance with the following terms and conditions: 1. Description of Services. CONTRACTOR shall provide a 40 foot by 20 foot inflatable movie screen, all other audio/visual equipment to transmit movie audio to in -vehicle radios, and all labor required for one (1) movie screening to be held at Plaza Bonita Westfield located at 3030 Plaza Bonita Road, National City, CA 91950 on October 23, 2020. The City shall provide the movie to be presented and a pre -show video presentation to be played before the movie screens. The CONTRACTOR is responsible for ensuring that the movie screening shall begin at dusk (or as soon thereafter as agreed upon by both PARTIES), including all services as outlined in the attached proposal, Exhibit "A". 2. Lenath of Agreement. The schedule is set forth below: Work to begin on Friday, October 23, 2020 by 3:30 pm and will be completed on Friday, October 23, 2020 before midnight (12:00 am). 3. Compensation. The total compensation to CONTRACTOR for providing the services set forth herein shall not exceed $2,600 (two thousand six hundred dollars). A down payment of $1,300 (one thousand three hundred dollars) is due once the Agreement has been executed. The compensation for CONTRACTOR'S work shall be based upon and shall not exceed the amount reflected in the "Balance Due" section of the attached invoice #7158999 (Exhibit "A") without prior written authorization from CITY. 4. Payment Schedule. CITY shall make final payment by November 5, 2020 for the satisfactorily completed services of CONTRACTOR. 5. Termination. CITY may terminate this Agreement at any time by providing 14 (fourteen) days' written notice to CONTRACTOR. If the City must cancel because of inclement weather or the occurrence of a force majeure event, including but not limited to rain, fire, flood, or earthquake, CONTRACTOR shall apply City's deposit to a rescheduled event. 6. Independent Contractor. It is agreed that CONTRACTOR is an independent Contractor, and all persons working for or under the direction of CONTRACTOR are CONTRACTOR'S agents, servants and employees, and said persons shall not be deemed agents, servants, or employees of CITY. 7. Insurance. CONTRACTOR shall obtain: A. ❑ If checked, Professional Liability Insurance (errors and omissions) with minimum limits of $1,000,000 per occurrence. B. Automobile insurance covering all bodily injury and property damage incurred during the performance of this Agreement, with a minimum coverage of $1,000,000 combined single limit per accident. Such automobile insurance shall include schedule autos. The policy shall name the CITY and its officers, agents, employees, and volunteers as additional insureds, and a separate additional insured endorsement shall be provided. C. Commercial General Liability Insurance, with minimum limits of $1,000,000 per occurrence and $2,000,000 aggregate, covering all bodily injury and property damage arising out of its operations, work, or performance under this Agreement. The policy shall name the CITY and its officers, agents, employees, and volunteers as additional insureds, and a separate additional insured endorsement shall be provided. The general aggregate limit must apply solely to this "project" or "location". The "project" or "location" should be noted with specificity on an endorsement that shall be incorporated into the policy. D. Workers' compensation insurance in an amount sufficient to meet statutory requirements covering all of CONTRACTOR'S employees and employers' liability insurance with limits of at least $1,000,000 per accident. In addition, the policy shall be endorsed with a waiver of subrogation in favor of the CITY. Said endorsement shall be provided prior to commencement of work under this Agreement. If CONTRACTOR has no employees subject to the California Workers' Compensation and Labor laws, CONTRACTOR shall execute a Declaration to that effect. Said Declaration shall be provided to CONTRACTOR by CITY. E. The aforesaid policies shall constitute primary insurance as to the CITY, its officers, employees, and volunteers, so that any other policies held by the CITY shall not contribute to any loss under said insurance. Said policies shall provide for thirty (30) days' prior written notice to the CITY's Risk Manager, at the address listed in subsection G below, of cancellation or material change. F. Said policies, except for the professional liability and workers' compensation policies, shall name the CITY and its officers, agents, employees, and volunteers as additional insureds, and separate additional insured endorsements shall be provided. G. The Certificate Holder for all policies of insurance required by this Section shall be: City of National City c/o Risk Manager 1243 National City Boulevard National City, CA 91950-4397 H. If required insurance coverage is provided on a "claims made" rather than "occurrence" form, the CONTRACTOR shall maintain such insurance coverage for three years after expiration of the term (and any extensions) of this Agreement. In addition, the "retro" date must be on or before the date of this Agreement. I. Insurance shall be written with only insurers authorized to conduct business in California which hold a current policy holder's alphabetic and financial size category rating of not less than A:VII according to the current Best's Key Rating Guide, or a company of equal financial stability that is approved by the City's Risk Manager. In the event coverage is Standard Short Form Agreement Page 2 of 6 City of National City and Revised May 2019 Ultimate Entertainment LLC provided by non -admitted "surplus lines" carriers, they must be included on the most recent List of Approved Surplus Line Insurers ("LASLI") and otherwise meet rating requirements. J. This Agreement shall not take effect until certificate(s) or other sufficient proof that these insurance provisions have been complied with, are filed with, and approved by the CITY's Risk Manager. If the CONTRACTOR does not keep all insurance policies required by this Section 7 in full force and effect at all times during the term of this Agreement, the CITY may treat the failure to maintain the requisite insurance as a breach of this Agreement and terminate the Agreement as provided herein. K. All deductibles and self -insured retentions in excess of $10,000 must be disclosed to and approved by the CITY. CITY reserves the right to modify the insurance requirements of this Section 7, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. L. If the CONTRACTOR maintains broader coverage or higher limits (or both) than the minimum limits shown above, the CITY shall be entitled to the broader coverage or higher limits (or both) maintained by the CONTRACTOR. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the CITY. 8. Indemnification and Hold Harmless. To the maximum extent provided by law, the CONTRACTOR agrees to defend, indemnify and hold harmless the City of National City, its officers, officials, agents, employees, and volunteers against and from any and all liability, loss, damages to property, injuries to, or death of any person or persons, and all claims, demands, suits, actions, proceedings, reasonable attorneys' fees, and defense costs, of any kind or nature, including workers' compensation claims, of or by anyone whomsoever, resulting from or arising out of the CONTRACTOR'S performance or other obligations under this Agreement; provided, however, that this indemnification and hold harmless shall not include any claims or liability arising from the established sole negligence or willful misconduct of the CITY, its agents, officers employees, or volunteers. CITY will cooperate reasonably in the defense of any action, and CONTRACTOR shall employ competent counsel, reasonably acceptable to the City Attorney. The indemnity, defense, and hold harmless obligations contained herein shall survive the termination of this Agreement for any alleged or actual omission, act, or negligence under this Agreement that occurred during the term of this Agreement. 9. EMPLOYEE PAYMENTS AND INDEMNIFICATION. 9.1 PERS Eligibility Indemnification. If CONTRACTOR'S employee(s) providing services under this Agreement claims, or is determined by a court of competent jurisdiction or the California Public Employees Retirement System ("PERS") to be eligible for enrollment in PERS of the CITY, CONTRACTOR shall indemnify, defend, and hold harmless CITY for the payment of any employer and employee contributions for PERS benefits on behalf of the employee as well as for payment of any penalties and interest on such contributions which would otherwise be the responsibility of the CITY. CONTRACTOR'S employees providing service under this Agreement shall not: (1) qualify for any compensation and benefit under PERS; (2) be entitled to any benefits under PERS; (3) enroll in PERS as an employee of CITY; (4) receive any employer contributions paid Standard Short Form Agreement Page 3 of 6 City of National City and Revised May 2019 Ultimate Entertainment LLC by CITY for PERS benefits; or (5) be entitled to any other PERS-related benefit that would accrue to a CITY employee. CONTRACTOR's employees hereby waive any claims to benefits or compensation described in this Section 9. This Section 9 applies to CONTRACTOR notwithstanding any other agency, state or federal policy, rule, regulation, law or ordinance to the contrary. 9.2 Limitation of CITY Liability. The payment made to CONTRACTOR under this Agreement shall be the full and complete compensation to which CONTRACTOR and CONTRACTOR's officers, employees, agents, and subcontractors are entitled for performance of any work under this Agreement. Neither CONTRACTOR nor CONTRACTOR's officers, employees, agents, and subcontractors are entitled to any salary or wages, or retirement, health, leave or other fringe benefits applicable to CITY employees. The CITY will not make any federal or state tax withholdings on behalf of CONTRACTOR. The CITY shall not be required to pay any workers' compensation insurance on behalf of CONTRACTOR. 9.3 Indemnification for Employee Payments. CONTRACTOR agrees to defend and indemnify the CITY for any obligation, claim, suit, or demand for tax, retirement contribution including any contribution to PERS, social security, salary or wages, overtime payment, or workers' compensation payment which the CITY may be required to make on behalf of (1) CONTRACTOR, (2) any employee of CONTRACTOR, or (3) any employee of CONTRACTOR construed to be an employee of the CITY, for work performed under this Agreement. This is a continuing obligation that survives the termination of this Agreement. 10. Acceptability of Work. The CITY shall, with reasonable diligence, determine the quality or acceptability of the work, the manner of performance, and/or the compensation payable to the CONTRACTOR. 11. Business License. CONTRACTOR must possess or shall obtain business license from National City Finance Department before beginning work. 12. Prevailin2 Wages. State prevailing wage rates may apply to work performed under this Agreement. State prevailing wages rates apply to all public works contracts as set forth in California Labor Code, including but not limited to, Sections 1720, 1720.2, 1720.3, 1720.4, and 1771. CONTRACTOR is solely responsible to determine if State prevailing wage rates apply and, if applicable, pay such rates in accordance with all laws, ordinances, rules, and regulations. 13. Administrative Provisions. A. Computation of Time Periods. If any date or time period provided for in this Agreement is or ends on a Saturday, Sunday or federal, state or legal holiday, then such date shall automatically be extended until 5:00 p.m. Pacific Time of the next day which is not a Saturday, Sunday or federal, state, or legal holiday. B. Counterparts. This Agreement may be executed in multiple counterparts, each of which shall be deemed an original, but all of which, together, shall constitute but one and the same instrument. C. Captions. Any captions to, or headings of, the sections or subsections of this Agreement are solely for the convenience of the parties hereto, are not a part of this Standard Short Form Agreement Page 4 of 6 City of National City and Revised May 2019 Ultimate Entertainment LLC Agreement, and shall not be used for the interpretation or determination of the validity of this Agreement or any provision hereof. D. No Obligations to Third Parties. Except as otherwise expressly provided herein, the execution and delivery of this Agreement shall not be deemed to confer any rights upon, or obligate any of the parties hereto, to any person or entity other than the parties hereto. E. Exhibits and Schedules. The Exhibits and Schedules attached hereto are hereby incorporated herein by this reference for all purposes. To the extent any exhibits, schedules, or provisions thereof conflict or are inconsistent with the terms and conditions contained in this Agreement, the terms and conditions of this Agreement will control. F. Amendment to this Agreement. The terms of this Agreement may not be modified or amended except by an instrument in writing executed by each of the parties hereto. G. Assignment & Assumption of Rights. CONTRACTOR shall not assign this Agreement, in whole or in part, to any other party without first obtaining the written consent of CITY. H. Waiver. The waiver or failure to enforce any provision of this Agreement shall not operate as a waiver of any future breach of any such provision or any other provision hereof. I. Applicable Law. This Agreement shall be governed by and construed in accordance with the laws of the State of California. The venue for any legal action arising under this Agreement shall be in either state or federal court in the County of San Diego, State of California. The CONTRACTOR shall comply with all laws, including federal, state, and local laws, whether now in force or subsequently enacted. J. Audit. If this Agreement exceeds ten -thousand dollars ($10,000), the parties shall be subject to the examination and audit of the State Auditor for a period of three (3) years after final payment under the Agreement, per Government Code Section 8546.7. K. Entire Agreement. This Agreement supersedes any prior agreements, negotiations and communications, oral or written, and contains the entire agreement between the parties as to the subject matter hereof. No subsequent agreement, representation, or promise made by either party hereto, or by or to an employee, officer, agent, or representative of any party hereto shall be of any effect unless it is in writing and executed by the party to be bound thereby. L. Successors and Assigns. This Agreement shall be binding upon and shall inure to the benefit of the successors and assigns of the parties hereto. M. Subcontractors or Subconsultants. The CITY is engaging the services of the CONTRACTOR identified in this Agreement. The CONTRACTOR shall not subcontract any portion of the work, unless such subcontracting was part of the original proposal or is allowed by the CITY. In the event any portion of the work under this Agreement is subcontracted, the subcontractor(s) shall be required to comply with and agree to, for the benefit of and in favor of the CITY, both the insurance provisions in Section 7 and the indemnification and hold harmless provision of Section 8 of this Agreement. N. Construction. The parties acknowledge and agree that (i) each party is of equal bargaining strength, (ii) each party has actively participated in the drafting, preparation and negotiation of this Agreement, (iii) each such party has consulted with or has had the opportunity to consult with its own, independent counsel and such other professional advisors as such party has deemed appropriate, relative to any and all matters contemplated under this Agreement, (iv) any rule or construction to the effect that ambiguities are to be resolved against the drafting party Standard Short Form Agreement Page 5 of 6 City of National City and Revised May 2019 Ultimate Entertainment LLC LN WITNESS WHEREOF, this Agreement is executed by CITY and by CONTRACTOR on the date and year first above written. CITY OF NATIONAL CITY Bv: APPROVED AS TO FORM: CONTACT INFORMATION CITY OF NATIONAL CITY 1243 National City Boulevard National City, CA 91950-4397 Phone: (619) 336-4358 Fax: (619) 336-4292 Contact: Juanita Castaneda Title: Recreation Center Supervisor Dep.: Community Services Email: adertham(aynationakityca.gov Standard Shun Form Acre -anent Res ixd Maa 2019 Ultimate Entertainment LLC Wore - sigerMarrs of haunorporateW -. r trepan,* (Panrar,/cyarSae P sP- r.trr cvmattserl By (Name) By: Steven Nero (Print) Member (Title) (Name) Olga Nero (Print) Member (Title) Ultimate Entertainment LLC Address: 16633 Ventura Blvd #735 Los Angeles, CA, 91436 Phone: (424)360-1153 Fax: N/A Contact Ideal Gandarilla Title:_ Account Representative Email: ideal(ameaaoutdoorentertainment.com Taxpayer I.D. No.: Page 6 of 6 City of National City and Utti»tate Entmananent LLC ij®j a OUTDOOR Exhibit A MOVIES Invoice #7158999 Sign & Pay Online! If you need to print and mail your contract, please mail to: Ultimate Entertainment, LLC 16633 Ventura Blvd #735 Los Angeles, CA 91436 Phone: 877-735-4257 Billing Information - Ref # (if applicable) The City of National City Juanita Castaneda 140 E. 12th Street National City, CA 91950 Home Phone: Cell Phone: Office Phone: (619) 336-4358 Delivery Location Information Plaza Bonita On -site Contact: Juanita Castaneda 3030 Plaza Bonita Rd National City, CA 91950 Rain Date Hold is Available At A Rate of $149 - $499 Depending on Screen Size. PO# or Ref#: Event ID #: 7158999 Order Date: 10/12/2020 Rep: Ideal Gandarilla Screen Rental Date: 10/23/2020 Rain Date Hold: Arrival Time: 3:30pm Movie Start Time: 6:30pm Movie End Time: 8:30pm Delivery Method: Tech on Site Surface Type: Pavement We hold your screen and a 2nd Date in our system for your backup date. Rental Items Qty Total 40' x 20' - The Epic 1 $2,449.00 Microphone 1 $0.00 Make it a Drive -In w/FM Transmitter 1 $0.00 Generator Rental, Large 1 $150.00 Certificate of Insurance (COI) FREE 1 $0.00 Order subtotal $2,599.00 Staffing $0.00 Damage Waiver* 8.5% $220.92 Delivery $42.52 Discount $262.44 Total $2,600.00 Deposit Due $1,300.00 Amount Paid $0.00 Balance Due $2,600.00 *8.5% Damage Waiver is added to all rentals in case of accidental damage to our equipment. Damage Waiver fee cannot be removed without customer providing a signed Equipment Liability Release acknowledging full financial responsibility for any damage that occurs to our equipment while on customer property. Neither the Damage Waiver or the Equipment Liability Release relieves customer from any responsibility for intentional damage or negligence. Pre -Paid Gratuity: As a convenience to our customers, you can include a pre -paid gratuity for your technician at the time of your booking. If you would like to pay gratuity later, you can give it directly to your tech on -site or call our office after your event and we'll be happy to add it then. Post -Event Gratuity: If you would like to add gratuity after your event is complete, you can contact our office to add it to your invoice EVENT NOTES: Aco CERTIFICATE OF LIABILITY INSURANCE o9/l°i2020 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 have ADDITIONAL INSURED provisions or 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 Infinity Insurance Agency Inc Po Box 2048 Birmingham, AL 35201-2048 CONTACT NAME: CUSTOMER SERVICE PHONE FAX (A/C, No, Ext): 8004282342 (A/C, No): 8553794454 E-MAIL ADDRESS: I N F I NITYBROKE RSERV IC EOIPACC. COM INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Infinity Select Insurance Company 20260 INSURED Creative Edge Amusements 14210 Mulholland Dr Los Angeles, CA 90077 INSURED B : INSURED C : INSURED D : INSURED E : INSURED F : 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUER WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ CLAIMS -MADE OCCUR MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE POLICY OTHER: LIMIT APPLIES PRO-LOC JECT PER: PRODUCTS - COMP/OP AGG $ $ A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS NON -OWNED AUTOS ONLY 504610061952001 06/30/2020 06/30/2021 COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $1,000,000 BODILY INJURY (Per accident) $1,000,000 PROPERTY DAMAGE (Per accident) $100,000 UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N N E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION For Informational Purposes Only 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 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: FWC 00000314523-00 COMMERCIAL GENERAL LIABILITY CG20110413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises (Part Leased To You): Name Of Person(s) Or Organization(s) (Additional Insured) City Of National City CIO: Risk Manager 1243 National City Boulevard, National City, CA 91950 Additional Premium: $ Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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 arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organization(s) shown in the Schedule. 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. CG20110413 © Insurance Services Office, Inc., 2012 Page 1 of 1 CERTIFICATE OF LIABILITY INSURANCE 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. DATE 9/28/2020 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 Cossio Insurance Agency PO Box 5987 Greenville, SC 29606 (864) 688-0121 INSURED Ultimate Entertainment LLC, Dba Ultimate Outdoor Entertainment, Ultimate Outdoor Movies, Ultimate Party Jump, Hollywood, Hollywood Outdoor Movies 14210 Mulholland Drive Los Angeles, CA 90077 COVERAGES Contact Name: Larry Cossio Phone (A/C, No, Ext): E-Mail: (864) 688-0121 tammy@cossioinsurance.com Fax (A/C, No): INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Nationwide Mutual Insurance Company 23787 INSURER B: INSURER C: Berkley Life & Health Insurance Company 64890 INSURER D: INSURER E: 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF POLICY ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF POLICY EXP (MM/DDIYY) (MMIDDIYY) LIMBS A X COMMERCIAL GENERAL LIABILITY X FWC 00000314523-00 7/31/2020 7/31/2021 General Agg (Other than Products -Co $2,000,000 Each Occurrence $1,000,000 Products and Completed Operations $1,000,000 Personal and Advertising Injury $1,000,000 Legal Liability to Participants $1,000,000 Professional Liability (for Event Plann $1,000,000 Damages to Premises Rented to You $300,000 Participant Accident - Excess Medical $10,000 Deductible $0 ❑ L CLAIMS MADE El OCCUR ❑ ❑ GEM_ AGGREGATE LIMIT APPLIES PER X POLICY [PROJECT LOC ❑ OTHER: AUTOMOBILE LIABIUTY ❑ ANY AUTO ALL OWNED SCHEDULED ❑ AUTOS ❑AUTOS ❑ HIRED AUTOS NON -OWNED ❑ AUTOS ❑ ❑ COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per Person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ ❑ UMBRELLA LIAB _J OCCUR ❑ EXCESS LIAB ] CLAIMS -MADE ❑ DED ❑ RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N I I N/A PER STATUTE OTH- ER OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below B Accident Medical PAI L012010778501 7/31/2020 7/31/2021 Total Benefit Maximum for all Accident M $25,000 Class 1 Principal Sum $25,000 Benefit Maximum $500,000 Accident Medical Deductible $100 DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule may be attached If more space Is required) Party Equipment Rentals Operations located at 737 S State College BLVD Unit 94 Fullerton, CA 92831. Certificate Holder is listed as additional insured per form CG2011. The certificate holder is added as an additional insured, but only for liability caused, in whole or in part, by the acts or omissions of the named insured Amusement devices on file with the company for special event(s) dated 10/23/2020 to 10/23/2020 located at 1243 National City Boulevard, National City, CA 91950. CERTIFICATE HOLDER: CANCELLATION City Of National City C/O: Risk Manager 1243 National City Boulevard National City, CA 91950 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE D IVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD -- CALIFORNIA NATIONAL CI Tv rNronronNTco City of National City (To be submitted only when there are no employees subject to Workers' Compensation) DECLARATION AND ADDENDUM TO ALL CONTRACTS AWARDED TO: Mega Outdoor Movies (Company Name For the purpose of inducing the City of National City to go forward with any contracts awarded to Mega Outdoor Movies (Company), I declare as follows: 1, Stephen Amendt (name) , Consultant (title), am authorized to execute this document on behalf of _(company) with respect to compliance with the California Workers' Compensation and Labor laws. All work required will be performed personally and solely by volunteers of Mega Outdoor Entertainment (company), who are independent contractors. If, however, Mega Outdoor Entertainment (company) shall ever be required to hire employees or Subcontractors to perform this contract, Mega Outdoor Entertainment (company) shall obtain Workers' Compensation Insurance and/or provide proof of Workers' Compensation Insurance coverage to the City of National City. This document constitutes a declaration by Mega Outdoor Entertainment (company) against its financial interest, relative to any claims which may be asserted under the Califomia Workers' Compensation and/or Labor laws against the City of National City relating to any bid or contract awarded Mega Outdoor Entertainment (company). Mega Outdoor Entertainment (company) wilt defend, indemnify, and hold harmless the City of National City, its officers and employees, from any and all claims and liability, including Workers' Compensation claims and liability that may be asserted or established by any party in the event it hires an employee in violation of this addendum or if a volunteer of the organization makes a claim against or alleges liability of the City of National City for Workers' Compensation, and it will further indemnify the City of National City, its officers and employees, for all damages the City thereby suffers. I agree that these declarations shall constitute an addendum to any bid or contract awarded to: Mega Outdoor Entertainment (company). Dated: September 29 , 2020 . (Insert company name in all caps) By: (Signature of Authorized Representative) Stephen Amendt, Consultant (Name and Title) Revised 5-18-2017 CONTRACT TRANSMITTAL FORM (Attach as cover sheet to Documents dropped off to City Clerk's Office) Date: OcM 2Co/ 202.0 From (Dept.): %pn'I/YI qh i & S`e.VV 1 cie.S Submitted by (First & Last Name): -As 44cLr€_/ ben kqr-, Vendor: Uf+iv/1411,+ + ihJ.We.N+ (..1✓C/ Resolution: YES / Resolution No. (if applicable): 3 4 Originals Provided to City Clerk (circle quantity) y , 12 I, S Co+� k1 O-k,e.S Cepartment has Co / Duplicate Original Vendor has Cop Duplicate Original