Placentia City Council
December 17, 2024

GREAT 'WESTERN
BYarpion SEI
9ra.donMgirpakron
147

GameTime C/O Great Western Recreation
(Gamelime) P.O. Box 680121
Fort Payne, AL 35967
Office: 435-245-5055 Fax: 435-245-5057
A PLAYCORE con,a.n www.gwpark.com
McFadden Park Playground Option 5A
11/27/2024
Quote #
111924-01-06
Qty Part # Description List $ Selling $ Ext. Selling $
1 INSTALL
Other Products 1 - DEMO AND DISPOSE OF EXISTING EQUIPMENT. INCLUDING 4,170 SQFT. OF POUR IN PLACE RUBBER SURFACING -
Prevailing Wages
1 INSTALL Other Products 1 - RE -GRADE AND COMPACT SUB BASE MATERIALS.

APPROXIMATELY 4,170 SQFT.-
Prevailing Wages
1 INSTALL Other Products 1 - INSTALLATION ONLY OF GAMETIME PLAY EQUIPMENT - REFER TO DRAWING 111924 -01 -OPT 5 ORTCO INC ISA CERTIFIED GAMETIME

INSTALLER -
Prevailing Wages
1 INSTALL Other Products 1 - PROVIDE AND INSTALL POUR IN PLACE RUBBER SURFACING. 50/50 BLACK AND STANDARD COLOR WITH AROMATIC BINDER.

EXCLUDES DESIGNS AND GRAPHICS. APPROXIMATELY 3,990 SQFT. FOR AN AVG. CFH OF 8'-
• 1005 sf 100% beige shoreline
• 350 sf 100% light blue shoreline wave
• 2565 sf 100% standard blue aliphatic
• 30 sf 100% gray for shark
• 25 sf 100% light green for turtles
• 5 sf 100% color red for crab
• 10 sf 100% color orange for starfish
Prevailing Wages
$28,235.00 $28,235.00 $28,235.00
$5,580.00 $5,580.00 $5,580.00
$82,749.00 $82,749.00 $82,749.00
$124,154.00 $124,154.00 $124,154.00
Sub Total $461,703.80
Estimated Freight $17,815.18
Tax $18,480.07
Total $497,999.05

GREAT WESTERN
BYarpion SEI
9ra.donMgapakron
148

GameTime C/O Great Western Recreation
(Gamelime)P.O. Box 680121
Fort Payne, AL 35967
Office: 435-245-5055 Fax: 435-245-5057
PL +YCORE camwny www.gwpark.com
McFadden Park Playground Option 5A
11/27/2024
Quote #
111924-01-06
Comments
Your Sales Rep is Brandon Seitz. Please reach out to Brandon at 805-910-5971 if you should have any questions regarding this quote.

Due to the volatility of freight costs, the freight pricing is subject to change at the time of order.

Pricing is subject to change. Request updated pricing when purchasing from quotes more than 30 days old.

Shipping to:

Installer
2163 N GlasseII St
Orange, CA 92865
Site Address:
900 S Melrose St,
Placentia, CA 92870
`Freight charges are based on listed zip code and are subject to change if shipping information changes. "Deposit may be required.

Permitting not included, unless otherwise noted.

Prevailing wage

GREAT WESTERN
Brarpion $Nil!
9ra.donMgapakron
149

GameTime C/O Great Western Recreation
(Gamelime)P.O. Box 680121
Fort Payne, AL 35967
Office: 435-245-5055 Fax: 435-245-5057
PL +YCORE camwny www.gwpark.com
McFadden Park Playground Option 5A
Remit Payment to:

GameTime
P.O. Box 680121
Fort Payne, AL 35968
Taxes:

All applicable taxes will be added at time of invoicing unless otherwise included or a tax-exempt certificate is provided.

If sales tax exempt, you must provide a copy of certificate to be considered exempt.

Prices:

FOB Factory.
11/27/2024
Quote #
111924-01-06
Orders:

All orders shall be in writing by purchase order, contract, or similar document made out to PlayCore Wisconsin Inc., dba GameTime.

Standard GameTime equipment orders over $100,000 may require a deposit of 25% at the time of order and an additional 25% at or before order ships Standard orders with equipment, installation and surfacing are requested to be split billed.

Equipment, Taxes & Freight as noted above
Installation and Surfacing billed as completed and Due Upon Receipt.

Terms:

Cash With Order Discount (CWO): Orders for GameTime equipment paid in full at time of order via check, Electronic Funds Transfer (ACH or wire) are eligible for a three percent (3%) cash with order discount.

Payment via credit card: If you elect to pay by credit card, GameTime charges a 2.50% processing fee that is assessed on the amount of your payment. This fee is shown as a separate line item and included in the total amount charged to your credit card. You have the option to pay by check, ACH or Wire without any additional fees.

Credit terms are Net 30 days, subject to approval by the GameTime Credit Manager. A completed credit application must be submitted and approved prior to the order being received. Please allow at minimum 2 days for the credit review process. GameTime may also require:

Completed Project Information Sheet (if applicable)
Copies of Payment and Performance Bonds (if applicable) A 1.5% per month finance charge will be imposed on all past due invoices.

Retainage not accepted.

Orders under $5,000 require payment with order.

Landmark Design GFRC:

Orders require a 50% deposit at the time of order.

GREAT WESTERN
Brarpion SfflI
9ra.donMgapakron
150

(GameTime)
A PLAYCORE Caen WS.

GameTime C/O Great
P.O. Box 680121
Fort Payne, AL 35967
Office: 435-245-5055
www.gwpark.com
Western Recreation
Fax: 435-245-5057
McFadden Park Playground Option 5A
ACCEPTANCE OF QUOTATION:

Billing and Shipping information will be as stated on quote unless indicated below.

O Change billing information to:

Address:

Contact:

O Change shipping information to:

Address:

Contact:

Colors: Per Renderings O Palette
0 Per Submittals
0 Other Colors, please specify
Purchase Amount: $497,999.05
Signature:

Date:

Acceptance of this proposal indicates your agreement to the terms and conditions stated herein.

DIR# 1000015526 CSLB#855664

11/27/2024
Quote #
111924-01-06

GREAT WESTERN
Bwarpio7 SEI
9ra.donMgapakron
151

(GameTime)
A PLAYCORE Caen WS.

INSTALLATION CONDITIONS:

GameTime C/O Great
P.O. Box 680121
Fort Payne, AL 35967
Office: 435-245-5055
www.gwpark.com
Western Recreation
Fax: 435-245-5057
McFadden Park Playground Option 5A
11/27/2024
Quote #
111924-01-06
• ACCESS: Site should be clear, level and allow for unrestricted access of trucks and machinery. • STORAGE: Customer is responsible for providing a secure location to off-load and store the equipment during the installation process. Once equipment has delivered to the site, the owner is responsible should theft or vandalism occur unless other arrangements are made and noted on the quotation.
• FOOTER EXCAVATION: Installation pricing is based on footer excavation through earth/soil only. Customer shall be responsible for unknown conditions such as buried utilities (public & private), tree stumps, rock, or any concealed materials or conditions that may result in additional labor or materials cost.
• UTILITIES: Owner is responsible for locating any private utilities. • ADDITIONAL COSTS: Pricing is based on a single mobilization for installation unless otherwise noted. Price includes ONLY what is stated in this quotation. If additional site work or specialized equipment is required, pricing is subject to change.

GREAT WESTERN
BYarpion SEI
9ra.donMgirpakron
152

ACORO®

CERTIFICATE OF LIABILITY INSURANCE

DATE (MM/DD/YYYY)
09/10/2024
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
MARSH USA, LLC.

Two Alliance Center
3560 Lenox Road, Suite 2400
Atlanta, GA 30326
Attn: [email protected] / Fax: 212-948-4321 CN 102326389-CAS-GAUWX-23-24

INSURED
PlayCore Wisconsin, Inc.

Dba GameTime
150 PlayCore Drive SE
Fort Payne, AL 35967
I CONTACT NAME: Justin Llizo
(A/C No. Extl: (202) 258-5895 FAX
Not:

ADDRESS: [email protected]
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A : Evanston Insurance Comoanv 35378
INSURER B : Continental Casualty Company 20443
1 INSURER C : American Casualty Comoanv Of Reading_ . Pa 20427 INSURER o : Transportation Insurance Co 20494
INSURER E : N/A N/A
1 INSURER F : The Continental Insurance Cmmnanv 35289
COVERAGES CERTIFICATE NUMBER: ATL -005801687-00 REVISION NUMBER: 0

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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS

LTR IND WVD POLICY NUMBER IMM/DDIYYYYI IMMIDD/YYYY)
A X COMMERCIAL GENERAL LIABILITY MKLV2PBC002287 08/01/2024 08/01/2025 EACH OCCURRENCE $

CLAIMS -MADE
X SIR $250,000 Per Occ.

X
OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:

PRO-
JECT
POLICY
X
LOC
OTHER:

B AUTOMOBILE LIABILITY BUA7039895527 08/01/2024 08/01/2025 F
C
C
D
C
X
X

ANY AUTO

OWNED SCHEDULED

AUTOS ONLY AUTOS

HIRED NON -OWNED

AUTOS ONLY AUTOS ONLY

UMBRELLA LIAB

EXCESS LIAB
DED
X
OCCUR

CLAIMS -MADE
X RETENTION $ 0

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY

ANYPROPRI ETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED?
(Mandatory in NH)
11 yes, describe under
DESCRIPTION OF OPERATIONS below
Y/N
N
N/A
7039984806 08/01/2024 08/01/2025
RETENTION Umb Catastrophe $25,000
WC 7 39895530
WC 7 39895544
WC 7 39918871
WC 7 39929062
08/01/2024 08/01/2025
08/01/2024 08/01/2025
08/01/2024 08/01/2025
08/01/2024 08/01/2025
DAMAGE TO REN !EU
PREMISES (Ea occurrence) $
MED EXP (Any one person) $
PERSONAL 8 ADV INJURY $
GENERAL AGGREGATE $
PRODUCTS - COMP/OP AGG $
POLICY AGGREGATE $

COMBINED SINGLE LIMIT
(Ea accident)
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $

PROPERTY DAMAGE
(Per accident)
Comp./Coll, Ded.: $1,000 $
EACH OCCURRENCE $
AGGREGATE $
PER

X STATUTE
OTH-
ER
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) RE: McFadden Park
The City of Placentia, its officers, officials, employees, agents, and volunteers are listed as additional insured, in regard to services performed by the Insured, on a primary and non-contributory basis, on the General Liability via CG 2010 & CG 2037 (04/13 versions) and Automobile Liability via CA 2048, when required by written contract. A Waiver of Subrogation applies in favor of the additional insureds on all policies, when required by written contract.

CERTIFICATE HOLDER CANCELLATION
City of Placentia
Attn: City Administrator
401 E. Chapman
Placentia, CA 92870
ACORD 25 (2016/03)
2,000,000
100,000
10,000
2,000,000
4,000,000
4,000,000
10,000,000
1,000,000
10,000,000
10,000,000
1,000,000
1,000,000
1,000,000

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
of Marsh USA LLC
©1988-2016 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

ACORO®
AGENCY
MARSH USA, LLC.

POLICY NUMBER

CARRIER

ADDITIONAL REMARKS
AGENCY CUSTOMER ID: CN102326389
LOC #: Atlanta

ADDITIONAL REMARKS SCHEDULE

NAIC CODE

NAMED INSURED
PlayCore Wisconsin, Inc.

Dba GameTime
150 PlayCore Drive SE
Fort Payne,AL 35967
EFFECTIVE DATE:

THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers' Compensation (Continued):

Carrier: Transportation Insurance Company
Policy Number: WC 7039918885
Dates: 08/01/2024 - 08101/2025
WC 7 39895530 - AL,CO,FL,GA,ID,IL,IN,KS,KY,MA,ME,MD,MI,MN,MO,MT,NV,NY,NC,OK,PA,SC,TN,TX,UT,VA WC 7 39895544 - CA
WC 7 39918871 - AZ, OR, WI
WC 7039918885- OH, ND, WY, WA

ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

POLICY NUMBER: MKLV2PBC002287
EFFECTIVE: AUGUST 1, 2024
EXPIRES: AUGUST 1, 2025

COMMERCIAL GENERAL LIABILITY
CG 20 10 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY

ADDITIONAL INSURED - OWNERS, LESSEES OR

CONTRACTORS - SCHEDULED PERSON OR

ORGANIZATION
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s)
As required by written contract executed by both parties prior to loss
Location(s) Of Covered Operations
All locations
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 for "bodily injury", "property damage" or "personal and advertising injury"
caused, in whole or in part, by:

1. Your acts or omissions; or

2. The acts or omissions of those acting on your
behalf;
in the performance of your ongoing operations for
the additional insured(s) at the location(s)
designated above.

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 additional
exclusions apply:

This insurance does not apply to "bodily injury" or
"property damage" occurring after:

CG 20 10 04 13

1. 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
location of the covered operations has been
completed; or

2. 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 for a
principal as a part of the same project.

C. 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
© Insurance Services Office, Inc., 2012 Page 1 of 2

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.
© Insurance Services Office, Inc., 2012 Page 2 of 2
CG 20 10 04 13

ti
POLICY NUMBER: MKLV2PBC002287
EFFECTIVE: AUGUST 1, 2024
EXPIRES: AUGUST 1, 2025

COMMERCIAL GENERAL LIABILITY
CG 24 04 05 09

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY

AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART

SCHEDULE
Name Of Person Or Organization:

As required by written contract executed by both parties prior to loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of
Section IV — Conditions:

We waive any right of recovery we may have against
the person or organization shown in the Schedule
above because of payments we make for injury or
damage arising out of your ongoing operations or
"your work" done under a contract with that person
or organization and included in the "products -
completed operations hazard". This waiver applies
only to the person or organization shown in the
Schedule above.
© Insurance Services Office, Inc., 2008 Page 1 of 1
CG 24 04 05 09

EFFECTIVE: AUGUST 1, 2024
EXPIRES: AUGUST 1, 2025
POLICY NUMBER: MKLV2PBC002287

COMMERCIAL GENERAL LIABILITY
CG 20 01 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
The following is added to the Other Insurance
Condition and supersedes any provision to the
contrary:

Primary And Noncontributory Insurance
This insurance is primary to and will not seek
contribution from any other insurance available
to an additional insured under your policy
provided that:
(1) The additional insured is a Named Insured
under such other insurance; and
CG 20 01 04 13
(2) You have agreed in writing in a contract or
agreement that this insurance would be
primary and would not seek contribution
from any other insurance available to the
additional insured.
© Insurance Services Office, Inc., 2012 Page 1 of 1

CNA
Product Name
?LUAU
It is understood and agreed that this endorsement amends the BUSINESS AUTO COVERAGE FORM as follows:

SCHEDULE
Name of Additional Insured Persons Or Organizations
" Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was rvecntrrl nrinr to thr rlaty of lncc "

1. In conformance with paragraph A.1.c. of Who Is An Insured of Section II - LIABILITY COVERAGE, the person or organization scheduled above is an insured under this policy.

2. The insurance afforded to the additional insured under this policy will apply on a primary and non- contributory basis if you have committed it to be so in a written contract or written agreement executed prior to the date of the "accident" for which the additional insured seeks coverage under this policy.

All other terms and conditions of the policy remain unchanged.

This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy.

Form No: CNA71527XX (10-2012)
Endorsement Effective Date: 08/01/2024
Endorsement No: 59; Page: 1 of 1
Underwriting Company: CONTINENTAL CASUALTY COMPANY
Copyright CNA All Rights Reserved.

Policy No: BUA7039895527
Policy Effective Date: 08/01/2024
Policy Page: 165 of 221

Product Name
CNA
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the following:

AUTO DEALERS COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement.

This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.

This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.

Named Insured: PlayCore Group, Inc.

Endorsement Effective Date: 08/01/2024

SCHEDULE
Name Of Person(s) Or Organization(s): " Any person or organization whom you have agreed to include as an additional insured under a written contract, provided such contract was executed prior to the date of loss." Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form.

Copyright Insurance Services Office, Inc., 2011

CNA
Form No: CA 20 48 10 13
Endorsement Effective Date: 08/01/2024
Endorsement No: TBD; Page: TBD
Underwriting Company: CONTINENTAL CASUALTY COMPANY
© Copyright Insurance Services Office, Inc., 2011
Product Name
Policy No: BUA 703895527
Policy Effective Date: 08/01/2024
Policy Page: TBD

CNA
Product Name
Workers' Compensation
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.

Schedule
"Any person or organization whom you have agreed to waive your right of recovery in a written contract, provided such contract was executed prior to the date of loss"
The premium charge for the endorsement is reflected in the Schedule of Operations.

All other terms and conditions of the policy remain unchanged.

This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy unless another expiration date is shown below.

Form No: WC 00 03 13 (04-1984)
Endorsement Effective Date: 08/01/2024 Endorsement Expiration Date:08/01 /2025 Endorsement No: TBD; Page: TBD
Underwriting Company: AMERICAN CASUALTY COMPANY OF READING PENNSYLVANIA;

TRANSPORTATION INSURANCE COMPANY
Copyright 1983 National Council on Compensation Insurance.

Policy No: WC739895530; WC739895544;
WC739918871; WC739929062
Policy Effective Date: 08/01 /2024
Policy Page: TBD

POLICY NUMBER: MKLV2PBC002287
EFFECTIVE: AUGUST 1, 2024
EXPIRES: AUGUST 1, 2025

COMMERCIAL GENERAL LIABILITY
CG 20 37 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED - OWNERS, LESSEES OR

CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
Name Of Additional Insured Person(s)
Or Organization(s)
As required by written contract executed by both
parties prior to loss

SCHEDULE
Location And Description Of Completed Operations
All locations
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 for "bodily injury" or
"property damage" caused, in whole or in part, by
"your work" at the location designated and
described in the Schedule of this endorsement
performed for that additional insured and
included in the "products -completed operations
hazard".

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.

CG 20 37 04 13
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.
© Insurance Services Office, Inc., 2012 Page 1 of 1

CNA
1 Product Name

BUSINESS AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

This endorsement modifies insurance provided under the following:

BUSINESS AUTO

SCHEDULE
Name of Person or Organization: " Any person or organization whom you have agreed to include as an additional insured under a written contract provided such contract was executed prior to the date of lose " (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)
We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for the injury or damage. This injury or damage must arise out of your activities under a contract with that person or organization. The waiver applies only to the person or organization shown in the Schedule.

All other terms and conditions of the policy remain unchanged.

This endorsement, which forms a part of and is for attachment to the policy issued by the designated Insurers, takes effect on the Policy Effective date of said policy at the hour stated in said policy, unless another effective date (the Endorsement Effective Date) is shown below, and expires concurrently with said policy.

Form No: 9-23186-B (12-2010)
Endorsement Effective Date: 08/01/2024
Endorsement No: 60 ; page: 1 of 1
Underwriting Company: CONTINENTAL CASUALTY COMPANY
Copyright CNA All Rights Reserved.

Policy No: BUA7039895527
Policy Effective Date: 08/01/2024
Policy Page: 177 of 221

DocuSign Envelope ID: 2A4096F2-5DE9-4F1 E-AC16-EE17C46F3E93

BENEFICIARY AGREEMENT BETWEEN THE COUNTY OF ORANGE AND

THE CITY OF PLACENTIA FOR AMERICAN RESCUE PLAN ACT

FUNDING
This Beneficiary Agreement (the "Agreement") is made and entered into by and between the County of Orange, a political subdivision of the State of California, hereinafter referred to as "County," and the City of Placentia, a California municipal corporation, hereafter referred to as "Beneficiary," with the County or Beneficiary referred to as "Party," or collectively as "Parties."
WHEREAS, on February 26, 2020, the County Health Officer declared a local health emergency based on an imminent and proximate threat to public health from the introduction of a novel coronavirus (named "COVID-19") in Orange County (the "COVID-19 Emergency"); and
WHEREAS, on March 2, 2020, the Board of Supervisors adopted Resolution No. 2020-11 ratifying the local health emergency declared by the County's Health Officer; and
WHEREAS, on March 4, 2020, the Governor of the State of California declared a State of Emergency to exist in California because of the threat of COVID-19; and WHEREAS, on March 13, 2020, the President of the United States issued a Proclamation on Declaring a National Emergency Concerning the COVID-19 Outbreak; and
WHEREAS, the American Rescue Plan Act (ARPA) was passed by Congress and signed into law by the President of the United States on March 11, 2021; and WHEREAS, under the State and Local Fiscal Recovery Funds (SLFRF) program, enacted as part of (ARPA), more than $350 billion in emergency funding was distributed to state, local, territorial, and Tribal governments with the County receiving a total of $616.8 million in two equal allocations of SLFRF funds; and WHEREAS, ARPA provides that SLFRF funds may be used to replace lost public sector revenue to pay for government service expenses that are incurred during the period that begins on March 3, 2021, and ends on December 30, 2024; and WHEREAS, on January 6, 2022, the United States Department of Treasury released its Final Rule for the SLFRF program, which among other things, authorizes State and local government recipients to use SLFRF funds to replace lost public sector revenue and use such funding to provide government services up to the amount of revenue loss due to the pandemic; and
WHEREAS, on June 28, 2022, the Orange County Board of Supervisors authorized the allocation of $9,500,000 in SLFRF funds to be used for various Fourth

165

DocuSign Envelope ID: 2A4096F2-5DE9-4F1 E-AC16-EE17C46F3E93 District priority projects, including local governments for educational and infrastructure projects; and
WHEREAS, Beneficiary is a local government with educational and infrastructure projects; and
WHEREAS, in order to assist Beneficiary in its educational and infrastructure projects, the Parties have agreed that the County shall transfer the Grant Amount described herein to Beneficiary.

NOW, THEREFORE, the Parties mutually agree as follows:

1. TERM OF AGREEMENT. The term of this Agreement begins on the date when fully executed by the Parties, and terminates on June 30, 2024, or when all the Parties' obligations under this Agreement are fully satisfied, whichever occurs earlier.

2. USE OF GRANT AMOUNT.
a. The grant funds provided are federal funds and subject to the Single Audit Act of 1984. The following information is provided in accordance with the Single Audit Act.

Grant Amount
Beneficiary Name:

Beneficiary Unique Entity
Identifier (UEI)
Awarding County Agency
County Contact
Assistance Listing
Number (ALN) / Name
Federal Award
Identification Number
Awarding Federal Agency
Indirect Cost Rate
Whether Award is R&D:
$500,000
City of Placentia
WN5YQKL2QFZ5
County Executive Office
Oana Cosma (714) 834-7410

21.027 / Coronavirus State and Local Fiscal
Recovery Funds
SLFRP1607
US Treasury Department
10% MTDC or Federally Approved Rate
No
b. Beneficiary shall use Grant Amount provided under this Agreement for costs associated with the development, construction, and maintenance of a senior center.
c. Indirect costs may not exceed 10% of the modified total direct costs per 2 CFR section 200.68 or the federally approved indirect cost rate, if applicable.
d. Beneficiary must utilize the Grant Amount in accordance with all Federal and State laws, including but not limited to the American Rescue Plan

166

DocuSign Envelope ID: 2A4096F2-5DE9-4F1 E-AC16-EE17C46F3E93 Act of 2021 (ARPA), codified at 42 U.S.C. § 802, et seq., and all applicable regulations and guidelines implementing ARPA, including the regulations issued by the Department of Treasury at 31 CFR Part 35 regarding costs that are payable from SLFRF Funds.

3. PAYMENT OF GRANT AMOUNT
a. The County will issue a one-time contribution to the Beneficiary of the Grant Amount set forth in Paragraph 2.a within 10 business days of the full execution of this Agreement. All of Beneficiary's expenditures of the Grant Amount must be for costs as described in Paragraph 2.b of this Agreement.
b. It is understood that the County makes no commitment to fund this Agreement beyond the terms set forth herein.

4. STATUTES AND REGULATIONS APPLICABLE TO GRANT. Beneficiary must comply with all applicable requirements of State, Federal, and County of Orange laws, executive orders, regulations, program and administrative requirements, policies and any other requirements governing this Agreement.

Beneficiary must comply with applicable State and Federal laws and regulations pertaining to labor, wages, hours, and other conditions of employment. Beneficiary must comply with new, amended, or revised laws, regulations, and/or procedures that apply to the performance of this Agreement. These requirements include, but are not limited to:
a. Office of Management and Budget (OMB) Guidance. Beneficiary must comply with the Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards per 2 CFR Part 200 (the "Uniform Guidance"), including the procurement standards set forth in 2 CFR 200.318 through 2 CFR 200.327 when using the Grant Amount to procure goods and services.
b. Single Audit Act. Since Federal funds are used in the performance of this Agreement, Beneficiary must, as applicable, adhere to the rules and regulations of the Single Audit Act (31 USC Sec. 7501 et seq.), OMB Circular A-133 and any administrative regulation or field memoranda implementing the Act.
c. Political Activity Prohibited. None of the funds, materials, property or services provided directly or indirectly under this Agreement may be used for any partisan political activity, or to further the election or defeat of any candidate for public office. Funds provided under this Agreement may not be used for any purpose designed to support or defeat any pending legislation or administrative regulation.

167

DocuSign Envelope ID: 2A4096F2-5DE9-4F1 E-AC16-EE17C46F3E93 d. SAM.aov Requirements. Beneficiary is required to have an active registration with the System for Award Management ("SAM") ( https://www.sam.gov) .

5. COMPLIANCE WITH GRANT REQUIREMENTS. Grant funds awarded must be used solely for the purposes identified in Paragraph 2 of this Agreement. In accordance with Paragraph 11, Beneficiary agrees to indemnify, defend, and hold harmless the County of Orange for any sums the State or Federal government contends or determines Beneficiary used in violation of this Agreement. Beneficiary shall immediately return to the County any funds the County or any responsible State or Federal agency, including the Department of Treasury, determines the Beneficiary has used in a manner that is inconsistent with Paragraph 2 of this Agreement. The provisions of this paragraph shall survive termination of this Agreement.

6. CERTIFICATION. Beneficiary hereby certifies that the Beneficiary will use the Grant Amount for eligible expenses as described Section 2 above.

7. RECORDS MAINTENANCE. Beneficiary shall maintain records in their original form in accordance with requirements prescribed by the County with respect to all matters specified in this Agreement. Original forms are to be maintained on file for all documents specified in this Agreement. Such records must be retained for a period of four (4) years after termination of this Agreement and after final disposition of all pending matters. "Pending matters" include, but are not limited to, an audit, litigation or other actions involving records. Records, in their original form pertaining to matters covered by this Agreement, must be retained within the County of Orange unless authorization to remove them is granted in writing by the County.

8. RECORDS INSPECTION. At any time during normal business hours and as often as either the County, Inspector General acting pursuant to the Inspector General Act of 1978, or the Auditor General of the State of California may deem necessary, Beneficiary must make available for examination all its records with respect to all matters covered by this Agreement. The County, Inspector General, and the Auditor General of the State of California each have the authority to audit, examine and make excerpts or transcripts from records, including all Beneficiary's invoices, materials, payrolls, records of personnel, conditions of employment and other data relating to all matters covered by this Agreement. Beneficiary agrees to provide any reports requested by the County regarding performance of this Agreement. With respect to inspection of Beneficiary's records, the County may require that Beneficiary provide supporting documentation to substantiate Beneficiary's expenses with respect to the Beneficiary's use or expenditure of monies provided by the County to the Beneficiary under this Agreement.

9. INDEPENDENT CONTRACTOR. The Beneficiary shall be considered an independent contractor and neither the Beneficiary, its employees, nor anyone

168

DocuSign Envelope ID: 2A4096F2-5DE9-4F1 E-AC16-EE17C46F3E93 working under the Beneficiary shall be considered an agent or an employee of County. Neither the Beneficiary, its employees nor anyone working under the Beneficiary shall qualify for workers' compensation or other fringe benefits of any kind through County.

10. PERMITS, LICENSES, APPROVALS, AND LEGAL OBLIGATIONS.

Beneficiary shall be responsible for obtaining all permits, licenses, and approvals required for performing any work under this Agreement.

Beneficiary shall be responsible for observing and complying with any applicable Federal, State, or local laws, or rules or regulations affecting any such work. Beneficiary shall provide copies of permits and approvals to the County upon request.

11. INDEMNITY. The Beneficiary agrees to indemnify, defend with counsel approved in writing by County, and hold County, its elected and appointed officials, officers, employees and agents and those special districts and agencies which County's Board of Supervisors acts as the governing Board harmless from any claims, demands or liability of any kind or nature, arising from or related to the Beneficiary's receipt of the Grant Amount under this Agreement, including any claims that the amounts paid by the County to Beneficiary were not used consistent with the restrictions on the use of SLFRF program funds as set forth in the regulations and guidance issued by the Department of Treasury regarding the use of such funds. The provisions of this paragraph shall survive the termination of this Agreement.

12. NOTICES. All notices, requests, demands and other communications contemplated, called for, permitted, or required to be given hereunder shall be in writing. Any written communications shall be deemed to have been duly given upon actual in-person delivery, if delivery is by direct hand, or upon delivery on the actual day of receipt or no greater than four (4) calendar days after being mailed by US certified or registered mail, return receipt requested, postage prepaid, whichever occurs first. The date of mailing shall count as the first day. All communications shall be addressed to the appropriate party at the address stated herein or such other address as the parties hereto may designate by written notice from time to time in the manner aforesaid.

Beneficiary:

Damien R. Arrula, City Manager
darrula@nlacentia. ora
401 East Chapman Ave.

Placentia, CA 92870
County:

Oana Cosma, County Budget Office
[email protected]
400 W. Civic Center Dr., 5th Floor
Santa Ana, CA 92701-4062

169

DocuSign Envelope ID: 2A4096F2-5DE9-4F1 E-AC16-EE17C46F3E93

13. DEFAULTS. Should either Party fail for any reason to comply with the contractual obligations of this Agreement within the time specified by this Agreement, the non -breaching Party reserves the right to terminate the Agreement, reserving all rights under State and Federal law.

14. ATTORNEY FEES. In any action or proceeding to enforce or interpret any provision of this Agreement, each Party shall bear its own attorney's fees, costs, and expenses.

15. ENTIRE CONTRACT: This Agreement contains the entire contract between the Parties with respect to the matters herein, and there are no restrictions, promises, warranties or undertakings other than those set forth herein or referred to herein. No exceptions, alternatives, substitutes or revisions are valid or binding on the parties unless authorized by the Parties in writing.

16. AMENDMENTS. No alteration or variation of the terms of this Agreement shall be valid unless made in writing and signed by the parties; no oral understanding or agreement not incorporated herein shall be binding on either of the Parties; and no exceptions, alternatives, substitutes or revisions are valid or binding on County unless authorized by County in writing.

IN WITNESS WHEREOF, the Parties hereto have executed this Agreement on the day and year dated below.

DocuSigned by:

BY:

Damien R. Arrula, City Manager
City of Placentia
BY:

DocuSigned by:

Helen Hernandez, Deputy Purchasing Agent
County Procurement Office
County of Orange, California
DATED:

DATED:
5/16/2023
5/16/2023
APPROVED AS TO FORM:

Office of the County Counsel
County of Orange, California
BY:

DocuSigned by:
ruts hVwkadn,
—.:...

James C. Harman, Chief Assistant
DATED:
5/16/2023

170

Docusign Envelope ID: 063170C4-6D40-4C8D-B0B8-COEDOF1 DEC9A

FIRST AMENDMENT TO BENEFICIARY AGREEMENT BETWEEN THE

COUNTY OF ORANGE AND THE CITY OF PLACENTIA FOR AMERICAN

RESCUE PLAN ACT FUNDING
This First Amendment to the Beneficiary Agreement (the "First Amendment") is made and entered into as of June 29, 2024, by and between the County of Orange, a political subdivision of the State of California, hereinafter referred to as "County," and the City of Placentia, a California municipal corporation, hereafter referred to as "Beneficiary," with the County and Subrecipient referred to as "Party," or collectively as "Parties."
WHEREAS, on June 28, 2022, the Orange County Board of Supervisors authorized the allocation of $9,500,000 in State Local Fiscal Recovery Funds (SLFRF) funds to be used for various Fourth District priority projects, including local governments for educational and infrastructure projects; and WHEREAS, on May 16, 2023, the Parties entered into a Beneficiary Agreement for American Rescue Plan Act Funding ("Agreement"); and WHEREAS, the Parties wish to amend the Agreement to revise the use of grant amount terms.

NOW, THEREFORE, the Parties mutually agree as follows:

1. Paragraph 1 of the Agreement shall be deleted and replaced in its entirety by the following:

1. TERM OF AGREEMENT. The term of this Agreement begins on May 16, 2023, and terminates on June 30, 2026, or when all the Parties' obligations under this Agreement are fully satisfied, whichever occurs earlier.

2. Paragraph 2, subparagraph (b) of the Agreement shall be deleted and replaced in its entirety by the following:
b. Beneficiary shall use Grant Amount provided under this Agreement for costs associated with the development, construction, and maintenance of the playground at McFadden Park.

3. Paragraph 11 of the Agreement shall be deleted and replaced in its entirety by the following:

INDEMNITY. The Beneficiary agrees to indemnify, defend with counsel approved in writing by County, and hold County, its elected and appointed officials, officers, employees and agents and those special districts and agencies which County's Board of Supervisors acts as the governing Board harmless File Folder: 2759906
MA -017- 25010713 Page 1 of 2
192

Docusign Envelope ID: 063170C4-6D40-4C8D-B0B8-COEDOF1 DEC9A from any claims, demands or liability of any kind or nature, arising from or related to the Beneficiary's receipt or use of the Grant Amount under this Agreement, including any claims that the amounts paid by the County to Beneficiary were not used consistent with the restrictions on the use of SLFRF program funds as set forth in the regulations and guidance issued by the Department of Treasury regarding the use of such funds. The provisions of this paragraph shall survive the termination of this Agreement.

4. All other terms and conditions of the Agreement shall remain unchanged and in full force and effect.

IN WITNESS WHEREOF, the Parties hereto have executed this First Amendment on the date first above written.

BY:

BY:

BY:
�DocuSigned by:
rOSaulLa arvi)
"-13F77724C3C3450...

Rosanna Ramirez,
Acting City Administrator
City of Placentia
1—Signed by:
"— 6A4F3F0FA5254E8...

Jennifer Lampman,
Director of Finance
City of Placentia
Signed by:
rimA,illixt, fx,04
DODA113FD3E540C...

Ranique Beas,
Deputy Purchasing Agent
County of Orange, California
File Folder: 2759906
DATED: 12/3/2024
DATED: 12/3/2024
12/4/2024
DATED:

APPROVED AS TO FORM:

Office of the County Counsel
County of Orange, California
DocuSigned by:
b- .44
BY: 00514730 F 26 D481...

James C. Harman, Chief Assistant
12/4/2024
DATED:

MA -017- 25010713 Page 2 of 2
193

PLACENTIA CITY COUNCIL AGENDA REPORT
Meeting Date: December 17, 2024
Submitted by: Carole Wayman
From: Mayor Jeremy B. Yamaguchi
Agenda Item No: 1.e
Subject:

Resolution Appointing an Interim City Administrator and Approving the Retired Annuitant Employment Agreement with the City
Financial Impact:

Fiscal Impact:

The City Administrator is a regularly allocated position within the City's budget. The costs associated with an Interim City Administrator can be covered in the current year's FY 2024-25 budget.

Summary:

The City Council has expressed a desire to appoint Thomas R. Hatch (Appointee) to serve as Interim City Administrator effective January 6, 2025. It is estimated that it may take up to six additional months to complete the recruitment and hiring process.

The City Council considered candidates for the Interim City Administrator position, and ultimately selected Appointee to perform the duties of City Administrator during the completion of the recruitment process, and to prevent stoppage of vital city services.

The attached form of resolution and employment agreement will officially appoint appointee as the City Administrator on an interim basis. The interim appointment complies with Government Code Sections 7522.56 and 21221(h), which allows retired annuitants of the California Public Employees' Retirement System (CaIPERS) to work in a limited term appointment under specific rules.

In accordance with CaIPERS requirements, the hourly rate shall be $143.79 per hour, which is the current salary for the City Administrator position. Furthermore, as required by CaIPERS rules, no other benefits will be provided. The proposed Employment Agreement specifies that the appointee serves at the pleasure of the City Council until the soonest of the following occurs: (1) July 11, 2025, (2) upon appointment of a permanent City Administrator, (3) until the appointee works his/her 960th hour for any CaIPERS agency during the 2024-2025 or 2025- 2026 fiscal years, or (4) upon earlier termination of the employment by either the appointee or the City.
173

Recommendation:

Recommended Action: It is recommended that the City Council:

1. Adopt Resolution R-2024-86, approving the appointment of an Interim City Administrator; and

2. Approve the Retired Annuitant Employment Agreement.

Strategic Plan Statement:

There is no strategic plan goal associated with this item.

Fiscal Impact Summary:

The City Administrator is a regularly allocated position within the City's budget. The costs associated with an Interim City Administrator can be covered in the current year's FY 2024-25 budget.

Attachments
Resolution No. R-2024-86 12-17-24.docx
Retired Annuitant Employment Agreement 12-17-24.pdf
174

RESOLUTION NO. R-2024 —86

A RESOLUTION OF THE CITY COUNCIL OF THE

CITY OF PLACENTIA, CALIFORNIA APPOINTING THOMAS
R. HATCH AS INTERIM CITY ADMINISTRATOR AND

APPROVING THE RETIRED ANNUITANT EMPLOYMENT

AGREEMENT

RECITALS
WHEREAS Government Code section 21221(h) of the Public Employees' Retirement Law permits the governing body to appoint a CaIPERS retiree to a vacant position requiring specialized skills during recruitment for a permanent appointment, and provides that such appointment will not subject the retired person to reinstatement from retirement or loss of benefits so long as it is a single appointment that does not exceed 960 hours in a fiscal year; and,
WHEREAS the City Council desires to appoint Thomas R. Hatch ("Appointee") as an interim appointment retired annuitant to the vacant position of City Administrator for the City of Placentia under Gov. Code section 21221(h), effective January 6, 2025; and, WHEREAS, under Government Code section 21221(h), the City can appoint a retired annuitant of CaIPERS to work in a vacant position during the recruitment to permanently fill the vacancy or during an emergency to prevent stoppage of public business; and,
WHEREAS, the City Council has authorized the search and recruitment for a permanent appointment on November 19, 2024; and,
WHEREAS this appointment pursuant to Gov. Code section 21221(h) shall only be made once and therefore will end on the soonest of: (1) July 11, 2025, or (2) upon appointment of a permanent City Administrator, or (3) until Appointee works his/her 960th hour for any CaIPERS agency during the 2024- 2025 or 2025-2026 fiscal years, or (4) upon termination of this employment by Appointee or the City; and, WHEREAS consistent with the Government Code, compensation shall be $143.79 per hour which is within the current established salary range for City Administrator and will not include any benefits, nor accrued vacation or leave time, or any other form of compensation in addition to this hourly pay rate; and,
WHEREAS the City Council and Appointee certify that Appointee has not and will not receive a "golden handshake" agreement, as described in Government Code 20903, or any other retirement -related incentive.

NOW, THEREFORE, BE IT RESOLVED:

1. That the City Council of the City of Placentia authorizes and approves the form of Retired Annuitant Employment Agreement for the position of Interim City Administrator between the City of Placentia and Appointee, in substantial form as the agreement attached hereto as Exhibit 1;

2. The City Council finds that the appointment of Appointee to the Interim City Administrator position, commencing on January 6, 2025, is necessary to fill a critically needed position for the City of Placentia because of the need for his specialized skills during the recruitment of a permanent city administrator.

3. The Mayor is authorized and directed to execute the Retired Annuitant Employment Agreement for and on behalf of the City of Placentia, in substantial form as attached hereto, and to execute Resolution R-2024-86

175

any other necessary documents to effectuate the terms of the Employment Agreement, in a form approved by the City Attorney.

PASSED, ADOPTED AND APPROVED THIS 17th DAY OF DECEMBER 2024.

Jeremy B. Yamaguchi, Mayor
ATTEST:

Robert S. Mckinnell, City Clerk

STATE OF CALIFORNIA

COUNTY OF ORANGE
I, Robert S. McKinnell, City Clerk of the City of Placentia, do hereby certify that the foregoing resolution was adopted at a regular meeting of the City Council of the City of Placentia held on the 17th day of December 2024 by the following vote:

AYES: Councilmembers:

NOES: Councilmembers:

ABS ENT:Councilmembers:

ABSTAIN:Councilmembers:

Robert S. Mckinnell, City Clerk
APPROVED AS TO FORM:

Christian Bettenhausen, City Attorney
EXHIBIT(S):
1 — Retired Annuitant Employment Agreement
Resolution R-2024-86

176

RETIRED ANNUITANT EMPLOYMENT AGREEMENT
For the Position Of

INTERIM CITY ADMINISTRATOR
This Employment Agreement ("Agreement") is made and entered into this day of , 2024, by and between the CITY OF PLACENTIA ("CITY"), a California Charter city, and THOMAS R. HATCH ("ANNUITANT"), an individual, on the following terms and conditions:

RECITALS
CITY desires to employ the services of ANNUITANT as its Interim City Administrator, temporarily, to carry out the duties and responsibilities of City Administrator as provided for by the City's Charter and Municipal Code, in consideration of and subject to the terms, conditions, and benefits set forth in this Agreement.

ANNUITANT desires to accept employment as Interim City Administrator in consideration of and subject to the terms, conditions, and benefits set forth in this Agreement.

CITY has commenced an open recruitment to permanently fill the vacant position of City Administrator. During the recruitment period, the CITY has an immediate need for an Interim City Administrator, a position involving specialized skills and training, and which is critically necessary for the ongoing duties and functions of the CITY.

ANNUITANT, affirms that he/she has the necessary skills required by the City by virtue of his/her significant experience serving as a City Manager in other cities.

ANNUITANT represents that he/she is a retired annuitant of CaIPERS within the meaning of Government Code §§ 7522.56 and 21221(h) and acknowledges that Annuitant's compensation is statutorily limited as provided in Government Code § 21221(h).

ANNUITANT represents that, as of the effective date of this Agreement, ANNUITANT has not worked for another CaIPERS state or contracting agency as a retired annuitant during the CITY's 2024-2025 fiscal year, and that ANNUITANT therefore acknowledges that he/she is restricted to working no more than 960 hours for CITY, a state agency or other CaIPERS contracting agencies (collectively "CaIPERS Agencies") in a fiscal year, and that his/her compensation is statutorily limited as provided in Government Code § 21221(h). ANNUITANT represents that he/she has not received unemployment compensation from any CaIPERS agencies during the 12 -month period preceding the effective date of this Agreement. ANNUITANT further represents that his/her CaIPERS retirement date became effective prior to the 180 -day period preceding the effective date of this Agreement; that ANNUITANT has not received a retirement incentive upon retirement within the meaning of Government Code § 7522.56(g), and that ANNUITANT has attained normal retirement age within the meaning of Government Code § 21220.5. 1 177

OPERATIVE PROVISIONS
In consideration of the promises and covenants contained herein, the parties agree as follows:

1. Position and Duties.

1.1 Position. ANNUITANT accepts employment with CITY as its Interim City Administrator and shall perform all functions, duties and services set forth in Section 1.4 (Duties) of this Agreement. ANNUITANT shall provide service at the direction and under the supervision of the City Council. It is the intent of the parties that ANNUITANT, as the Interim City Administrator, shall keep the City Council fully apprised of all significant ongoing operations of CITY. Toward that end, ANNUITANT shall report directly to the City Council and will periodically, or as may be otherwise specifically requested by the City Council, provide status reports to the City Council on his activities and those of CITY.

1.2 Term. This Agreement shall become effective and executed both by ANNUITANT and CITY's Mayor, which date shall be the date first referenced above. ANNUITANT shall commence the performance of the required duties as the Interim City Administrator on January 6, 2025, or at such later date as the parties hereto shall agree in writing ("Commencement Date"). This Agreement shall expire as of the first of the following to occur: (i) 5:00 p.m. on July 11, 2025; (ii) upon the employment commencement date of a permanent City Administrator employed by CITY; (iii) upon ANNUITANT working ANNUITANT's 960th hour during the 2023-2024 or 2024-2025 fiscal years, including hours worked for other CaIPERS agencies during such fiscal years; or (iii) upon termination of the Agreement by either ANNUITANT or CITY as provided in Section 4 (Termination) of this Agreement.

1.3 At -Will. ANNUITANT acknowledges that ANNUITANT is an at -will, temporary employee of CITY who shall always serve at the pleasure of the City Council during the period of his service hereunder. The terms of CITY's personnel rules, policies, regulations, procedures, ordinances, and resolutions regarding City Administrative Personnel (collectively "Personnel Policies") , as they may be amended or supplemented from time to time, shall not apply to ANNUITANT, and nothing in this Agreement is intended to, or does, confer upon ANNUITANT any right to any property interest in continued employment, or any due process right to a hearing before or after a decision by the City Council to terminate his employment, except as is expressly provided in Section 1.2 (Term) or Section 4 (Termination) of this Agreement. Nothing contained in this Agreement shall in any way prevent, limit or otherwise interfere with the right of CITY to terminate the services of ANNUITANT, as provided in Section 1.2 (Term) or Section 4 (Termination).

Nothing in this Agreement shall prevent, limit or otherwise interfere with the right of ANNUITANT to resign at any time from this position with CITY, subject only to the provisions set forth in Section 1.2 (Term) or Section 4 (Termination) of this Agreement.

This at -will employment Agreement shall be expressly subject to the rights and obligations of CITY and ANNUITANT, as set forth in Section 1.2 (Term) or Section 4 (Termination) below.
2 178

1.4 Duties. ANNUITANT shall serve as the Interim City Administrator and shall for the Term of the Agreement be vested with the powers, duties and responsibilities of the City Administrator as set forth in the City's Charter and the City's Municipal Code, the terms of which are incorporated herein by reference. ANNUITANT shall provide service at the direction and under the supervision of the City Council. It is the intent of the parties that the Interim City Administrator shall keep the City Council fully apprised of all significant ongoing operations of CITY. Toward that end, ANNUITANT shall report directly to the City Council and will periodically, or as otherwise specifically requested by the City Council, provide status reports to the City Council on his/her activities and those of CITY. It is the intent of the City Council for the Interim City Administrator to function as the chief executive officer of CITY's organization. Without additional compensation, ANNUITANT shall provide such other services as are customary and appropriate to the position of Interim City Administrator, with such additional services assigned from time to time by the City Council as may be consistent with California law and the City Charter. ANNUITANT shall devote his/her best efforts and full-time attention to the performance of these duties, except as may be specifically agreed to by the City Council and ANNUNITANT.

1.5 Hours of Work. ANNUITANT shall devote the time necessary to adequately perform his duties as Interim City Administrator. The parties anticipate that ANNUITANT will work a sufficient number of hours per week allocated between regular business hours and hours outside of regular business hours including, without limitation, attendance at regular and special City Council meetings, attendance at activities of Directed Organizations (as defined below), and attendance at such community events and CITY functions as the Council may direct. Toward that end, ANNUITANT shall be allowed reasonable flexibility in setting ANNUITANT's own office hours, provided the schedule of such hours provides a significant presence at City Hall, reasonable availability to the City Council, CITY staff, and members of the community during regular CITY business hours and for the performance of ANNUITANT's duties and of CITY business. However, in no event shall ANNUITANT be required to work more than 960 hours per fiscal year for CITY, including hours worked for other CaIPERS Agencies during the 2023-2024 or 2024-2025 fiscal years. The position of Interim City Administrator shall be deemed an exempt position under California wage and hour law.

1.6 Reimbursements. The CITY shall reimburse ANNUITANT for reasonable and necessary travel, subsistence and other business expenses incurred by ANNUITANT in the performance of his duties. All reimbursements shall be subject to and in accordance with California law and applicable CITY reimbursement policies. Further, to the degree it may be specifically directed by the City Council, the Council desires ANNUITANT to be reasonably active in statewide, regional and/or local organizations which the Council deems to be necessary towards maintaining and contributing to the advancement of CITY's interests and standing ("Directed Organizations").

1.7 Other Activity. In accordance with Government Code § 1126, during the period of his employment, ANNUITANT shall not accept, without the express prior written consent of the City Council, any other employment or engage, directly or indirectly, in any other business, commercial, or professional activity (except as permitted under Section 1.6 3 179

[Reimbursements]), whether or not to pecuniary advantage, that is or may be competitive with CITY, that might cause a conflict of interest with CITY, or that otherwise might interfere with the business or operation of CITY or the satisfactory performance of ANNUITANT's duties as Interim City Administrator.

2. Compensation.

2.1 Rate of Pay. For all services performed by ANNUITANT as the Interim City Administrator under this Agreement, CITY shall pay ANNUITANT compensation at the rate of $143.79 per hour according to the current payroll schedule for the City Administrator, paid bi-weekly subject to the limitations provided below.

2.1.1 Compliance with CaIPERS requirements. It is the intent of the parties to compensate ANNUITANT only to the extent permitted under Government Code § 21221(h) and corresponding CaIPERS regulations, including but not limited to 7522.56(d), and policy statements. The Rate of Pay is within the established salary range for City Administrator ($143.79 per hour). ANNUITANT acknowledges that ANNUITANT will be compensated at the rate of $143.79 per hour and will not receive any benefits, incentives, compensation in -lieu of benefits or any other form of compensation.

2.1.2 Recordation and Reporting of Hours Worked. ANNUITANT will comply with all applicable CaIPERS regulations governing employment after retirement, including the recordation and reporting of all hours worked for CITY to CaIPERS as may be required.

CITY shall assist in any such reporting obligations to CaIPERS. Additionally, ANNUITANT shall keep CITY continually apprised of any hours worked by ANNUITANT for other CaIPERS Agencies during the term of this Agreement.

2.2 Benefits.

2.2.1 No Benefits. Pursuant to Government Code §21221(h) and related CaIPERS regulations and policy statements, ANNUITANT shall not receive from CITY any benefits CITY commonly provides to its employees, including without limitation health, dental, or vision insurance coverage, life insurance, employee assistance programs, and similar benefits.

3. Vacation and Leave.

3.1 No Leave. ANNUITANT and CITY agree that ANNUITANT, in accordance with Government Code §21221(h) and related CaIPERS regulations and policy statements, shall not be provided or accrue any personal time off, vacation, sick leave, administrative lease, paid holidays or similar leave benefits.
4 180

4. Termination.

4.1 Bv CITY. This Agreement may be terminated by CITY for any reason thirty (30) days after providing written notice to ANNUITANT of such termination. CITY 's only obligation in the event of such termination will be payment to ANNUITANT of all compensation then due and owing as set forth in Section 2.1 (Rate of Pay) up to and including the effective date of termination. However, this Agreement may be terminated immediately if necessitated by changes to Cal PERS statutory or regulatory requirements.

4.2 Bv ANNUITANT. This Agreement may be terminated by ANNUITANT for any reason thirty (30) days after providing written notice to CITY of such termination. CITY shall have the option, in its complete discretion, to make ANNUITANT's termination effective at any time prior to the end of such period, provided CITY pays ANNUITANT all compensation as set forth in Section 2.1 [Rate of Pay] then due and owing him through the last day actually worked.

4.3. No Notice for Expiration. Nothing in this Section 4 (Termination) shall be construed to require either party to give advance written notice for the Agreement to expire as set forth in Section 1.2 (Term).

4.4 Termination Obligations. ANNUITANT agrees that all property, including, without limitation, all equipment, tangible Proprietary Information (as defined below), documents, records, notes, contracts, and computer-generated materials furnished to or prepared by him incident to his employment belongs to CITY and shall be returned promptly to CITY upon termination of ANNUITANT's employment. ANNUITANT's obligations under this subsection shall survive the termination of his employment and the expiration of this Agreement.

5. Proprietary Information.
"Proprietary Information" is all information and any idea pertaining in any manner to the business of CITY (or any CITY affiliate), its employees, clients, consultants, or business associates, which was produced by any employee of CITY during his/her employment or otherwise produced or acquired by or on behalf of CITY. Proprietary Information shall include, without limitation, trade secrets, product ideas, inventions, processes, formulae, data, know-how, software and other computer programs, copyrightable material, marketing plans, strategies, sales, financial reports, forecasts, and customer lists. All Proprietary Information not generally known outside of CITY' s organization, and all Proprietary Information so known only through improper means, shall be deemed "Confidential Information." During ANNUITANT's employment by CITY, ANNUITANT shall use Proprietary Information, and shall disclose Confidential Information, only for the benefit of CITY and as is, or may be, necessary to perform his job responsibilities under this Agreement. Following termination, ANNUITANT shall not use any Proprietary Information and shall not disclose any Confidential Information, except with the express written consent of CITY. ANNUITANT's obligations under this Section shall survive the termination of his employment and the expiration of this Agreement. 5 181

6. Conflict of Interest.

ANNUITANT represents and warrants to CITY that he presently has no interest, and represents that he will not acquire any interest, direct or indirect, financial or otherwise, which would conflict in any manner or interfere in any way with performance of his services under this Agreement.

7. General Provisions.

7.1 Recitals. The recitals, inclusive of all facts and representations, are incorporated into this Agreement as if set forth in the Operative Provisions.

7.2 Vehicle Operation. ANNUITANT shall operate any vehicle used in connection with the performance of his duties as Interim City Administrator in a safe manner and otherwise in observance of all established traffic safety laws and ordinances and shall maintain a valid California automobile's driver's license during the period of employment.

7.3 Notices. All notices, requests, demands and other communications under this Agreement shall be in writing and shall be effective upon delivery by hand or three (3) business days after deposit in the United States mail, postage prepaid, certified or registered, and addressed to CITY at the address below, and or at the last known address maintained in ANNUITANT's file. ANNUITANT agrees to notify CITY in writing of any change in his/her address during his/her employment with CITY. Notice of change of address shall be effective only when accomplished in accordance with this Section.

City's Notice Address:
401 E. Chapman Avenue,
Placentia CA 92870
Attn: Mayor and City Council
Interim City Administrator's Address:
[Deliver to last updated address in personnel file]

7.4 Indemnification. Subject to, in accordance with, and to the extent provided by the California Government Claims Act [Government Code §810 et seq.], CITY will indemnify, defend, and hold ANNUITANT harmless from and against any action, demand, suit, monetary judgment or other legal or administrative proceeding, and any liability, injury, loss or other damages, arising out of any negligent act or omission occurring as a result of ANNUITANT's tenure as the CITY's Interim City Administrator.

7.5 Bonding. CITY shall bear the full cost of any fidelity or other bonds required of the Interim City Administrator under any law or ordinance. 6 182

7.6 Integration. This Agreement is intended to be the final, complete, and exclusive statement of the terms of ANNUITANT 's employment by CITY. This Agreement supersedes all other prior and contemporaneous agreements and statements, whether written or oral, express or implied, pertaining in any manner to the employment of ANNUITANT, and it may not be contradicted by evidence of any prior or contemporaneous statements or agreements. To the extent that the practices, policies, or procedures of CITY, now or in the future, apply to ANNUITANT and are inconsistent with the terms of this Agreement, the provisions of this Agreement shall control.

7.7 Amendments. This Agreement may not be amended except in a written document signed by ANNUITANT, approved by the City Council and signed by CITY's Mayor.

7.8 Waiver. Failure to exercise any right under this Agreement shall not constitute a waiver of such right.

7.9 Assignment. ANNUITANT shall not assign any rights or obligations under this Agreement. CITY may, upon prior written notice to ANNUITANT, assign its rights and obligations hereunder.

7.10 Severabilitv. If a court or arbitrator holds any provision of this Agreement to be invalid, unenforceable, or void, the remainder of this Agreement shall remain in full force and effect.

7.11 Attorneys' Fees. In any legal action, arbitration, or other proceeding brought to enforce or interpret the terms of this Agreement, the prevailing party shall be entitled to recover reasonable attorneys' fees and costs.

7.12 Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of California, with venue proper only in Orange County, State of California.

7.13 Interpretation. This Agreement shall be construed, according to its fair meaning, and not in favor of or against any party. By way of example and not in limitation, this Agreement shall not be construed in favor of the party receiving a benefit nor against the party responsible for any language in this Agreement. Captions are used for reference purposes only and should be ignored in the interpretation of the Agreement. This Agreement may be altered, amended or modified only by an instrument in writing, executed by the parties to this Agreement and by no other means. Each party waives 7 183

their future right to claim, contest or assert that this Agreement was modified, cancelled superseded or changed by any oral agreement, course of conduct, waiver or estoppel.

7.14 Acknowledgment. ANNUITANT acknowledges that he has had the opportunity to consult legal counsel regarding this Agreement, that he has read and understands this Agreement, that he is fully aware of its legal effect, and that he has entered into it freely and voluntarily and based on his own judgment and not on any representations or promises other than those contained in this Agreement.

IN WITNESS WHEREOF, CITY has caused this Agreement to be signed and executed on its behalf by its Mayor and duly attested to by its City Clerk, and ANNUITANT has signed and executed this Agreement, as of the date first indicated above.

INTERIM CITY ADMINISTRATOR
("ANNUITANT")

CITY OF PLACENTIA,
A California Charter City and municipal
corporation,
By:

Thomas R. Hatch Mayor
Attest:

By:

City Clerk
Approved as to form:

By:

City Attorney
8 184

Agenda Item No: 3.a

PLACENTIA CITY COUNCIL AGENDA REPORT
Meeting Date: December 17, 2024
Submitted by: Carole Wayman
From: City Clerk
Subject:

Certification of the Canvass of the November 5, 2024 General Municipal Election Results Financial Impact:

Fiscal Impact: None
Summary:

Every even -numbered year, the Placentia Charter requires the holding of a General Municipal Election for the purpose of electing City officials. Through City Council action, the November 5, 2024 General Municipal Election was consolidated with the Statewide General Election conducted by the Orange County Registrar of Voters held on the same day.

The State Elections Code requires the City Council to certify the election results no later than the next regularly scheduled City Council meeting following the Orange County Registrar's final Canvass of the Returns. The City Clerk is submitting the subject Resolution (Attachment No. 1) for adoption as required by the State Elections Code and City Charter.

The Resolution and the Certificate of Registrar of Voters to Result of the Canvass of the General Election Returns (Attachment No. 1, Exhibit A) provide the specific numbers of ballots cast and votes received by each candidate in the November 5, 2024 election.

Oranae County Reaistrar of Voters Analysis and Results
The municipal elective offices open in the election were as follows:
• One (1) member of the City Council, District 1 for a full term of four (4) years.

Candidates: Thomas Hummer
Joshua Correa
• One (1) member of the City Council, District 3 for a full term of four (4) years.

Candidates: Jeremy B. Yamaguchi
Kenneth Stevenson
185

• One (1) member of the City Council, District 5 for a full term of four (4) years.

Candidates: Ward L. Smith
Colson Teal
• One (1) City Treasurer for a full term of four (4) years.

Candidate: Kevin A. Larson
Pursuant to the vote of the people of the City of Placentia, the following individuals were elected to the following offices:

Member of the City Council, District 1: Thomas Hummer
Member of the City Council, District 3: Jeremy B. Yamaguchi Member of the City Council, District 5: Ward L. Smith
City Treasurer: Kevin A. Larson
The City Council's adoption of the proposed Resolution is required to certify the election results. According to the City Charter, the term of all members shall commence at the first regular Council meeting following the certification of the election results and each member shall serve until a successor is elected and qualified. The official canvass of the election contains a report of the numbers of votes cast for each candidate.

Recommendation:

Recommended Action: It is recommended that the City Council:

1. Receive and file the Certificate of Registrar of Voters to Result of the Canvass of the General Election Returns; and

2. Adopt Resolution No. R-2024-87, a Resolution of the City Council of the City of Placentia, California, reciting the fact of the General Municipal Election held on Tuesday, November 5, 2024 declaring the result and such other matters as provided by law.

Attachments
Attachment 1 - Resolution R-2024-87- 2024 Election Resolution.docx City of Placentia OCROV Certification - Exhibit A.pdf
186

RESOLUTION NO. R-2024-87

A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF

PLACENTIA, CALIFORNIA, RECITING THE FACT OF THE

GENERAL MUNICIPAL ELECTION HELD ON TUESDAY,
NOVEMBER 5, 2024, DECLARING THE RESULT AND

SUCH OTHER MATTERS AS PROVIDED BY LAW
A. Recitals.
(i). A General Municipal Election ("Election") was held and conducted in the City of Placentia, California, on Tuesday, November 5, 2024, as required by law. (ii). Notice of the Election was given in the time, form and manner as provided by law; voting precincts were properly established; that election officers were appointed and that in all respects the election was held and conducted and the votes were cast, received and canvassed and the returns made and declared in time, form and manner as required by the provisions of the Election Code of the State of California for the holding of elections in general law cities and pursuant to the requirements of the Placentia City Charter.
(iii). The Orange County Election Department canvassed the returns of the election and has certified the results to this City Council, the results are received, attached, and made a part hereof as "Exhibit A".
(iv). All legal prerequisites to the adoption of this Resolution have occurred.

B. Resolution.

NOW, THEREFORE, THE CITY COUNCIL OF THE CITY OF

PLACENTIA, CALIFORNIA, DOES RESOLVE, DECLARE, DETERMINE AND ORDER AS FOLLOWS:

1. In all respects as set forth in the Recitals, Part A., above.

2. The whole number of ballots cast in the precincts except vote by mail voter ballots and provisional ballots, was 6,227.

3. The whole number of vote by mail voter ballots cast in the City was 19,529, making a total of 25,756 ballots cast in the City.

4. The names of persons voted for at the election for Member of the City Council, District 1 are as follows:

Thomas Hummer
Joshua Correa
Resolution R-2024-87 ATTACHMENT 1

187

5. The names of persons voted for at the election for Member of the City Council, District 3 are as follows:

Jeremy B. Yamaguchi
Kenneth Stevenson

6. The names of the persons voted for at the election for Member of the City Council, District 5 are as follows:

Ward L. Smith
Colson Teal

7. The name of the person voted for at the election for City Treasurer is as follows:

Kevin A. Larson

8. The number of votes given in the City to each of the persons above named for the respective offices for which the persons were as listed in "Exhibit A" attached hereto and by this reference made a part hereof.

9. The City Council does declare and determine that:

Thomas Hummer was elected as Member of the City Council, District 1 for the full term of four (4) years;
Jeremy B. Yamaguchi was elected as Member of the City Council, District 3 for the full term of four (4) years;
Ward L. Smith was elected as Member of the City Council, District 5 for the full term of four (4) years;
Kevin A. Larson was elected as City Treasurer for the full term of four (4) years.

10. The City Clerk shall enter on the records of the City Council of the City, a statement of the result of the Election, showing: (1) The whole number of ballots cast in the City; (2) The names of the persons voted for; (3) For what office each person was voted for; and (4) The total of number of votes given to each person.

11. The City Clerk shall immediately make and deliver to each of the persons so elected a Certificate of Election signed by the City Clerk and authenticated; that the City Clerk shall also administer to each person elected the Oath of Office prescribed in the Constitution of the State of California and shall have them subscribe to it and file it in the Office of the City Clerk. Each and all of the persons so elected shall then be inducted into the respective office to which they have been elected.

Resolution R-2024-87 ATTACHMENT 1

188

12. The City Clerk shall certify to the passage and adoption of this Resolution and enter it into the book of original Resolutions.

PASSED, ADOPTED AND APPROVED this 17th day of December 2024.

Jeremy B. Yamaguchi, Mayor
ATTEST:

Robert S. McKinnell, City Clerk

STATE OF CALIFORNIA

COUNTY OF ORANGE
I, Robert S. McKinnell, City Clerk of the City of Placentia, do hereby certify that the foregoing Resolution was adopted at a regular meeting of the City Council of the City of Placentia held on the 17th day of December 2024, by the following vote:

AYES: Councilmembers:

NOES: Councilmembers:

ABSENT: Councilmembers:

ABSTAIN: Councilmembers:

Robert S. McKinnell, City Clerk
APPROVED AS TO FORM:

Christian L. Bettenhausen, City Attorney
Resolution R-2024-87 ATTACHMENT 1

189

EXHIBIT "A"

CERTIFICATE OF REGISTRAR OF VOTERS TO RESULT OF THE

CANVASS OF THE PRESIDENTIAL GENERAL ELECTION RETURNS

STATE OF CALIFORNIA)
)ss.

COUNTY OF ORANGE )
I, Bob Page, Registrar of Voters of Orange County, do hereby certify the following to be a full, true, and correct Statement of the Vote, consolidated with the Presidential General Election held on November 5, 2024.

CITY OF PLACENTIA
MEMBER OF THE CITY COUNCIL, DISTRICT 1
THOMAS HUMMER 1,469
JOSHUA CORREA 892
VOTE CENTER BALLOTS CAST: 816
VOTE -BY -MAIL BALLOTS CAST: 1,857
TOTAL BALLOTS CAST: 2,673
MEMBER OF THE CITY COUNCIL, DISTRICT 3
JEREMY YAMAGUCHI 3,089
KENNETH STEVENSON 1,536
VOTE CENTER BALLOTS CAST:

VOTE -BY -MAIL BALLOTS CAST:

TOTAL BALLOTS CAST:

MEMBER OF THE CITY COUNCIL, DISTRICT 5
WARD L. SMITH 2,744
COLSON TEAL 1,952
VOTE CENTER BALLOTS CAST:

VOTE -BY -MAIL BALLOTS CAST:

TOTAL BALLOTS CAST:
1,421
3,889
5,310
1,284
4,135
5,419

CITY TREASURER
KEVIN A. LARSON 19,455
VOTE CENTER BALLOTS CAST:

VOTE -BY -MAIL BALLOTS CAST:

TOTAL BALLOTS CAST:
6,227
19,529
25,756
I hereby certify that the number of votes cast for each candidate is as set forth above and appears in the Certified Statement of the Vote.

WITNESS my hand and Official Seal this 3rd day of December, 2024. 6-11"

BOB PAGE
Registrar of Voters
Orange County

Docusign Envelope ID: 063170C4-6D40-4C8D-B0B8-COEDOF1 DEC9A

FIRST AMENDMENT TO BENEFICIARY AGREEMENT BETWEEN THE

COUNTY OF ORANGE AND THE CITY OF PLACENTIA FOR AMERICAN

RESCUE PLAN ACT FUNDING
This First Amendment to the Beneficiary Agreement (the "First Amendment") is made and entered into as of June 29, 2024, by and between the County of Orange, a political subdivision of the State of California, hereinafter referred to as "County," and the City of Placentia, a California municipal corporation, hereafter referred to as "Beneficiary," with the County and Subrecipient referred to as "Party," or collectively as "Parties."
WHEREAS, on June 28, 2022, the Orange County Board of Supervisors authorized the allocation of $9,500,000 in State Local Fiscal Recovery Funds (SLFRF) funds to be used for various Fourth District priority projects, including local governments for educational and infrastructure projects; and WHEREAS, on May 16, 2023, the Parties entered into a Beneficiary Agreement for American Rescue Plan Act Funding ("Agreement"); and WHEREAS, the Parties wish to amend the Agreement to revise the use of grant amount terms.

NOW, THEREFORE, the Parties mutually agree as follows:

1. Paragraph 1 of the Agreement shall be deleted and replaced in its entirety by the following:

1. TERM OF AGREEMENT. The term of this Agreement begins on May 16, 2023, and terminates on June 30, 2026, or when all the Parties' obligations under this Agreement are fully satisfied, whichever occurs earlier.

2. Paragraph 2, subparagraph (b) of the Agreement shall be deleted and replaced in its entirety by the following:
b. Beneficiary shall use Grant Amount provided under this Agreement for costs associated with the development, construction, and maintenance of the playground at McFadden Park.

3. Paragraph 11 of the Agreement shall be deleted and replaced in its entirety by the following:

INDEMNITY. The Beneficiary agrees to indemnify, defend with counsel approved in writing by County, and hold County, its elected and appointed officials, officers, employees and agents and those special districts and agencies which County's Board of Supervisors acts as the governing Board harmless File Folder: 2759906
MA -017- 25010713 Page 1 of 2
192

Docusign Envelope ID: 063170C4-6D40-4C8D-B0B8-COEDOF1 DEC9A from any claims, demands or liability of any kind or nature, arising from or related to the Beneficiary's receipt or use of the Grant Amount under this Agreement, including any claims that the amounts paid by the County to Beneficiary were not used consistent with the restrictions on the use of SLFRF program funds as set forth in the regulations and guidance issued by the Department of Treasury regarding the use of such funds. The provisions of this paragraph shall survive the termination of this Agreement.

4. All other terms and conditions of the Agreement shall remain unchanged and in full force and effect.

IN WITNESS WHEREOF, the Parties hereto have executed this First Amendment on the date first above written.

BY:

BY:

BY:
�DocuSigned by:
rOSaulLa arvi)
"-13F77724C3C3450...

Rosanna Ramirez,
Acting City Administrator
City of Placentia
1—Signed by:
"— 6A4F3F0FA5254E8...

Jennifer Lampman,
Director of Finance
City of Placentia
Signed by:
rimA,illixt, fx,04
DODA113FD3E540C...

Ranique Beas,
Deputy Purchasing Agent
County of Orange, California
File Folder: 2759906
DATED: 12/3/2024
DATED: 12/3/2024
12/4/2024
DATED:

APPROVED AS TO FORM:

Office of the County Counsel
County of Orange, California
DocuSigned by:
b- .44
BY: 00514730 F 26 D481...

James C. Harman, Chief Assistant
12/4/2024
DATED:

MA -017- 25010713 Page 2 of 2
193