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HomeMy WebLinkAboutC-6426 - On-Call PSA for Consulting Arborist-9 N ? AMENDMENT NO. 1 TO 15 ON-CALL PROFESSIONAL SERVICES AGREEMENT WITH WALTER WARRINER FOR C1 CONSULTING ARBORIST THIS AMENDMENT NO. 1 TO ON-CALL PROFESSIONAL SERVICES AGREEMENT ("Amendment No. 1") is made and entered into as of this 31st day of December, 2016 ("Effective Date"), by and between the CITY OF NEWPORT BEACH, a California municipal corporation and charter city ("City"), and WALTER WARRINER, a sole proprietor ("Consultant"), whose address is 47-568 Hakuhale Street, Kaneohoe, HI 96744, and is made with reference to the following: RECITALS A. On December 15, 2015, City and Consultant entered into a Professional Services Agreement ("Agreement") to engage Consultant to provide on-call professional arborist consulting services ("Project"). B. The parties desire to enter into this Amendment No. 1 to extend the term of the Agreement to December 31, 2017 and to update the Independent Contractor Section. NOW, THEREFORE, it is mutually agreed by and between the undersigned parties as follows: 1. TERM Section 1 of the Agreement is amended in its entirety and replaced with the following: "The term of this Agreement shall commence on the Effective Date, and shall terminate on December 31, 2017, unless terminated earlier as set forth herein." 2. INDEPENDENT CONTRACTOR Section 10 of the Agreement is amended in its entirety and replaced with the following: "10.1 It is understood that City retains Consultant on an independent contractor basis and Consultant is not an agent or employee of City. The manner and means of conducting the Work are under the control of Consultant, except to the extent they are limited by statute, rule or regulation and the expressed terms of this Agreement. No civil service status or other right of employment shall accrue to Consultant or its employees. Nothing in this Agreement shall be deemed to constitute approval for Consultant or any of Consultant's employees or agents, to be the agents or employees of City. Consultant shall have the responsibility for and control over the means of performing the Work, provided that Consultant is in compliance with the terms of this Agreement. Anything in this Agreement that may appear to give City the right to direct Consultant as to the details of the performance of the Work or to exercise a measure of control over Consultant shall mean only that Consultant shall follow the desires of City with respect to the results of the Services. Walter Warriner Page 1 10.2 Consultant agrees and acknowledges that no individual performing Services pursuant to this Agreement shall: work full-time for more than six (6) months; work regular part-time service of at least twenty (20) hours per week for one year or longer; work nine hundred sixty (960) hours in any fiscal year; or already be a CalPERS member." 3. INTEGRATED CONTRACT Except as expressly modified herein, all other provisions, terms, and covenants set forth in the Agreement shall remain unchanged and shall be in full force and effect. [SIGNATURES ON NEXT PAGE] Walter Warriner Page 2 IN WITNESS WHEREOF, the parties have caused this Amendment No. 1 to be executed on the dates written below. APPROVED AS TO FORM: CITY ATTORNEY'S OFFICE Date:1 By: Aaron C. Harp U o►.Oq.l} City Attorney `-AM-J, ATTEST: �� Date: �' 1• BrownLeilani 1. City Clerk 1= a�P ,ALI F01 --dr CITY OF NEWPORT BEACH, a Californi municipal corporation Date: 0112-3L) By: f� — — Y: Mike Pisani Municipal Operations Director — General Services CONSULTANT: Walter Warriner, a sole proprietor Date: �- - �1 By: L) � � - Walter Warriner Owner [END OF SIGNATURES] Walter Warriner Page 3 4 CERTIFICATE OF INSURANCE CHECKLIST City of Newport Beach This checklist is comprised of requirements as outlined by the City of Newport Beach. * Date Received: 12/28/16 Dept./Contact Received From: Joan Date Completed: 12/28/16 Sent to: Joan By: Alicia Company/Person required to have certificate: Walter Warriner Type of contract: All Other I. GENERAL LIABILITY E FFECTIVEIEXPI RATION DATE: 4/8/16-4/8/17 A. INSURANCE COMPANY: Everest Indemnity Insurance Company B. AM BEST RATING (A-: VII or greater): A+: XV C. ADMITTED Company (Must be California Admitted): Is Company admitted in California? ❑ Yes S No D. LIMITS (Must be $1 M or greater): What is limit provided? 1,000,000/2,000,000 E. ADDITIONAL INSURED ENDORSEMENT — please attach S Yes ❑ No F. PRODUCTS AND COMPLETED OPERATIONS (Must include): Is it included? (completed Operations status does not apply to Waste Haulers or Recreation) S Yes ❑ No G. ADDITIONAL INSURED FOR PRODUCTS AND COMPLETED OPERATIONS ENDORSEMENT (completed Operations status does not apply to Waste Haulers) S Yes ❑ No H. ADDITIONAL INSURED WORDING TO INCLUDE (The City its officers, officials, employees and volunteers): Is it included? ® Yes ❑ No I. PRIMARY & NON-CONTRIBUTORY WORDING (Must be included): Is it included? S Yes ❑ No J. CAUTION! (Confirm that loss or liability of the named insured is not limited solely by their negligence) Does endorsement include "solely by negligence' wording? ❑ Yes S No K. ELECTED SCMAF COVERAGE (RECREATION ONLY): S N/A ❑ Yes ❑ No L. NOTICE OF CANCELLATION: ❑ N/A S Yes ❑ No II. AUTOMOBILE LIABILITY EFFECTIVE/EXPIRATION DATE: 12/16/16-12/16/17 A. INSURANCE COMPANY: American Fire and Casualty Ins. B. AM BEST RATING (A-: VII or greater) A: XV C. ADMITTED COMPANY (Must be California Admitted): Is Company admitted in California? D. LIMITS - If Employees (Must be $1 M min. BI & PD and $500,000 UM, $2M min for Waste Haulers): What is limits provided? E LIMITS Waiver of Auto Insurance / Proof of coverage (if individual) (What is limits provided?) F. PRIMARY & NON-CONTRIBUTORY WORDING (For Waste N/A S Yes ❑ No Haulers only): S N/A ❑ Yes ❑ No G. HIRED AND NON -OWNED AUTO ONLY: ❑ N/A ❑ Yes S No H. NOTICE OF CANCELLATION: 0 N/A 0 Yes ❑ No III. WORKERS' COMPENSATION EFFECTIVE/EXPIRATION DATE: Exemption Form on File Eff 12/15/16 A. INSURANCE COMPANY: B. AM BEST RATING (A-: VII or greater): C. ADMITTED Company (Must be California Admitted): ❑ Yes ❑ No D. WORKERS' COMPENSATION LIMIT: Statutory []Yes ❑ No E. EMPLOYERS' LIABILITY LIMIT (Must be $1 M or greater) F. WAIVER OF SUBROGATION (To include): Is it included? []Yes ❑ No G. SIGNED WORKERS' COMPENSATION EXEMPTION FORM: ❑ N/A ® Yes ❑ No H. NOTICE OF CANCELLATION: ❑ N/A ® Yes ❑ No ADDITIONAL COVERAGE'S THAT MAYBE REQUIRED IV. PROFESSIONAL LIABILITY V POLLUTION LIABILITY V BUILDERS RISK ❑ N/A ® Yes ❑ No ® N/A ❑ Yes ❑ No ® N/A ❑ Yes ❑ No HAVE ALL ABOVE REQUIREMENTS BEEN MET? 1. ® Yes ❑ No IF NO, WHICH ITEMS NEED TO BE COMPLETED? Approved: ( - 12/28/1 Agent of Alliant Insurance Services Date Broker of record for the City of Newport Beach RISK MANAGEMENT APPROVAL REQUIRED (Non -admitted carrier rated less than Self Insured Retention or Deductible greater than $ ) ❑ N/A ❑ Yes ❑ No Reason for Risk Management approval/exception/waiver: Risk Management approval needed due to GL carrier being non -admitted. Sheri approved 12/15/15. Approved: Risk Management Date * Subject to the terms of the contract. WALTE-3 OP ID: C3 ,acoRar CERTIFICATE OF LIABILITY INSURANCE M1 E(MMA)DoYj"Y) 1212212016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Wateridge Insurance Services 10717 Sorrento Valley Rd. c0NTACT Jan Underiee, AIS AINS CRIS NA PHONE FAX ac No ..858-888-7812 Arc No: 858-888-7823 aoDREss:lunderlee Watered e.com San Diego, CA 92121 Advance Integrated Busn Solut INSURER(S) AFFORDING COVERAGE NAIC4 INSURER A: Everest lndem nity Insurance Co INSURED Walter Warriner INSURER B:AmericanFire BCasualty Ins. 24066 47-568 Hakuhale Street Kaneohe, H196744 INSURER C: X X INSURER D INSURER E: 04108MO17 NSURER F : MED EXP (Myon person) $ 5,00 COVERAGES CERTIFICATE NUMBER' REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INBRTYPEOFINSURANCE LTR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN AODL SUER City of Newport Beach POUCYEFPDLICYNUMBER MMIDONYY MMIDCYEXP LIMITS A COMMERCIAL GENERAL LIABILITY Newport Beach, CA 92658 ----- e ---- EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE IX I OCCUR X X EF4ML05615161 04/0912016 04108MO17 PREMISES Eaoccurrence $ 50,00 MED EXP (Myon person) $ 5,00 X PERSONAL B ADV INJURY S 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMPrOP AGO $ 2,000,00 X POLICY F_] JEa 1-1 LOC $ OTHER I AUTOMOBILE LIABILITYNEO SINGLE LIMIT $ 1,000,00 a accident BODILY INJURY (Per person) $ B ANY AUTO X BAA1767722886 12/1612016 12116/2017 BODILY INJURY(Peraccident) $ ALLOWNEDX SCHEDULED AUTOS AUTOS X NON -OWNED HIRED AUrOS HAUTOS PROP HY DAMAGE $ Peraccident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ 1 1$ WORKERSCOMPENSATION AND EMPLOYERS'LIABILITY UTYIN ANY PROPRIETOWPARTNEWEXEOVE PER STATUTE ER E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ (Mandatory In NH) NIA E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE -POLICY LIMIT $ If yea, dewibe under DESCRIPTION OF OPERATIONS below A Prof Liability EF4ML06616161 04/08/2016 04108/2017 Prof Llab 1,000,00 Poll Liability EF4ML05615161 04108/2016 04108/2017 Poll Llab 1,000,00 DESCRIPTION OF OPERATIONS/ LOCATIONS(VEHICLES (ACORD 101, Additional Rematks Schedule, may W attached H more space is required) RE: Evidence of Coverage *Please see attached notes* CERTIFICATE HOLDER CANCELLATION CITYOFN (D 1988-2014 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Newport Beach 100 Civic Center Drive PO Box 1768 AUTHORIZED REPRESENTATIVE Newport Beach, CA 92658 ----- e ---- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: EF4ML05615-161 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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): Locations Of Covered Operations Blanket where required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — 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) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to 'bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment 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 in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 13 POLICY NUMBER: EF4ML05615-161 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 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 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations Blanket where required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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 "properly dam- age" caused, in whole or in part, by "your work' at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 ❑ Policy #EF4 M L05615161 ECG 24 588 06 15. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY PROVISION - YOUR ONGOING AND/OR COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTOR'S POLLUTION LIABILITY COVERAGE PART Paragraph 4., Other Insurance of Conditions (Section IV) is amended by the addition of the following: If insurance similar to this insurance is held by a person or organization that is: a. An owner of real or personal property on which you are performing operations; or b. A contractor on whose behalf you are performing operations, this insurance is primary to that other insurance, and that other insurance shall not contribute to amounts payable under this insurance, for liability arising out of your ongoing and/or completed operations performed for that per- son or organization under a written contract. However, this does not apply to any person or organization from whom you did not receive a specific written request that this insurance be primary insurance, or if you did not receive that request prior to the date that your operations for that person or organization commenced. ECG 24 568 06 15 Copyright Everest Reinsurance Company, 2015 Page 1 of 1 ❑ Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy #EF4ML05615161 ECG 24 506 06 15 THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILTY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART MOTOR VEHICLE POLLUTION LIABILITY COVERGE PART SCHEDULE Name of Person or Organization: Blanket where required by written contract Any person or organization that is: RECOVERY 1. An owner of real or personal property on which you are performing operations, but only at the specific writ- ten request by that person or organization to you, and only if that request is made prior to the date your operations for that person or organization commenced; or 2. A contractor on whose behalf you are performing operations; but only at the specific written request by that person or organization to you, and only if that request is made prior to the date your operations for that person or organization commenced. (If no entry appears above, information required to complete this endorsement will be shown_in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV — CONDITIONS) is amended by the addition of the following: 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. ECG 24 506 06 15 Copyright, Everest Reinsurance Company, 2015 Page 1 of 1 O Includes copyrighted material of Insurance Services Office, Inc., with its permission M COMMERCIAL AUTO CA 88 10 01 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. f eZsi # ;T-Tcl :1 t kl i] � 7 SUBJECT ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT ACCIDENTAL AIRBAG DEPLOYMENT AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS AMENDED FELLOW EMPLOYEE EXCLUSION AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE BROAD FORM INSURED BODILY INJURY REDEFINED EMPLOYEES AS INSUREDS (including employee hired auto) EXTENDED CANCELLATION CONDITION EXTRA EXPENSE - BROADENED COVERAGE GLASS REPAIR - WAIVER OF DEDUCTIBLE HIRED AUTO PHYSICAL DAMAGE (including employee hired auto and loss of use) HIRED AUTO COVERAGE TERRITORY LOAN / LEASE GAP PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) PERSONAL EFFECTS COVERAGE PHYSICAL DAMAGE - ADDITIONAL TRANSPORTATION EXPENSE COVERAGE RENTAL REIMBURSEMENT SUPPLEMENTARY PAYMENTS TOWING AND LABOR TWO OR MORE DEDUCTIBLES UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS WAIVER OF TRANSFER OF RIGHTS OF RECOVERYAGAINST OTHERS TO US SECTION II - LIABILITY COVERAGE is amended as follows: 1. BROAD FORM INSURED PROVISION NUMBER 3 12 19 5 13 1 22 2 23 10 15 6 20 14 16 11 8 9 4 7 17 18 20 SECTION II - LIABILITY COVERAGE, paragraph A.I. - WHO IS AN INSURED is amended to include the following as an insured: d. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the policy period. However, "insured" does not include any organization that: (1) Is a partnership or joint venture; or (2) Is an insured under any other automobile policy; or (3) Has exhausted its Limit of Insurance under any other automobile policy. Paragraph d. (2) of this provision does not apply to a policy written to apply specifically in excess of this policy. e. Any organization you newly acquire or form, other than a partnership or joint venture, of which you own more than 50 percent of the voting stock. This automatic coverage is afforded only for 180 days from the date of acquisition or formation. However, coverage under this provision does not apply: (1) If there is similar insurance or a self-insured retention plan available to that organization; 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 7 (2) If the Limits of Insurance of any other insurance policy have been exhausted; or (3) To "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 2. EMPLOYEES AS INSUREDS SECTION II - LIABILITY COVERAGE, paragraph A.1. - WHO IS AN INSURED is amended to include the following as an insured: f. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow, but only for acts within the scope of their employment by you. Insurance provided by this endorse- ment is excess over any other insurance available to any "employee". g. An "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee's" name, with your permission, while performing duties re- lated to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee". 3. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION II - LIABILITY COVERAGE, paragraph A.1. - WHO IS AN INSURED is amended to include the following as an insured: h. Any person or organization with respect to the operation, maintenance or use of a covered "auto", provided that you and such person or organization have agreed in a written contract, agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured". However, such person or organization is an "insured": (1) Only with respect to the operation, maintenance or use of a covered "auto"; (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or agreement, or the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit 4. SUPPLEMENTARY PAYMENTS SECTION II - LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, para- graphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations ) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the insured at our request, including actual loss of earn- ings up to $500 a day because of time off from work. 5. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by law, fellow employees are not entitled to the protection afforded to s the employer by the workers compensation exclusivity rule, or similar protection, the following provision is added: SECTION II - LIABILITY, exclusion 113.5. FELLOW EMPLOYEE does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. N SECTION III - PHYSICAL DAMAGE COVERAGE is amended as follows: 6. HIRED AUTO PHYSICAL DAMAGE Paragraph A.4. Coverage Extensions of SECTION III - PHYSICAL DAMAGE COVERAGE, is amended by adding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos": a. You hire, rent or borrow; or © 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 7 s b. Your "employee" hires or rents under a written contract or agreement in that "employee's" name, but only if the damage occurs while the vehicle is being used in the conduct of your business, subject to the following limit and deductible: A. The most we will pay for "loss" in any one "accident" or "loss" is the smallest of: (1) $50,000; or (2) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, minus a deductible. B. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. C. Subject to the limit, deductible and excess provisions described in this provision, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. D. Subject to a maximum of $1,000 per "accident", we will also cover the actual loss of use of the hired "auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial loss. E. This coverage extension does not apply to: (1) Any "auto" that is hired, rented or borrowed with a driver; or (2) Any "auto" that is hired, rented or borrowed from your "employee". For the purposes of this provision, SECTION V -DEFINITIONS is amended by adding the following: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. 7. TOWING AND LABOR SECTION III - PHYSICAL DAMAGE COVERAGE, paragraph A.2. Towing, is amended by the addition of the following: We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" classified and rated as a private passenger type, "light truck" or "medium truck" is dis- abled: a. For private passenger type vehicles, we will pay up to $50 per disablement. b. For "light trucks", we will pay up to $50 per disablement. "Light trucks" are trucks that have gross vehicle weight (GVW) of 10,000 pounds or less. c. For "medium trucks" , we will pay up to $150 per disablement. "Medium trucks" are trucks that have agross vehicle weight (GVW) of 10,001 -20,000 pounds. However, the labor must be performed at the place of disablement. 8. PHYSICAL DAMAGE -ADDITIONAL TRANSPORTATION EXPENSE COVERAGE Paragraph AA.a., Coverage Extension of SECTION III - PHYSICAL DAMAGE COVERAGE, is amend- ed to provide a limit of $50 per day and a maximum limit of $1,500 © 2013 Liberty Mutual Insurance CA 88 10 01. 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 7 9. RENTAL REIMBURSEMENT SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following: a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "accident" or "loss", to an "auto" for which we also pay a "loss" under Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those expenses incurred after the first 24 hours following the "accident" or "loss" to the covered "auto." b. Rental Reimbursement will be based on the rental of a comparable vehicle, which in many cases may be substantially less than $75 per day, and will only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your tools and equipment from the covered "auto". d. This coverage does not apply unless you have a business necessity that other "autos" avail- able for your use and operation cannot fill. e. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under Paragraph 4. Coverage Extension. f. No deductible applies to this coverage. For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined in provision 11. 10. EXTRA EXPENSE - BROADENED COVERAGE Under SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE, we will pay for the expense of returning a stolen covered "auto" to you. The maximum amount we will pay is $1,000. 11. PERSONAL EFFECTS COVERAGE A. SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following: If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects" stolen with the "auto." The insurance provided under this provision is excess over any other collectible insurance. B. SECTION V - DEFINITIONS is amended by adding the following: For the purposes of this provision, "personal effects" mean tangible property that is wom or carried by an insured." "Personal effects" does not include tools, equipment, jewelry, money or securities. u 12. ACCIDENTAL AIRBAG DEPLOYMENT s SECTION III - PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS is amended by adding the follow- ig: $ If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to the accidental discharge of an airbag. Any insurance we provide shall be excess over any other collectible insurance or reimbursement by manufacturer's warranty. However, we agree to pay any deductible applicable to the other cov- erage or warranty. 13. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION III - PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS, exception paragraph a. to exclu- sions 4.c. and 4.d. is deleted and replaced with the following: © 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 4 of 7 Exclusion 4.c. and 4.d. do not apply to: a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not designed solely for the reproduction of sound, if the equipment is permanently installed in the covered "auto" at the time of the "loss" and such equipment is designed to be solely operated by use of the power from the "auto's" electrical system, in or upon the covered "auto" and physical damage coverages are provided for the covered "auto"; or If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this equipment, then our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by a $100 deductible. 14. LOAN/ LEASE GAP COVERAGE A. Paragraph C., LIMIT OF INSURANCE of SECTION III - PHYSICAL DAMAGE COVERAGE is _ amended by adding the following: The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one "accident" is the greater of the: 1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is subject at the time of the "loss" less the amount of: a. Overdue payments and financial penalties associated with those payments as of the date of the "loss", a b. Financial penalties imposed under a lease due to high mileage, excessive use or ab- normal wear and tear, c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease, d. Transfer or rollover balances from previous loans or leases, e. Final payment due under a "Balloon Loan", f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of a covered "auto", g. Security deposits not refunded by a lessor, h. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement on a covered "auto", i. Any amount representing taxes, j. Loan or lease termination fees; or 2. The actual cash value of the damage or stolen property as of the time of the "loss". An adjustment for depreciation and physical condition will be made in determining the actual " cash value at the time of the "loss". This adjustment is not applicable in Texas. a B. ADDITIONAL CONDITIONS This coverage applies only to the original loan for which the covered "auto" that incurred the loss serves as collateral, or lease written on the covered "auto" that incurred the loss. C. SECTION V - DEFINTIONS is changed by adding the following: As used in this endorsement provision, the following definitions apply: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. A "balloon loan" is one with periodic payments that are insufficient to repay the balance over the term of the loan, thereby requiring a large final payment. 0 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 5 of 7 15. GLASS REPAIR- WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: No deductible applies to glass damage if the glass is repaired rather than replaced. 16. PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: The deductible does not apply to "loss" caused by collision to such covered "auto' of the private passenger type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as maximum loaded weight the "auto" is designed to carry while it is: a. In the charge of an "insured"; b. Legally parked; and c. Unoccupied. The "loss" must be reported to the police authorities within 24 hours of known damage. The total amount of the damage to the covered "auto' must exceed the deductible shown in the Declarations. This provision does not apply to any 'loss" if the covered "auto" is in the charge of any person or organization engaged in the automobile business. 17. TWO OR MORE DEDUCTIBLES Under SECTION III PHYSICAL DAMAGE COVERAGE, if two or more company policies or coverage forms apply to the same accident, the following applies to paragraph D. Deductible: a. If the applicable Business Auto deductible is the smaller (or smallest) deductible it will be waived; or b. If the applicable Business Auto deductible is not the smaller (or smallest) deductible it will be reduced by the amount of the smaller (or smallest) deductible; or c. If the loss involves two or more Business Auto coverage forms or policies the smaller (or smallest) deductible will be waived. For the purpose of this endorsement company means any company that is part of the Liberty Mutual Group. SECTION IV - BUSINESS AUTO CONDITIONS is amended as follows: 18. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV- BUSINESS AUTO CONDITIONS, Paragraph B.2. is amended by adding the following: If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the inception date or renewal date of the Business Auto Coverage Form, the coverage afforded by this policy will not be prejudiced. a However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and we have the right to collect additional premium for any such hazard or exposure. 19. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS a SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A.2.a. is replaced in its entirety by the following: a. In the event of "accident", claim, "suit" or "loss", you must promptly notify us when it is known to: 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. Member, if you are a limited liability company; 4. An executive officer or the "employee" designated by the Named Insured to give such notice, if you are a corporation. © 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Page 6 of 7 To the extent possible, notice to us should include: (1) How, when and where the "accident" or "loss" took place; (2) The "insureds" name and address; and (3) The names and addresses of any injured persons and witnesses. 20. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A.5., Transfer of Rights of Recovery Against Others to Us, is amended by the addition of the following: If the person or organization has waived those rights before an "accident" or "loss", our rights are waived also. 21. HIRED AUTO COVERAGE TERRITORY SECTION IV - BUSINESS AUTO CONDITIONS, paragraph B.7., Policy Period, Coverage Territory, is amended by the addition of the following: p f. For "autos" hired 30 days or less, the coverage territory is anywhere in the word, provided that the insured's responsibility to pay for damages is determined in a "suit", on the merits, in the United States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver. SECTION V - DEFINITIONS is amended as follows: 22. BODILY INJURY REDEFINED Under SECTION V - DEFINITIONS, definition C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental $ anguish, mental injury, shock, fright or death resulting from any of these at any time. COMMMON POLICY CONDITIONS 23. EXTENDED CANCELLATION CONDITION s COMMON POLICY CONDITIONS, paragraph A. - CANCELLATION condition applies except as fol- lows: If we cancel for any reason other than nonpayment of premium, we will mail to the first Named Insured written notice of cancellation at least 60 days before the effective date Of cancellation. This provision does not apply in those states which require more than 60 days prior notice of cancella- tion. ® 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 7 ON-CALL PROFESSIONAL SERVICES AGREEMENT WITH WALTER WARRINER FOR CONSULTING ARBORIST THIS ON-CALL PROFESSIONAL SERVICES AGREEMENT ("Agreement') is made and entered into as of this 15th day of December, 2015 ("Effective Date"), by and between the CITY OF NEWPORT BEACH, a California municipal corporation and charter city ("City"), and WALTER WARRINER, a sole proprietor ("Consultant"), whose address is 47-568 Hakuhale Street, Kaneohoe, Hawaii 96744, and is made with reference to the following: RECITALS A. City is a municipal corporation duly organized and validly existing under the laws of the State of California with the power to carry on its business as it is now being conducted under the statutes of the State of California and the Charter of City. B. City desires to engage Consultant to provide on-call professional arborist consulting services ("Project'). C. Consultant possesses the skill, experience, ability, background, certification and knowledge to provide the on-call professional services described in this Agreement. D. City has solicited and received a proposal from Consultant, has reviewed the previous experience and evaluated the expertise of Consultant, and desires to retain Consultant to render on-call professional services under the terms and conditions set forth in this Agreement. NOW, THEREFORE, it is mutually agreed by and between the undersigned parties as follows: 1. TERM The term of this Agreement shall commence on the Effective Date, and shall terminate on December 31, 2016, unless terminated earlier as set forth herein. 2. SERVICES TO BE PERFORMED 2.1 Consultant shall perform the on-call professional services described in the Scope of Services attached hereto as Exhibit A and incorporated herein by reference ("Services" or "Work"). Upon written request from the Project Administrator as defined herein, Consultant shall provide a letter proposal for Services requested by the City (hereinafter referred to as the "Letter Proposal"). The Letter Proposal shall include the following: 2.1.1 A detailed description of the Services to be provided; and 2.1.3 The estimated number of hours and cost to complete the Services; 2.1 .4 The time needed to finish the specific project. 2.2 No Services shall be provided until the Project Administrator has provided written acceptance of the Letter Proposal. Once authorized to proceed, Consultant shall diligently perform the duties in the approved Letter Proposal. 3. TIME OF PERFORMANCE 3.1 Time is of the essence in the performance of Services under this Agreement and Consultant shall perform the Services in accordance with the schedule included in Exhibit A and the Letter Proposal. In the absence of a specific schedule, the Services shall be performed to completion in a diligent and timely manner. The failure by Consultant to strictly adhere to the schedule set forth in Exhibit A and the Letter Proposal, if any, or perform the Services in a diligent and timely manner may result in termination of this Agreement by City. 3.2 Notwithstanding the foregoing, Consultant shall not be responsible for delays due to causes beyond Consultant's reasonable control. However, in the case of any such delay in the Services to be provided for the Project, each party hereby agrees to provide notice within two (2) calendar days of the occurrence causing the delay to the other party so that all delays can be addressed. 3.3 Consultant shall submit all requests for extensions of time for performance in writing to the Project Administrator as defined herein not later than ten (10) calendar days after the start of the condition that purportedly causes a delay. The Project Administrator shall review all such requests and may grant reasonable time extensions for unforeseeable delays that are beyond Consultant's control. 3.4 For all time periods not specifically set forth herein, Consultant shall respond in the most expedient and appropriate manner under the circumstances, by hand-delivery or mail. 4. COMPENSATION TO CONSULTANT 4.1 City shall pay Consultant for the Services on a time and expense not-to- exceed basis in accordance with the provisions of this Section and the Letter Proposal and the Schedule of Billing Rates attached hereto as Exhibit B and incorporated herein by reference. Consultant's compensation for all Work performed in accordance with this Agreement, including all reimbursable items and subconsultant fees, shall not exceed Twenty Thousand Dollars and 001100 ($20,000.00), without prior written authorization from City. No billing rate changes shall be made during the term of this Agreement without the prior written approval of City. 4.2 Consultant shall submit monthly invoices to City describing the Work performed the preceding month. Consultant's bills shall include the name of the person Walter Warriner Page 2 who performed the Work, a brief description of the Services performed and/or the specific task in the Scope of Services to which it relates, the date the Services were performed, the number of hours spent on all Work billed on an hourly basis, and a description of any reimbursable expenditures. City shall pay Consultant no later than thirty (30) calendar days after approval of the monthly invoice by City staff. 4.3 City shall reimburse Consultant only for those costs or expenses specifically identified in Exhibit B to this Agreement and the Letter Proposal or specifically approved in writing in advance by City. 4.4 Consultant shall not receive any compensation for Extra Work performed without the prior written authorization of City. As used herein, "Extra Work" means any Work that is determined by City to be necessary for the proper completion of the Project, but which is not included within the Scope of Services and which the parties did not reasonably anticipate would be necessary at the execution of this Agreement. Compensation for any authorized Extra Work shall be paid in accordance with the Schedule of Billing Rates as set forth in Exhibit B and the Letter Proposal. 5. PROJECT MANAGER 5.1 Consultant shall designate a Project Manager, who shall coordinate all phases of the Project. This Project Manager shall be available to City at all reasonable times during the Agreement term. Consultant has designated Walter Warriner to be its Project Manager. Consultant shall not remove or reassign the Project Manager or any personnel listed in Exhibit A or assign any new or replacement personnel to the Project without the prior written consent of City. City's approval shall not be unreasonably withheld with respect to the removal or assignment of non-key personnel. 5.2 Consultant, at the sole discretion of City, shall remove from the Project any of its personnel assigned to the performance of Services upon written request of City. Consultant warrants that it will continuously furnish the necessary personnel to complete the Project on a timely basis as contemplated by this Agreement. 5.3 If Consultant is performing inspection services for City, the Project Manager and any other assigned staff shall be equipped with a cellular phone to communicate with City staff. The Project Manager's cellular phone number shall be provided to City. 6. ADMINISTRATION This Agreement will be administered by the Municipal Operations Department. City's Landscape Manager or designee shall be the Project Administrator and shall have the authority to act for City under this Agreement. The Project Administrator shall represent City in all matters pertaining to the Services to be rendered pursuant to this Agreement. Walter Warriner Page 3 7. CITY'S RESPONSIBILITIES To assist Consultant in the execution of its responsibilities under this Agreement, City agrees to provide access to and upon request of Consultant, one copy of all existing relevant information on file at City. City will provide all such materials in a timely manner so as not to cause delays in Consultant's Work schedule. 8. STANDARD OF CARE 8.1 All of the Services shall be performed by Consultant or under Consultant's supervision. Consultant represents that it possesses the professional and technical personnel required to perform the Services required by this Agreement, and that it will perform all Services in a manner commensurate with the highest professional standards. All Services shall be performed by qualified and experienced personnel who are not employed by City. By delivery of completed Work, Consultant certifies that the Work conforms to the requirements of this Agreement, all applicable federal, state and local laws, and the highest professional standard. 8.2 Consultant represents and warrants to City that it has, shall obtain, and shall keep in full force and effect during the term hereof, at its sole cost and expense, all licenses, permits, qualifications, insurance and approvals of whatsoever nature that is legally required of Consultant to practice its profession. Consultant shall maintain a City of Newport Beach business license during the term of this Agreement. 8.3 Consultant shall not be responsible for delay, nor shall Consultant be responsible for damages or be in default or deemed to be in default by reason of strikes, lockouts, accidents, acts of God, or the failure of City to furnish timely information or to approve or disapprove Consultant's Work promptly, or delay or faulty performance by City, contractors, or governmental agencies. 9. HOLD HARMLESS 9.1 To the fullest extent permitted by law, Consultant shall indemnify, defend and hold harmless City, its City Council, boards and commissions, officers, agents, volunteers and employees (collectively, the "Indemnified Parties") from and against any and all claims (including, without limitation, claims for bodily injury, death or damage to property), demands, obligations, damages, actions, causes of action, suits, losses, judgments, fines, penalties, liabilities, costs and expenses (including, without limitation, attorneys' fees, disbursements and court costs) of every kind and nature whatsoever (individually, a Claim; collectively, "Claims"), which may arise from or in any manner relate (directly or indirectly) to any breach of the terms and conditions of this Agreement, any Work performed or Services provided under this Agreement including, without limitation, defects in workmanship or materials or Consultant's presence or activities conducted on the Project (including the negligent, reckless, and/or willful acts, errors and/or omissions of Consultant, its principals, officers, agents, employees, vendors, suppliers, consultants, subcontractors, anyone employed directly or indirectly by any of them or for whose acts they may be liable, or any or all of them). Walter Warriner Page 4 9.2 Notwithstanding the foregoing, nothing herein shall be construed to require Consultant to indemnify the Indemnified Parties from any Claim arising from the sole negligence or willful misconduct of the Indemnified Parties. Nothing in this indemnity shall be construed as authorizing any award of attorneys' fees in any action on or to enforce the terms of this Agreement. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by Consultant. 10. INDEPENDENT CONTRACTOR It is understood that City retains Consultant on an independent contractor basis and Consultant is not an agent or employee of City. The manner and means of conducting the Work are under the control of Consultant, except to the extent they are limited by statute, rule or regulation and the expressed terms of this Agreement. No civil service status or other right of employment shall accrue to Consultant or its employees. Nothing in this Agreement shall be deemed to constitute approval for Consultant or any of Consultant's employees or agents, to be the agents or employees of City. Consultant shall have the responsibility for and control over the means of performing the Work, provided that Consultant is in compliance with the terms of this Agreement. Anything in this Agreement that may appear to give City the right to direct Consultant as to the details of the performance of the Work or to exercise a measure of control over Consultant shall mean only that Consultant shall follow the desires of City with respect to the results of the Services. 11. COOPERATION Consultant agrees to work closely and cooperate fully with City's designated Project Administrator and any other agencies that may have jurisdiction or interest in the Work to be performed. City agrees to cooperate with the Consultant on the Project. 12. CITY POLICY Consultant shall discuss and review all matters relating to policy and Project direction with City's Project Administrator in advance of all critical decision points in order to ensure the Project proceeds in a manner consistent with City goals and policies. 13. PROGRESS Consultant is responsible for keeping the Project Administrator informed on a regular basis regarding the status and progress of the Project, activities performed and planned, and any meetings that have been scheduled or are desired. 14. INSURANCE Without limiting Consultant's indemnification of City, and prior to commencement of Work, Consultant shall obtain, provide and maintain at its own expense during the Walter Warriner Page 5 term of this Agreement or for other periods as specified in this Agreement, policies of insurance of the type, amounts, terms and conditions described in the Insurance Requirements attached hereto as Exhibit C, and incorporated herein by reference. 15. PROHIBITION AGAINST ASSIGNMENTS AND TRANSFERS Except as specifically authorized under this Agreement, the Services to be provided under this Agreement shall not be assigned, transferred contracted or subcontracted out without the prior written approval of City. Any of the following shall be construed as an assignment: The sale, assignment, transfer or other disposition of any of the issued and outstanding capital stock of Consultant, or of the interest of any general partner or joint venturer or syndicate member or cotenant if Consultant is a partnership or joint-venture or syndicate or co-tenancy, which shall result in changing the control of Consultant. Control means fifty percent (50%) or more of the voting power or twenty-five percent (25%) or more of the assets of the corporation, partnership or joint-venture. 16. SUBCONTRACTING The subcontractors authorized by City, if any, to perform Work on this Project are identified in Exhibit A and the Letter Proposal. Consultant shall be fully responsible to City for all acts and omissions of any subcontractor. Nothing in this Agreement shall create any contractual relationship between City and any subcontractor nor shall it create any obligation on the part of City to pay or to see to the payment of any monies due to any such subcontractor other than as otherwise required by law. City is an intended beneficiary of any Work performed by the subcontractor for purposes of establishing a duty of care between the subcontractor and City. Except as specifically authorized herein, the Services to be provided under this Agreement shall not be otherwise assigned, transferred, contracted or subcontracted out without the prior written approval of City. 17. OWNERSHIP OF DOCUMENTS 17.1 Each and every report, draft, map, record, plan, document and other writing produced, including but not limited to, websites, blogs, social media accounts and applications (hereinafter "Documents"), prepared or caused to be prepared by Consultant, its officers, employees, agents and subcontractors, in the course of implementing this Agreement, shall become the exclusive property of City, and City shall have the sole right to use such materials in its discretion without further compensation to Consultant or any other party. Additionally, all material posted in cyberspace by Consultant, its officers, employees, agents and subcontractors, in the course of implementing this Agreement, shall become the exclusive property of City, and City shall have the sole right to use such materials in its discretion without further compensation to Consultant or any other party. Consultant shall, at Consultant's expense, provide such Documents, including all logins and password information to City upon prior written request. Walter Warriner Page 6 17.2 Documents, including drawings and specifications, prepared by Consultant pursuant to this Agreement are not intended or represented to be suitable for reuse by City or others on any other project. Any use of completed Documents for other projects and any use of incomplete Documents without specific written authorization from Consultant will be at City's sole risk and without liability to Consultant. Further, any and all liability arising out of changes made to Consultant's deliverables under this Agreement by City or persons other than Consultant is waived against Consultant, and City assumes full responsibility for such changes unless City has given Consultant prior notice and has received from Consultant written consent for such changes. 17.3 All written documents shall be transmitted to City in formats compatible with Microsoft Office and/or viewable with Adobe Acrobat. 18. CONFIDENTIALITY All Documents, including drafts, preliminary drawings or plans, notes and communications that result from the Services in this Agreement, shall be kept confidential unless City expressly authorizes in writing the release of information. 19. INTELLECTUAL PROPERTY INDEMNITY Consultant shall defend and indemnify City, its agents, officers, representatives and employees against any and all liability, including costs, for infringement or alleged infringement of any United States' letters patent, trademark, or copyright, including costs, contained in Consultant's Documents provided under this Agreement. 20. RECORDS Consultant shall keep records and invoices in connection with the Services to be performed under this Agreement. Consultant shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any Services, expenditures and disbursements charged to City, for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Consultant under this Agreement. All such records and invoices shall be clearly identifiable. Consultant shall allow a representative of City to examine, audit and make transcripts or copies of such records and invoices during regular business hours. Consultant shall allow inspection of all Work, data, Documents, proceedings and activities related to the Agreement for a period of three (3) years from the date of final payment to Consultant under this Agreement. 21. WITHHOLDINGS City may withhold payment to Consultant of any disputed sums until satisfaction of the dispute with respect to such payment. Such withholding shall not be deemed to constitute a failure to pay according to the terms of this Agreement. Consultant shall not discontinue Work as a result of such withholding. Consultant shall have an immediate right to appeal to the City Manager or designee with respect to such disputed Walter Warriner Page 7 sums. Consultant shall be entitled to receive interest on any withheld sums at the rate of return that City earned on its investments during the time period, from the date of withholding of any amounts found to have been improperly withheld. 22. ERRORS AND OMISSIONS In the event of errors or omissions that are due to the negligence or professional inexperience of Consultant which result in expense to City greater than what would have resulted if there were not errors or omissions in the Work accomplished by Consultant, the additional design, construction and/or restoration expense shall be borne by Consultant. Nothing in this Section is intended to limit City's rights under the law or any other sections of this Agreement. 23. CITY'S RIGHT TO EMPLOY OTHER CONSULTANTS City reserves the right to employ other Consultants in connection with the Project. 24. CONFLICTS OF INTEREST 24.1 Consultant or its employees may be subject to the provisions of the California Political Reform Act of 1974 (the "Act"), which (1) requires such persons to disclose any financial interest that may foreseeably be materially affected by the Work performed under this Agreement, and (2) prohibits such persons from making, or participating in making, decisions that will foreseeably financially affect such interest. 24.2 If subject to the Act, Consultant shall conform to all requirements of the Act. Failure to do so constitutes a material breach and is grounds for immediate termination of this Agreement by City. Consultant shall indemnify and hold harmless City for any and all claims for damages resulting from Consultant's violation of this Section. 25. NOTICES 25.1 All notices, demands, requests or approvals, including any change in mailing address, to be given under the terms of this Agreement shall be given in writing, and conclusively shall be deemed served when delivered personally, or on the third business day after the deposit thereof in the United States mail, postage prepaid, first- class mail, addressed as hereinafter provided. 25.2 All notices, demands, requests or approvals from Consultant to City shall be addressed to City at: Attn: Dan Sereno, Landscape Manager Municipal Operations Department City of Newport Beach 100 Civic Center Drive, PO Box 1768 Newport Beach, CA 92658 Walter Warriner Page 8 25.3 All notices, demands, requests or approvals from City to Consultant shall be addressed to Consultant at: Attn: Walter Warriner Walter Warriner 47-568 Hakuhale Street Kaneohe, HI 96744 26. CLAIMS Unless a shorter time is specified elsewhere in this Agreement, before making its final request for payment under this Agreement, Consultant shall submit to City, in writing, all claims for compensation under or arising out of this Agreement. Consultant's acceptance of the final payment shall constitute a waiver of all claims for compensation under or arising out of this Agreement except those previously made in writing and identified by Consultant in writing as unsettled at the time of its final request for payment. Consultant and City expressly agree that in addition to any claims filing requirements set forth in the Agreement, Consultant shall be required to file any claim Consultant may have against City in strict conformance with the Government Claims Act (Government Code sections 900 et seq.). 27. TERMINATION 27.1 In the event that either party fails or refuses to perform any of the provisions of this Agreement at the time and in the manner required, that party shall be deemed in default in the performance of this Agreement. If such default is not cured within a period of two (2) calendar days, or if more than two (2) calendar days are reasonably required to cure the default and the defaulting party fails to give adequate assurance of due performance within two (2) calendar days after receipt of written notice of default, specifying the nature of such default and the steps necessary to cure such default, and thereafter diligently take steps to cure the default, the non-defaulting party may terminate the Agreement forthwith by giving to the defaulting party written notice thereof. 27.2 Notwithstanding the above provisions, City shall have the right, at its sole and absolute discretion and without cause, of terminating this Agreement at any time by giving no less than seven (7) calendar days' prior written notice to Consultant. In the event of termination under this Section, City shall pay Consultant for Services satisfactorily performed and costs incurred up to the effective date of termination for which Consultant has not been previously paid. On the effective date of termination, Consultant shall deliver to City all reports, Documents and other information developed or accumulated in the performance of this Agreement, whether in draft or final form. 28. STANDARD PROVISIONS 28.1 Recitals. City and Consultant acknowledge that the above Recitals are true and correct and are hereby incorporated by reference into this Agreement. Walter Warriner Page 9 28.2 Compliance with all Laws. Consultant shall, at its own cost and expense, comply with all statutes, ordinances, regulations and requirements of all governmental entities, including federal, state, county or municipal, whether now in force or hereinafter enacted. In addition, all Work prepared by Consultant shall conform to applicable City, county, state and federal laws, rules, regulations and permit requirements and be subject to approval of the Project Administrator and City. 28.3 Waiver. A waiver by either party of any breach, of any term, covenant or condition contained herein shall not be deemed to be a waiver of any subsequent breach of the same or any other term, covenant or condition contained herein, whether of the same or a different character. 28.4 Integrated Contract. This Agreement represents the full and complete understanding of every kind or nature whatsoever between the parties hereto, and all preliminary negotiations and agreements of whatsoever kind or nature are merged herein. No verbal agreement or implied covenant shall be held to vary the provisions herein. 28.5 Conflicts or Inconsistencies. In the event there are any conflicts or inconsistencies between this Agreement and the Scope of Services or any other attachments attached hereto, the terms of this Agreement shall govern. 28.6 Interpretation. The terms of this Agreement shall be construed in accordance with the meaning of the language used and shall not be construed for or against either party by reason of the authorship of the Agreement or any other rule of construction which might otherwise apply. 28.7 Amendments. This Agreement may be modified or amended only by a written document executed by both Consultant and City and approved as to form by the City Attorney. 28.8 Severability. If any term or portion of this Agreement is held to be invalid, illegal, or otherwise unenforceable by a court of competent jurisdiction, the remaining provisions of this Agreement shall continue in full force and effect. 28.9 Controlling Law and Venue. The laws of the State of California shall govern this Agreement and all matters relating to it and any action brought relating to this Agreement shall be adjudicated in a court of competent jurisdiction in the County of Orange, State of California. 28.10 Equal Opportunity Employment. Consultant represents that it is an equal opportunity employer and it shall not discriminate against any subcontractor, employee or applicant for employment because race, religious creed, color, national origin, ancestry, physical handicap, medical condition, marital status, sex, sexual orientation, age or any other impermissible basis under law. 28.11 No Attorneys' Fees. In the event of any dispute or legal action arising under this Agreement, the prevailing party shall not be entitled to attorneys' fees. Walter Warriner Page 10 28.12 Counterparts. This Agreement may be executed in two (2) or more counterparts, each of which shall be deemed an original and all of which together shall constitute one (1) and the same instrument. [SIGNATURES ON NEXT PAGE] Walter Warriner Page 11 IN WITNESS WHEREOF, the parties have caused this Agreement to be executed on the dates written below. APPROVED AS TO FORM: CITY ATTORNEY'S OFFICE Date: )q/4//�7 CITY OF NEWPORT BEACH, a California municipal corporation Date:' /G By: % By: Aar n C. Harp tvo Mik Pisani City Attorney Municipal Operations Director — General Services ATTEST: '( Date: ' I • By: kAoic— Aiwn City Clerk® F- U SEW c\P CONSULTANT: Walter Warriner, a sole proprietpr Date: / .l ���niw By: , Walter Warriner Owner [END OF SIGNATURES] Attachments: Exhibit A — Scope of Services Exhibit B — Schedule of Billing Rates Exhibit C — Insurance Requirements Walter Warriner Page 12 EXHIBIT A SCOPE OF SERVICES o Furnish all labor, equipment, materials and supervision to provide consulting arborist services on an as-needed basis throughout the City. o Services shall include, but not be limited to: • review specifications, construction details and property developments; • provide tree inspections; • write risk assessment reports; and • consulting services. Walter Warriner Page A-1 EXHIBIT B SCHEDULE OF BILLING RATES Walter Warriner Page B-1 FEE SCHEDULE Walter Warriner Consulting Arborist 351 Palos Verdes Blvd. #10 Redondo Beach. CA 90277 PH-(310)378.1764 EM —wwca621 Raol.com Arboricultural and Urban Forestry Consulting $170.00 per hour Two-hour minimum for 18` site visit. Landscape Construction Inspections $150.00 per hour Two-hour minimum for 15` site visit. Litigation & Mediation Consulting $250.00 per hour Two-hour minimum. Deposition & Court Testimony $550.00 per hour Four-hour minimum. Minimum retainer for Litigation Consulting $2,200.00 Tree Inventories & multi-year Management Plans $5,000.00 Report Services Billed at a rate of one page per hour. Photographs & reproduction costs Cost +expenses Travel fees Hourly rate portal to portal unless written arrangements are made in advance. Air travel, car'rentals and out-of-town expenses reimbursed at cost. EXHIBIT C INSURANCE REQUIREMENTS — PROFESSIONAL SERVICES 1. Provision of Insurance. Without limiting Consultant's indemnification of City, and prior to commencement of Work, Consultant shall obtain, provide and maintain at its own expense during the term of this Agreement, policies of insurance of the type and amounts described below and in a form satisfactory to City. Consultant agrees to provide insurance in accordance with requirements set forth here. If Consultant uses existing coverage to comply and that coverage does not meet these requirements, Consultant agrees to amend, supplement or endorse the existing coverage. 2. Acceptable Insurers. All insurance policies shall be issued by an insurance company currently authorized by the Insurance Commissioner to transact business of insurance in the State of California, with an assigned policyholders' Rating of A- (or higher) and Financial Size Category Class VII (or larger) in accordance with the latest edition of Best's Key Rating Guide, unless otherwise approved by the City's Risk Manager. 3. Coverage Requirements. A. Workers' Compensation Insurance. Consultant shall maintain Workers' Compensation Insurance, statutory limits, and Employer's Liability Insurance with limits of at least one million dollars ($1,000,000) each accident for bodily injury by accident and each employee for bodily injury by disease in accordance with the laws of the State of California, Section 3700 of the Labor Code. Consultant shall submit to City, along with the certificate of insurance, a Waiver of Subrogation endorsement in favor of City, its officers, agents, employees and volunteers. B. General Liability Insurance. Consultant shall maintain commercial general liability insurance, and if necessary umbrella liability insurance, with coverage at least as broad as provided by Insurance Services Office form CG 00 01 , in an amount not less than one million dollars ($1,000,000) per occurrence, two million dollars ($2,000,000) general aggregate. The policy shall cover liability arising from premises, operations, personal and advertising injury, and liability assumed under an insured contract (including the tort liability of another assumed in a business contract). C. Automobile Liability Insurance. Consultant shall maintain automobile insurance at least as broad as Insurance Services Office form CA 00 01 covering bodily injury and property damage for all activities of Consultant arising out of or in connection with Work to be performed under this Agreement, including coverage for any owned, hired, non-owned or rented vehicles, in an amount not less than one million dollars ($1,000,000) combined single limit each accident. Walter Warriner Page C-1 D. Professional Liability (Errors & Omissions) Insurance. Consultant shall maintain professional liability insurance that covers the Services to be performed in connection with this Agreement, in the minimum amount of one million dollars ($1,000,000) per claim and two million dollars ($2,000,000) in the aggregate. Any policy inception date, continuity date, or retroactive date must be before the Effective Date of this Agreement and Consultant agrees to maintain continuous coverage through a period no less than three years after completion of the Services required by this Agreement. 4. Other Insurance Requirements. The policies are to contain, or be endorsed to contain, the following provisions: A. Waiver of Subrogation. All insurance coverage maintained or procured pursuant to this Agreement shall be endorsed to waive subrogation against City, its elected or appointed officers, agents, officials, employees and volunteers or shall specifically allow Consultant or others providing insurance evidence in compliance with these requirements to waive their right of recovery prior to a loss. Consultant hereby waives its own right of recovery against City, and shall require similar written express waivers from each of its subconsultants. B. Additional Insured Status. All liability policies including general liability, excess liability, pollution liability, and automobile liability, if required, but not including professional liability, shall provide or be endorsed to provide that City and its officers, officials, employees, and agents shall be included as insureds under such policies. C. Primary and Non Contributon/. All liability coverage shall apply on a primary basis and shall not require contribution from any insurance or self- insurance maintained by City. D. Notice of Cancellation. All policies shall provide City with thirty (30) calendar days notice of cancellation (except for nonpayment for which ten (10) calendar days notice is required) or nonrenewal of coverage for each required coverage. 5. Additional Agreements Between the Parties__ The parties hereby agree to the following: A. Evidence of Insurance. Consultant shall provide certificates of insurance to City as evidence of the insurance coverage required herein, along with a waiver of subrogation endorsement for workers' compensation and other endorsements as specified herein for each coverage. Insurance certificates and endorsement must be approved by City's Risk Manager prior to commencement of performance. Current certification of insurance shall be kept on file with City at all times during the term of this Agreement. City reserves the right to require complete, certified copies of all required insurance policies, at any time. Walter Warriner Page C-2 B. City's Right to Revise Requirements. City reserves the right at any time during the term of the Agreement to change the amounts and types of insurance required by giving Consultant sixty (60) calendar days advance written notice of such change. If such change results in substantial additional cost to Consultant, City and Consultant may renegotiate Consultant's compensation. C. Enforcement of Agreement Provisions. Consultant acknowledges and agrees that any actual or alleged failure on the part of City to inform Consultant of non-compliance with any requirement imposes no additional obligations on City nor does it waive any rights hereunder. D. Requirements not Limiting. Requirements of specific coverage features or limits contained in this Section are not intended as a limitation on coverage, limits or other requirements, or a waiver of any coverage normally provided by any insurance. Specific reference to a given coverage feature is for purposes of clarification only as it pertains to a given issue and is not intended by any party or insured to be all inclusive, or to the exclusion of other coverage, or a waiver of any type. If the Consultant maintains higher limits than the minimums shown above, the City requires and shall be entitled to coverage for higher limits maintained by the Consultant. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City. E. Self-insured Retentions. Any self-insured retentions must be declared to and approved by City. City reserves the right to require that self-insured retentions be eliminated, lowered, or replaced by a deductible. Self- insurance will not be considered to comply with these requirements unless approved by City. F. City Remedies for Non-Compliance. If Consultant or any subconsultant fails to provide and maintain insurance as required herein, then City shall have the right but not the obligation, to purchase such insurance, to terminate this Agreement, or to suspend Consultant's right to proceed until proper evidence of insurance is provided. Any amounts paid by City shall, at City's sole option, be deducted from amounts payable to Consultant or reimbursed by Consultant upon demand. G. Timely Notice of Claims. Contractor shall give City prompt and timely notice of claims made or suits instituted that arise out of or result from Contractor's performance under this Contract, and that involve or may involve coverage under any of the required liability policies. City assumes no obligation or liability by such notice, but has the right (but not the duty) to monitor the handling of any such claim or claims if they are likely to involve City. H. Consultant's Insurance. Consultant shall also procure and maintain, at its own cost and expense, any additional kinds of insurance, which in its own Walter Warriner Page C-3 judgment may be necessary for its proper protection and prosecution of the Work. Walter Warriner Page C-4 CERTIFICATE OF INSURANCE CHECKLIST City of Newport Beach This checklist is comprised of requirements as outlined by the City of Newport Beach. Date Received: 12/14/15 Dept./Contact Received From: Joan Date Completed: 1/6/16 Sent to: Joan By: Chris/Alicia Company/Person required to have certificate: Walter Warrmer Type of contract: All Other I. GENERAL LIABILITY EFFECTIVE/EXPIRATION DATE: 4/08/15-4/08/16 A. INSURANCE COMPANY: Everest Indemnity Insurance Company B. AM BEST RATING (A- : VII or greater): A+: XV C. ADMITTED Company(Must be California Admitted): Is Company admitted in California? ❑ Yes ® No D. LIMITS (Must be$1 M or greater): What is limit provided? 1,000,000/2,000,000 E. ADDITIONAL INSURED ENDORSEMENT—please attach ® Yes ❑ No F. PRODUCTS AND COMPLETED OPERATIONS(Must include): Is it included? (completed Operations status does not apply to Waste Haulers or Recreation) ® Yes ❑ No G. ADDITIONAL INSURED FOR PRODUCTS AND COMPLETED OPERATIONS ENDORSEMENT(completed Operations status does not apply to Waste Haulers) N Yes ❑ No H. ADDITIONAL INSURED WORDING TO INCLUDE(The City its officers, officials, employees and volunteers): Is it included? N Yes ❑ No I. PRIMARY&NON-CONTRIBUTORY WORDING(Must be included): Is it included? ® Yes ❑ No J. CAUTION! (Confirm that loss or liability of the named insured is not limited solely by their negligence) Does endorsement include"solely by negligence"wording? ❑ Yes N No K. ELECTED SCMAF COVERAGE(RECREATION ONLY): N N/A ❑ Yes ❑ No L. NOTICE OF CANCELLATION: ❑ NIA N Yes ❑ No II. AUTOMOBILE LIABILITY EFFECTIVE/EXPIRATION DATE: 3/20/15-3/20/16 A. INSURANCE COMPANY: Interinsurance Exchange of the Automobile Club B. AM BEST RATING(A- : VII or greater) A+:XV C. ADMITTED COMPANY(Must be California Admitted): Is Company admitted in California? N Yes ❑ No D. LIMITS - If Employees(Must be$1M min. BI & PD and $500,000 UM, $2M min for Waste Haulers): What is limits provided? 50/100/50 E LIMITS Waiver of Auto Insurance I Proof of coverage(if individual) (What is limits provided?) N/A F. PRIMARY& NON-CONTRIBUTORY WORDING (For Waste Haulers only): N N/A ❑ Yes ❑ No G. HIRED AND NON-OWNED AUTO ONLY: ❑ N/A ❑ Yes N No H. NOTICE OF CANCELLATION: ❑ N/A N Yes ❑ No III. WORKERS' COMPENSATION EFFECTIVE/EXPIRATION DATE: Signed WC Exemption Form 12/1all 5 A. INSURANCE COMPANY: B. AM BEST RATING (A- : VII or greater): C. ADMITTED Company(Must be California Admitted): ❑ Yes ❑ No D. WORKERS' COMPENSATION LIMIT: Statutory ❑ Yes ❑ No E. EMPLOYERS' LIABILITY LIMIT(Must be $1 M or greater) F. WAIVER OF SUBROGATION (To include): Is it included? ❑ Yes ❑ No G. SIGNED WORKERS' COMPENSATION EXEMPTION FORM: ® N/A ❑ Yes ❑ No H. NOTICE OF CANCELLATION: ❑ N/A ® Yes ❑ No ADDITIONAL COVERAGE'S THAT MAYBE REQUIRED IV. PROFESSIONAL LIABILITY Carrier- Everest Indemnity Ins Co. Limits- IM/2M ❑ N/A ® Yes ❑ No V POLLUTION LIABILITY ® NIA ❑Yes ❑ No V BUILDERS RISK ® N/A ❑Yes ❑ No HAVE ALL ABOVE REQUIREMENTS BEEN MET? ®Yes ❑ No IF NO, WHICH ITEMS NEED TO BE COMPLETED? Approved: a�415 1/6/16 Agent of Alliant Insurance Services Date Broker of record for the City of Newport Beach RISK MANAGEMENT APPROVAL REQUIRED(Non-admitted carrier rated less than_ Self Insured Retention or Deductible greater than $ ) ❑ N/A ❑ Yes ❑ No Reason for Risk Management approval/exception/waiver: Risk Management approval needed due to GL& PL carrier being non-admitted. Sheri approves GL and PL carrier 12/15/15. Approved: Risk Management Date * Subject to the terms of the contract. WALTWAR-02 FOSTERR CERTIFICATE OF LIABILITY INSURANCE °AT1�6/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#OE67768 CONTACT Teresa Rulon NAME: IDA Insurance Services PHONE FAX 2180 Harvard Street ac No Est:(916)692-7000 Aro No),(916)473-1797 Suite 450 a onlEss:Teresa.Rulon@ioausa.com Sacramento,CA 95815 INSURER(S)AFFORDING COVERAGE NAIC If INSURER A:Everest Indemnity Insurance Company 10651 INSURED INSURER B Walter Warriner INSURER C: 47.568 Hakuhale Street INSURER D Kaneohe,HI 96744 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE 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 ADDLSUBR POLICYEFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/TTY MM/OD/YYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE D OCCUR X X EF4ML05615151 04/082015 04/082016 PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) $ 5,0 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY PRO JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,0 OTHER: $ AUTOMOSILE LIABILITY COMBINED SINGLE LIMIT $ Es accident) ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS 8001LV INOPERJURY AMPeraccltlen[) $ HIREDAUTOS AUTOSWNEO Perr .ddentOAMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIM&MADE AGGREGATE $ DEO I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR,PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ A Prof Liability EF4ML05615151 04/082015 04/08/2016 Occurrence 1,000,00 A Prof Liability EF4ML05615151 04/082015 04/082016 Agg/Deduct$1,000 2,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Addis ml Remarks Schedule,may be Mlached If more apace is required) RE:Evidence of Coverage City of Newport Beach,its elected or appointed officers,agents,officials,employees and volunteers are Additional Insureds with respect to General Liability when required by written contract par forms CG2010(07.04)and CG2037(07.04);General Liability Waiver of Subrogation per form CG2404(10.93);Primary& Non-Contributory per form ECG24514(05-00). This voids and supersedes certificate Issued on 1M812015. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Newport Beach AUTHORIZED REPRESENTATIVE 100 Civic Center Drive PO Box 1768 New ort Beach CA 92658 ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: EF4ML05615151 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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): Locations Of Covered Operations Blanket where required by written contract Information required to complete this Schedule if not shown above will be shown in the Declarations. A. Section 11 — Who is An Insured is amended to B. With respect to the insurance afforded to these include as an additional Insured the person(s) or additional insureds, the following additional exclu- organization(s) shown in the Schedule, but only sions apply: with respect to liability for "bodily injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or In part,by: 1. Your acts or omissions;or 1• All work, including materials, parts or equip- ment furnished in connection with such work, 2. The acts or omissions of those acting on.your on the project (other than service, maintenance behalf; or repairs) to be performed by or on behalf of in the performance of your ongoing operations for the additional insured(s) at the location of the the additional insured(s) at the localioh(s) desig covered operations has been completed;or nated above. 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a earl of the same project. CG 20 10 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 ❑ POLICY NUMBER: EF4ML05615151 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 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 SCHEDULE Name Of Additional Insured Person(s) Or O anization s Location And Description Of Completed Operations Blanket where required by written contract Information required to complete this Schedule,if not shown above will be shown in the.Declaratiorrs. Section tl - 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 dam- age" caused, in whole or in part, by "your work' at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". CG 20 3707 04 0 ISO Properties,Inc.,2004 Page 1 of 1 13 Policy#EF4ML05615151 COMMERCIAL GENERAL LIABILITY CG 24 04 10 93 THIS ENDORSEMENT CHANGES.THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organizafion that is: 1. An owner of real or personal property on which you are performing operations, but only.at file specific writ- ten request by that person or organization to you, and only if: a. That request is made prior to the date your operations for that person or organization commenced;.and b. A certificate of insurance evidencing that request has been Issued byyour authorized insurance agent or broker;or 2. A contractor on whose behalf you are performing operations, but only at the specific written request by that person or organization to you, and only if: a. That request is made prior to the date your operations for that person or organization commenced;and b. A certificate of insurance evidencing that request has been issued by your authorized insurance agent or broker. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: 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 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. CO 24 04 10 93 Copyright; Insurance Services Office, Inc., 1992 Page 1 of 1 0 Policy#EF4ML05615151 COMMERCIAL GENERAL LIABILITY ECG 24,514 05 00 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY PROVISION - YOUR OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Paragraph 4.,Other Insurance of Conditions(Section IV) is amended by the addition of the following If insurance similar to this insurance is held by a person or organization that is: a. An owner of real or personal property on which you are performing operations; or b. A contractor on whose behalf you are performing operations,. this Insurance is primary to that other insurance, and that other insurance shall not contribute to amounts payable under this insurance, for liability arising out of your ongoing operalions performed for that person or organization under a written contract. However,this does not apply to any person or organization: a. From whom you did not receive a specific written request that this insurance be primary insurance, or if you did not receive that request prior to the date that your operations for that person or organization commenced; or b. For whom a certificate of insurance evidencing that request is not on file with, or received by, us prior to sixty days after the end of the policy period for this Insurance. ECG 24 514 05 00 Copyright, Everest Reinsurance Company 2000 I] Includes copyrighted material of Insurance Services Office, Inc. used with its permission Copyright, Insurance Services Office, Inc., 1997 Page i of 1 Interinsurance Exchange of the Automobile Club 0 Automobile Insurance Coverages and Limits NAMED INSURED MEMBERSHIP NUMBER POLICY NUMBER WARRINER,WALTER 60698333 CAA096806615 A. APPLICATION INFORMATION: APPLICANT'S NAME AND MAILING ADDRESS: APPLICANT'S RESIDENCE ADDRESS,IF DIFFERENT: WARR[NER,WALTER 351 PALOS VERDES BLVD APT 10 Redondo Beach CA 90277 B. DRIVER INFORMATION: In addition to yourself,list all permit and licensed drivers in your household,including relatives,roommates, residence employees,etc. Next, list all drivers who have regular access to your vehicles who DO NOT live with you,such as relatives,students away at school, friends and household help. Year First Relationship to Household Drivers'Names(Last First) Excluded Date of Birth Licensed Applicant Resident WARRINER,WALTER No 09-02-1953 1969 Same Yes WARRINER,CHEYENNE Yes 03-29-1990 Res Dep Son/Dtr-Rid Yes WARRINER,CHENOA Yes 09-19-1992 Res Dep Son/Dtr-Rid Yes C. VEHICLE INFORMATION: All vehicles to be insured. Veh. Annual Odometer Anti- Deductibles Car Rental Expense No. Year Make/Model Garaged Miles Reading Verified Mileage Theft Salvage Comp. Collision (Limit Per Day) 1 2001 DODG/RAM 1500 CLUB C PU 4 No 2104 170239 Verified No No $250 $500 D. VEHICLE EQUIPMENT(if applicable): Coverage may not be provided for any special equipment unless equipment is listed below. Vehicle No. Equipment Description Total Value E. REQUESTED COVERAGES,LIMITS AND PREMIUMS: Coverage is not afforded unless a premium is shown. Coverages Limits Bodily Injury 50,000 (each person) $187 100,000 (each occurrence) Property Damage 50,M) (each occurrence) $202 Medical Payments (each person) Excess Medical Payments (each person) Uninsured and Underinsured Motorist Bodily Injury 15,000 (each person) $21 30,000 (each accident) Uninsured Collision Uninsured Deductible Waiver Yes Included Comprehensive(Comp.) (See Deductibles Above) $30 Collision (See Deductibles Above) $217 Car Rental Expense (See Above) ANNUAL VEHICLE PREMIUM: $657 LIMIT OF LIABILITY(IF APPLICABLE)/TRAILERS,MOTORHOMES,CLASSIC VEHICLES: Vehicle No. Year Make/Model Purchase Price(Cost New) Limit of Liability F. YOUR ANNUAL PREMIUM INCLUDES THE FOLLOWING DISCOUNTS: Please review these carefully,as you are warranting that you are entitled to the following discounts. Driving ed Driver Student ood Student Multi- Multi-Vehicle Policy Parking gig Theft Driver Course Loyalty Professional Mileage Y Y 9 9 Yes No No No No No Yes No No No No No Yes 12-MONTH POLICY PREMIUM TOTAL: $657 X �. —grriner. 3/26/2015 5:28:37 At a.m. p.m. Applicant's Signature Date Time Xa.m. p.m. Co-Applicant's Signature Date Time 31195 12/14 Insurance provided to qualified Auto Club members by the Interinsurance Exchange of the Automobile Club. Pg.1 of 1 ema INTERINSURANCE EXCHANGE of the Automobile Club ffi-v EXCLUSION OF DESIGNATED PERSON ENDORSEMENT Effective 03/20/2015 12:01 A.M. Pacific Standard Time Forming a part of Policy No. CAA096806615 issued by the INTERINSURANCE EXCHANGE OF THE AUTOMOBILE CLUB. Named Insured: WARRINER,WALTER Designated Person(s): WARRINER, CHEYENNE A WARRINER, CHENOA We will issue or continue this policy because you and we have agreed that coverage afforded by Part I (Liability), Part II (Expenses for Medical Services), Part III (Physical Damage) and Part IV (Uninsured Motorist) of this policy for the use of or damage to any automobile insured shall not apply nor accrue to the benefit of you, any other person insured or any third party claimant while said automobile is being operated by a designated person. Under Part I (Liability), our obligation to defend shall not apply nor accrue to the benefit of you, any other person insured or any third party while any automobile is being operated by a designated person. We will defend you when all of the following apply to such designated person: 1. The designated person is a resident of the same household in which you reside. 2. Asa result of operating your insured automobile,the designated person is jointly sued with you. 3. The designated person is an insured under a separate automobile liability policy issued to the designated person as a named insured, which does not provide a defense to you. This agreement will be in force as long as your policy remains in force and shall apply to any continuation, renewal or replacement of your policy by you or to reinstatement of your policy within 30 days of any lapse thereof. When uninsured motorist coverage—bodily injury (Coverage F) is deleted with respect to one or more natural persons designated by name when operating a motor vehicle, California law requires the agreement to be in the following form: "The California Insurance Code requires an insurer to provide uninsured motorist coverage in each bodily injury liability insurance policy it issues covering liability arising out of the ownership, maintenance, or use of a motor vehicle. Those provisions also permit the insurer and the applicant to delete the coverage completely or to delete the coverage when a motor vehicle is operated by a natural person or persons designated by name. Uninsured motorists coverage insures the insured, his or her heirs, or legal representatives for all sums within the limits established by law, which the person or persons are legally entitled to recover as damages for bodily injury, including any resulting sickness, disease, or death, to the insured from the owner or operator of an uninsured motor vehicle not owned or operated by the insured or a resident of the same household. An uninsured motor vehicle includes an underinsured motor vehicle as defined in subdivision (p) of Section 11580.2 of the Insurance Code'." "Subdivision (p) of Section 11580.2 of the Insurance Code defines an underinsured motor vehicle as one that is insured under a motor vehicle liability policy, or automobile liability insurance policy, self-insured, or for which a cash deposit or bond has been posted to satisfy a financial responsibility law, but insured for an amount that is less than the uninsured motorist limits carried on the motor vehicle of the injured person. All provisions of your policy not affected by this endorsement remain unchanged. By accepting this endorsement you declare that you have read the endorsement and understand it, that it represents a voluntary agreement between you and us, and that you agree to be bound by the limitations it imposes. Warnner. 1 3/26/2015 5:28:37 Al Accepted " Signature of Insured Date Hour W. Warriner. Print Name Here ACSC Management Services,Inc. ATTORNEY-IN-FACT 2184 Ed.7-10 015 INTERINSURANCE EXCHANGE of the Automobile Club SELECTION OF UNINSURED/UNDERINSURED MOTORIST COVERAGE ENDORSEMENT (BODILY INJURY) Effective 03/20/2015 12:01 A.M. Pacific Standard Time Forming a part of Policy No. CAA096806615 issued by the INTERINSURANCE EXCHANGE OF THE AUTOMOBILE CLUB. You have the option of purchasing uninsured and underinsured motorist coverage limits equal to your bodily injury liability coverage limits. You also have the option of selecting lower limits. The limits available for selection are listed below. $15,000/$30,000 $50,000/$100,000 $250,000/$500,000 $20,0001$40,000 $100,000/$200,000 $500,000/$500,000 $25,000/$50,000 $100,000/$300,000 $500,000/$1,000,000 $30,0001$60,000 $300,000/$300,000 $1,000,000/$1,000,000 You and we have agreed that your policy shall provide uninsured and underinsured motorist coverage-bodily injury(Coverage F) with coverage limits lower than your bodily injury liability coverage limits. The limits you have selected from those listed above are shown on the declarations page. This agreement will be in force as long as your policy remains in force and shall apply to any continuation, renewal or replacement of your policy by you or to reinstatement of your policy within 30 days of any lapse thereof. California law requires the agreement to be in the following form: "The California Insurance Code requires an insurer to provide uninsured motorists coverage in each bodily injury liability insurance policy it issues covering liability arising out of the ownership, maintenance, or use of a motor vehicle. Those provisions also permit the insurer and the applicant to agree to provide the coverage in an amount less than that required by subdivision (m) of Section 11580.2 of the Insurance Code*but not less than the financial responsibility requirements**. Uninsured motorists coverage insures the insured, his or her heirs, or legal representatives for all sums within the limits established by law, that the person or persons are legally entitled to recover as damages for bodily injury, including any resulting sickness, disease, or death, to the insured from the owner or operator of an uninsured motor vehicle not owned or operated by the insured or a resident of the same household. An uninsured motor vehicle includes an underinsured motor vehicle as defined in subdivision(p) of Section 11580.2 of the Insurance Code***." *Subdivision (m) of Section 11580.2 of the Insurance Cade provides that uninsured motorist coverage must be offered with limits equal to the limits of liability for bodily injury in the underlying policy of insurance, but shall not be required to be offered with limits in excess of the following amounts: (1) A limit of thirty thousand dollars($30,000)because of bodily injury to or death of one person in any one accident. (2) Subject to the limit for one person set forth in paragraph (1), a limit of sixty thousand dollars ($60,000) because of bodily injury to or death of two or more persons in any one accident. Subdivision (n) of Section 11580.2 of the Insurance Code provides that underinsured motorist coverage must be offered with limits equal to the limits of liability for the insured's uninsured motorist limits in the underlying policy. Uninsured and underinsured motorist coverage must be offered as a single coverage. **The financial responsibility requirements in case of an accident that has resulted in bodily injury or death are defined in section 16056(a)of the Vehicle Code as a limit, exclusive of interest and costs, of: (1) Not less than fifteen thousand dollars($15,000) because of bodily injury to or death of one person in any one accident. (2) Subject to the above limit for one person, a limit of not less than thirty thousand dollars ($30,000) because of bodily injury to or death of two or more persons in any one accident. ***Subdivision (p) of Section 11580.2 of the Insurance Code defines an underinsured motor vehicle as one that is insured under a motor vehicle liability policy, or automobile liability insurance policy, self-insured, or for which a cash deposit or bond has been posted to satisfy a financial responsibility law, but insured for an amount that is less than the uninsured motorist limits carried on the motor vehicle of the injured person. All provisions of your policy not affected by this endorsement remain unchanged. By accepting this endorsement you declare that you have read the endorsement and understand it, that it represents a voluntary agreement between you and us and that you agree to be bound by the limitations it imposes. Accepted tWarrinec 3/26/2015 5:28:37 AM Signature of Insured Date Hour ACSC Management Services, Inc. ATTORNEY-IN-FACT 2298 E 8-09 slitre ®s Interinsurance Exchange of the Automobile Club ` Automobile Insurance Application NAMED INSURED MEMBERSHIP NUMBER POLICY NUMBER WARRINER WALTER 004-60698333 CAA096806615 1. ADDITIONAL APPLICANT INFORMATION: Do You Own Any Vehicles That You Do Not Want To Insure With Us Now? ❑ YES 5d NO 2. NON-DRIVER HOUSEHOLD RESIDENT INFORMATION: List ALL residents of your household who are NOT drivers.For each,give his/her reason for not driving. (For example,"child,""never learned,""license suspended,""disabled,"etc.) Name All Other Residents Last Name, First Name M.I. Gender Date of Birth Relationship To Applicant Reason For Not Driving 3. POLICY PERIOD:(Pacific Standard Time) 12-MONTH POLICY PREMIUM TOTAL:$ 657 FROM: Month March Day 20 Year 2015 12:01 A.M. TO: Month March Day 20 Year 2016 12:01 A.M. If the"FROM"date above has not been filled in,when do you want your policy to become effective? Month Day Year IMPORTANT INFORMATION AND BINDER OF INSURANCE: It is your responsibility to choose the level of insurance protection that best suits your needs by selecting and maintaining coverages and limits that will adequately protect you and your property in the event of a loss. While we review your application for insurance,coverage is bound effective at 12:01 A.M. Pacific Standard Time on the date requested above, BUT NOT EARLIER THAN the following date: - IF YOU PAID YOUR PREMIUM DEPOSIT BY CREDIT CARD OR ELECTRONIC FUNDS TRANSFER,OR IN PERSON BY CASH OR CHECK:Coverage is bound no earlier than the day after the dale you paid your premium deposit. - IF YOU PAID YOUR PREMIUM DEPOSIT BY CHECK VIA MAIL:Coverage is bound no earlier than the day after the postmark date on the envelope in which your premium deposit and signed application are mailed to us.If you do not enclose your premium deposit with the signed application,coverage does not become effective until after your application is approved by us and your payment is received. This binder will expire 60 days after its effective date or may be cancelled by the named insured at any time during this 60 day period.Approval of the application and issuance of a policy to you will void the binder.We may cancel this binder by mailing to the named insured at the address shown on the application at least 10 days' advance written notice of cancellation. Unless a policy is issued, a premium charge will be made for coverage provided under this binder.This binder provides the coverages and limits shown in this application and its enclosures, on the terms described in the applicable policy form and endorsements. This binder does not provide cumulative insurance with any existing policy. Comprehensive and Collision coverages may be severely restricted, suspended or revoked unless vehicles requiring inspection for physical damage coverage are inspected by an authorized inspector no later than seven days after the policy effective date. Notice of Short Rate Cancellation: Any cancellation of your entire automobile policy requested by you during the first policy period, including cancellation for nonpayment of premium,will be calculated on a short rate basis. This means the amount due us for the time your policy was actually in effect will be more than a proportionate share of the annual premium. The additional amount Will not exceed 11%of the annual premium. I have read, agree and subscribe to the subscriber's agreement of the Interinsurance Exchange of the Automobile Club and to all other statements, notices,terms, conditions and agreements appearing on all pages of this application, including all attachments and other documents provided with this application. I declare that all statements I have made are true and that I have fully disclosed all required information. I understand that my insurance policy will be issued in reliance on the information I provided,including information about my household,its vehicles and their drivers,and that such information will be used to determine my eligibility for insurance and premium.I also understand that inaccurate or incomplete information may jeopardize my coverage or change my premium. To the extent my authorization is required under applicable law,for a period of one year from the date I sign,I authorize the Automobile Club of So.California and the Interinsurance Exchange of the Automobile Club and their employees and agents(Authorized Parties)to verity the accuracy of the information I have provided using other available sources and to access personal and confidential information concerning me and other drivers. I hereby waive Cal.Veh.Code§1808.21 to allow the Authorized Parties to access confidential information(including residence address)concerning me and other drivers in Department of Motor Vehicles records. I reoues[t§suance of a oolicv wth the coverages and limits described in the accompanying Automobile Insurance Coverages and Limits form. X_N�Wrri aner. am .�W 3/26/2015 5.28.37 At a.m. p.m. nppn� 15 Date Time Xa.m. p.m_ Do-Applicant's Signature Date Time a.m. p.m. Representative's Signature Date Time 30551 12/11 Insurance provided to qualified Auto Club members by the/ntednsurance Exchange of the Automobile Club. Pg.1 of 2 Bite4' a Interinsurance Exchange of the Automobile Club m AAA Auto Pay Plan for Electronic Check (ACH) and Debit Card Terms and Conditions for Insurance and Membership The Authorization Agreement at the bottom of the this page is valid only for insurance policies written by the Interinsurance Exchange of the Automobile Club ("Exchange")and for your AAA membership.*Automatic debits from your checking account or charges to your debit card for insurance policies will begin with the first AAA Auto Pay Plan payment billed after the Authorization Agreement is received and processed.(Please allow 15 days for processing.)Until then,your insurance premium payment is still due on the date shown on your most recent billing statement and should be returned to us in the white envelope provided. Once AAA Auto Pay is active,your periodic billing statements will indicate the amount and timing of the next payment prior to your card being charged for that payment.Outstanding membership dues amounts will begin to be debited after the Authorization Agreement has been processed. AAA Auto Pay automatic payments are subject to all applicable Finance charges,installment and other fees. Insurance only: We gave you notice of the amount of all applicable finance charges and fees at the time you applied for the insurance policy(ies)below and upon renewals of your policy(ies).Installment payment plans and all fees are subject to change without notice. Membership only: At least one month before your AAA membership expires,well send a statement of your current services and renewal dues amount.We will automatically renew your membership and charge your debit card for the dues amount shown or debit your checking account in the amount of such dues 10-15 days before the renewal date, unless you contact us to make a change to or cancel AAA Auto Pay. Policyholders and members who have payments returned unpaid or otherwise rejected from their financial institution may have the AAA Auto Pay Plan authorization revoked as to all insurance policies by the Exchange and as to AAA membership by Automobile Club of Southern California ("AAA").In the event that this occurs,you will be notified by mail and a return payment fee and late fee may be added to your bill(or to a second attempted debit to your account). If AAA Auto Pay is revoked,installments remaining for the current insurance policy period will be billed on your regular payment plan with statements mailed to you and outstanding membership dues and fees will be billed with statements mailed to you periodically. If an error is made,the Exchange or AAA,as applicable,can correct it by initiating debits or credits to your financial institution account or debit card on file. You may revoke enrollment in the AAA Auto Pay Plan,as to any one or more insurance policies and/or your membership,at any time by completing a revocation form at AAA.com/form or upon request by contacting us at 1.800.924.6141 or your local AAA branch. If your VISA,MasterCard,or Discover debit card issuing bank participates in the Card Account Updater program,we may receive an updated debit card account number and/or expiration date for the card information you have previously provided us, unless you Opt Out of the service with your issuing bank.We will update our files and use the new information when we bill you under the AAA Auto Pay program.We won't receive updated information if your account has been closed. Debit card available with VISA, Mastercard or Discover only. * If you enroll in AAA Auto Pay for more than one insurance policy and/or membership,the processing bank will determine the order of processing debits(i.e., the order of payment)for each policy and/or membership. If you would like to make payments out of more than one checking account or debit card,you will need to complete one Authorization Agreement for each checking account or card.If you would like to enroll more than one insurance policy in AAA Auto Pay, please use one Authorization Agreement for each policy. Your current payment is still due on the date shown on your most recent billing statement and should be returned to us in the envelope provided. Please keep a copy of this form for your records. .a Please detach at line. 11 AUTHORIZATION AGREEMENT FOR INSURANCE AND MEMBERSHIP ACH OR DEBIT CARD PAYMENTS—AAA Auto Pay Plan • To use AAA Auto Pay for your membership,enter your Club Code and Membership Number in the boxes below. • Please enter the number of the insurance policy you want billed through AAA Auto Pay. • Unless the last 4 digits of your debit card(previously provided to us)have already been filled in, please enter your complete 16-digit account number and card expiration date below. Club Code FlM a Digits of NendNpNp prober MEMBER# ❑❑❑'❑❑❑❑❑❑❑❑ POLICY# CAA ooa®oa©oo I(we)hereby authorize the Interinsurance Exchange of the Automobile Club("Exchange)and Automobile Club of Southern California("AAA"),to initiate debit and credit entries to my (our): CHECKING ACCOUNT or DEBIT CARD ACCOUNT at the financial institution or account indicated below named("Institution),for(i)all amounts that become due by me(us) to the Exchange,including,without limitation,insurance premium on the above policy and any renewals thereof,finance charges,installment,return payment,late payment and other fees("Fees"),(ii)all membership dues that become due by me(us)to AAA and all related Fees,and to debit the same to such account.I(we)acknowledge that the origination of ACH transactions to my(our)account and all charges to my Debit card account must comply with the provisions of U.S.Law and is governed by the Terms and Conditions that accompanied this Agreement.This authorization is to remain in full force and effect until terminated by the Exchange or AAA or until the Exchange or AAA has received written notification from me (or either of us)of its termination in such time and in such manner as to afford,the Exchange or AAA,as applicable,and Institution,a reasonable opportunity to act on it. INSTITUTION NAME Muer a aaeclly 9 d191b Up to 17 digits ROUTING#❑❑❑❑❑❑❑❑❑ ACCOUNT# ❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑ ❑Visa® ❑ MasterCard® CARD#❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑❑ DATE EXPIRE ❑❑�❑❑ ❑ Discover® NM YY NAME(S)OF ACCOUNT HOLDER(S) DATE SIGNATURE(S)OF ACCOUNT HOLDER(S) 107651 89 004-60698333 AAA Employee#(if applicable) Braoch/Sec# Membership# Member Name 305511z/14 Insurance provided to qualified Auto Club members by the Interinsurance Exchange of the Automobile Club. Pg.2 of 2 CP����< Interinsurance Exchange of the Automobile Club N'ARRINER, WALTER, Policy Number: CAA096806615 351 PALOS VERDES BLVD APT 10 Redondo Beach CA 90277 J SUBSCRIBER'S AGREEMENT The Interinsurance Exchange of the Automobile Club is organized under the California Insurance Code as a "reciprocal" or "interinsurance exchange." In such an organization, the persons insured, known as "subscribers," exchange contracts of insurance with one another. As permitted by law, the Exchange uses a corporate attorney-in-fact, ACSC Management Services, Inc. to execute these insurance contracts. California law requires that each subscriber sign a power of attorney authorizing the attorney-in-fact to act on the subscriber's behalf. Therefore, in order for you to be insured by the Exchange and in order for us to conduct business on your behalf, you must sign a Subscriber's Agreement. It is applicable to all insurance policies you have now or will have with the Exchange. Subscriber's Agreement As a subscriber of the Interinsurance Exchange of the Automobile Club ("the Exchange"), I hereby agree as follows: 1. 1 appoint ACSC Management Services, Inc. ("Management Services"), a California corporation, as my attorney-in-fact and authorize it to act on my behalf under this power of attorney for the following purposes: To exchange with other subscribers of the Exchange insurance contracts providing insurance against any loss which may be insured against under the laws of the State of California. My attorney-in-fact is authorized to sign and deliver all necessary contracts and to perform all other related acts that subscribers may perform. 2. Management Services has the right and power to appoint a substitute attorney-in-fact and to revoke such appointment. 3. Management Services shall maintain its principal office at 2601 S. Figueroa Street, Los Angeles, California, 90007-3294. 4. Management Services shall exercise this power of attorney in accordance with the Rules and Regulations of the Board of Governors of the Exchange and the provisions of the Certificate of Authority issued by the Insurance Commissioner of the State of California. 5. All other rights reserved to subscribers, including the right of supervision and delegation of duties to the attorney-in- fact, shall be exercised on my behalf by the Board of Governors of the Exchange. This Board shall be composed of persons who are members of the Board of Directors of the Automobile Club of Southern California, and the members of this Board shall be appointed by the Board of Directors of the Automobile Club of Southern California. I agree to be bound by the bylaws and the Rules and Regulations adopted by the Board of Governors and any modifications that may be made to them. The Bylaws and the Rules and Regulations and any modifications to them shall be on file in the principal office of the Exchange and the principal office of the Automobile Club of Southern California. 6. No present or future subscriber of the Exchange shall be liable in excess of the amount of his or her premium for any portion of the debts or liabilities of the Exchange. Policyholder's dividends or credits may be returned to the subscriber by resolution of the Board of Governors. ACSC Management Services, Inc. ATTORNEY-IN-FACT �1M�Warriner. pis � 3/26/2015 5:28:37 AM 8216 Ed.01-07