HomeMy WebLinkAboutC-7426-1 - Community Interagency Agreement for Noncredit Educational Assistance Classes9
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CITY OF NEWPORT BEACH COMMUNITY
INTERAGENCY AGREEMENT FOR NONCREDIT
EDUCATIONAL ASSISTANCE CLASSES OFFERED BY
COAST COMMUNITY COLLEGE DISTRICT AND THE
CITY OF NEWPORT BEACH
THIS COMMUNITY INTERAGENCY AGREEMENT ("Agreement') is made and
entered into as of this list day of June, 2018 ("Effective Date"), by and between the CITY
OF NEWPORT BEACH, a California municipal corporation and charter city ("City"), and
COAST COMMUNITY COLLEGE DISTRICT, a California public educational agency
("District'), whose address is 1370 Adams Avenue, Costa Mesa, California 92626, 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 District to provide non-credit educational assistance classes
to adults with verifiable disabilities as reflected in the Scope of Classes attached
hereto as Exhibit "A" and incorporated herein by reference (individually a "Class"
and collectively, "Classes").
C. District possesses the skill, experience, ability, background, certification and
knowledge to provide the Classes described in this Agreement.
D. City has reviewed the experience and evaluated the expertise of District, and
desires to retain District to provide the Classes 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 June 30, 2022, unless terminated earlier as set forth herein.
CONSIDERATION
City shall provide a facility site for the Classes offered by District. City will not
charge District any rental fees. District shall facilitate the collection of all registration,
enrollment, and material fees associated with the Classes.
3. DUTIES OF CITY
3.1 Room Setup. City shall provide classroom setup and takedown for District.
District will provide a room set-up diagram to City three (3) business days before
Classes start.
3.2 Class Facility. City shall provide a location for the Classes based on Class
availability and allocation, as determined by the City. City facilities shall only be
used for Classes authorized by the City under this Agreement. Classes will be
conducted within City season -specific dates and calendar. Classes will not be held
on City -observed holidays. Class offerings, dates, and times will be determined
by mutual agreement of City and District.
4. DUTIES OF DISTRICT
4.1 Registration. District shall register all Class participants.
4.2 District Representatives.
4.2.1 Certification. District hereby certifies that it, or any subcontractor,
representative and/or employee ("Representative" or collectively, "Representatives") who
will be teaching the Classes or assisting in teaching the Classes is qualified to do so, and
qualified to perform the services above and in the Class outline submitted to the City.
District is responsible for all Class curriculum development. District is responsible for
training, supervising, evaluating, scheduling, and any other requirements by law for all
Representatives. District warrants that it will continuously furnish the necessary personnel
to adequately provide the Classes as contemplated by this Agreement.
4.2.2 Background Checks. District shall provide City with the names(s),
address(es) and phone number(s) of all Representatives who will be providing any
services pursuant to this Agreement. All Representatives must comply with the
Fingerprint and Criminal Background Check policy in this Agreement. All Representatives
must be able to provide proof of legal right to work in the United States.
4.4 Subcontracting. District shall not subcontract or assign any portion of the
rights, obligations or duties required under this Agreement, without first obtaining prior
written approval from City. Subcontracts, if any, shall contain a provision making them
subject to all provisions of this Agreement.
4.5 Supplies/Equipment. District shall be responsible for providing all supplies,
equipment, personnel and materials at District's sole expense. District shall also be
responsible for repairing and maintaining all equipment and supplies in good working
condition.
4.6 Anti -Discrimination Laws. District agrees and certifies that no person shall,
on the grounds of race, religious creed, color, national origin, ancestry, age, physical
disability, mental disability, medical condition, including the medical condition of Acquired
Coast Community College District Page 2
Immune Deficiency Syndrome ("AIDS") or any condition related thereto, marital status,
sex, sexual orientation or any other impermissible bias under the law, be excluded from
participation in, or be denied the benefits of the services provided pursuant to this
Agreement except as otherwise permitted by law. District shall, where applicable, conform
to the requirements of the Americans with Disabilities Act in the performance of this
Agreement.
4.7 Class Size. District shall determine the minimum and maximum number of
participants required for each Class in cooperation with City staff to ensure the quality of
instruction and safety of the Class participants.
4.8 Absences. District shall notify City and Class participants at least one (1)
calendar week prior to any planned absence from the Classes. In the event of illness,
when possible, District shall notify City and Class participants at least twelve (12) hours
prior to any Class cancellation.
4.9 Contact Information. District is required to notify City in writing of any name,
address, telephone number, and email and/or website changes within forty-eight (48)
hours of such change.
4.10 Insurance. Without limiting District's indemnification of City, and prior to
commencement of Classes, District shall obtain, provide and maintain at its own
expense during the 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 "B" and incorporated herein by
reference.
4.11 Other Requirements. District shall:
4.11.1 Cooperate fully with all reasonable requests from City staff;
4.11.2 Maintain the highest degree of participant safety possible;
4.11.3 Immediately complete a District Incident Report, on a form to
be provided by City, and report to City staff by phone or email any injuries
as a result of participation in Classes, damages to the facility that could
cause potential injury to a Classes participant, and/or other needed
maintenance repairs;
4.11.4 Clear all participants from the designated Classes area at the
end of class;
4.11.5 Know facility rules and regulations and provide pertinent
information to participants;
4.11.6 Abide by all City policies and procedures;
4.11.7 Provide City with a Class roster and emergency contact
information, or Representative must have on -hand at every Class; and
4.11.8 Obtain City approval of Class type prior to the enrollment and
start of such Class.
Coast Community College District Page 3
5. PROJECT ADMINISTRATOR
This Agreement will be administered by the Recreation & Senior Services
Department. The Recreation Supervisor 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.
6. NOTICES
Unless otherwise indicated, all notices, demands, requests or approvals, including
change of address notices, 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.
6.1 All notices, demands, requests or approvals from District to City shall be
addressed to City at:
Attn: Recreation Supervisor
Recreation & Senior Services Department
City of Newport Beach
100 Civic Center Drive
Newport Beach, CA 92660
6.2 All notices, demands, requests or approvals from City to District shall be
addressed to District at:
Attn: Instructor/Coordinator
Special Programs and Services
Coastline Community College
1515 Monrovia Avenue
Newport Beach, CA 92663
INDEPENDENT CONTRACTOR
The parties intend and agree that at all times during the performance of services
or provision of the Classes under this Agreement, District and District's agents,
employees and Representatives shall act as an Independent Contractor and shall not be
considered an agent or employee of City. As such, District shall have the sole legal
responsibility to remit all federal and state income and social security taxes and to provide
for his/her own workers compensation and unemployment insurance and that of his/her
employees or representatives. District also agrees to provide liability insurance as
required by City and described more fully below. City shall not be liable for any payment
Coast Community College District Page 4
or compensation in any form to District other than as provided herein. City reserves the
right to employ other independent contractors who teach the same or similar Classes.
8. COMPLIANCE WITH ALL LAWS
District and its employees, agents and Representatives shall at all times observe
and comply with all laws, ordinances and regulations.
9. FINGERPRINTS AND CRIMINAL BACKGROUND
District certifies that all representatives, agents and/or employees of District
submitted to and passed a criminal background investigation and provided a complete
set of fingerprints on file with the Department of Justice. District further certifies that
Representatives, agents and/or employees shall provide to City a copy to confirm this
requirement has been met. District shall not permit any Representative, agent and/or
employee to participate in Classes if this requirement has not been met.
At any time during the term of this Agreement, if any Representative, agent and/or
employee is arrested for, or convicted of, a felony crime, District must report this to the
City within one (1) business day of receiving such information. District must immediately
remove said Representative, agent and/or employee from any Classes.
10. CONFIDENTIALITY; OWNERSHIP OF DOCUMENTS
All class rosters, participant addresses and contact information, and any other
such information or documents compiled by City and provided to District, shall remain the
property of City. District shall not release such information to others without the prior
written authorization by City. District shall not use such information for any other purpose
than that authorized by City, except as otherwise required by law. All Class rosters,
participant addresses and contact information shall be used by District solely for
administration of Classes and performing City business. District shall take reasonable
steps consistent with the law to prevent distribution of such information. District's
obligations under this Section shall survive the termination of this Agreement.
The rosters may not be used to market or advertise for the District's program
offerings that are not jointly between City and District.
11. USE OF NAMES AND LOGOS; ADVERTISING, PRESS RELEASES AND
PUBLICITY
District and District's agents, employees and Representatives shall not include
City's name, seal, logos or insignia, or photographs of class site or participants, in any
publicity pertaining to District's services or Program in any magazine, trade paper,
newspaper, radio or television production, Internet, or other printed or electronic medium
without prior written consent of City and participants. Location of Classes will be included
in District's printed and electronic Coastline Community College class schedule. City shall
Coast Community College District Page 5
promote and market the Classes in City's Newport Navigator publication, City's OASIS
Newsletter, City's website, and City's social media platforms.
12. HOLD HARMLESS
12.1 To the fullest extent permitted by law, District shall defend, indemnify, and
hold harmless City, its elected and appointed officers, employees, agents,
representatives, volunteers, the City Council, boards and commissions and any person
or entity owning or otherwise in legal control of the property upon which District provides
the Classes contemplated by this Agreement ("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
Classes performed or provided under this Agreement including, without limitation, defects
in workmanship or materials or District's presence or activities conducted with respect to
the Classes (including the negligent, reckless, and/or willful acts, errors and/or omissions
of Contractor, its principals, officers, agents, employees, vendors, suppliers, Contractors,
subcontractors, anyone employed directly or indirectly by any of them or for whose acts
they may be liable, or any or all of them).
12.2 Notwithstanding the foregoing, nothing herein shall be construed to require
District to indemnify the Indemnified Parties from any Claim arising from the 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 District.
13. INTELLECTUAL PROPERTY
District shall defend, indemnify, and hold harmless the Indemnified Parties from
any claim of infringement or other proceedings brought against City for any intentional or
unintentional violation by District, its employees, representatives, officers and agents of
the legally protected rights of any third parties, with respect to works performed, logos
displayed, or written or digital materials provided by District and used during the
performance of this Agreement. Such legally protected rights of third parties include but
are not limited to trade secrets, moral rights, proprietary acts, U.S. patents, trademarks,
service marks and copyrights vested or issued as of the Effective Date of this Agreement.
If District provides a public performance of musical compositions or arrangements that is
subject to a license held by a third party, it is the responsibility of District to obtain the
appropriate license to perform the material prior to the public performance.
Coast Community College District Page 6
14. TERMINATION
City or District has the right, at its sole discretion and with or without cause, to
terminate this Agreement at any time by giving thirty (30) calendar days' prior written
notice to the other parry.
15. STANDARD PROVISONS
15.1 Compliance with all Laws. District 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.
15.2 Waiver. A waiver by City or District of any term, covenant, or condition in
the Agreement shall not be deemed to be a waiver of any subsequent breach of the same
or any other term, covenant or condition.
15.3 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 contract or implied covenant shall be held to vary the provisions herein.
15.4 Conflicts or Inconsistencies. In the event there are any conflicts or
inconsistencies between this Agreement and the Exhibits attached hereto, the terms of
this Agreement shall govern.
15.5 Amendments. This Agreement may be modified or amended only by a
written document executed by both District and City and approved as to form by the City
Attorney.
15.6 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.
15.7 Equal Opportunity Employment. District represents that it is an equal
opportunity employer and does not discriminate against any subcontractor, employee or
applicant for employment because of race, religion, color, national origin, handicap,
ancestry, sex, age or any other impermissible basis under law.
15.8 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 parry by reason of the authorship of the Agreement or any other rule of
construction which might otherwise apply.
Coast Community College District Page 7
15.9 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.
15.10 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.
15.11 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 and the same instrument.
[SIGNATURES ON NEXT PAGE]
Coast Community College District Page 8
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:
By:
Aa n C. arp CA. ,W41 '
City Attorney
ATTEST:
Date: �• ._. - —
CITY OF NEWPORT BEACH,
A California municipal corporal
Date: S • 2z • 1 a
nior Services Director
AGENCY: COAST COMMUNITY COLLEGE
DISTRICT, a California public educational
agency
Date: $ lg
By:INYVt4 By:
Leilani Brown Joh W spfenning, Ph.D.
City Clerk Chancellor
Attachments
�PPROVED AS
ate:
Ge
[END OF SIGNATURES]
Exhibit A - Scope of Classes
Exhibit B - Insurance Requirements
, Esq.
Coast Community College District Page 9
EXHIBIT A
SCOPE OF CLASSES
District will provide non-credit, educational assistance classes for adult students
with verified intellectual disabilities.
District will provide non-credit, adapted fitness, educational assistance classes
for adult students with verified mobility impairments.
Coast Community College District Page A-1
INSURANCE REQUIREMENTS
Provision of Insurance. Without limiting District's indemnification of City, and prior
to commencement of Work, District 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. District agrees to
provide insurance in accordance with requirements set forth here. If District uses
existing coverage to comply and that coverage does not meet these requirements,
District 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 Reauirements.
A. Workers' Compensation Insurance. District 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.
District shall submit to City, along with the certificate of insurance, a Waiver
of Subrogation endorsement in favor of City, its City Council, boards and
commissions, officers, agents, volunteers and employees.
B. General Liability Insurance. District 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. District 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.
Coast Community College District Page C-1
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 City Council, boards and commissions, officers, agents, volunteers
and employees or shall specifically allow District or others providing
insurance evidence in compliance with these requirements to waive their
right of recovery prior to a loss. District 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, its City Council, boards and commissions, officers, agents, volunteers
and employees shall be included as insureds under such policies.
C. Primary and Non Contributory. 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.
E. Subcontractors. District shall require and verify that all subcontractors
maintain insurance meeting all the requirements stated herein, and District
shall ensure that City is an additional insured on insurance required from
subcontractors. For CGL coverage subcontractors shall provide coverage
with a format at least as broad as CG 20 38 04 13.
5. Additional Agreements Between the Parties. The parties hereby agree to the
following:
A. Evidence of Insurance. District 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 endorsements 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.
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 District sixty (60) calendar days' advance
Coast Community College District Page C-2
written notice of such change. If such change results in substantial
additional cost to District, City and District may renegotiate District's
compensation.
C. Enforcement of Agreement Provisions. District acknowledges and agrees
that any actual or alleged failure on the part of City to inform District 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 District maintains higher limits
than the minimums shown above, the City requires and shall be entitled to
coverage for higher limits maintained by District. 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 District 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 District'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 District or reimbursed by
District upon demand.
G. Timely Notice of Claims. District shall give City prompt and timely notice of
claims made or suits instituted that arise out of or result from District'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. District's Insurance. District shall also procure and maintain, at its own cost
and expense, any additional kinds of insurance, which in its own judgment
may be necessary for its proper protection.
Coast Community College District Page C-3
CERTIFICATE OF INSURANCE
CHECKLIST
City of Newport Beach
This checklist is comprised of requirements as outlined by the City of Newport Beach. *
Date Received: 2/13/18
Dept./Contact Received From:
Date Completed: 3/29/18 Sent to:
Company/Person required to have certificate:
Type of contract:
Teri
By:
Coast Community College
Jan
I. GENERAL LIABILITY
EFFECTIVE/EXPIRATION DATE: 7/1/17 — 7/1/18
B. AM BEST RATING (A-: VII or greater) Not Rated— Insurance Pool
A.
INSURANCE COMPANY: Statewide Association of Community
Colleges
B.
AM BEST RATING (A-: VII or greater): Not Rated— Insurance Pool
C.
ADMITTED Company (Must be California Admitted):
❑ No
D. LIMITS - If Employees (Must be $1 M min. BI & PD and $500,000
Is Company admitted in California?
® Yes ❑ No
D.
LIMITS (Must be $1 M or greater): What is limit provided?
$1,000,000
E.
ADDITIONAL INSURED ENDORSEMENT— please attach
® Yes ❑ No
F.
PRODUCTS AND COMPLETED OPERATIONS (Must
F. ADDITIONAL INSURED WORDING: ® N/A
❑ Yes
include): Is it included? (completed Operations status does
G. PRIMARY & NON-CONTRIBUTORY WORDING: ® N/A
❑ Yes
not apply to Waste Haulers or Recreation)
❑ Yes ❑ No
G.
ADDITIONAL INSURED FOR PRODUCTS AND
I. NOTICE OF CANCELLATION: ❑ N/A
0 Yes
COMPLETED OPERATIONS ENDORSEMENT (completed
Operations status does not apply to Waste Haulers)
❑ 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?
® 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 ® No
K.
ELECTED SCMAF COVERAGE (RECREATION ONLY):
® N/A ❑ Yes ❑ No
L.
NOTICE OF CANCELLATION:
❑ N/A ® Yes ❑ No
II. AUTOMOBILE LIABILITY
EFFECTIVE/EXPIRATION DATE: 7/1/17 — 7/1/18
A. INSURANCE COMPANY: Statewide Association of Community Colleges
B. AM BEST RATING (A-: VII or greater) Not Rated— Insurance Pool
C. ADMITTED COMPANY (Must be California Admitted):
Is Company admitted in California?
® Yes
❑ No
D. LIMITS - If Employees (Must be $1 M min. BI & PD and $500,000
UM, $2M min for Waste Haulers): What is limits provided? $1,000,000
E LIMITS Waiver of Auto Insurance / Proof of coverage (if individual)
(What is limits provided?) N/A
F. ADDITIONAL INSURED WORDING: ® N/A
❑ Yes
❑ No
G. PRIMARY & NON-CONTRIBUTORY WORDING: ® N/A
❑ Yes
❑ No
H. HIRED AND NON -OWNED AUTO ONLY: ® N/A
❑ Yes
❑ No
I. NOTICE OF CANCELLATION: ❑ N/A
0 Yes
❑ No
III. WORKERS' COMPENSATION
EFFECTIVE/EXPIRATION DATE: 7/1/17 — 7/1/18
A. INSURANCE COMPANY: Protected Insurance Program for Schools
B. AM BEST RATING (A-: VII or greater): Not Rated— Insurance Pool
C. ADMITTED Company (Must be California Admitted):
® Yes
❑ No
D. WORKERS' COMPENSATION LIMIT: Statutory
® Yes
❑ No
E. EMPLOYERS' LIABILITY LIMIT (Must be $11M or greater)
$1,000,000
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
HAVE ALL ABOVE REQUIREMENTS BEEN MET?
IF NO, WHICH ITEMS NEED TO BE COMPLETED?
® N/A ❑ Yes ❑ No
® N/A ❑ Yes ❑ No
® N/A ❑ Yes ❑ No
® Yes ❑ No
Agent of Alliant Insurance Services
Broker of record for the City of Newport Beach
Date
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 for un -rated pools for General Liability, Auto Liability and Workers
Compensation. 2/14/18 Risk Management approved.
Approved:
Risk Management
Date
* Subject to the terms of the contract.