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HomeMy WebLinkAboutC-7426-1 - Community Interagency Agreement for Noncredit Educational Assistance Classes9 z f" 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.