HomeMy WebLinkAboutC-4250 - Independent Contractor Agreement Recreation Instructora CITY OF NEWPORT BEACH
Recreation & Senior Services Department
INDEPENDENT CONTRACTOR AGREEMENT
This Agreement is made and entered into as of this 1st day of June 2009 by and between the City of
Newport Beach, California, a Municipal Corporation and Charter City ( "City "), and Andrew Todd - Sole
Proprietor, DBA Trifytt Sports (Instructor) to provide the classes or programs in Youth Sports scheduled
and described in the Newport Navigator, which is incorported herein by this reference, and as approved in
writing by the City.
NOW, THEREFORE, it is mutually agreed by and between the undersigned parties as follows:
TERM
The term of this Agreement shall commence on the above written date, and shall terminate on the
301' day of September 2010 unless terminated earlier as provided herein.
2. COMPENSATION
City will pay Instructor within 21 business days after their last class meeting. City will pay the
Instructor the following percentages of the amount of the total enrollment fees collected below,
minus the non - resident fee and a $3 per person administration fee for each class held:
• All Locations except Newport Coast Community Center & Summer Camps — 65%
• Newport Coast Community Center — 60%
• Summer Camps (excluding Newport Coast Community Center) — 65%
City may renegotiate compensation with Instructor anytime during the term of this Agreement, if the
City has to take on additional responsibility.
3. DUTIES OF CITY
A. Registration. City shall register all participants for classes and collect all enrollment fees.
Instructor shall not accept enrollment fees directly from a participant unless the City
approves, in writing, the acceptance of enrollment fees by the Instructor. Instructors shall
only collect materials fees that are pre- approved by the City and published in advance in the
Newport Navigator. Such materials fees should be collected by Instructor at the first class
meeting.
B. Publicity. City shall provide publicity for the class in the Newport Navigator, which is
published four times a year. City shall have the sole discretion to decide what information
will be included in the Newport Navigator about the class and the Instructor.
C. Class Facility. City shall provide a location for the class without charging Instructor any
rental fees, unless otherwise agreed by the parties. City shall also provide all necessary
utilities.
D. Refund Processing.
City shall provide refunds to participants who:
• Drop the class before the second class meetings;
• Drop a one -day workshops 5 business days before the workshop; or
• The class is canceled by the City or Instructor.
INDEPENDENT CONTRACTOR AGREEMENT
Trifytt Sports Page 2
The Instructor must provide the City with all required paperwork. -
E. Class Roster. City shall provide class rosters to Instructor online. Instructor will request a
log -in and password from City. The City will not mail, fax or email rosters to instructors.
4. INSTRUCTOR DUTIES
A. Instructors. Instructor hereby certifies that he/she or any instructor, representatives, or
employee who will be teaching the class or assisting in teaching the class is qualified to do
so, and qualified to perform the services described above and in the course outline
submitted to City. City staff must approve in writing all assigned instructors, representatives
and employees prior to any of them performing any services under this Agreement. A
current roster of instructors, representatives, and employees must be provided prior to new
instructors, representatives and employees being approved. All instructors must be able to
provide proof of legal right to work in the United States.
B. Representatives/Employees. Instructor shall provide the City with Name, Address and
Phone Number of all representatives or employees who will be providing any services
pursuant to this Agreement. All representatives or employees must comply with the City's
fingerprint policy (Section 8). Please mark the following that apply:
_ I will not be using representatives or employees.
I will be using representatives or employees (Please complete Exhibit A).
- Instructor must notify the City in writing at least thirty (30) calendar days before the start of
the first class or program with any additions or deletions to Exhibit A. Instructor 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.
C. Supplies/Equipment. Instructor shall be responsible for providing all supplies, equipment,
personnel, materials, and any additional publicity desired for the class, at Instructor's sole
expense, unless otherwise agreed to in writing by City. Instructor shall also be responsible
for repairing and maintaining all equipment and supplies in good working condition.
D. Anti - Discrimination Laws. Instructor agrees and certifies that, except as permitted by law,
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 Immune Deficiency Syndrome (AIDS) or any condition related thereto, marital
status, sex or sexual orientation, be excluded from participation in or be denied the benefits
of the services provided pursuant to this Agreement, and Instructor agrees not to
discriminate on said grounds in the hiring and retention of employees and representatives,
unless authorized under Section 12940 of the California Government Code. Instructor shall,
where applicable, conform to the requirements of the Americans with Disabilities Act in the
performance of this Agreement.
D. Class Size. Instructor shall determine the minimum and maximum number of participants
required for each class in cooperation with City staff. The City can determine the
minimum /maximum number of participants in a class to ensure the quality and, safety of the
class. Instructor or Instructor's authorized representative is required to attend the first class
meeting of all class offerings advertised in the Newport Navigator unless Instructor cancels
the class three (3) business days prior to the start date, with the prior written approval of
City. In the event of such approved cancellation, Instructor shall be responsible for
INDEPENDENT CONTRACTOR AGREEMENT
Trifytt Sports
Page 3
informing all registered participants. In the event that the minimum number of participants is
not met by the first class meeting, the class will be cancelled and the Instructor shall not be
compensated for attending the first meeting or for any cancelled class. Instructor shall not
be obligated to provide any additional services in regards to the cancelled class. If the
minimum number of participants is met or exceeded, the class will be held as scheduled
(even if any of the initial participants subsequently drop the class), subject to paragraph 14
of this Agreement. If the demand is such that an additional class could be offered, it shall be
taken under consideration and negotiated by City and Instructor. If class(es) are cancelled
for two (2) consecutive quarters due to lack of enrollment, the class will not be scheduled
again until City determines that public demand has increased.
E. Use of Non -City Facilities for Classes. If Instructor desires to conduct the class at his/her
place of business, or some other non City -owned site or facility, Instructor must:
i. Notify City at least twenty -four (24) hours in advance;
ii. Provide sufficient parking for all participants;
iii. Post signs at the site to direct participants to the location of class; and
iv. Allow access to City staff to the location when requested.
F. Absences. Instructor shall obtain permission from City one (1) week prior to any planned
absence from the class. In the event of illness, Instructor is required to notify City and
Participants twelve (12) hours prior to any class cancellation.
City urges Instructor to get a substitute, whenever possible, instead of cancelling classes.
All Instructor employees or representatives must be fingerprinted and clear a background
check before teaching a class as provided in paragraph 8 of this Agreement. Instructor shall
obtain City's prior written approval of any substitute instructor. When cancelling a class,
Instructor shall contact all participants as soon as possible.
G. Contact Information. Instructor is required to notify City in writing of any name, address,
telephone number, email, website or direct deposit payment changes within 48 hours of
such change.
H. Training. Instructor or Instructor's authorized representative must attend the Annual
Instructor Training on Wednesday, May 12, 2010, at Newport Coast Community Center
(6401 San Joaquin Hills Road, Newport Coast, CA 92657) from 5:00 — 8:30pm. Failure to
attend without prior written approval shall result in City retaining an additional 5% of the total
enrollment fees collected.
I. Other Requirements. Instructors shall:
i. Cooperate fully with all reasonable requests from City staff.
ii. Maintain the highest degree of participant safety possible.
iii. Immediately report to the Recreation & Senior Services Office any injuries as a result
of class participation.
iv. Immediately report to the Recreation & Senior Services Office any damage to the
classroom or program facility that could cause potential injury to a class participant,
or other needed maintenance repairs.
V, Contact participants, if /when a class is cancelled and confirm all cancellations and /or
make -up classes, in writing, with City staff.
vi. Clear all participants from the designated class area at the end of class time unless
participants continue to use public City facilities for personal use without conflict with
other scheduled activities and in accordance with posted hours and availability
limitations.
INDEPENDENT CONTRACTOR AGREEMENT
Trifytt Sports
Page 4
vii. Ensure that any music or sound system is kept at levels that will not interfere with other
classes or create a public disturbance /nuisance. -
viii. Close and secure the room or building at the end of each class.
ix. Turn off any lights, heat, air conditioning, or other utilities when class is finished.
X. Schedule make -up classes in advance through City.
A. Complete and return the quarterly "Contract Class Schedule" on the date stated which
will be emailed to the Instructor. Instructor is given two (2) weeks to return the
completed quarterly schedule back to the City.
xii. Know facility rules and regulations and provide pertinent information (i.e. refunds) to
participants. (Copy provided).
xiii. Pay a $20 lost key /replacement fee when Instructor requests replacement key.
xiv. Abide by all City policies and procedures including, but not limited to, the requirements
set forth in the Newport Navigator and the Contract Instructor's Handbook 2009 -10,
which is attached hereto and incorporated by this reference.
Direct Deposit. All Instructors are required to use direct deposit for payments made from the
City pursuant to this Agreement.
K. Email — All instructors are required to have an email address.
L. Instructor 1D Badge — Instructors and their employees /representatives are required to wear
Recreation Instructor ID Badge provided by the City at all times while teaching. Pay a $5
Instructor ID Badge lost/replacement fee will be charged. Instructor ID Badges are replaced
each year upon renewal of contract.
5. INDEPENDENT CONTRACTOR
The parties intend and agree that at all times during the performance of services under this
Agreement; Instructor shall act as an Independent Contractor and shall not be considered an agent
or employee of City. As such, Instructor 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 representative. Instructor also
agrees to provide liability insurance as required by City and described more fully below. City shall
not be liable for any payment or compensation in any form to Instructor other than as provided
herein. City reserves the right to employ other independent contractors and instructors who teach
the same or similar classes.
6. INSURANCE
General Liability Insurance. Instructor must provide and maintain at all times general liability
insurance in an amount not less than one million dollars ($1,000,000) per occurrence for bodily
injury, personal injury, and property damage. The policy shall carry a general liability special
endorsement naming the City of Newport Beach, its elected or appointed officers, employees,
agents and volunteers as additional named insured in the amount of one million dollars
($1,000,000) per occurrence. Evidence of insurance certificate shall be sent to the Recreation &
Senior Services Department and must be approved by the City Risk Manager prior to the first
class /day of instruction. Instructor shall have the option of purchasing coverage through the City of
Newport Beach's Special Event insurance program, or providing his/her own coverage. If an
Instructor elects to obtain his /her own coverage, said coverage must have the policy limits
described above and be provided by an insurance carrier with a Best's Insurance Guide Rating of A
(or higher) and Financial Size Category Class of VII (or larger). Said policy must also provide a
written 30 -day notice of cancellation (10 -day written notice for non - payment of premium) to the City
INDEPENDENT CONTRACTOR AGREEMENT
Trifytt Sports
Page 5
of Newport Beach Recreation & Senior Services Department, at the following address: 3300
Newport Boulevard, Newport Beach, CA 92663.
Workers' Compensation Insurance. By executing this Agreement, Instructor certifies that Instructor
is aware of and will comply with Section 3700 of the Labor Code of the State of California requiring
every employer to be insured against liability for workers' compensation or to undertake self -
insurance before commencing any work. Instructor shall carry the insurance or provide for self -
insurance required by California law to protect said Instructor from claims under the Workers'
Compensation Act.
Please mark the following that apply:
XI am attaching a copy of the General Liability Insurance with Additional Insured
Endorsement that meet the above requirements. (Please see Exhibit D).
I will be using the City provide insurance through Southern California Municipal Athletic
Federation (SCMAF) and will pay all required fees quarterly billed by the City. Please see
Contract Instructor Handbook 2009 -10 (Exhibit B) for complete information.
7. COMPLIANCE WITH ALL LAWS
Instructor, and his/her employees, agents and representatives shall at all times observe and comply
with all laws, ordinances and regulations.
8. FINGERPRINTS AND CRIMINAL BACKGROUND CHECK
All Instructors and their employees, agents and representatives must submit to and pass a criminal
background investigation by providing a complete set of fingerprints to City at least thirty (30)
calendar days prior to teaching or assisting with any class or program. Such Instructors and their
employees, agents and representatives are required to submit fees in the amount of $54 per person
to the City of Newport Beach, Recreation & Senior Services Department, to cover all costs
associated with fingerprinting through the City of Newport Beach Police Department and the
Department of Justice. Fingerprints are required to be updated every five (5) years. This
requirement is mandatory.
In addition, all classes involving minors age seventeen (17) or younger must be taught in an open
atmosphere where parents and guardians are able to observe class instruction if so desired. At no
time can the parent or guardian of a minor be denied access to a class. By signing this Agreement,
Instructor agrees to the provisions of this Paragraph.
9. TRANSPORTING OF MINOR PARTICIPANTS
Unless the class or program specifically involves travel or transportation of minors to an offsite
location, Instructor, or Instructor's employees, agents or representatives, shall not transport any
minor participant by vehicle or otherwise. If, after the conclusion of any class session, a minor
participant has not been picked up, Instructor shall make every effort to contact the minor
participant's parent, legal guardian, or other authorized individual to whom the minor may be
released. If no contact can be made with any of the above individuals, Instructor shall contact the
City Recreation Supervisor or Recreation Manager at the Recreation & Senior Services Office at
949 - 644 -3151 (Monday through Friday, 8am to 5pm.), or the Park Patrol at 949 - 795 -2381 (Monday
through Friday, 5 to 9pm, and Saturday and Sunday, 9am to 5pm.) During all other hours,
Instructor shall contact the Newport Beach Police Department for assistance.
INDEPENDENT CONTRACTOR AGREEMENT
Trifytt Sports
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 Instructor, shall remain the property of City. Instructor
shall not release such information to others without the prior written authorization by City. Instructor
shall not use such information for any other purpose than those authorized by City. All class
rosters, class participant addresses and contact information, shall be used by the Instructor solely
for administration of classes and performing City business. Instructor will take reasonable steps
consistent with the law to prevent distribution of such information. Instructor's obligations under this
paragraph shall survive the termination of this Agreement.
11. USE OF NAMES AND LOGOS; ADVERTISING, PRESS RELEASES AND PUBLICITY
Instructor shall not include City's name, logos or insignia, or photographs of the class site or
participants, in any publicity pertaining to Instructor's services or class in any magazine, trade
paper, newspaper, radio or television production, Internet, or other printed or electronic medium
without the prior written consent of City and participants.
12. BUSINESS LICENSE
Newport Beach Municipal Code Chapter 5.04 provides that every business operating in the City
must obtain a business license prior to conducting business in the City, and pay the required
business license fee. This ordinance applies to businesses operating at commercial or residential
locations within the City, or using a City of Newport Beach address or P.O. Box for receiving mail.
The City Business License Fee is an annual tax, due every twelve (12) months. Instructor agrees to
obtain a City business license as required by Chapter 5.04 and provide proof of compliance
annually. Business License Applications are available in the Revenue Division Office in Newport
Beach City Hall. In certain circumstances, Instructor may be eligible for paying a reduced Business
License Tax, which is known as an Apportioned Business Tax. A Declaration for Apportioned
Business Tax is available in the Revenue Division Office at City Hall. A copy of your Business
License must be submitted with this agreement. Please see Exhibit C.
13. INDEMNIFICATION
General. Instructor shall defend, indemnify, and hold harmless City, its elected and appointed
officers, employees, agents, representatives, the City Council, boards and commissions
( "Indemnified Parties') with respect to any loss, liability, injury or damage that arises out of, or is in
any way related to, the acts or omissions of Instructor, his or her employees, representatives,
officers and agents in the course of performing services under this Agreement; however, Instructor
shall not be required to indemnify City from any claim arising from the sole negligence or willful
misconduct of the Indemnified Parties.
Intellectual Property. Instructor 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 Instructor of the legally protected rights of any third parties, with respect to
works performed, logos displayed, or written or digital materials provided by Instructor 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 Instructor will
be providing a public performance of musical compositions or arrangements that are subject to a
license held by a third party, it is the responsibility of Instructor to obtain the appropriate license to
perform the material prior to the public performance.
INDEPENDENT CONTRACTOR AGREEMENT
Trifytt Sports
14. TERMINATION
Page 7
City has the right, at its sole discretion and with or without cause, to terminate this Agreement at
any time by giving three (3) calendar days prior written notice to Instructor. In the event of
termination under this Section, City shall pay Instructor on a prorated basis for any classes or
programs that were actually taught by Instructor, if any, up to the effective date of termination.
15. CONTROLLING LAW AND VENUE
The laws of the State of California shall govern this Agreement and all matters relating to it. Any
action brought relating to this Agreement shall be adjudicated in a court of competent jurisdiction in
the County of Orange.
16. AMENDMENTS
This Agreement may be modified or amended only by a written document executed by both
Instructor and City and approved as to form by the City Attorney.
17. 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 this
Agreement or any other rule of construction which might otherwise apply.
18. INTEGRATED CONTRACT
This Agreement represents the full and complete understanding of every kind or nature whatsoever
between the parties, and all preliminary negotiations and agreements are merged herein. No verbal
agreement or implied covenant shall be held to vary the provisions herein.
19. 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.
20. 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.
INDEPENDENT CONTRACTOR AGREEMENT
Trifytt Sports
Page 8
IN WITNESS WHEREOF, the parties have caused this Agreement to be executed on the day and
year first written above.
APPROVED AS TO FORM:
OFFICE OF THE CITY ATTORNEY
By:
ynet eaump
Assistant City At:Vey
ATTEST'
By:
Leilani Brown, City Jerk
CITY OF NEWPORT BEACH,
A Municipal Corporation
By
Detweiler, Director
onviiii.Recreation d Senior Services
INSTRUCTOR-Trif Sports
By:S- Z 9- v9
Signature Andrew Tod Date Signed
Before submitting your contract package to the City, the following documents must be completed and or enclosed.
1) Three tropias of the signed contract (a completed original wntract will be mailed back for your records after processing
2) Exhibit A - Completed List of Contract Instructor Representative, Employee and/or Agent Names P rm
3) Exhibit C - Copy of valid ray of Newport Beach Business License; and
4) Exhibit D - Insurance Certificate with Additional Insured Endowment if not using SCMAAF Insurance Plan
Exhibits: A - Contract Instructor Representative, Employee and/or Agent Fonn Y
B -- Contract Instructor Handbook 200910
C - Business License P/
D - Certificate of Liability Insurance with Additional Insured Endorsement V/
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TRIPYTT SPORTS
CITY OF NEWPORT BEACH
INSTRUCTIONS AND CONDITIONS
ACCOUNT NUMBER:
EXPIRATION DATE: 05/31/2010
Welcome to the City of Newport Beach, and thank you for your business tax payment. This business tax certificate is evidence that the
named business has paid a tax to conduct the business activity designated, within the City of Newport Beach, until the expiration date shown.
Please notify the Revenue Division immediately if any of the information on the certificate changes.
This certificate is valid only at the address indicated and must be displayed in a conspicuous location. If your business is not conducted at a
permanent location Municipal Code requires that any representative, while transacting business within the city, carry this certificate.
This business tax cedificate does not authorize the named business to conduct any activities regulated by the City of Newport Beach or other
agencies. Authorization for such activities must be obtained from the appropriate departments prior to application for business tax. Certificates
are not transferable to any other party or person and are not pro -rated.. Refunds are not provided once the certificate has been issued.
Your business tax certificate Is valid until the expiration date, and must be renewed annually poor to that date. Changes in type of ownership
(i.e. from a sole proprietorship to a pedrershw or LLC), nature of business, or ownership void the current certificate and require filing of and
payment for a new application. Additional certificates are required if additional types of business activity are initiated at the same address, or
additional locations of the same business are established (Municipal Code sections 5.04 through 5.081.
For your convenience, the Revenue Ciwsion will mail a courtesy renewal notice, prior to the expiration nate, to the billing address of record.
Non -receipt of the notice does not alleviate the requirement to renew. Penalties are Imposed for late renewal at a rate of 25% per month to a
maximum of 100% of the base lax..
The Revenue Division is available to answer any questions regarding business tax certification and requirements. Call (949) 644-3141; e-mail us
at: RevenueHelp®city.newpoh-beach ca. us, or visit us on the internet at walw.ciftynewpor-beach.caas_ and view the Municipal Cade on-line.
DISPLAY CONSPICUOUSLY AT PLACE OF BUSINESS FOR WHICH ISSUED
CITY OF NEWPORT BEACH
BUSINESS TAX CERTIFICATE
THIS TAX PAYMENT EXPIRES: 05/31/2010 ACCOUNT NUMBER:
SERVICE ADDRESS: OWNER/PRINCIPAL NAME:
TRIPYTT SPORTS ANDREU! TODD
BUSINESS CATEGORY:
MISC.PERSONAL SVCS
SELLERS PERMIT: NO SELLERS PERMIT
OWNERSHIP TYPE:
SOLE PROPRIETORSHIP
TAX INCLUDES PAYMENT FOR:
0.00 EMPLOYEES _
DATE OF ISSUE: 05/29/2009
PRINT DATE: 05/29/2009
ACORD. CERTIFICATE OF LIABILITY INSURANCE DA E(MMIDD Y)
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PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
FOR SERVICE CALL:
FRANCIS L. DEAN &ASSOCIATES OF FLORIDA, LLC
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER
THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
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THE NAMED INSURED DURING THE POLICY PERIOD.
CERTIFICATE HOLDER
CANCELLATION
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City Of Newport Beach, its directors, officers, agents
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3300 Newport Blvd.
BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANYWAL
ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE
3OHOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE
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Newport Beach, California 92663
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AUTHORIZED REPRESENTATIVE
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THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
1776 S. NAPERVILLE RD., BLDG. S
COVERAGE AFFORDED BY THE POLICIES BELOW.
P.O. BOX 4200-
COMPANIES AFFORDING COVERAGE
WHEATON, IL 60788
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CERTIRCATEHOLDER
CANCELLATION
SHOULD ANT OF TIE ABOVE DESCRIBED POLICIES BE CANCELLED
TIIF,f6 Sports
1205 N. Red Gum Street, Suite A
Anaheim, CA 92805
BEFORE THE EXPIRATON DATE THEREOF, THE ISSUING COMPANY WILL
ENDEAVOR TO MAIL 30 HAYS WRITTEN NOTICE TO TME CERTIFICATE
HOLDER NAMED TO WE LEFT. BUT FAILURE TO MAR SUCH MOTCE
SHALL IMPOSE NO OBLIGATION OR LMBUTV OF ANY KIND UPON THE
COMPANY ITS AGENTS OR REPRESENES
NTAT.
AUTHORIZED REPRESENTATIVE
-
PTaans4 Dean
ACORD 28.8 (1195)
o Acow WRPORATIOH Taw
ADDITIONAL INSURED
note IMMADONYI
5rz7roe
AGENCY 800-745-2409
830-885-7284
FRANCIS L. DEAN & ASSOCIATES, INC.
1776 S. NAPERVILLE RD., BLDG. B
P.O. BOX 4200
WHEATON, IL 60187
APPLICANT (First Named Insured) =*w oa
TnFYtt Sports
EFFECTNE DATE E IRATION DATE COPIAN
smano9 6113H0
POLICY NUMBER:
ACCOUNT N1A.RBER
CODE sLIBCODE:
AGENCY CUSTOMER IO
INTEREST wit
MVAEANOMN S REMSENCEC CERTIFICATERWUIRED
Sunrise Chnsllan School
INTERMTINq MNMMR
DIIA9Ta INSURED
X
1980 PAYEE
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IMEiEST ARNo:
T EMDMDRM REFERENCER CEMIFIUTEREWIRED
Antioch Soo" conno EX
IMERELT IN fTEM N1MffR
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vvmr E BOAT.
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City of Diamond Bar
MEGPAYEE 21825 Copley
Diamond Bar, CA 91765
INLERMTINnEMNUMBER
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X
Loss
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HEREBY
RANK
NAMEANDADpEA9 REFEREMEV LER11FlU1E REWIgEO
The City of YucalPa
34272 Yucaipa Blvd.
Yucaipa, CA 92399
IMEREBTINrtEMMMWR
X ASCTp INSURED
LESS PAYEE
MORTGAGE
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Christ Tho Kind Cathdic Church
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ADDITIONAL INSURED
D"°(" "0D
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ROEXCV I FMC�C 800.74&2409
Fr" 830.865-7284
PRANCIS L. DEAN 8 ASSOCIATES, INC.
1778 S. NAPERVILLE RD., BLDG. 9
P.O. BOX 4200
WHEATON, IL 80187
APPLICANT (First Named lnaurad)
EFFECTIVE GATE EXPIRATION GATE COPLAN
&13109 e'A"
POLICY NIMSM
ACCOUMNtMBER:
CODE: SUSCDDE:
ADENCY CUSTOMER IO
INTERESTWK
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RANK
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LOBS PAYEE
MCMWE
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MXK
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X
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USM ER
EMPLOYEE AS LESSYR
MMEMDMKfESB REFERENCE! CEATRGTEREWIRED
City Cf Laguna NguelLOGTKYI:
77801 La Pa: Road
Laguna Niguel, CA 92877
IMPRF.aiNnEYMMffN-
X
aURODO:
8M
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1
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EM0.0YEEASLE&MR
NAMEANDAOGQESS REFERENCE! ow"AMTEREWRED
CRY of Anaheim
200 South Anaheim Blvd.
Anaheim, CA 92805
IWEREM IN ITEM MIMaER
X
I L Mm: I NNLDNM
NP.IECIE: I BOAT
EDIEWIED ITEM NUMEEM
MXER
ITEM DPBLMMION
(MEREST
RANK
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MORTOACE
LIENHOLDER
EMPLOYEEIS LESSOR
MMEANDADDRESS REFEREWEP CEMMWEREWIRED
City of Dana Point,
33282 Golden Lantern
Dan Point, CA 92829
IMERWW1MMWM7R
X
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NAMEANDADORESS I REFERENCES: CEnfiF TEREOMMO
CRY of Orange,
300 E. ChaPmen Avenue
Orange, CA 92888
RITMiEMNITEMMWIMER
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Data tMNUD7ffi9
n
AGENCY PIINEER:800-74&2409
MP.
�F.A`wV. 830-88&7294
FRANCIS L. DEAN 8 ASSOCIATES. INC.
1776 S. NAPERVILLE RD., BLDG. B
P.O. BOX 4200
WHEATON, IL 80187
R101B
MS w, 4,t
TnFva Sports
EFFEETIVE DATE E%PIMTgN RATE COiPLAN
6/13/09 6/13110
POLICY NUMBER
CGDE: SUBCODE:
AGENCY CUSTOMER ID
ACCOUNT NUMBER:
INTEREST
PARK
ADDITRMULNSURED
LOSS PAYEE
MCRTGGE
NENHMDER
EYPIAYEE081E680R
NAMEANDADDRESS REFERENCE* CERTIRGTE REQUIRED
City of TUMID,
300 Centennial Way
Tustin, CA 92780
INFERear N ITEM UMBES
X
uocAnd: WILDING:
4£NIcIz BOAT:
I
�1FRULED REM NUMBER:
OTNTp
ITEM pESCRIPIIOX:
INTEREST
RPNN:
ADDITIONAL INSURED
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NRIIEANDADORE88 REFERENCEN: CERTIFIGTEREWIREO
City of West Downs,
1444 West Garvey Avenue
West Covina, CA 91790
INTEREST IN ITEM NUMBER
X
LocnrlON: anu MNG:
VEHICLE I BOAT:
SLHECIIIEDITEMNDleER:
OTHER
ITEM DESCRIPTION:
INTEREST
I RANK
ADDITIONAL INSURED
Loss PAYEE
MORTGAGE
uENNOLOER
EMROYEEASIESSOR
NWEANUADDRESS REFERENCE/: CEgngGTEREry11PED
City of Lake Forest,
25550 CommereerHre Drive, suite 100
. Lake Forest, CA 92630
INIERESTNITEMMIMBER
X
IDCATION: BUTUANG
VEHICLE: BwT:
SCHEWIEDREMMABER'
mxER
REN OE6CPIPTON'.
INTEREST
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q
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RANK
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POSTGAME
NENHOILER
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HOME PIq AppREdS REFERENCE! CETRIFMATEREpAPEDIHIEREBTWrtEN
City of Ime
1 Civic Center Plaza
Invins, CA 92623BdEWLFDREMNUMBER'
HUMMER
X
LOGnoM BUILDING'
VExICM: Boxr:
oTHEP
ITEM DESCNPTICft
INRPEST
PARK
ADDrTIOW. W6LRED
LOSS PAYEE
MO rGASE
UENHOLLER
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NANEANOACDRE66 REFERENCES CERTIFIGTEREWRED
INTEREST INREM NUMBER
X
LDCATO: PXILRN3
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8w1EDUU D REN NUMBER :
MEN
REM DESCRIPRON'
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X AOOTIOUL INSURED
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ENFLDYEEAB LE&4(M
NAAEAIGACOREBS REFERENCES. CERTIRGTEREWIRED IWERES IRREMNU4BER
City Of Costa was LO'ATgN: BUILDING'
77 Fair Drive YEHICIE: BOAT:
Costa Mesa, CA 92628 BCHEOIIEB IiEN HUMBEq:
OTXEA
ITEM CE6LRIPi1M.
ADDITIONAL INSURED
Dam(MkB7ro9 Y
srza
AGENCY
, 800-745-2409
APPLICANT (First rlB Insured)
TnFv6 Sports -
IFAr"G.m 830$65-7294
FRANCIS L. DEAN & ASSOCIATES, INC.
1776 S. NAPERVILLE RD., BLDG. B
P.O. BOX 420D
WHEATON, IL 60187
EFFECTYNE GATE E%PIMTION GATE COIPUN
6/13109 16/13/10
POLICY NUMBER:
ACCMWNUMUMR:
CODE: aUBCODE:
A(ENOY CUSTOMER IO
RTEREST
RANK:
AMITg WSMtED
LOSS PAYEE
MOR MAGE
11EM401➢ER
EMROYEE A41E450R
NAMEMDADOFEBB REFEREMCEk CERMCATE REWIRED
City of Newport Beach, its Directors, of icem, agents and employees
3300 Newport Road
Newport Beach, CA. 92663
INTERESTINREMNUMBER
X
LGCAnGN: I NUMMI,
VEHICLE: I BOAT:
SC DJ ED REM NUMEMI :
OTHER
ITEM DEIRRIPTION
MEREST
pAMC
ACdTNVMLMIBURED
LWB PAYEE
MORTGAGE
UENHWDER
EMPLOYEE AS LESSOR
NAMEAVADORES$ IREEEPENCE/: CERTIFICATE REWIRED
Wawasee High School
INTEREST IN ITEM NUMBER
X
LDCLMM: aMLOINC:
VEucur BJAT:
SCHEWIE0ITEMNIMBER
OTHER
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MnEPEST
RAMKI
ADMTg INNRED
LOBS PAYEE
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LIENIOLOER
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REFERENCE* CERTIFKATEREOURED
14 v r Hinh C hl Fre ,mm Campus
I INTEREST IN REM NUMBER
X
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VEWCIE: B7AT
Sg1EDI.iFDnFMpIMBEA:
O1HER
ITEM DESCRIPTION.
INTEREST
RANK
ADMnwwmsuRED
su
LOSS PAYEE
MORTGAGE
LIENI NER
EMRAYEEASIEESCR
Homs pAoh Sc REFERENCED: CERFIFIGIE REIXEREp
HOOveT Koh School
INTEREST INII
X
1nCATgx:
WILDIM
WILGINO:
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BOAT
6CXEWLEO NEM NUMBER:
Un1ER
ITEM CESCRIPTIpIL
IMEPEBT
PNAI
ADOIR INSURED
1958 PAYEE
MORTGAGE
UENM DER
EMPoYEEASU$P0R
NAIV=NA ADDRESS I REPEREMCE* CERTIFICATE NEgARED
Hoover Board of Education
IXTEPESTINxEM HLMOER
X
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VEHIo E: BWT:
SCHEDV1ED REM NUMSSR:
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"MeASanta Margarita dscapREFORENLE/'. CEMIRCATEPWVIPEO
Santa Margarita Landscape and Recreation Corporation (SAMLARC)
MRNI PFnroIW MNn]nPMan(, IRG
Iran IN IIEM NUMBER
X
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VEHICLE: BMT
SWEWIEDrtEM WMSER:
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MNK
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Up wft
EMPLOYEE AS LES6LR
NAMEANOAWNESB REFERENCE* URRFICATEREQUIE0 INTEAEST IN ITEM NUMBER
X
Antioch SpDds Complex LOCATON: WILDING
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ITEM OTBCMMIW:
ADDITIONAL INSURED 1 °MeW710D
MMwD
AaENCY 800-748-2408 A LIG NTIF
N=.•+/ f330-086-7294 TdFvU Sports
FRANCIS L. DEAN & ASSOCIATES, INC.
1776 S. NAPERVILLE RD., BLDG. B
P.O. BOX 4200
WHEATON, IL 60187
EFF 6113 WTE IXPIMTIONOATE COIPIAN
6/13/09 6/73H0
LiPoucyNUMBER:
ACCOUW NUMBER:
GGEENC suecoDB:
AGENCY CUSTCMERm
INIEYD
RONK
Ffid11CNPLNISUREp
LOSE PAYEE
MORTGN35
UENHCRDEN
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REFERENCE( CERNFMATEREOUYLEp
City of El Segundo
ORY pi E SB9U11E0
Attn: Recrea ion and Palls Director
350 Main Street, Rooms
EI SB9MIMa, CA. 901953813
IMERE6i INITEM NVMBER
X
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