HomeMy WebLinkAboutC-4260 - Independent Contractor Agreement Recreation InstructorJ CITY OF NEWPORT BEACH
g 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 Toes on the Nose LLC
414e-a California limited liability company (Instructor) to provide the classes or programs in Surfing Classes
hereby agreed upon, as 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
30•' 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 surf classes — 75%
• Private Lessons — 80%
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.
The Instructor must provide the City with all required paperwork.
INDEPENDENT CONTRACTOR AGREEMENT
Toes on the Nose Retail, Inc.
Page 2
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.
jS 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 he 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
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
INDEPENDENT CONTRACTOR AGREEMENT
Toes on the Nose Retail, Inc.
Page 3
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.
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.
ix. Close and secure the room or building at the end of each class.
INDEPENDENT CONTRACTOR AGREEMENT
Toes on the Nose Retail, Inc.
Page 4
X. Turn off any lights, heat, air conditioning, or other utilities when class is finished.
xi. Schedule make-up classes in advance through City.
xii. 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.
xiii. Know facility rules and regulations and provide pertinent information (i.e. refunds) to
participants. (Copy provided).
xiv. Pay a $20 lost key/replacement fee when Instructor requests replacement key.
xv. 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.
Instructor ID 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
of Newport Beach Recreation & Senior Services Department, at the following address: 3300
Newport Boulevard, Newport Beach, CA 92663.
INDEPENDENT CONTRACTOR AGREEMENT
Toes on the Nose Retail, Inc.
Page 5
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:
I 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.
10. CONFIDENTIALITY; OWNERSHIP OF DOCUMENTS
INDEPENDENT CONTRACTOR AGREEMENT
Toes on the Nose Retail, Inc.
Page 6
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
Toes on the Nose Retail, Inc.
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
Toes on the Nose Retail, Inc.
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: 462,12
yne D. ea p
sistant
AsCity ttorney
ATTEST:
By: U ✓�1thl/
Leilani Brown, Cdy Clerk
INSTRUCTOR - Toes on the Nose
By: ✓/�I��s� X Q p
signature Jehn Allred V.W6WA
CITY OF NEWPORT BEACH,
A Municipal Corporation
610)b10�
Date Blamed
Before submitting your contract package to the City, the following documents must be completed and or enclosed
1) Three copies ofthe signed contract (a completed original contract will be meiledbacirfor your records after processing
2) Exhibit A - Completed Llst of Contract Instructor Representative, Employee and/or Agent Names Form
3) Exhibit C - Copy of valid City of Newport Beach Business License; and
4) Exhibit D - Insurance Certificate with Additional Insured Endorsement if not using SCMAF Insurance Plan
Exhibits: A - Contract Instructor Representative, Employee and/or Agent Form ux/
B -- Contract Instructor He book 2009-10
C - Business License ✓
D - Certificate of Liability Insurance with Additional Insured Endorsement
9E��e CITY OF NEWPORT BEACH
v 5¢
TOES ON THE MSE ACCOUNT NUMBER:
no/*o"nYn
Welcome to the City of Newport Beach, and thank you for your business lax paymaM. This business tat certificate is evidence that the
named bustness has paid a tax ho conduct the business activity designate0, within the City of Newport Beech, unlit the expiration data shown.
Please notify the Revenue Di FrnImmnrllanan ae,.,,me,.im,,,....,,,,_,._.x...._.,,,__,__._____
This cenifterm is valid only at the ookeess indicated and must be displayed in a conspicuous iocaaon. If your business Is not conducted at a
permanent location Municipal Code requires that any representative, while transacting business within Ma city, carry this certificate.
This business tax cemlloate does not authorize the named business to conduct any activi iaa mmlaMd me rsn„e Mm...,.,w o ... . _. _....
>yrr.-U,r . „umormauen Tor sucn acuwues must oe obtained from the appmptiete departments priorto a9Qfication for business tax. Certificates
are not transferable to any other Perry or person and are not pro -rated. Refunds are not provided Ori�Egk9 certificate has been issued.
Your business tax wrtificete is valid until the expiration date, and must be renewed annually prior to met date. Charges In type of ownership
e ...m
. .. _,... .. _._.'_. ,..._....„.,,.,,...ofbuinssativityw WrullVale arq requu Iing orsne
payment for a new of the same
business am astaes are r(Mulretl II l Cod nsi types business actively are initialed et ma same 8'tldress, or
additional locations of the same bua(ness are established (Municipal Code awBans 5.06 though S.OH.
For your convenience, the Revenue Division will mail a cou isay renewal notice, prior to the expiration date, to the bilkg address of retold.
Non-recelpt s the notice does not alleviate the requirement to renew. Penalties are Imposed for late renewal at a We of 25% per month to a
The Revenue DIVtson is available to answer any questions regarding business tax cemllOol on and requirements. Cal (949) 6643141; emal us
at: Rev WHelP@dW.ne od.ewh.oe.us. orvlsit us on the intemat at w.,m,.es.�nwm„nrw..l..w.M..n,m,., e.. nn,...:.:�...., .,_...__„__
DISP6Y CONSPICUOUSLY AT PLACE OF BUSINBSS FOR WHICH ISSUED
THIS TAX PAYMENT EXPIRES:
SERVICE ADDRESS:
CITY OF NEWPORT BEACH
t%L1bIVES5 LAX GEHTIFICATE
02/28/2010 ACCOUNT NUMBER
BUSINESS CATEGORY:
NBHB a BUYS CLOTHIR[i STORES!
SELLERS PERM7: 099192912
VnrYp1V [aWVl.1YHL ryNIVIC:
ALX&M, RICHARD
OWNERSHIP TYPE:
CORPORATION
TAX INCLUDES PAYMENT FOR:
9.00 WLOYEHS
DATE OF ISSUE: 02/01/2003
PRINT DATE: 05/26/2009
/29/09
.AGORD CERTIFICATE OF LIABILITY INSURANCE OP ID °05/29/09
ROOKS -3 ID t( 29 D9
PRODUCER
CLAREE MARINE INSURANCE
245 FISCHER AVENUE, SUITE D-8
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
COSTA MESA CA 92626
Phone: 714-444-2679 Fax:714-444-0176
INSURERS AFFORDING COVERAGE
NAIC9
INSURED
INSURER A: Burlington Insurance CO
A
INSURER B: Travelers Insurance Co
10647 ._
RODE, Inc.
dba: Toes On The Nose;
Toes On The Nose Retail LLC
INSURER c: Zenith Insurance
05/23/10
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INSURER D. mJ UnLm Fire Inzoranw_
INSURER E
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V THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NIDCAMID. NOTWITWTNAMC
MY REQUIREMENT. TERM OR COMIT IDN OF ANY CONTRACT ON OTHER DOCUMENT WITH RESPECT TO WHmH THIS CERTIFICATE MMT BE ISSUED OR
MY PERTAIN. THE INSURANCE ATFCRBED BY THE P0.ICIES DESCRBE0 HEREIN IS SUMEM TO ALL THE TERMS. INCLUSIONS AM WHOTIOVE OF SUCH
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PoLIVES. AGGREGATE LMWAe
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$1,000,000
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$1 000 000
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DESCRIPTOR OF OPERATIONS I LOCATIONS IVFNICLES I EXCLUSIONS ABUSE BY ISMAD MENT I SPECIAL PROVI$pxs
City of Newport Beach is additional insured to the general liability per
the limits inclusive and not to exceed as required by written contract for
surf school business of the Insured. Per general liability
policy's additional insured endorsement form no. GSG-0-010 0399. *except 10
day notice of cancellation for non payment of premium.
WOULD ANY OF THE ABOVE OMMOED POLICIES BE CANCELLED BEFORE THE EXMRATIC
DATE THEREOF, THE ISSUING INSURER WILL M@i&XA) MAIL 30A WYSIVRRTEN
City Of Newport Beach NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, WTffAICVRP]RWSIXiC9F1
Parks s RecreationyOpgdyayABgMpYpppAgBlppRAgxpppT pppMTNpNppRNttl{SApF1;NAgH
3300 Newport Blvd. AWXEERsN4Ex
Newport Beach CA 92663 .....O....�..
go�RQ. CERTIFICATE OF LIABILITY INSURANCE OE®, I DA= I
CIARKR [MAINE INSURANCE
245 FISCHER AVENUE, SUITE D -S
441:14
Phone:714-444-2679 Fax:714-444-0176 I INSURERS AFFORDING COVERAGE INAIC#
Roox, Inc. INSIRER B:
dba: Toes On The Nose;
T,an On Thn T]nuu ne1a,I T.TP INSURER O:
INSURER B:
THE POLICIES OF INSURANCE LISTED BELOW AWE BEEN ISSUED TO ME INSURED NAMED MOVE FOR RUE PoLICY PERM INDICATED. IpOMMETPNDING
ANYREDUIREMEM, TERM OR CONDITION OF MY CONTRACT OR OTHER DCCUM1ENT'MRI RESPECT TO MICH THIS CERTFICATE WAYNE ISSUED OR
MY PERTAIN. ME INSURANCE AFFORDED BY ME PMICES DESCRIBED HEREIN IS SJBUECT TO ALL THE TERMS. IXCLU OCNS AND CONDMONS OF SUCH
POLICIES. AGGREGATE LIM"SHPNN MY HAVE BEEN REDUCED SY PND CLAIMS
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05/23/09
05/23/10
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City of Newport Beach is additional insured to the general liability per
the limitss inclusive and not to excoed as required by written contract for
serf school business of the Insured. Per general liability
policy's additional insured endorsement form no. CSG -G-010 0399
City 0£ Newport Beach
SHOULD ANY OF THE ABOVE DEWMW POLICIES BE CANCELLED SEPoRE UNE RPOS LTO
DATETHET .THEIMINGINSURFRSTLLENOE RT)MAIL 30 DAYSMYTTEN
ROME TO THE CERTFICATE HOLDER MARKED TO THE LEFT. BUT FAILURE TO m m SHALL
IM POSE NO COUGADON DO UMBIHUTTY OF ANY NMO UPON ME SSIRER, In AGENTS OR
RAE/PRESSSEENNN T�ATIIVE {&�\��/�
V 00
Insured: Roox, Inc. dba: Toes on the Nose
Toes on the Nose Retail, LLC
Policy no: _
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSUREDS BY CONTRACT, AGREEMENT OR PERMIT
This endorsement Modified insurance provided under the folowing.
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1 SECTION II- WHO IS AN INSURED is amended to include as an insured any parson or
organization with whom you agreed, because of a written contract, wrillen agreement a permit,
to provide insurance such as is afforded under this Coverage Part but only with respect to your
operations, "your work" or facilities owned or used by you
2. This provision does rwl apply.
a. Unless the written contract, agreement or permit has been issued prior to the "bodily Into ry',
"property damage", "personal injuN'or"advertising injury'
b. To any person or organization inc uded as an insured by an endorsement issued by us and
made pal of this Coverage Part
a. To any lessor of equipment
(1) After the equipment lease expires; or
(2) It the "bodily injury', "property damage', "personal injury" or "advertising injury" arises out
of the sola negligence of the lessor
J. To any engineer, architect or surveyor it the'boddy inryry", "property damage". "personal
injury" or "advertising injury'artses out of the rendering or failure to render professional
services by or for you, including'
(1) The preparing, approving, or failing to prepare or approve maps, drawings, opinions.
reports, surveys, change orders, designs or specifications; and
(2) Supervisory, inspection or engineering services
a. To any:
(1) Owners or other interests from whom land has been leased; or
(2) Managersor lessors of premises it
(a) The occurrence lakes place after you cease to be a tenant in that premises; or
(b) The "bodily injury", "property damage', "personal injury" or "advertising injury" arises
out of structural atlerations. new construction or demolition operations pedormed by
a on behalf of the manager or lessor
f. To any person or organization included as an insured under Paragraph 4 Newly Acquired or
Formed Organizations of Section II - Who Is An Insured
ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED,
GSG-G-010 0399
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001/08)
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