HomeMy WebLinkAboutC-4562 - Production Agreement for Fourth of July Fireworks ShowPyro Spectaculars, Inc,
P.O. Box 2329
Rialto, CA 92377
Tel: 909-355-8120:::: Fax: 909 - 355.9813
City of Newport Reach
Revised Program A — Ver. 9 I
July 4, 2613
PRODUCTION AGREEMENT
q rte, ^{��t
(Special)
'this agreement ( "Agreement ") is made this h 1' ' day of _ 2013 by and batnnen Pyro Spectaculars, Inc, a Culiforuie
corporation, hereinafter referr ^d to as ( "PYRO) and City of Newport Reach, a municipal cooperation bercinaft- referred to as ( "CLIENT"). PYRO and
i� CLIENT are sometimes referred teas "Parry o- as "Parries" herein
V i Engagement - CLIENT hereb en2agvs PYRO R+ pri ;vide to CLIENT one fire -works produc {ion ( "Prnduciian 1> and PYRO accepts such eogagurnent
upon all of the promises, terms and conditions hereimaiter :et forth The Pradazeiacr> hall be substaauilly as outlined in Program "A', atached hereto and
incorporated herein by this reference
Y L l PYRO Dales- PYRO Shull provide all pgrotecr is equipment, trained pymtcchnir-ians, shipping, p}rorecht v products, application fir
Specific pyrotechnic permits (It)- cn: of wbo.lu including standii, fees, such be paid by CLIENT) relating to file Production, insurance covering the
Production and the other things on its part to be performed as more specifieffly set bath bolpw in this Agroenreat and in the Scope of Work ( ',Scope of
Work "), attached hereto, incogx)rated l sin ho this reference, and made a par. of this Agreommt is though set Barth fully herein.
12 CLIENT Dulles - CLIENT shall provide to PYRO a suitable site (`Site') for the Production, security f^r the Site a, set forth to Pei igraph
6 hereof access to die Site, any permission noc.casaty to utilize the Site I -or the Production, and the ether things on itv part to be perfauned as more
spccificall?^ set forth below in dh s A+ :oii and in the Scope of Wurk. All Site arrimplatms are subject to FYRO's reasonable appcavat as to
pyrotechnic safety, suitability, and selor-ty. All other Conditions of the Site shall be the responsibility of CLIENT, including, but not limited lo, access,
use, control, parking and general safety with negwct to the public, CLIENT personnel and o he contractors_
2- 'Time and Place -The Piodnelitln shsdl take pleb on duly 4, 2013, at approximately 9:00 ant., at Nc vno t Di lies- 1131 Sack Bay Drive, West vide
of lagoon , Newport Beach, CA, Site
3. Fees, Interest, and Expenses -
3. t Fee - CLIENT rgm-es to pay PYRO a I @e of $25-000.00 USD (TWENTY -Rll TL)(7SAND DOLLARSS ("Fee ") Tot tire production
'The total balance of the Fee shall be paid no later than J"( a 2013. CLtEN`z authorizes PYRO to re eiva and v nifj credit and financial intiannatlon concerning
CLIENT from any agency, person m cooly including but not limited to credit forting agencies- The "PRICE FIRh9" date, the date by which tilt, executed
Agreement most be delivered to Pyro, is set forth in paragraph 20.
3.2 Interest- In the event that too Rice is not paid in a hm,.:, manner, CLIEN I" vvill In responsible for the payment of 1 51 o interest pox month
or 16% annually on the unpaid balance. If litigation arises out of this Agreement, [he prevailing party shall be, antitwd to reasonable coals incurred in connection
with the litigation, including, but not limited to atma e}9' flues
3.3 Expenses --PYRO shall pay all normal expenses+. = ,'ready tripled to the Production including freight, insurance as outlined, pyrotechnic
products, pyrotcclmtc equipment, experienced pyr,nalaru personnel to set up and c ia,;h.,rge the pyrotechnics and those additional items as outlined as PYRO's
responsibility in the Scope of Work. CLIENT shall pay all costs related to the enoiductiour net supplied try PYRO includu, but not limited to, thn,se items
outlined as CLIEN F's responsibility in this Agteement air Scope of Work,
4. Proor4cta iv Rights -PYRO represents and wrurirds that it oens all copyright_, including parParmenu riphis, to this Production, except that PYRO
does not own CUENf -owned material or third- party -owned material that has been included in the Production, a ed'as to aaeh CLIFNL - owned and third- pariy-
owned mrtritU, CLIENT assumes full respo r,im'ity therefore_ CLIENT agrees that PYRO skall retain ownership of, anti all copyrights and other rights to, the
Production, except that PYRO snail not acquire or retain lay ownership cr Other right, in or to CLIENT-owned material and third- party -owned matelot and shall
not be reaponstaSe in in_, . v<ay for such material. II'applicable, CLIE €N consents to the use of CLIENT -owned material! and represurts that it has or will obtain
any permission from appropriate third parties sufficient to rat ire public exhibition of any snah material in connection with this Production. PYRO reserves the
ownership right; in its trade names that are uses,' in or are a product of the Production Any reproduction by sound, video or other duplication or recording pwc ess
without Cho uxprts:+ written permission of PYRO is prohibi[d.
9. aS. feN- PYRO and CLIENT shall each comply with applicable federal, state and local laws and regulations and employ safi-y progranvs and measures
consistent with rec4ignized applicable industry standard; end practices. At all times- before and during the Po ductian, it stall be within PYRO's :role discretion to
determine whether or not the Production may be satiety discharged or continued. ILshal! not cunstilute a breach of this Agreement by PYRO fm ;fireworks to fail
or malfunction, or for PYRO to determine that the Production cannot be dischargt it er comimrcd-as a res.di of any conditions or circumstances affecting safety
beyond tit reasonable control of PYRO. CLIENT reccgiiitc3 that beeawe of the nature of fireworks, an industry accepted'.<vel of 356 of the product used in any
diap'•uy, cry not function as deigned and has level of nonparformance a accepollyn as inII performance.
b 5eanr,FiY- CL7FtiYshail pnwide ad;x ,'sate seeurtCp4.rsaanui, barricades -, vtd Petite Depamnent services:u ; *>sy he nec.,vsary :o prcolude indtvidaals
other than music authorized by PYRO from evernig an area it> be dc,ia„ noted by PYRO asthe ilea tar the set-up and discharge ofthe Productual, including a
fallout area satisfactory to PYRO chars the pyrotechnics may sail 1p rise and any debris may _afely fad, s>YRfi shalt have m ^z rielm nsibibly f ;r u;omtor+r,; >er
continuing CLIENT's other contraetnrs, provn,crs er vol In er dse public; areas to ohieh the poblr or w^nra. -tas h v., access; or any other public or contractor
facilities associated with I -` Production.
7 Cleanup - PYRO !gall be ream ible for the o>mo+a} of all actdpment pre ulcd by MY 0 mid clean up cf y live Inimu chnic debris made necvsary
by PY120 CL[EPNT shall be responsible for any other clean up which may be requirad of the Production or set -up, di charge and fallout areas including any
environmental clean -up.
$ P,d niits - PYRO wrca to apply A% rye tai4s for the filing of rr AL,dlaics only from the Newport Beach Fire Department, FAA, and USC4 it
rzfufrcJ CLIEN1 shad Inv.. pmrOible for m tries xisct,uutul w Ih'!u,c permits including 5t >nGby fai% (a IUNT shall tx_^ responsible for cbtainind any other
nr.cussery permits, paying vsosiated feex and making athcx appropriate ananxen>ents tar Police Deployments, other Firc Departments, rood cl>stuv's,
uvcnVuctivity or land use permits or any perm(ssfdm ur partial rai1wred b, d -y Li, %;, Re i ail, Str e ur Fah al O :x - riarwt
PS V I -2a
Special Val, e I
Pyro Spectaculars, Inc, City of Newport Beach
P.O. Box 2329 Revised Program A — Ver. t# I
Rialto, CA 92377 July 4, 2013
Tel: 909-155-8120:::: Fax: 909- 355 -9813
9. nsuyance - PYRO shall are]] times during the performance or services herein ensure that the tollo)ying insurance is maintained in connection with
PYRO's performance orthis Agreement: (1) commercial general liability inscrance, including products, completed operations, and contractual liability under this
AgreemenL (2) automobile liability insurance, (3) nodreW co :mpcnsat,on insurance and employer liability insurance. Such insurance is to protect CLIENT from
claims for bodily injury, including death, personal injury, and from claims of property damage, which may arise from PYRO's performance of tlds Agreement,
wily The types and amounts of coverage shall be as set firth in the Sc pe of Work. Such insucatoe shall not include elamis wines arise 4rcm CLIENT's
negligence or willful conduct or from failure cfCI JENT to perfemi its obligations under this Agreement, coverage for which shall be provided by CLfLN'T.
Tim coverage of these pnticies s ?half he subject to reasonable inspccdon by CLIENT. Certificates of Insu rake evidencing the required general liability coverage
shall be famished to CLIENT pric-rto the rendering of r.rvices hereunder and shall include that the ford ung Inc named as additionally insured: CLIENT;
Sponsors, Landew=otts, Barge Owners, Tinny; and Permitting AtnhorRies, with respect to The operations of PYRO at tine Production Pyrotechnic subeonlraeton
as provider,:' any, not etwcin i under ficocies oC insurance requaeat lxxetvy, shall secure, maintain and provide their own insurance coverage with respect to their
respective operatiom and services.
10, Snt{emnificalion -PYRO represents and warrants that it is caoab:e of fumi,hi ng the naeetxary experience, personnel, equipment, materials, providers,
and expertise to produce the Production in a safe and professional manner. N givithstanding anxthing* in Iris Agreement to the contrary, PYRO shall indemnify,
hold hmrnhua, and defend CLIENT' and the additional insureds from and against any and all claims, actions, danages, liabilities and expe tscs, including but not
limited to, attorney and other professionel fee ;?cud court cr°,ts, in connection with the loss of life, personal injury, andoor damage to property, arising frtcut or Out
of the Produchon and the presentation thereof to flat extent such ire cccasicaed by any act or omission at'PYRO, their officer, agents, contractors, provides, u7
employee.. CLIP.NT shall indemnify, hold odmL^ s, and defend PYRO from and against any and all claims, actions, damages, liability and expenses, including
but not limited to, attorney and other profes rat loci, and court costs in connection with the loss of life, personal injury, and /or damage to property, arising from
or cut of the Production and the presentation thereof to the extent such are occasional by any act or omission ofCLIEN 1, its officers, agents; contactors,
providers, iT canp!eyccs. In no event shall either party be liable (or the consequential ifir e; of the other party,
! I. jyyunitn @on of Damages for Ordinary iSri Rfw - Except in the case o€ bodily injiuy, sad praPerty damage as proeidcd in the insurance ,,,ad
iodconnification provisions of Pwayrssphs 9 and 10. above, in the event CLIENT claims that PYRO has breached this Agreement or was ntherwise negligent in
performing the Production provided for hsfcm, CLiANT shall nit be eratit,ed to claim or recover monetary damages from PYRO beyond the amount CIIE31T has
nand to PYRO under this Agreement, and shall not be untitled to claim or recover any consquential dan.gee feem PYRO including, without limited at, dameges
for lots ofin,ame, bnsinc,e orpxnfai
12. I +curer Mitieure - CLIEN F agrees to assume the rids of uxeatVier, stake, civil unrest, terrorism, what ry lemon, govcnunenud action, and any o41sr
causes beyond Inc control of Py "W which stay pm,crit the Producti,o from being safely discharged on the scheduled date, a$ich may cause the canzcllinnOn of
any event (rr which CLIENT has purchased the Pmdactioor, or which man affect cur damage, such portion of the exhibits as most be placed and exposed a
necessary time before the Production. If, for any such reartiI, PYRO is not r�r,onably able to safidy discharge the Production on the scheduled date, or at the
scheduled time., or should any event for which CLIENT' has purcha_ d the Production be canceled as a result o; scc'h causes, CLIENT may fit reschedule the
Production and pay PYRO such owns as provided in paragraph 13, or (ii) cancel the Production and pay PYRU such sums a5 provided in Paragraph 14, based
upon when the Production is camel, :d.
13, Rescheduling Of Bvent - IfC1.1I NT elects to reschedule ire; Production, PYRO shall bs paid the original Fee plus Al additional expenses made
accessary by rescheduling plus a 15% service fec on such additional expenses. Said expenses will be invoiced separately and payment will be due in full within 5
daps of oaropt. CLIENT cvnd PYRO shad; agree up: a t ;- reschedated date ta'6rg into consideration availability of permits, mxtcriats, equipment, transportation
and tabor The Production shall be rescheduled fcr a date not snore than Sit Days srbsequcnt to the date fitat set for the Production. The Production shalt m I, be
reschedules to a date, or for an event- that historically has mvtwed a fncwmrke prei+rcdian The Production shall ant be rescheduled between June 15th and Any
15th unteax the Original date was holy 4th of :ors same year, or between December 15th ana January i9feo unless the original date was Dcacmbci 31 rt of the earlier
year units PYRO agrees that such m6cheduiing will nos adrri,ziy affect mime[ meioess operations daring thusie periods
14. ll�t Tu Cancel -- CLi;`?NT shah have the option io ueihinn ally cancel the Production prior to the scheduled date. If CLIENT exercises this option.
CL.IE.N'i' agrees to pay to PYKO, as liquidated damngas; lire fallowing percentages of the Pec as sat forth nn far agrapfi 3.L I) SC:o it cancetletion oacars .3O fn 9f,
days prior h1 the scheduled (late, 2) 75% if canccihation occuts 15 to 29 days* prior to the schndulcil date, 3) 1ptl4e thereafter. In the event CLIENT cancels the
Production, it will be impracticd or extramcly difficult to fix actu'd amount of PYRO'e damage,. The foregoing represents a reasonable estimate of the damages
PYRO will sulker if CLIENT cancels the ProduAiou.
15 - NI.)toint Venture - It is agreed, nothing in this Aarocxnent or in PYRO's performance of the Production shall be construed as forming a partnership or
joint venture between CLIENT and PYRO. PYRO shad be and is an independent cenirr for with CII.IENT and not an empbyie of CLIENT. The Parties heretr.
shall be severally oaponsibL for their own irparale debts and gbiigalimis and neither Party shall he hcFd responsible for any agreements or obli,,,adons not
exprocxsly provided for herein_
16- Applicable Law -This Agreement and the rights and obligations of.de Parties hereunder shall *.re amsteaed in accordance with the lays or CalbernL,
In the event that the scrape oftkc Production 3s redoing by auhordies haying ioriedi,fior or i p either' erty for safety ocncxrru, the MI dDlIa; amounts outlined in
this Agreement are eri'urceable.
17. Notices - Any Notice to the Parties permitted or required und, r this Agreement may be given by mailing x,ich No &c in the United States Mitt,
postage prepaid, first class, addressed a> fifo)vs: PYRO -- Py'ro Bosses uk : s, Inc , PO_ Box 23-19, Riaim, Ciddontia, 9237?, or far oversight dchvwy to 3 1O N
Cacust rlvenua, Rian),Cal airma 92377 h1000 f;yprBlyd - 9265br c , .
19 kindification of -Ferns - All terms of the A resment are in mitma, and may only be modit7cd by written agreement of both Prod., hereto. Beth
i'ai,,its uckaow, cdzc they have receivcd a cr)py of said written A is -Mena and agree to be bound by said terms of written Agreement only.
19_ serrtlni Ifl -If di,.-rc is more tl un occ CLILN i tic; sit e;! h J.andy or.r'severa'.y reepmsi's *e in perform CLIENT "s rbhga 1, nni under the
Agreement. This Agreement wall l:covnt effective after a is vxecuted ,'d accepted by CLIIdN'f and after of is execu .;d and ae., +pted by PYRO at iiYRM
P5 V 1 -2r.
Spec it Ver. If I
Pyro Spectaculars, Inc.
P.O. Box 2329
City of Newport Beach
Revised Program A — Ver. # I
Rialto, CA 92377 July 4, 2013
Tel: 909-355-8120 :::: Fax: 909-355-9813
offices in Rialto, California. This Agreement may be executed in sevi rat counterparts, including faced and emailed copies, each one of which shall be deemed an
original against the Party executing same. This Agreement shall be binding upon the Parties hereto and upon their heirs, successors, executors, administrators and
assigns
20. Price Firm — If any changes or alterations are made by CLIENT to this Agreement or if this Agreement is not executed by CLIENT and del ivcred to
PYRO on or before the PRICE FIRM date shown below, then die price, date, and scope of the Production are subject to review and acceptance by PYRO for a
period of 15 days following delivery to PYRO of the executed Agreement. In the event it is not accepted by PYRO, PYRO shall give CLIENT written notice, and
this Agreement shall be void.
PRICE FIRM through June 14, 2013
EXECUTED AGREEMENT MUST BE DELIVERED TO PYRO BY THIS DATE,
See PRICE FIRM conditions, paragraph 20, above,
EXECUTED as of the date first written above:
PYRO SPECTACULARS, INC.
By: _
James R, Souza, �Pr,,id,n
By:
Iteryl A. Sat t
io, Corporate Secretary \Q
SHOW PRODUCER: Jeff Martin
PS V 1-2e
Special Ver. # 1
CITY OF NEWPORT BEACH,
A California municipal corporation
By:
Its: �-A VVIN ?ice—iri
kL c6` � vie NO, k.
I
Print Name
APPROVED AS TO FORM
CITY ATTORNE, Y' OFFICE
DA'L'E: /
By:
Aa on C. Harp, City Attorney
ATTEST: 6 •2, 6%3
Date: �/
ti
By.
Leilani L Brown, City Clerk
%t;L/ PO riN i
Pyro Spectaculars, Inc. City of Newport Beach
P.O. Box 2329 Revised Program A— Ver. # 1
Rialto, CA 92377 July 4, 2013
Tel: 909-355-8120:::: Fax: 909 -355 -9813 Pa;,c A ot4
SCOPE OF WORK
PYRO SPECTACULARS, INC. ( "PYRO ")
and
City of Newport Beach ( "CLIENT ")
Pyro shall provide the following goods and services to CLIENT:
One Pyro Spectaculars, Inc., Production on July 4, 2013 at approximately 9:00 p.m. at Newport Dunes, West side of
lagoon: 1131 Back Bay Drive Newport Beach, CA.
• All pyrotechnic equipment, trained pyrotechnicians, shipping, and pyrotechnic product.
• Application for specific pyrotechnic permits relating to the Production,
• Musical soundtrack for the Production supplied in agreed upon format, Insurance covering the Production as set forth in the
Agreement with the following limits:
/rtsurunce Requirements Ctmiis
Commercial General Liability $5,000,000.00 Combined Single Limit- Each Occurrence
(Bodily Injury & Property Damage)
Business Auto Liability- $5,000,000.00 Combined Single Limit- Each Occurrence
Owned Non -Owned and Hired Autos (Bodily Injury & Property Damage)
Workers' Compensation Statutory
Employer LiabLtitX $1,000,000 Per Occurrence
CLIENT shall provide to PYRO the fol €owing goods and services:
O All on -site labor costs, if any, not provided or performed by PYRO personnel including, but not limited to, local union
requirements, all Site security, Police and Fire Dept, standby personnel, stagehands, electricians, audio and fire control monitors,
carpenters, plumbers, clean -up crew. All these additional personnel and services shall be fully insured and the sole responsibility
of CLIENT.
+ Coordination and any applicable non - pyrotechnic permitting with the local, state or federal government that may hold
authority within the Production.
• Costs of all permits required for the presentation of the Production and the event as a whole.
• Provision of a Safety Zone in accordance with applicable standards and all requirements of the authorities having jurisdiction
throughout the entire time that the pyrotechnics are at the Site or the load site (if different) on the date of the Production and all
set -up and load -out dates, including water security to keep unauthorized people, boats, etc. from entering the Safety Zone.
< A professional grade Audio System including all necessary equipment, installation of such equipment and trained audio
engineers for operation based on audio and communications requirements provided by PYRO.
s General Services including, but not limited to, Site and audience security, fencing, adequate work light, dumpster
accessibility, a secure office for PYRO personnel within the venue, secure parking for PYRO vehicles, access to washrooms,
tents, equipment storage, hazurat storage, electrical power, fire suppression equipment, access to worksites, necessary
credentialing, etc., will be required as necessary.
PS v 1 -2e
Special vecH 1
Product Synopsis * Pyrotechnic Proposal
City of N "port Beach
PROGRAM Y
Opening
Descri #on
♦ 3" Souza Designer Opening Salutes
. r
Main Body - Aerial Shells
Description
♦ 3" Souza Designer Selections
♦ 4" Souza Designer Selections
♦ 5" Souza Designer Selections
Total of Main Body - Aerial Shells
Pyrotechnic Devices
Description
♦ Sousa Platinum Line Custom Multishot Device
♦ Double Rising White Pearl Cascade UFO
♦ Sousa Emerald Line Custom Multishot Device
♦ Sousa Pearl Line Custom Multishot Device
Qwnti
35
Quantity
79
104
95
2713
QMntily
300 Shots
5
1,020 Shots
100 Shots
Total of Pyrotechnic Devices 1,425
Grand Finale
Description _Ouantity
♦ 2" Souza Designer Bombardment Shells 100
♦ 3" Souza Designer Bombardment Shells 30
♦ 3" Souza Designer Finale Shells 180
♦ 4" Souza Designer Finale Shells 90
♦ 5" Souza Designer Finale Shells 12
Total of Grand Finale 412
Grand Total 2,150
Policy Number: CA000002771 -27
Number: 114
Effective Date: June 12, 2013
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization:
City of Newport Beach Dunes Resort, LLC
Newport Dunes Waterfront Resort Newport Dunes Marina, LLC
Terra Vista Management County of Orange
Newport Dunes Resort and Marina The Irvine Company
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization
shown in the Schedule as an insured but only with respect to liability caused by your operations or
premises owned by or rented to you.
The insurance afforded any Additional Insured does not include coverage for any injury or damage
arising from the failure of such Additional Insured to fulfill its obligations specified in its contract with
the Named Insured.
POLICYHOLDER COPY
s0
CERTIFICATE OF WORKERS` COMPENSATION INSURANCE
ISSUE DATE: OS- 11-2013
CITY OF NEWPORT BEACH SD
23300 NEWPORT BLVD
NEWPORT BEACH CA 92WS-3816
GROUP.
POLICY NUMBER: 0803749 -2012
CERTIFICATE ID: 940
CERTIFICATE EXPIRES: 10- 14-2012
10- 14- 2012/10 -14 -2015
This is to certify that we have Issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer married below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 20 days advance written notice to the employer.
We wilt also give you 30 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of Insurance Is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document
with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms, fexclusions, and conditions„ of such policy.
Authorizad Representative/" President and CEO
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #2005 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-14-2002 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
-� ENDORSEMENT #2670 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2013-08 -11 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY, THIRD PARTY NAME:
CITY OF NEWPORT BEACH
EMPLOYER
PYRO SPECTACULARS, IND, SD
PC BOX 2329
RIALTO CA 92377
IP14,SDj
inev.1�2e +u PRIMED t 06 -11 -2013
POLICYHOLDER COPY
s0
- f; �Li�S�T�31����T .^T1rTiisl�i7_�Zb� T 1
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 06-11 -2013
TERRA VISTA MANAGEMENT ED
6310 SAN VICENTE BLVD STE NO
LOS ANGELES CA 90048 -5446
GROUP.
POLICY NUMBER: 08033749 -2012
CERTIFICATE IR 939
CERTIFICATE EXPIRES: 10 -14-2013
10-14- 2012/10 -14 -201$
This ss to certify that we have Issued a valid Workers' Compensation insurance policy In a form approved by the
California Insurance Commissioner to the employer ranted below for the policy period indicated
This pobcy is not subject to cwcallaM(m by the Fund except upon 30 days advance written notice to the employer.
We will also give you 30 days advance notice should this policy be cancelled prior to Its normal expiration.
This certificate of insurance is not an Insurance policy and does not amend, extend or alter the coverage afforded
b)E the policy listed herein. Notwithstanding arty requirement, term or conditions of any contract or other document
with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy.
Authorised RapresantaUve President and CEO
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE,
ENDORSEMENT X2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-14 -2002 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
.®,.4 -.. ENDORSEMENT X2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2015 -06 -11 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME:
TERRA VISTA MANAGEMENT
EMPLOYER
PYRO SPECTACULARS, INC. s0
PC BOX 2429
RIALTO CA 92377
(P14,SDI
tp,tv,t_ypig; PRIMED : 06-11 -2013
Acorxo CERTIFICATE OF LIABILITY INSURANCE 6/112201!20 1011 " ""
�...., -- 13
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
IMPORTANT: Ifthe certificate holder is an ADDITIONAL INSURED, the poiicy(les) must be endorsed. if SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONIACI
Britton Gallagher nN
One Cleveland Center, Floor 30 Enl �� Nor2i6' —'
1375 East 9th Street
Cleveland OH 44114 ........_.._...__.._ INSNRERISIAFFORDINGCOVERAGE NAICx
INSURED INSURERS Maxtim Indemnity Company 26743_
Pyro Spectaculars Inc. INSURER c.
San Diego Fireworks INSURER 0:
P. O. Box 2328 .. ....
Rialto CA 92377 INSURER E,:— .
INSURER F: I
COVERAGES CERTIFICATE NUMBER: 2044342015 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE,' LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS_
.. ..____- .. .. —.. ..
.'... HNSRC Pmmo,
TYPE #FNSURANCE....
VWQ.+._.
POLICYNUMBER oDmi Y LIMITS
GENERAL LIABILITY
FACH OCCURRENCE $
Z AMAGEYORENTeO
D
t OMMERCIALOENERPL.UABIUTY (
1 IFj{EMjSES {EaprcylCep {e) &_ _ -- ..._..
i CLAiM5 MADE t OCCUR
r MED EXP {Any_onerson} _$
_
+PERSONAL &ADVINJURY $
GENERALAGGREOATE 18
IPRGDUCTS
OENL AGGREGATE LIMIT APPLIES PER
.._... _, _ COMPIOPAGG $
... __ o.....
- POLICY 1 PRO , LOC
..... .._ . _...._ ._..
AUTOMOBILE LIABittTY
�CA53460006 1/13`2013 I t ttl3frdlT4 1 1 Qp0 OQ.__
i• ANY AUTO
I DOWLY INJURY Per erwn I $
( P
SCHEDULED
� � I EODILY INJURY
AUTOS
AUTOS _ .,
� (Per accmenf)� $
i
,r NONOWNED
^
1 1,ROPEftYYDAMAGE ($
HIRED AUTOS ;AUTOS
i (Paf acrltlgcll ...........
8 UMBROAALIAB e: I OCCUR
EXC6017995 713+2013 111 3 730 1 4 I EACH OCCURRENCE $90007000
.. .__ ........ ___.,...
N EXCS
ESLIAB CLAIMS, MADE
J.
I i E G 000000
I i ADORATE $9
r —
t LED RETENTION$
... ... _ ......... ...
S
WORNERSCOMPENSARON
i WCSTATU OTH-
AND EMPLOYERS LIABILITY Y,N
ANY PROPRIETOPWARTNEREXECUSVE (- -';iN
(Et EACH ACCIDENT $
OFFICERlMSaf E+CLUDED7 r A
(Mai datmy illNHi
IE6 DISEASE -EA EMPLOYEE$
DESCRIPTION OF OPERATIONS Tdow
EL DISEASE -PODGY LIMIT $
,
I
I 1 I
DESCRIPTION OF OPERATIONS i LOCATIONS rvWHICL.ES (Afladr AC ORD ie1, AdYdionai Raman¢ Shcarule, H 11416 %xe is fe4uiwl)
City of Newport Beach
3300 Newport Boulevard
Newport Beach CA 92658
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ACORD 25 (2010N5) The ACORD name and logo are registered marks of ACORD
AC"ROF CERTIFICATE OF LIABILITY INSURANCE
6f1112013
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TI-E CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(! es) must be endorsed. It SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
PPGOUCER
Britton Gallagher
One Cleveland Center, Floor 30
PHONE FAX
Exa-216-658-71OU
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUGIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
1375 East Sin Street
_ �.
Cleveland OH 44114
_._..._.., .. „ - „_ INSURERtSj AF €Di�ING COVERAGE NAiC
..... .......
_INSURER - ----- MAI--
INSURED
INSURER B:Maxum Indemnity Company 26743
Pyro Spectaculars Inc.
INSURER C:
San Diego Fireworks
INSURER D
P. O. Box 2329
GENERALAGOREGATE I$
Rialto CA 92377
INSURER E
PQ PRO- LOC
UC� ECT
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1227602815 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUGIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONSAND CONDITIONS OF SUCH POLICIES. OMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS,
-U jADOL P 0 LCY E F PO L C Y E K P NS TYPEOF INSURANCE NSR
POLICY (MMODYYYY1 (MM: LIMITS
GENERAL LIABILITY
EArH OCCURRENCE $
- b I AM BE R N
),
COMMEFOALGENERALLIARILDY
CLAIMS MADE (OCCUR
MEP -P< nv 1) pwsm)
DVINJURY
GENERALAGOREGATE I$
GENT AGGREGATE OAT APPLIES PER
PRODUCTS-COMPtOPAQO
PQ PRO- LOC
UC� ECT
............ .
I AUTTMOBILIELIABILITY
111112011 11113111114 S�INOLE UMIT
CA5346OQ06 61
ANY AUTO
1
ALLOWNED SCHEDULED
HODILY INJURY IFer acownt) I s
AUTOS AUTOS
Ix NON-OWNED
(PROPERTY DAN A Is
HIREDAUTOS AUTOS
Is
0MMRELLA LIAR 1 OCCUR
FXC6017995 I/M2013 1/1312014 EACH OCCURRENCE $4,000,000
.. 1 1 1-1-1--l-,
X EXCESSLUM CLAIMS�MADE
F-A-0-GRE"GATE 1$ 4 .00 0. 000
DEC RETENTIONIF
Is
',IAURUERSCOMPIUNSATION
I • Y�C ITATU,
j
AND IDARLOYERsLIAIALITY Y,N
NY PROPRIETOPWARTNERENEOUTIVE
ANY
1 E.L. EACH ACCIDENT
E i1A
OFF OER�M ME 0
DISEASE- FA - - - - --------
1 E L EMPLOYEd IF
GES RIPTION OF OPERATIONS
i EL DISEASE -POUCf LIMIT I $
TE-SrBIPTIONOF OPERATIONS LOCATlOt4S!VEHICLES(A"adiACORDIGI,Afiddio.,4Rwmik Sdiedi,letimrespatalsiecluitpd)
Date of Display: July 4, 2013
Display Location: Newport Dunes, West side of lagoon on the beach, Newport Beach, CA
Additional Insureds:Tetra Vista Management, Inc., and Newport Dunes Waterfront Resort, and Newport Dunes Resod and Marina, and
Dunes Resort, LLC., and Newport Dunes Marina, and County of Orange, and The Irvine Company, and Waterfront Properties, L.P., and G &
K Management, Inc.
Terra Vista Management
6310 San Vicente Boulevard, Suite 560
Los Angeles CA 90048
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED REPRESENTATIVE
"JAW-
16 1 988 -2010 ACORD CORPORATION Allriaht.
ACORD 26 (2010M) The ACORD name and logo are registered marks of ACORD
I
t
v
Pyro Spectaculars, Inc.
P.O. Box 2329
Rialto, CA 92377
Tel: 909-355-8120:::: Fax: 909- 355 -9813
City of Newport Beach
Program B - Ver. N 1
July 4, 2010
Pagel of4
PRODUCTION AGREEMENT
)/�
(Special)
This agreement ( "Agreement") is made this ja-day of , -jGfQi , 2010 by and between Pyrn Spectaculars, Inc., a California
corporation, hereinafter refined to as ( "PYRO "), and City of Newport Beach, hereinafter referred to as ( "CLIENT'). PYRO and CLIENT are sometimes referred
to as "Party" or collectively as "Parties" herein.
1. Etweemenl - CLIENT hereby engages PYRO to provide to CLIENT one fireworks production ("Production "), and PYRO accepts such engagement
upon all of the promises, terns and conditions hereinafter set forth. The Production shall be substantially as outlined in Program "B", attached hereto and
incorporated herein by this reference
1.1 PYRO Dudes - PYRO shall provide all pyrotechnic equipment, trained pyrotechnicians, shipping, pyrotechnic products, application for
specific pyrotechnic permits (the cost of which, including standby fees, shall be paid by CLIENT) relating to the Production, insurance coveting the
Production and the other things on its pan to be performed as more specifically set forth below in this Agreement and in the Scope of Work ( "Scope of
Work "), attached hereto, incorporated herein by this reference, and made a part of this Agreement as though set forth fully herein.
1.2 CLIENT Dudes - CLIENT shall provide to PYRO a suitable site ( "Site') for the Production, security for the Site as set forth in Paragraph
6 hereof, access to the Site, any permission necessary to utilize the Site for the Production, and the other things on its pan to be performed as more
specifically set forth below in this Agreement and in the Scope of Work. All Site arrangements are subject to PYRO's reasonable approval as to
pyrotechnic safety, suitability, and security. All other conditions of the Site shall be the responsibility of CLIENT, including, but not limited lo, access,
use, control, parking and general safety with respect to the public, CLIENT personnel and other contractors.
2. Three and Place -The Production shall take place an July 4.2010, m approximately 9:00 mm • at Newoort Dimes: 1131 Back Bay Drive . Newoort
Beach, CA. Site.
3. Fees. Interest, and Exaenses-
3.1 Fee - CLIENT agrees to pay PYRO a fee of $25.000.00 USD (TWENTY FIVE THOUSAND DOLLARS) ( "Fee') for the Production.
CLIENT shall pay to PYRO $12.500.06 LSD (TWELVE THOUSAND FIVE HUNDRED DOLLARS) of the Fee plus estimated permit and standby fees,
specified production costs, and other regulatory costs approximated at $ 0000 for a total of $12,500.00, as a deposit ( "Deposit ") upon the execution of this
Agreement by both panics but no later than Juno It. 2010., The balance of the Fee shall be paid no later than July 5.2010. CLIENT authorizes PYRO to receive
and verify credit and financial information concerning CLIENT from any agency, person or entity including but not limited to credit reporting agencies. The
"PRICE FIRM" date, the date by which the executed Agreement must be delivered to Pyro, is set forth in paragraph 20.
3.2 Interest - In the event that the Fee is not paid in a timely manner, CLIENT will be responsible for the payment of 1.5% interest per moth
or 18% annually on the unpaid balance. If litigation arises out of this Agreement, the prevailing party shall be entitled to reasonable costs incurred in connection
with the litigation, including, but not limited to attorneys' fees.
3.3 Expenses - PYRO shall pay all normal expenses directly related to the Production including freight, insurance as outlined, pyrotechnic
products, pyrotechnic equipment, experienced pyrotechnic personnel to set up and discharge the pyrotechnics and those additional items as outlined as PYRO's
responsibility in the Scope of Work. CLIENT shall pay all costs related to the Production not supplied by PYRO including, but not limited to, those items
outlined as CLIENT's responsibility in this Agreement and Scope of Work.
4. Proorktartr Riehu - PYRO represents and warrants that it owns all copyrights, including performance rights, to this Production, except that PYRO
does not own CLIENT -owned material or third- pany-awned material that has been included in the Production, and as to such CLIENT-owned and third-party-
owned material, CLIENT assumes full responsibility therefore. CLIENT agrees that PYRO shall retain ownership of, and all copyrights and other rights to, the
Production, except that PYRO shall not acquire or retain any ownership or other rights in or to CLIENT-owned material and third -patty -owned material and shall
not be responsible in any way for such material. If applicable, CLIENT consents to the use of CLIENT -owned material and represents that it has or will obtain
any permission from appropriate third parties sufficient to authorize public exhibition of any such material in connection with this Production. PYRO reserves the
ownership rights in its trade names that amused in or are a product of the Production. Any reproduction by sound, video or other duplication or recording process
without the express written permission of PYRO is prohibited.
5. Safetv - PYRO and CLIENT shall each comply with applicable federal, state and local laws and regulations and employ safety programs and measures
consistent with recognized applicable industry standards and practices. At all times before and during the Production, it shall be within PYRO's sole discretion to
determine whether or not the Production may be safely discharged or continued. It shall not constitute a breach of this Agreanent by PYRO for fireworks to fail
' or malfunction, or for PYRO to determine that the Production cannot be discharged or continued as a result of any conditions cr circumstances affecting safety
beyond the reasonable control of PYRO.
6. Security - CLIENT shall provide adequate security personnel, barricades, and Police Department services as may be necessary to preclude individuals
other than those authorized by PYRO from entering an area to be designated by PYRO as the area for the set -up and discharge of the Production, including a
fallout area satisfactory to PYRO where the pyrotechnics may safely rise and any debris may safely £a1L PYRO shall have no responsibility for monitoring or
controlling CLIENT's other contractors, providers or volunteers; the public; areas to which the public or contractors have access; or any other public or contractor
facilities associmed with the Production.
7. Cleanup - PYRO shall be responsible for the removal of all equipment provided by PYRO and clean up of any live pyrotechnic debris made necessary
by PYRO. CLIENT shall be responsible for any other clean up which may be required of the Production or set -up, discharge and fallout areas including any
enviromarm al clean -up.
PS V 1 -2c
Special Ver. H 1
Pyro Spectaculars, Inc.
P.O. Box 2329
Rialto, CA 92377
Tel: 909-355-8120:::: Fax: 909- 355 -9813
City of Newport Beach
Program B — Ver. # 1
July 4, 2010
Page 2 of 4
8. Permits - PYRO agrees to apply for permits required for the discharge of pyrotechnics from the Newport Beach Fire Department (or atber authority
havingjurisdiclion), FAA, USCG, and the State of California, as required. CLIENT shall be responsible for any fees associated with these permits including
standby fees. CLIENT shall be responsible for obtaining any other necessary permits, paying associated fees, and making other appropriate arrangements for
Police Departments, other Fire Departments, road closures, event/activity or land use Permits or any permission or permit required by any Local, Regional, State
or Fedeml Goverment.
9. Insurance - PYRO shall at all times during the performance of services herein ensure that the following insurance is maintained in connection with
PYRO's performance of this Agreement (1) commercial general liability insurance, including products, completed operations, and contractual liability under this
Agremi (2) automobile liability insurance, (3) workers compensation insurance and employer liability insurance. Such insurance is to protect CLIENT from
claims for bodily injury, including death, personal injury, and from claims of property damage, which may arise from PYRO's performance of this Agreement,
only. The types and amounts of coverage shall be as set forth in the Scrape of Work. Such insurance shall not include claims which arise from CLIENT's
negligence or willful conduct or from failure of CLIENT to perform its obligations under this Agreement, coverage for which shall be provided by CLIENT.
The coverage of these policies shall be subject to reasonable inspection by CLIENT. Certificates of Insurance evidencing the required general liability coverage
shall be famished to CLIENT prior to the rendering of services hereunder and shall include the following: (1) that it may not be canceled or modified without the
insurance carrier providing at least thirty (30) days prior written notice to CLIENT; and (2) that the following are named as additionally insured: CLIENT;
Sponsors, Landowners, Barge Owners, if any; and Permitting Authorities, with respect to the operations of PYRO at the Production. Pyrotechnic subcontractors
or providers, if any, not covered under policies of insurance required hereby, shall secure, maintain and provide their own insurance coverage with respect to their
respective operations and services. Evidence of other insurance shall be provided upon CLIENT's written request to PYRO.
10. Indemnification - PYRO represents and warrants that it is capable of furnishing the necessary experience, personnel, equipment, materials, providers,
and expertise to produce the Production in a safe and professional manner. Notwithstanding anything in this Agreement to the cenuary, PYRO shall indemnify,
hold harmtms, and defend CLIENT and the additional insureds from and against any and all claims, actions, damages, liabilities and expenses, including but not
limited lo, attorney and other professional fees and court costs, in connection with the loss of life, personal injury, and/or damage to property, arising from or out
of the Production and the presentation thereof to the extent such are occasioned by any act or omission of PYRO, their officers, agents, contractors, providers, or
cmployeea CLIENT shall indemnify, hold harmless, and defend PYRO from and against any and all claims, actions, damages, liability and expenses, including
but not limited to, anomey and other professional fees and court costs in connection with the loss of life, personal injury, and/or damage to property, arising from
or out of the Production and the presentation thereof to the extent such are occasioned by any act or omission of CLIENT, its officers, agents, contractors,
providers, or employees. In no event shall either party be liable for the consequential damages of the other party.
11. Limitation of Damages for Ordinary Breach - Except in the case of bodily injury and property damage its provided in the insurance and
indemnification provisions of Paragraphs 9 and 10, above, in the event CLIENT claims that PYRO has breached this Agreement or was otherwise negligent in
performing the Production provided for herein, CLIENT shall not be entitled to claim or =ova monetary damages from PYRO beyond the amount CLIENT has
paid to PYRO under this Agreanent, and shall not be entitled to claim or recover any consequential damages from PYRO including, without limiration, damages
for loss of income, business or profits.
12. Force Mule ure - CLIENT agrees to assume the risks of weather, strike, civil unrest, terrorism, military action, governmental action, and any other
causes beyond the control of PYRO which may prevent the Production from being safely discharged on the scheduled date, which may cause the cancellation of
any event for which CLIENT has purchased the Production, or which may affect or damage such portion of the exhibits as must be placed and exposed a
necessary time before the Production. If, for any such reason. PYRO is not reasonably able to safely discharge the Production on the scheduled date, or at the
scheduled time, or should any event for which CLIENT has purchased the Production be canceled as a result of such causes, CLIENT may (i) reschedule the
Production and pay PYRO such sums as, provided in Paragraph 13, or (ii) cancel the Production and pay PYRO such sums as provided in Paragraph 14, based
upon when the Production is canceled.
13. Rescheduling Of Even[ - If CLIENT elects to reschedule the Production, PYRO shall be paid the original Fee plus all additional expenses made
necessary by rescheduling plus a 15% service fee on such additional expenses. Said expenses will be invoiced separately and payment will be due in full within 5
days of receipt. CLIENT and PYRO shall agree upon the rescheduled date taking into consideration availability of permits, materials, equipment, transportation
and labor. The Production shall be rescheduled for a date not more than 90 Days subsequent to the date first set for the Production. The Pmduction shall not be
rescheduled to a dale, or for an event, that historically has involved a fireworks production. The Production shall not be rescheduled between June 15th and July
15th unless the original date was July 4th of that same year, or between December 151h and January 15th unless the original date was December 31 at of the earlier
year unless PYRO agrees that such rescheduling will not adversely affect normal business operations during those periods.
14. Sir tut To Cancel - CLIENT shall have the option to unilaterally cancel the Production prior to the scheduled date. If CLIENT exercises this option,
CLIENT agrees to pay to PYRO, as liquidated damages, the following percentages of the Fee as set forth in Paragraph 3.1. 1) 50% if cancellation occurs 30 to 90
days prior to the scheduled date, 2) 75% if cancellation occurs 15 to 29 days prior to the scheduled date, 3) 100° /o thereafter. In the event CLIENT cancels the
Production, it will be impractical or extremely difficult to fix actual amount of PYRO's damages. The foregoing represents a reasonable estimate of the damages
PYRO will suffer if CLIENT cancels the Production.
15. No Joint Venture - h is agreed, nothing in this Agreement or in PYRO's performance of the Production shall be construed as forming a partnership or
joint venture between CLIENT and PYRO. PYRO shall be and is an independent contractor with CLIENT and not an employee of CLIENT. The Parties hereto
shall be severally responsible for their own separate debts and obligations and neither Parry shall be held responsible for any agreements or obligations not
expressly provided for herein.
16. Applicable Law -This Agreement and the rights and obligations of the Parties hereunder shall be consumed in accordance with the laws of California.
In the event that the scope of the Production is reduced by authorities havingjurMiction or by either Party for safety concerns, the full dollar amounts outlined in
this Agreement are enforceable.
17. Notices - Any Notice to the Parties permitted or required under this Agreement may be given by mailing such Notice in the United States Mail,
postage prepaid, first class, addressed m follows: PYRO - Pyro Spectaculars, Inc., P.O. Box 2329, Rialto, Calitbmia, 92377, or for overnight delivery to 3196 N.
Locust Avenue, Rialto, California 92377. CLIENT -City ofNewteort Beach; 3300 Newport fl d Ne eon Beach CA, 92658
PS V 1.2c
Special Ver. 4 1
Pyro Spectaculars, Inc.
P.O. Box 2329
Rialto, CA 92377
Tel: 909-355-8120:::: Fax: 909- 355 -9813
City of Newport Beach
Program B — Ver. # I
July 4, 2010
Page 3 of
18. Modification of Terms —All terms of the Agreement are in writing and may only be modified by written agreement of both Parties hereto. Both
Parties acknowledge they have received a copy of said written Agreement and agree to be bound by said terms of written Agreement only.
19. SeverabiRty — If there i5 more than one CLIENT, they shall bejointly and severally responsible to perform CLIENT's obligations under this
Agreement. This Agreement shall become effective after it is executed and accepted by CLIENT and after it is executed and accepted by PYRO at PYRO's
offices in Rialto, California. This Agreement maybe executed in several counterparts, including faxed and mailed copies, each one of which shall be deemed an
original against the Party executing same. This Agreement shall he binding upon the Parties hereto and upon their heirs, successors, executors, administrators and
assigns.
20. Price Firm— If any changes or alterations are made by CLIENT to this Agreement or if this Agreement is not executed by CLIENT and delivered to
PYRO on or before the PRICE FIRM date shown below, than the price, date, and scope of the Production are subject to review and acceptance by PYRO for a
period of 15 days following delivery to PYRO of the executed Agreement. In the event it is not accepted by PYRO, PYRO shall give CLIENT written notice, and
this Agreement shall he void.
PRICE FIRM through June 11, 2010
EXECUTED AGREEMENT MUST BE DELIVERED TO PYRO BY THIS DATE.
See PRICE FIRM conditions, paragraph 20, above.
EXECUTED as of the date first written above:
PYRO SPECTACULARS, INC.
g:
James R. Souza, President
SHOW PRODUCER: Jeff Martin
V I -2c
Special Ver, # I
City of Newport Beach
By:
Its: t Manager
Dave Kiff
Print Name
7--ty-
PS O D AS TO fr0RM:
Pyro Spectaculars, Inc. City of Newport Beach
P.O. Box 2329 Program B — Yer. # 1
Rialto, CA 92377 July 4, 2010
Tel: 909-355-8120:::: Fax: 909 - 355 -9813 Page 4 of 4
SCOPE OF WORK
PYRO SPECTACULARS, INC. ( "PYRO ")
and
City of Newport Beach ( "CLIENT ")
Pyro shall provide the following goods and services to CLIENT:
• One Pyro Spectaculars, Inc., Production on July 4. 2010 at approximately 9:00 P.m. at Newport Dunes: 1131 Back Bay
Drive Newport Beach. CA.
• All pyrotechnic equipment, trained pyrotechnicians, shipping, and pyrotechnic product.
• Application for specific pyrotechnic permits relating to the Production.
• Musical soundtrack for the Production supplied in agreed upon format. Insurance covering the Production as set forth in the
Agreement with the following limits:
Insurance Requirements Limits
Commercial General Liability $1,000,000.00 Combined Single Limit- Each Occurrence
(Bodily Injury & Property Damage)
Business Auto Liability- $5,000,000.00 Combined Single Limit- Each Occurrence
Owned. Non -Owned and Hired Autos (Bodily Injury & Property Damage)
Workers' Compensation Statutory
Employer Liability $1,000,000 Per Occurrence
CLIENT shall provide to PYRO the following goods and services:
• All on -site labor costs, if any, not provided or performed by PYRO personnel including, but not limited to, local union
requirements, all Site security, Police and Fire Dept. standby personnel, stagehands, electricians, audio and fire control monitors,
carpenters, plumbers, clean -up crew. All these additional personnel and services shall be fully insured and the sole responsibility
of CLI ENT.
• Coordination and any applicable non - pyrotechnic permitting with the local, state or federal government that may hold
authority within the Production.
• Costs of all permits required for the presentation of the Production and the event as a whole.
• Provision of a Safety Zone in accordance with applicable standards and all requirements of the authorities having jurisdiction
throughout the entire time that the pyrotechnics are at the Site or the load site (if different) on the date of the Production and all
set -up and load - out dates, including water security to keep unauthorized people, boats, etc. from entering the Safety Zone.
• A professional grade Audio System including all necessary equipment, installation of such equipment and trained audio
engineers for operation based on audio and communications requirements provided by PYRO.
• General Services including, but not limited to, Site and audience security, fencing, adequate work light, dumpster
accessibility, a secure office for PYRO personnel within the venue, secure parking for PYRO vehicles, access to washrooms,
tents, equipment storage, hazmat storage, electrical power, fire suppression equipment, access to worksites, necessary
credentialing, etc., will be required as necessary.
PS V 1 -2c
Special Vu. # I
=7
Grand Total 1,578
Approximate duration of display will be 15 minutes.
Description
Quantity
♦
3" Sky Concert Opening Salutes
25
Total of Opening
25
Main Body - Aerial Shells
Description
Quantity
♦
3" Sky Concert Selections
60
♦
4" Sky Concert Selections
75
♦
5' Sky Concert Selections
90
Total of Main Body - Aerial Shells
225
Pyrotechnic Devices
Description
Quantity
♦
Sousa Gold Line Custom Multishot Device
200 Shots
♦
Sousa Platinum Line Custom Multishot Device
300 Shots
♦
Sousa Diamond Line Custom Multishot Device
600 Shots
Total of Pyrotechnic Devices
1,100
Grand
Finale
Description
Quantity
♦
2.5" Sky Concert Bombardment Shells
72
♦
3" Sky Concert Finale Shells
120
♦
4" Sky Concert Finale Shells
30
♦
5" Sky Concert Finale Shells
6
Total of Grand Finale
228
Grand Total 1,578
Approximate duration of display will be 15 minutes.
DRAYTON INSURANCE BROKERS,
2500 CENTER POINT ROAD, SUITE 301 .an.,� ... POS°f OPFICR BOX 94067
BIRMINGHAM, ALABAMA 35215 BIRMINGHAM, ALABAMA 35220
TELEPHONE: (205) 854.5806 FAX: (205) 854 -5899
CERTIFICATE OF INSURANCE NO. 020150
We certify that msumnce es outlined below is sflh dad the Numral Inaural undor policy CA06(Xx)2771 -24 issued by Admiral Insmanw Company.
]AWD INSURIill Pyto Spectaculars, Inc. Pyro Specaculars by Sower
Pyle Eacats, Inc Pyro SpnArcular Industries, the
Pyre Spectaculars productions, Inc, North American Pueworku Co., lac. (NAFCO)
P.O. RON 2329 San Diego F¢ew,rka
Rialto- Catifomio 92377
PERIOD January 13, 2010 to Jmmary 12,2011: Roth days indu we.
COVERAGE
LRVITS OF
LIABU,ITY
Comnisicial General Liability. Cowuing against the legal liability of the Named Insured for Bodily injury
and Property Damage causal by, or arising from, the preparation for, the firing of, or the clearance following
fireworks displays) stated Iwlow.
A) Each Occunrcnce
B) General Aggregate
C) Products & Completed Operations Aggregate
$1.000,000
$2,000,000
$2,000,000
Tim addition of morn than one insured does not serve to inumeso the ('units of liability. Aggregate lints shown
may have bewt reduced by paid claims.
It is Mitred Must, in aawudtmce with, and subject 1% the terms rd'the above policy, the following SPONSORS AND PROPERTY OWNERS
AND LICENSING AUTI3GRITIES ate included as Additional lnsur,d(s), but only in respect ofthe legal liability of reach Additional Insured(s)
for Eedily Injury and Property Damage caased by the operations of the Named Insured in connection with the firing of the fireworks displey(s)
stated below. The insurance afforded any Additional Insured does not inolude comings for any injury or damage arising &an the failure of such
Additional humid to fitifill its obligations specified in its wmrraet with the Named Insured.
NAME & ADDRESS OF INSURED SPONSORS
PROPERTY OWNERS, f.ICRNSORS
City of Newport Beach
3300 Newport Boulevard
Newport Beach, CA 92658.5915
ADDITIONAL INSURWXS): City of Newport Beach, Newport Dunes Waterfront Resort, Terra Vista
Management, Newport Beach Fire Department, Waterfront Resort Properties, LP, G &K
Management Co., Inc, Newport Dunes Resort and Marina, Dunes Resort LLC., Newport Dunes
Marina, LLC, County of Orange and their officers, agents and employees when acting in their official
capacity as such.
DISPLAY LOCATION DISPLAY DATE(S)
Newport Dames, West side of Lagoon on the Beach Jaly 4, 2010
Newport Beach, CA
This insurance applies automatically if the described display is fired on any altemaliw date heoartse of cancellation on this date shown due to
wenther orothw cause; however, IN NO EVENT WILL COVERAGE APPLY TO BODILY INJURY OR PROPERTY DAMAGE
SUSTAINED AFTER Jamrary 12, 2011.
This certificate is not an insurance policy and does not in any way amend, extend or alter the coverage afforded by the policy listed idemse. Far
partioulars coucaning the temp, exclusions and conditions of such policy each Additional Insured is referred to the policy documents in the
possession ofthe Named Insured. Should the above described policy be cancelled befere the expiration date thernf, the issuing company will mail 30
days' prior written notice to the above named Additional Insured.
DRAYTON INSURANCE EROKERS, INC.
Mgx 7.2010
DATE OF ISSUE�PRESID
CALIFORNIA LICENSE O.OA18664
Policy Number: CA000002771 -24
Number: 104 Effective Date: May 7, 2010
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Name of Person or Organization.
City of Newport Beach Dunes Resort, LLC
Newport Dunes Waterfront Resort Newport Dunes Marina, LLC
Terra Vista Management County of Orange
Newport Dunes Resort and Marina The Irvine Company
Waterfront Resort Properties, L.P. G & K Management Co., Inc.
(If no entry appears above, information required to complete this endorsement will be shown in the
Declarations as applicable to this endorsement.)
WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization
shown in the Schedule as an insured but only with respect to liability caused by your operations or
premises owned by or rented to you.
The insurance afforded any Additional Insured does not include coverage for any injury or damage
arising from the failure of such Additional Insured to fulfill its obligations specified in its contract with
the Named Insured
C
POLICYHOLDER COPY 50
P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 10 -14 -2009
CITY OF NEWPORT BEACH So
3300 NEWPORT BLVD
NEWPORT BEACH CA 82663 -3816
GROUP.
POLICY NUMBER: 0803749 -2009
CERTIFICATE ID: 563
CERTIFICATE EXPIRES: 10 -14 -2010
10 -14- 2008/10-14-2010
This is to certify that we have issued a valid Workers Compensation insurance policy In a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 3O days advance written notice to the employer.
We will also give you 90 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of Insurance Is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document
with respect to which this certificate of Insurance may be issued or to which it may pertain the insurance
afforded by the policy described herein is subject to all the terms, exclusions, and Conditions, of such policy.
d:RIZED REPRESENTATI PRESIDENT
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 41,000,000 PER OCCURRENCE.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-14 -2002 IS
ATTACHED TD AND FORMS A PART OF THIS POLICY.
EMPLOYER
PYRO SPECTACULARS, INC. SD
PO BOX 2329
RIALTO CA 92377
PRINTED : 09 -17 -2008
IRI:v.2 -051
M0410
ACORD. CERTIFICATE OF LIABILITY INSURANCE
DA EIMM DDMYU
s .I /2o10
PRODUCER Phone: 440 249-4115 Fax: 440 - 544712.14
Britton:- Gallagher and Associates, Inc.
6240 SOM Center Rd.
Cleveland OH 44139
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.
POIICYNUMBEA
POLN:Y
RATER/
INSURERS AFFORDING COVERAGE
NAICS _
INSURED
Pyro Spectaculars Inc.
San Diego Fireworks
P. O. Box 2329
INSURERA.B.CK
' NSURER a:iec Rally Ins Co
&rC HgpQg_jajL
wsuase c'
PSURER D:
S
Rialto CA 92377
INSURER E:
MEDUP IAno
f
COVERAGES
THE POLTCIRS OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE. FOR THE POLICY PERIOD INDICATED.
CTWITHSTANDING ANY RBQUIRENENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR NAY. PERTAIN, THE INSURANCE AFMY)NDEU MY 'IHE PUL[Ct ES DESCRIBED HEREIN 19 SUaJECT TO ALL THE
EMS, EXCLUSIONS AND CONDITLONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POIICYNUMBEA
POLN:Y
RATER/
LIMITS
UEN ERAL LABII_M
CONMERCLL GEERPLLABNTY
GLAIMSMADE ❑OCCUR
UCHOCCVRPfq 9 Cn E
S
c s
S
MEDUP IAno
f
PERSONALSADVINAIRY
OENERALAGGREGATE
i
'
GENWLAGGREGATE UMITAIMLIES PER:
PODCY LOG
PRODUCTS- COWMPAGG
S
A
AYTOMODILELIABIUTY
ANY AUTO
ALLOMMEDAUTOS
SCHEDJLE'OAUTOS
HIREDAUTOS
NO"WNEDAUTOS
CA53460083
1/13/2010
1/13/2011
COM&NEDSINGLEUIMIT
ffAsmld e)
$1,000,000
BODILY INJURY
IPerp.rt )
f
SODILYINJURY
IP«e,«Wanl)
i
PROPERTYMWM
II'aa4ade�
f
OARAGELIMUTY
ANYAUTO
AUTOONLY- EAACCR)ENT
$
ODRERTHAN EAACC
AUTO ONLY: ADD
S
f
B
t BELlA 11ABfJTM
CLVMS MADE
BLE ON f
UFP0024S10
1 {13/2010
1/13/2011
EacHOCCURRENCE
f QOQ.Ot
AGGREGATE
f 4 0
S
10110ORKERSCOMP19"TION AND
EAPLOYERS'LABiIlII'
ANYPROPRIEIO fUPART1�RrE.YEGITIVE
OFFRRIMEMSER E%CLUDED'I
n EesWbpunUer
P N I
E.L UCIIACCIOENT
i
E.L. DISEASE - EA EMPLOYEE
S
E.L. DISEASE AOUCYLIMIT
S
Ol11ER
DESCRIPTION OF OPERATIONS I LOCATHMIYEIACLE61PIICLUSIONS ADDED BY ENDORSIENTI SPECIALPROVISIONS
of irate Holder is Named as an additional insured.
City of Newport Beach
3300 Newport Boulevard
Newport Beach CA 92658 -8915
LU ANY OP THE ABOVE DESCRIBED POIACUS BE CANCELLED
RE THE EXPIRATION DATE :HEREOF, THE ISSUING INSURER
ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE
IFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO
:. IMPOSE NO OBLIGATION OR LIABILITY OF ANY RIND UPON
INSURER, ITS AGENTS OR REPRESENTATIVES.
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 after the coverage afforded by the policies listed thereon.
CERTHOLDER COPY
so
P.O. BOX 420807, SAN FRANCISCO,CA 94142 -0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 05-07 -2010
TERRA VISTA MAMAGEMENT SD
6310 SAM VICENTE BLVD STE $00
LOS ANGELES CA 80048 -5445
GROUP:
POLICY NUMBER: 0803748 -2008
CERTIFICATE 14 680
CERTIFICATE EXPIRES: 10 -14 -2010
10 -14- 2008/10-14 -2010
This is to certify that we have issued a valid Workers Compensation Insurance policy in a form approved by the
California Insurance Commissicner to the employer named below for the policy period indicated
This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer
We will also give you 30 days advance notice should this policy be cancelled prior to Its normal expiration.
This certificate of insurance Is not an Insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document
with respect to which this certificate of insurance may be issued or to which it may pertain, the Insurance
afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy.
V •%
iced Representative Interim President and CEO
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT 82065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10 -14 -2002 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
ENDORSEMENT 82570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2010 -05-07 IS
ATTACHED TO AND FORTIS A PART OF THIS POLICY. THIRD PARTY NAME:
TERRA VISTA MANAGEMENT
EMPLOYER
PYRO SPECTACULARS, INC. SO
PO SOX 2328
RIALTO CA 82377
[610,90]
(REV.1 -20101 PRINTED : 05- 07-2010
ACORD CERTIFICATE OF LIABILITY INSURANCE
n
MIOD/YYYY,
S %/2010
Z7 /2
PRODUCER Phone: 44C -248 -4711 Fax: 440- 544 -1234
Britton- Callagher and Associates, Inc.
6240 SOM Center Rd.
Cleveland OH 44139
THIS CERTIFICATE IS ISSUED AS A MATTER OF
ONLY AND CONFERS NO RIGHTS UPON THE
HOLDER THIS CERTIFICATE DOES NOT AMEND,
ALTER THE COVERAGE AFFORDED BY THE POLICIES
INFORMATION
CERTIFICATE
EXTEND OR
BELOW.
Y
7
LNA1T6
INSURERS AFFORDING COVERAGE
1N3i°'� "- `�- llaplpp.Y11Y.@ zn�uran�e
!^'S'a+pe: _.Sppgialtv_Ins Co
NAICS
_.
Pyro SpeCLaculars Inc.
San Diego Fireworks
NSURERC:
_
P. O. Box 2329
IMSURERO
$
Rialto CA 92377
MSURPR CO
$
PERSONALSADVINLURY
• r ; . e
8 POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE TN.P,URED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.
NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFPORDED BY THE POLICIES DESCRIBED HF.RHIN IS SUBJECT TO ALL THE
TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGORROATE I.TMI-I'S SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS.
R
jumx
Awl
POLICYNU18IRt
Y
7
LNA1T6
QENERALLIABAJTY
COMMERCIAL GENERAL LIABILITY
GLAIMSMADE ❑OCCUR
EACHOCCURRENCE
$
6R
ISFS e
MEDEXPIAnym,;W.a
$
$
PERSONALSADVINLURY
$_—
_
OENERK__AO_OREGATE
--- _
$
GE AGGREGATE LIMITAPPLES PER:
POLICY LOC
PRODU S•CDMPMPAGG
$
A
ANY AUTO
ALLONNEDAUTOS
SCXEDULEDAVTOS
HIREOAUTO.4
ND WNEDALITOS
CA53460083
1/13/2010
1/13/2011
COMBINED SINGLE LIMIT
(Ea am: l)
$1,000,000
BODILY INJURY
(Papvmanl
$
BODILY NlJURY
IPeraaManl)
$
PROPERTY DAMAGE
(PaIt,mmm,Q
$
GARAGE LIADRWY
ANYAUTO
AUTO ONLY• EAACCIDENT
$
OTHERTHAN EA ACC
AVTOONLY: AGE
$
$
B
EXCEB&UMBRE.ULLUIBRITY
OCCUR CLAIMS MADE
DEDUCTIBLE
RETENTION $
UFP0024510
1/13/ 2010
1/13/2011
EAU I OLti1IRRENCE
$
AGGREGATE
S4,000•,
_
$
$
$
'I'D"I RS MMPE1 51ITRNIAND
Ci1PLDYPRe'IIABIIITY
ANYP�PIEMB RTARTNERIExECUTNE
OFFICFAMAEMSEREXCLUOED?
Syw iALP OVISIa!
8PECbLLPROVL410NS aw
ATI} TFF YLWIM ER
LL.EACHACCIDENT
$
E1. DISEASE -EA EMPLOYEE
$
E.L. DISEa$E -POLICY LIMIT
$
07MER
OsBUnPTxwaPOPeunsNBrLDDArwNervENR X.�r$zcLLwtGNS ILnDwereiDanacMExrraPa _auwTOYlsroMs
erti£icate Holder is Named aB an additional insured.
Terra Vista Management
6310 San Vicente Boulevard,
Los Angeles CA 90046
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER
Suite 560 WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE
CERTIFICATE HOLDER NAMED TO TILE LEFT, BUT FAI1.4RIE TO DO SO
SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON
THE INSURER, ITS AGENTS OR REPRBSENTATIVRS.
I ..
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(es) 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 endamement(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.