HomeMy WebLinkAboutC-4596 - Independent Contractor Agreement Recreation Instructor0
CITY OF NEWPORT BEACH
Recreation & Senior Services Department
INDEPENDENT CONTRACTOR AGREEMENT
This Agreement is made and entered into as of this 20.of ' +- J 2010 by and between the City of
Newport Beach, California, a Municipal Corporation and Charter City ( "City "), and Genaf Kerr dba
Olympic Academy - Sole Proprietor, (Instructor) to provide the classes or programs in water polo 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
3& 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:
• Classes /Programs - 75%
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.
E. Class Roster. City shall provide class rosters to Instructor online. Instructor will request a
log -in and password from City. The City will not mail, fax or email rosters to instructors.
4. INSTRUCTOR DUTIES
A. Instructors. Instructor hereby certifies that he /she or any instructor, representatives, or
employee who will be teaching the class or assisting in teaching the class is qualified to do
so, and qualified to perform the services described above and in the course outline
submitted to City. City staff must approve in writing all assigned instructors, representatives
and employees prior to any of them performing any services under this Agreement. A
current roster of instructors, representatives, and employees must be provided prior to new
instructors, representatives and employees being approved. All instructors must be able to
provide proof of legal right to work in the United States.
B. Representatives/Employees. Instructor shall provide the City with Name, Address and
Phone Number of all representatives or employees who will be providing any services
pursuant to this Agreement. All representatives or employees must comply with the City's
fingerprint policy (Section 8). Please mark the following that apply:
I will not be using representatives or employees.
I will be using representatives or employees (Please complete Exhibit A).
Instructor must notify the City in writing at least thirty (30) calendar days before the start of
the first class or program with any additions or deletions to Exhibit A. Instructor shall not
subcontract or assign any portion of the rights, obligations or duties required under this
Agreement, without first obtaining prior written approval from City. Subcontracts, if any,
shall contain a provision making them subject to all provisions of this Agreement.
C. Supplies/Equipment. Instructor shall be responsible for providing all supplies, equipment,
personnel, materials, and any additional publicity desired for the class, at Instructor's sole
expense, unless otherwise agreed to in writing by City. Instructor shall also be responsible
for repairing and maintaining all equipment and supplies in good working condition.
D. Anti- Discrimination Laws. Instructor agrees and certifies that, except as permitted by law,
no person shall, on the grounds of race, religious creed, color, national origin, ancestry, age,
physical disability, mental disability, medical condition including the medical condition of
Acquired Immune Deficiency Syndrome (AIDS) or any condition related thereto, marital
status, sex or sexual orientation, be excluded from participation in or be denied the benefits
of the services provided pursuant to this Agreement, and Instructor agrees not to
discriminate on said grounds in the hiring and retention of employees and representatives,
unless authorized under Section 12940 of the California Government Code. Instructor shall,
where applicable, conform to the requirements of the Americans with Disabilities Act in the
performance of this Agreement.
D. Class Size. Instructor shall determine the minimum and maximum number of participants
required for each class in cooperation with City staff. The City can determine the
minimum /maximum number of participants in a class to ensure the quality and, safety of the
class. Instructor or Instructor's authorized representative is required to attend the first class
meeting of all class offerings advertised in the Newport Navigator unless Instructor cancels
the class three (3) business days prior to the start date, with the prior written approval of
City. In the event of such approved cancellation, Instructor shall be responsible for
informing all registered participants. In the event that the minimum number of participants is
not met by the first class meeting, the class will be cancelled and the Instructor shall not be
compensated for attending the first meeting or for any cancelled class. Instructor shall not
be obligated to provide any additional services in regards to the cancelled class. If the
minimum number of participants is met or exceeded, the class will be held as scheduled
(even if any of the initial participants subsequently drop the class), subject to paragraph 14
of this Agreement. If the demand is such that an additional class could be offered, it shall be
taken under consideration and negotiated by City and Instructor. If class(es) are cancelled
for two (2) consecutive quarters due to lack of enrollment, the class will not be scheduled
again until City determines that public demand has increased.
E. Use of Non -City Facilities for Classes. If Instructor desires to conduct the class at his/her
place of business, or some other non City -owned site or facility, Instructor must:
i. Notify City at least twenty -four (24) hours in advance;
ii. Provide sufficient parking for all participants;
iii. Post signs at the site to direct participants to the location of class; and
iv. Allow access to City staff to the location when requested.
F. Absences. Instructor shall obtain permission from City one (1) week prior to any planned
absence from the class. In the event of illness, Instructor is required to notify City and
Participants twelve (12) hours prior to any class cancellation.
City urges Instructor to get a substitute, whenever possible, instead of cancelling classes.
All Instructor employees or representatives must be fingerprinted and clear a background
check before teaching a class as provided in paragraph 8 of this Agreement. Instructor shall
obtain City's prior written approval of any substitute instructor. When cancelling a class,
Instructor shall contact all participants as soon as possible.
G. Contact Information. Instructor is required to notify City in writing of any name, address,
telephone number, email, website or direct deposit payment changes within 48 hours of
such change.
H. Orientation. Instructor or Instructor's authorized representative must attend the Annual
Instructor Orientation 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.
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.
J. Direct Deposit: All Instructors are required to use direct deposit for payments made from the
City pursuant to this Agreement.
K. Email — All instructors are required to have an email address.
L. Instructor /D 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.
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.
11
12.
CONFIDENTIALITY; OWNERSHIP OF DOCUMENTS
All class rosters, participant addresses and contact information, and any other such information or
documents compiled by City and provided to Instructor, shall remain the property of City. Instructor
shall not release such information to others without the prior written authorization by City. Instructor
shall not use such information for any other purpose than those authorized by City. All class
rosters, class participant addresses and contact information, shall be used by the Instructor solely
for administration of classes and performing City business. Instructor will take reasonable steps
consistent with the law to prevent distribution of such information. Instructor's obligations under this
paragraph shall survive the termination of this Agreement.
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.
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.
14.
15.
16.
17
18.
19.
TERMINATION
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.
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.
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.
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.
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.
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.
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:
nee . Beauc p
Assistant City Att n y
CITY OF NEWPORT BEACH,
A Municipal Corporation
& Senior Services
'�(i -n�I-no If
Social Security or Tax ID Number
h+ �2)b- (72 rj j -z+ SL
Cell Ph ne /� 1 Business Phone Home Phone
2Q192,('Ci INM '—aL2 J Cby•CDi" WUX4.)s e) bN p;<`ae-gj d_gt�a�
Em I Address Web Sites
Home Address (if different from above) City State Zip
Before submitting your contract package to the City, the following documents must be completed and or enclosed.
Three copies of the signed contract (a completed original contract will be mailed back for your records after proce-s$ing
1) Exhibit A —Completed List of Contract Instructor Representative, Employee and /or Agent Names Form /V4
2) Exhibit C — Copy of valid City of Newport Beach Business License; and 1✓
3) Exhibit D — insurance Certificate with Additional Insured Endorsement if not using SCMAF insurance Plar✓
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:
nee .Beauc
sistant p
AsCity Att y C nl�pl(6
ATTEST:
By:
Lei ani Brown, City Clerk
CITY OF NEWPORT BEACH,
A Municipal Corporation
By
k.L)ura Detweile irector
ecreation & Senior Services
O 9e
u
eM
INSTRUCTOR —Olympic Academy cy Nor
<1FON
By: j I11I/tl
signate a Genal K rr Date Si. ned
Before submitting your contract package to the City, the following documents must be completed and or enclosed:
Three copies of the signed contract (a completed original contract will be mailed back for your records afterproce-s-$$mg
1) Exhibit A- Completed List of Contract Instructor Representative, Employee and/or Agent Names Form NR
2) Exhibit C - Copy of valid City of Newport Beach Business License; and ✓
3) Exhibit D - Insurance Certificate with Additional Insured Endorsement if not using SCMAF Insurance Plallo�
Cost
Encompass Detail
Acct. Type:
Business Tax
License #:
Bus. ID:
Name:
OLYMPIC ACADEMY
Owner Name:
GENAIKERR
Owner Phone:
Owner Type:
Exp. Date:
3/31/2011
S Addy:
S Addy 2:
Addr3:
Zip:
B Addr1:
B Addr2:
B Addr3:
B Zip:
Phone:
FEIN:
SEIN:
Established:
3/1/2010
SIC:
7032 -SPORTING R RECREATIONAL CAMPS
Owner #:
# of Emps:
usr1:
usr2:
usr3:
usr4:
usr5:
usr6:
usr7:
Emergency Contact
Info
Contact:
GENAI KERR
Phone:
Page 1 of 1
http://apps.citynet.newportbmehca.gov/masterid/ENC_detail.asp?EID=BT30031132 03/15/2010
ACORD CERTIFICATE OF LIABILITY INSURANCE
ODUCER TMIS CFRTIFM`ATF IS ISSI I
Iratum Insurance Agency, LLC
212 Dupont, Suite P
Ane, CA 92612
19-270-0609
Genal Kerr DBA Olympic Academy
INBLI
NAIC N
FHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
%NY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OF
MPERTAIN,, THE INSATC ANCAIM0 AFFOO RDED BY THEcPOLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCF
DnI
R kDVIPoMCYEFFECTME
POLICTXUMBER
M p
POLICTEXPIMTIIXi
UNITS
1
GENERALUABIUTY
06/24/2010
06/24/2010
EACH OCCURRENCE
a 1 000,00
SEa
MED EXP omy one SI
s 10000
% COMMEFFWLGENEPALLIABILRY
OIAIMSMADE OOCCUR
4 6,00
PERSONAL&ADV INJURY
$ 100000
GENERALAGGREGITE
& 1,000,00
GI
AGGREGATE LIMIT APPLIES PER
PRODUCTS-COMPIDPAGG
$ 1,000 W
POLICY PR6 LOC
AUTOMOBILE
LIABILITY
ANYAUTO
COMBINEDSINGLELIMIT
(Eas II
4
BODILY INJURY
perp®aCn)
4
ALLOWNEOAU CS
SCLEDULEDAUTOS
BODILYINJURY
(Pereaident)tlenll
E
HIREDAUTOB
NON-OWNEDAUTOS
PRI I OAISACF
/PeracdIE
E
GARAGE LIABILMY
AUTOONC-EAACCINI NT
$
ANYAUTO
OTHER THAN AACG'T
E
AUTOONLv: qGG
EXCESSIUMBRELLA
LIABILITY
-7
EACHOCCURRENCE
S
AGGREGATE
4
OCCUR CLAIMSM90E
4
g
oEOucTIaLE
4
RETENTION 4
WORKERS COMPENSATIONANDWC
EMPLOYERS-LIABIL"
SiAAiV, OIH-
TORYL _. _R
g
ANY PROPRIETOWPARTNEWEXECUTNE
E.L EACH ACa a -NT
%
OFFICERIMEMBEREXCWDEPI
KTIA.dpcnbaantle,
EL.06EA-AS.T'LOVFY
— -
-
3
SPECIAL PROVISIONS C¢IPx
ELOISEA:F-P_- VJ,.IU
OTHER
Professional Liability
06/24/2010
06/24/2911
Each act: $1,000,000
Aggregate: $1,000,000
SISSETON OF OPERUMONS/LOCATIONS/ VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
ty of Newport Beach, its elected or appointed officers, employees, agents, and volunteers are named as additional insured and is
mary per the General Liability coverage form CG8224 attached to the policy, when required by contractual agreement.
Is certificate replaces a prior certificate issued on 07/01/2010.
=xcept 10 days notice for non-payment of premium.
City of Newport Beach
ATTN: Ted Craig
3300 Newport Blvd
Newport Beach, CA 92663
Manager or Lessor of Premises
SHOULD ANY OF THE ABOVE DESCRIBED POUCHES
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 'OO DAYS WRRTE
NOTICE TO THE CERTIFICATE HOLDER MAMED TO THE LEFT, BUT FAILURE TO DOSO $HAL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, RS AGENTS 0
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.
'^MM nC Inn^4 /00\
Administrative Offices
580 Walnut Street
Cincinnati, Ohio 45202
GREAT IiICAM Tel: 1-513-369-5000 �+
INSURANCE COMPANIES CG 82 24
(Ed. 12 01)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
SOCIAL SERVICE AGENCY GENERAL LIABILITY BROADENING ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
1. The following provision is added to SECTION
II - WHO IS AN INSURED
5. AUTOMATIC ADDITIONAL INSURED(S)
a. Additional Insured - Manager or
Lessor of Premises
(1) This policy is amended to include
as an insured any person or or-
ganization (hereinafter called Ad-
ditional Insured) from whom you
lease or rent property and which
requires you to add such person
or organization as an Additional
Insured on this policy under:
(a) a written contract; or
(b) an oral agreement or con-
tract where a Certificate of
Insurance showing that per-
son or organization as an
Additional Insured has been
issued,-
but
ssued;
but the written or oral contract or
agreement must be an "insured
contract," and,
(i) currently in effect or be-
come effective during the
term of this policy; and
(ii) executed prior to the "bodily
injury," "property damage,"
"personal and advertising in-
jury."
(2) With respect to the insurance af-
forded the Additional Insured
identified in Paragraph A.0) of
this endorsement, the following
additional provisions apply:
(a) This insurance applies only
to liability arising out of the
ownership, maintenance or
use of that portion of the
premises leased to you.
(b) The Limits of Insurance ap-
plicable to the Additional In-
sured are the lesser of those
specified in the written con-
tract or agreement or in the
Declarations for this policy
and subject to all the terms,
conditions, and exclusions
for this policy. The Limits of
Insurance applicable to the
Additional Insured are inclu-
sive of and not in addition to
the Limits of Insurance
shown in the Declarations.
(c) In no event shall the cov-
erages or Limits of Insurance
in this Coverage Form be in-
creased by such contract.
(d) Coverage provided herein is
excess over any other valid
and collectible insurance
available to the Additional In-
sured whether the other in-
surance is primary, excess,
Includes copyrighted material of Insurance Service Office with its permission.
Copyright, Insurance Services Office, Inc., 2001
CG 82 24 (Ed. 12/01) XS (Pacle 1 of 4)
contingent or on any other
basis unless a written con-
tractual arrangement specifi-
cally requires this insurance
to be primary.
(3) This insurance does not apply to:
(a) Any "occurrence" or offense
which takes place after you
cease to be a tenant in that
premises.
(b) Structural alterations, new
construction or demolition
operations performed by or
on behalf of the "Additional
Insured."
b. Additional Insured - Funding
Sources
(1) This policy is amended to include
as an Insured any Funding Source
which requires you in a written
contract to name the Funding
Source (hereinafter called Addi-
tional Insured) as an Insured but
only with respect to liability aris-
ing out of your premises, "your
work" for such Additional Insured,
or acts or omissions of such Ad-
ditional Insured in connection with
the general supervision of "your
work" and only to the extent set
forth as follows:
(a) The Limits of Insurance ap-
plicable to the Additional In-
sured are the lesser of those
specified in the written con-
tract or agreement or in the
Declarations for this policy
and subject to all the terms,
conditions, and exclusions
for this policy. The Limits of
Insurance applicable to the
Additional Insured are inclu-
sive of and not in addition to
the Limits of Insurance
shown in the Declarations.
(b) The coverage provided to
the Additional Insured(s) is
not greater than that cus-
tomarily provided by the
policy forms specified in and
required by the contract.
(c) In no event shall the cov-
erages of Limits of Insurance
in this Coverage Form be in-
creased by such contract.
c. Additional Insured - Contractual
Obligations
(1) This policy is amended to include
as an Insured any person or or-
ganization (hereinafter called Ad-
ditional Insured) that you are re-
quired by a written "insured con-
tract" to include as an Insured,
subject to all of the following
provisions:
(a) Coverage is limited to liability
arising out of:
(i) your ongoing oper-
ations performed for
such Additional Insured;
or
(ii) that Insured's financial
control of you; or
(iii) the maintenance, opera-
tion or use by you of
equipment leased to
you by such Additional
Insured; or
(iv) a state or political sub-
division permit issued
to you.
(b) Coverage does not apply to
any "occurrence" or offense:
(i) which took place be-
fore the execution of,
or subsequent to the
completion or expira-
tion of, the written "in-
sured contract", or
(ii) which takes place after
you cease to be a ten-
ant in that premises.
Includes copyrighted material of Insurance Service Office with its permission.
Copyright, Insurance Services Office, Inc., 2001
CG 82 24 (Ed. 12/01) XS (Paae 2 of 4)
(c) With respect to architects,
engineers, or surveyors,
coverage does not apply to
"Bodily Injury," "Property
Damage," "Personal and Ad-
vertising Injury" arising out
of the rendering or the fail-
ure to render any profes-
sional services by or for you
including:
(i) the preparing, approv-
ing, or failing to pre-
pare or approve maps,
drawings, opinions, re-
ports, surveys, change
orders, designs or
specifications; and
(ii) supervisory, inspection,
or engineering services.
If an Additional Insured endorsement is at-
tached to this policy and specifically names a
person or organization as an Insured, then the
coverage in Section II - WHO IS AN
INSURED 5. Automatic Additional Insured(s)
does not apply to that person or organization.
2. BLANKET WAIVER OF SUBROGATION
SECTION IV - COMMERCIAL GENERAL
LIABILITY CONDITIONS, Item 8. is replaced
with:
8. Transfer of Rights of Recovery Against
Others to us and Blanket Waiver of
Subrogation
a. If an Insured has rights to recover all
or part of any payment we have made
under this Coverage Part, those rights
are transferred to us. The Insured must
do nothing after loss to impair them.
At our request, the Insured will bring
"suit" or transfer those rights to us and
help us enforce them.
b. If required by a written "insured con-
tract", we waive any right of recovery
we may have against any person or
organization because of payments we
make for injury or damage arising out
of your ongoing operations or "your
work" done under a contract for that
person or organization and included in
the "products -completed operations
hazard."
3. NON -OWNED OR CHARTERED WATER-
CRAFT
Section I - Coverages, Coverage A, Item
2.9.(2) is replaced with:
(2) A watercraft you do not own that is:
(a) less than 51 feet long; and
(b) not being used to carry persons or
property for a charge.
4. BROADENED PERSONAL AND ADVERTISING
INJURY
Unless "Personal and Advertising Injury" is ex-
cluded from this policy:
SECTION V - DEFINITIONS Item 14. is re-
placed by:
14. "Personal and Advertising Injury" means
injury, including consequential "bodily in-
jury," arising out of one or more of the
following offenses:
a. false arrest, detention or imprison-
ment;
b. malicious prosecution,-
c.
rosecution;
c. the wrongful eviction from, wrongful
entry into, or invasion of the right of
private occupancy of a room, dwelling
or premises that a person occupies by
or on behalf of its owner, landlord or
lessor,-
d.
essor;
d. oral, written, televised, videotaped, or
electronic publication of material, in
any manner, that slanders or libels a
person or organization or disparages a
person's or organization's goods, pro-
ducts or services;
e. oral, written, televised, videotaped, or
electronic publication of material, in
any manner, that violates a person's
right of privacy; or
Includes copyrighted material of Insurance Service Office with its permission.
Copyright, Insurance Services Office, Inc., 2001
CG 82 24 (Ed. 12/01) XS (Paae 3 of 4)
f. mental injury, mental anguish, humili-
ation, or shock, if directly resulting
from Items 14.a. through 14.e.
g. the use of another's advertising idea in
your "advertisement"; or
h. infringing upon another's copyright,
trade dress or slogan in your "adver-
tisement."
5. MENTAL INJURY, MENTAL ANGUISH,
HUMILIATION, OR SHOCK INCLUDED IN
BODILY INJURY DEFINITION
Section V - Definitions, Item 3. is replaced
with:
3. "Bodily injury" means physical injury, sick-
ness, or disease, including death of a per-
son. "Bodily injury" also means mental in-
jury, mental anguish, humiliation, or shock
if directly resulting from physical injury,
sickness, or disease to that person.
6. MEDICAL PAYMENTS
A. The Medical Expense Limit in Paragraph 7.
of SECTION III - LIMITS OF INSURANCE
is replaced by the following Medical Ex-
pense Limit.
The Medical Expense Limit provided by
this policy shall be the greater of:
a. $10,000,- or
b. The amount shown in the Declarations
for Medical Expense Limit.
B. This provision 7. is subject to all the terms
of SECTION III - LIMITS OF INSURANCE.
C. This provision 7. does not apply if
COVERAGE C. MEDICAL PAYMENTS is
excluded either by the provisions of the
Coverage Part or by endorsement.
7. DAMAGE TO PREMISES RENTED TO YOU
LIMIT
A. SECTION III - LIMITS OF INSURANCE,
Item 6. is replaced with:
Subject to 5. above, the Damage to Prem-
ises Rented to You Limit is the most we
will pay under Coverage A for damages
because of "property damage" to your
building, or to personal -property of others
in your care, custody and control while at
premises rented to you or temporarily
occupied by you with permission of the
owner, arising out of any one fire.
The Damage to Premises Rented To You
Limit is replaced by the following Damage
to Premises Rented To You Limit.
The Damage to Premises Rented To You
Limit is the greater of:
(1) $300,000; or
(2) the amount shown in the Declarations
for Damage to Premises Rented to
You Limit.
B. This provision is subject to all the terms
of SECTION III - LIMITS OF INSURANCE.
C. This provision 5. does not apply if Damage
to Premises Rent to You Liability of COV-
ERAGE A (SECTION 1) is excluded either
by the provisions of the Coverage Part or
by endorsement.
8. SUPPLEMENTARY PAYMENTS
A. In the SUPPLEMENTARY PAYMENTS -
COVERAGES A and B provision, Item 1.b.,
and 1.d are replaced with:
1.1b. Up to $500 for cost of bail bonds
required because of accidents or traf-
fic law violations arising out of the use
of any vehicle to which the Bodily In-
jury Liability Coverage applies. We do
not have to furnish these bonds.
1.d. All reasonable expenses incurred by
the Insured at our request to assist us
in the investigation or defense of the
claim or "suit," including actual loss of
earnings up to $500 a day because of
time off work.
This endorsement does not change any other
provision of the policy.
Includes copyrighted material of Insurance Service Office with its permission.
Copyright, Insurance Services Office, Inc., 2001
CG 82 24 (Ed. 12/01) XS (Paae 4 of 4)
CITY OF NEWPORT BEACH
CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE
I hereby certify that in the perforniance of the work for which this Agreement is entered
into, I shall not einploy any person in any manner so as to become subject to the Workers"
Compensation Laws of the State of California,
+&* 1010
Executed on this (a day of J#J 14% -,,29K at Newport Beach,
California.. 47 q(-
- 6 WK,: C67,0
[Add Consultant's name and title]
-
n
a
-
N
g�8
9
r
p m T
6 X Z
o
z
m n y
Pam
_
vt DHERE
FOL HEW..
R
A
�
n
a
I
Q
n
FOL HEW..