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HomeMy WebLinkAboutC-4619 - Independent Contractor Agreement Recreation InstructorCITY OF NEWPORT BEACH Recreation & Senior Services Department V 9 INDEPENDENT CONTRACTOR AGREEMENT SENIOR SERVICES Qj This Independent Contractor Agreement ( "Agreement ") is made and entered into as this 151 day of October, 2011 by and between the City of Newport Beach, a California municipal corporation and charter city ( "City "), and Keith Glassman, a sole proprietor, ( "Contractor ") to provide the classes or programs in Fitness ( "Class" or "Program ") hereby agreed upon, as scheduled and described in the Newport Navigator and /or OASIS News, which is incorporated 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: 1. TERM The term of this Agreement shall commence on the above written date, and shall terminate on December 31, 2012 unless terminated earlier as provided herein. 2. COMPENSATION 2.1 City shall pay Contractor within twenty one (21) business days after the last Class meeting. City shall pay the Contractor an amount equal to seventy percent (70 %) of the amount of the total enrollment fees collected, minus the non - resident fee and a five dollar and no /100 ($5.00) per person administration fee for each Class held. Effective January 1, 2012, for each Class that starts at 5:00pm or later, City shall pay the Contractor an amount equal to sixty -five percent (65 %) of the amount of the total enrollment fees collected, minus the non - resident fee and a five dollar and no /100 ($5.00) per person administration fee. 2.2 City may renegotiate compensation with Contractor anytime during the term of this Agreement, during the period that the Class is conducted should Contractor fail to perform any of the terms contemplated herein. 2.3 The City pays Contractors electronically; the Contractor shall be responsible for ensuring an up to date "Direct Deposit Authorization Form" is on file with OASIS Senior Center Administration Office staff. 3. DUTIES OF CITY 3.1 Registration. City shall register all participants for classes and shall collect all enrollment fees. Contractor shall not accept enrollment fees directly from a participant unless the City approves, in advance and in writing, the acceptance of enrollment fees by the Contractor. Contractors shall only collect material fees that are pre- approved by the City and published in advance in the Newport Navigator and /or the OASIS News. Such material fees shall be collected by Contractor at the first class meeting. 3.2 Publicity. City shall provide publicity for the Class in the Newporl Navigator (published on a quarterly basis) and /or the OASIS News (published on a monthly basis). City shall have the sole discretion to decide what information will be included in the Newport Navigator and/or the OASIS News about the Class and the Contractor. Publicity may also include flyers created by the City or the Contractor. Contractor created flyers must be approved in writing by the City before distribution. 3.3 Class Facility. City shall provide a location for the Class without charging Contractor any rental fees, unless otherwise agreed by the parties. The Contractor will request dates and times for the Classes; the City will inform the Contractor if the facility is available. It is the Contractor's sole responsibility to request these dates /times, the City will not schedule the Contractors Classes for them. 3.4 Refund Processing. City shall provide refunds to participants when: 3.4.1 The participant drops the class before the second class meeting; 3.4.2 The participant drops a one (1) day or more workshop five (5) or more business days before the workshop begins; or 3.4.3 The class is canceled by the City or Contractor. In the later instance, the Contractor must provide the City with all required paperwork. 3.5 Class Roster, Sign -Out and Attendance Sheets. City shall provide class rosters, sign -out sheets and attendance sheets to Contractor online via http : / /newportbeachca.gov /index.asox ?pane =1432. Contractor is responsible for requesting a log -in and password from the City. 4. CONTRACTOR DUTIES 4.1 Contractors. Contractor hereby certifies that he/she or any contractor, 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 in the course outline submitted to City which is incorporated herein by reference. Contractor is responsible for all Class curriculum development. 4.1.1 City staff must approve in writing all assigned contractors, representatives and employees prior to any of them performing any services under this Agreement. The City requires the Contractors and all representatives and employees of the Contractor to be fingerprinted prior to performing services under this Agreement in accordance with Section 8 below. A current roster of Contractors, representatives, and employees must be provided prior to City approval of new contractors, representatives and employees. All Contractors must be able to provide proof of legal right to work in the United States. Contractor is responsible for training, supervising, evaluating, INDEPENDENT CONTRACTOR AGREEMENT Page 2 scheduling, and any other requirements by law for all contractors, representatives, and employees. 4.2 Representatives /Employees. Contractor shall provide the City with the name(s), address(es) and phone number(s) of all representatives or employees who will be providing any services pursuant to this Agreement. All representatives or employees must comply with the fingerprint policy (Section 8). 4.2.1 Please initial the statement that applies: I will not be using representatives or employees. ❑ I will be using representatives or employees. Attached please find as Exhibit A, and incorporated herein by reference, the full names, addresses and phone numbers of all representatives or employees who will be providing any services pursuant to this Agreement. This information must be updated with the Recreation and Senior Services Department each time the Contractor adds or deletes representatives or employees. 4.2.2 Subcontracting. Contractor shall not subcontract or assign any portion of the rights, obligations or duties required under this Agreement, without first obtaining prior written approval from the City. Subcontracts, if any, shall contain a provision making them subject to all provisions of this Agreement. 4.3 Supplies/Equipment. Contractor shall be responsible for providing all supplies, equipment, personnel, materials, and any additional publicity desired for the class, at Contractor's sole expense. Contractor shall also be responsible for repairing and maintaining all equipment and supplies in good working condition. 4.4 Anti- Discrimination Laws. Contractor 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 Contractor 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. Contractor shall; where applicable, conform to the requirements of the Americans with Disabilities Act in the performance of this Agreement. 4.5 Class Size. Contractor shall determine the minimum and maximum number of participants required for each class to ensure the quality and, safety of the class. Contractor or Contractor's authorized representative is required to attend the first Class meeting of all Class offerings advertised in the Newport Navigator and/or OASIS News unless Contractor 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, INDEPENDENT CONTRACTOR AGREEMENT Page 3 Contractor 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 shall be cancelled and the Contractor shall not be compensated for attending the first meeting or for any cancelled Class. Contractor 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 shall be held as scheduled (even if any of the initial participants subsequently drop the Class), subject to Section 14 of this Agreement. If the demand is such that an additional Class could be offered, it shall be taken under consideration and negotiated between City and Contractor. 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. 4.6 Absences. Contractor shall obtain permission from City one (1) week prior to any planned absence from the class. In the event of illness, Contractor is required to notify City and Participants twenty-four (24) hours prior to any class cancellation. 4.6.1 City urges Contractor to get a substitute, whenever possible, instead of cancelling Classes. Contractor shall obtain City's prior written approval of any substitute Contractor. Any substitute contractor, representative or employee must have completed a criminal background check pursuant to Section 8 prior to teaching any City programs or Classes. 4.6.2 When cancelling a Class, Contractor shall contact all participants as soon as possible and confirm all cancellations and /or make -up classes, in writing, with OASIS Senior Center Administration Office staff. 4.7 Contact Information. Contractor 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. 4.8 Sign -Out Sheets. All Contractors must have participants sign in for each Class. Sign in sheets along with Attendance sheets are available to the Contractor online through their instructor login. 4.9 Other Requirements. Contractors shall: 4.9.1 Cooperate fully with all reasonable requests from City staff. 4.9.2 Maintain the highest degree of participant safety possible. 4.9.3 Injuries or Damages. Immediately report to the OASIS Senior Center Administration Office any injuries as a result of Class participation, damages to the classroom or Program facility that could cause potential injury to a participant and any needed maintenance repairs. Contact the OASIS Senior Center Administrative Office staff by phone or email. 4.9.4 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 INDEPENDENT CONTRACTOR AGREEMENT Page 4 without conflict with other scheduled activities and in accordance with posted hours and availability limitations. 4.9.5 Ensure that any music or sound system is kept at levels that will not interfere with other classes or create a public disturbance /nuisance. 4.9.6 Close and secure the room or building at the end of each Class. 4.9.7 Turn off any lights, heat, air conditioning, or other utilities when Class is finished. 4.9.8 Complete and return the quarterly "Contract Class Schedule" requested by the City if Contractor wishes to be a part of the marketing materials. 4.9.9 Know facility rules and regulations and provide pertinent information (i.e. refunds) to participants. 4.9.10 Pay a $20 lost key /replacement fee when Contractor requests replacement key. 4.9.11 Abide by all City policies and procedures including, but not limited to, the requirements set forth in the Newport Navigator and OASIS News and the Contractor Handbook which is incorporated herein by this reference. Contractor's signature on this Agreement signifies acknowledgment of receipt of the Contractor Handbook. 4.10 Contractor Photo ID Badge. Contractors and their employees/representatives are required to wear a City provided Contractor Photo ID Badge at all times while engaging in services for the City. Contractor shall be required to pay five dollars and no /100 ($5.00) for any lost/replacement Contractor Photo ID Badge. Contractor Photo ID Badges are distributed upon renewal of Agreement with City. 5. NOTICES 5.1 Unless otherwise indicated, all notices, demands, requests or approvals to be given under the terms of this Agreement shall be given in writing, and conclusively shall be deemed served when delivered personally, or on the third business day after the deposit thereof in the United States mail, postage prepaid, first -class mail, addressed as hereinafter provided. All notices, demands, requests or approvals from Contractor to City shall be addressed to City at: Attn: OASIS Senior Center Administrative Office Recreation Supervisor City of Newport Beach 801 Narcissus Ave Corona Del Mar, CA 92625 Phone: (949) 718 -1822 E -mail: mbvers(&newoortbeachca.4ov INDEPENDENT CONTRACTOR AGREEMENT Page 5 5.2 All notices, demands, requests or approvals from City to Contractor shall be addressed to Contractor at the contact information provided on page 12 of this Agreement. 6. INDEPENDENT CONTRACTOR The parties intend and agree that at all times during the performance of services under this Agreement; Contractor shall act as an Independent Contractor and shall not be considered an agent or employee of City. As such, Contractor 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. Contractor 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 Contractor other than as provided herein. City reserves the right to employ other independent contractors and Contractors who teach the same or similar classes. City shall provide Contractor with IRS 1090 or other applicable IRS forms at the end of the calendar year for all fees paid to Contractor. 7. INSURANCE 7.1 General Liabilitv Insurance. (Required for senior fitness programs only) Contractor 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 Management or their designee prior to the first Classiday of instruction. 7.1.1 Contractor shall have the option of purchasing coverage through the City of Newport Beach's Special Event insurance program, or through Southern California Municipal Athletic Federation ( "SCMAF "), or providing his/her own coverage. If a Contractor 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). 7.1.2 Contractor's insurance coverage shall be primary insurance and/or primary source of recovery as respects to City, its elected or appointed officers, agents, officials, employees and volunteers as respects to all claims, losses or liability arising directly or indirectly from the Contractor's operations or Service provided to the City. Any insurance or self- insurance maintained by City, its officers, officials, employees and volunteers shall be excess of the Contractor's insurance and shall not contribute with it. INDEPENDENT CONTRACTOR AGREEMENT Page 6 7.1.3 Said policy must also provide a written thirty (30) day notice of cancellation (ten (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, PO Box 1768, Newport Beach, CA 92658. 7.2 Workers' Compensation Insurance. By executing this Agreement, Contractor certifies that Contractor 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. Contractor shall carry the insurance or provide for sell- insurance required by California law to protect said Contractor from claims under the Workers' Compensation Act. 7.2.1 The insurer issuing the Workers' Compensation insurance shall amend its policy by endorsement to waive all rights of subrogation against the City, its elected or appointed officers, agents, officials, employees and volunteers. Contractor shall submit to City, along with the required certificate of insurance a copy of such waiver of subrogation endorsement. 7.2.2 In the event Contractor has no employees requiring Contractor to provide Workers' Compensation insurance, Contractor shall so certify to City in writing prior to City's execution of this Agreement. 7.3 Automobile Liability Coverage. Contractor shall maintain automobile insurance covering bodily injury and property damage for all activities of the Contractor arising out of or in connection with work to be performed under this Agreement, including coverage for any owned, hired, non -owned or rented vehicles, in an amount not less than one million dollars ($1,000,000) combined single limit for each occurrence, or as approved by the City s Risk Manager or his/her designee. 7.4 Please initial the statement that applies: M/4 Contractor is providing a copy of the General Liability Insurance with Additional Insured Endorsement that meets the above requirements. ❑ Contractor shall be utilizing the City provided insurance through Southern California Municipal Athletic Federation ( "SCMAF ") and will pay all required fees billed on a quarterly basis by the City. I have reviewed the Contract Contractor Handbook for complete information. Please note that SCMAF does not provide coverage for Worker's Compensation or Automobile Insurance Liability. 8. FINGERPRINTS AND CRIMINAL BACKGROUND CHECK 8.1 All Contractors and their employees, agents and representatives must submit to and pass a criminal background investigation by providing a complete set of fingerprints to the City at least thirty (30) calendar days prior to teaching, substituting for INDEPENDENT CONTRACTOR AGREEMENT Page 7 contractor or assisting with any Class. Such Contractors and their employees, agents and representatives are required to submit fees in the amount of up seventy three dollars and no /100 ($73) 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 may be required to be updated every five (5) years. 8.2 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, Contractor agrees to the provisions of this Section. 9. 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 Contractor, shall remain the property of City. Contractor shall not release such information to others without the prior written authorization by City. Contractor 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 Contractor solely for administration of Classes and performing City business. Contractor will take reasonable steps consistent with the law to prevent distribution of such information. Contractor's obligations under this Section shall survive the termination of this Agreement. 10.USE OF NAMES AND LOGOS; ADVERTISING, PRESS RELEASES AND PUBLICITY Contractor shall not include City's name, logos or insignia, or photographs of the Class site or participants, in any publicity pertaining to Contractor'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. 11. 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. Contractor 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, Contractor 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 INDEPENDENT CONTRACTOR AGREEMENT Page 8 City Hall. A copy of your Business License must be submitted with this Contract. All Contractors must have a valid business license. 12. INDEMNIFICATION 12.1 General. Contractor shall indemnify, defend 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 Contractor, his or her employees, representatives, officers and agents in the course of performing services under this Agreement; however, Contractor shall not be required to indemnify City from any claim arising from the sole negligence or willful misconduct of the Indemnified Parties. 12.2 Intellectual Property. Contractor 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 Contractor of the legally protected rights of any third parties, with respect to works performed, logos displayed, or written or digital materials provided by Contractor 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 Contractor 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 Contractor to obtain the appropriate license to perform the material prior to the public performance. 13.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 Contractor. In the event of termination under this Section, City shall pay Contractor on a prorated basis for any Classes or Programs that were actually taught by Contractor, if any, up to the effective date of termination. 14.CLAIMS The Contractor and the City expressly agree that in addition to any claims filing requirements set forth in the Contract and Contract documents, the Contractor shall be required to file any claim the Contractor may have against the City in strict conformance with the Government Tort Claims Act (Government Code sections 900 et seq.). 15. STANDARD PROVISIONS 15.1 Compliance with all Laws. Contractor shall at its own cost and expense comply with all statutes, ordinances, regulations and requirements of all governmental - entities, including federal, state, county or municipal, whcthor now in force or hereinafter INDEPENDENT CONTRACTOR AGREEMENT Page 9 enacted. In addition, all Work prepared by Contractor shall conform to applicable City, county, state and federal laws, rules, regulations and permit requirements and be subject to approval of the Project Administrator and City. 15.2 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. 15.3 Integrated Contract. This Agreement represents the full and complete understanding of every kind or nature whatsoever between the parties hereto, and all preliminary negotiations and agreements of whatsoever kind or nature are merged herein. No verbal agreement or implied covenant shall be held to vary the provisions herein. 15.4 Conflicts or Inconsistencies. In the event there are any conflicts or Inconsistencies between this Agreement and the Scope of Services or any other attachments attached hereto, the terms of this Agreement. shall govern. 15.5 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 the Agreement or any other rule of construction which might otherwise apply. 15.6 Amendments. This Agreement may be modified or amended only by a written document executed by both Contractor and City and approved as to form by the City Attorney. 15.7 Severability. If any term or portion of this Agreement is held to be invalid, illegal, or otherwise unenforceable by a court of competent jurisdiction, the remaining provisions of this Agreement shall continue in full force and effect. 15.8 Controlling Law and Venue. The laws of the State of California shall govern this Agreement and all matters relating to it and any action brought relating to this Agreement shall be adjudicated in a court of competent jurisdiction in the County of Orange. 15.9 No Attorney's Fees. In the event of any dispute or legal action arising under this Agreement, the prevailing party shall not be entitled to attorney's fees. 15.10 Counterparts. This Agreement may be executed in two (2) or more counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument. INDEPENDENT CONTRACTOR AGREEMENT Page 10 IN WITNESS WHEREOF, the parties have caused this Agreement to be executed on the dates written below. APPROVED AS TO FORM: OFFICE OF THE CITY ATTORNEY Date: By: KAgk. Rowan Acting Assistant City Attorney ATTEST: Date: �(7'a� • �� By: Leilani Brown, City Clerk CONTRACTOR: KEITH GLASSMAN CITY OF NEWPORT BEACH, A California municipal corporation Date: I o • ? o . wOO60 By Laura De ler, Director Recreation & Senior Services ( Cb1 4 a � q - K 11 Keith Glassman Contractor Signat re Date Print Name Print Title Signature Date Print Name Print Title Attachments: Exhibit A—Representatives and/or Employees of Contractor INDEPENDENT CONTRACTOR AGREEMENT Page 11 k a f Luc \ z ) � � 33 y 2 || / `g .| !! ;■ o §; k {( �| g � � 0 , \ { ) 3 i ( zE z)� §,) 7ƒ/ (D(So \ z ) � � 0 City of NEWPORT BEACH October 7, 2011 Keith Glassman Dear Vendor: Thank you for your certificate submission to the City of Newport Beach. You are currently compliant! Please remember to send any changes in coverage, and renewal certificate(s) prior to expiration. Thank you, City of Newport Beach C"kwIIII�R CERTIFICATE OF LIABILITY INSURANCE Mtt�! PCOI THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION MarnewsNaD[a AP•n,Ire. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE xnov�wrMwrero HOLDER. THIS CERTIFICATE DOES NOT AMMEND, ERTEND OR .weµ ufxEfaALTERTHE COVERAGE AFFORDED BYTHE POLICIES BELOW, Iaillaxc>asf COVERAGES WE POLICIES OF INSUMNCE LISTED BELOW HAVE BEEN ISSOED TO THE INSURED NAMED ABOVE MR THE POLICY PERIOD INDICATED. NOTWDHSEANDING ANY REQUIREMENT, TERM OR CONDRON OF ANY CONTACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CEMFICATION MAY BE ISSUED OR MAY PERTAIN, ME INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREN IS SUENCIE TO AU. ME TERMS, EMISSIONS AND CONDITIONS OF SUCH INDUCES, AGGREGATE LIMEMSHOWN MAYAVE BEEN MDIICED BY PAID CLAMS. amwrxa.Bw MM w. r.a,ufzM�auE GE�EPoc�mNOOrIOAnON UUPOLITHE lwRRSANSORmnnvo� MMEN K V[attY[IOMTKKI sloxE tt08," A X H LWNIIIY[�m ny➢6/Nu Mi SLrDFW So ewansn E MIL ❑ OWES 9100,000 Sum slax)(m pnOEmlOxu LwellmPERSONALLIADVINJUREF pgWCR-mMe/m qa &vxDpOFvRo rixM1 Auxrtwuure! X PoUCY FMDIECe LAW utt MXABINDSMILESAFF IEAarsXaMl BIDLYIXNA ALL OEM EDAI sp6VLmANm SALAMI NOMMO ESS m:E�"^0 PRnERrvMMwe PerreanD MMMEREMYtt AOf00XLY-FAAIDOEX! OTHOSIMAM wNO Awo ABBOOKII fxtlEF/VMYdALWNY FMagLUMNY 7 CODES F-1 CLALMSMADE VIDECTNEp/EXE� OFIKERMEflMBER XCW[fDi NiWF in ELEIOI MGW1e LmMaxry FXXI 5 FI�CiNIRWI510NSDwex E.LNEFAY-PoLIp YNrt OBLER DE[<flIr11ON r orEMnmasl LDunaxsl ATxaEs/EXumwns MDmM MDONEBrr/sNONvww IoM n6 vAeNaW aM.mMUMMwMMn [nnn MaMM...n.eallbnl Ysune Menly uM1n n.patl.[e DI. opemw, W [renaM Inau,tl mplMXu.RIXy nwMgamah NaNpnX IleurtSssde rc{Ipun.ine CXv pl Nerya,1.The (fiv Its pnNen,dhbly empM'eei ana wDn W n. CANCELLATION ACORD 2512009/DI) EI 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SECURE], ANY OF BY MOW D6w0ED PONIES BE UN.fILED SEWN MF "I'MATwx SAFE Tne Ma n xea.Pa. enn. Tre w m.xxeO, amn.x, e.ge.a...e.a.M.a. amwrxa.Bw w. r.a,ufzM�auE GE�EPoc�mNOOrIOAnON UUPOLITHE lwRRSANSORmnnvo� AUT}UP�TA71YE sloxE ACORD 2512009/DI) EI 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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 This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01) POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 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 Additional Insured Person(s) Or Organizations) The City of Newport Beach, The City Its officers, officials, employees and volunteers 3300 Newport Blvd Newport Beach CA 92663.3816 Information required to complete this Schedule, If not shown above, will be shown In the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or orgam- zation(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury"caused, in whole or in part, by your acts or omissions or the ads or omis- sions of those acting on your behalf. A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 0ISO Properties, Inc., 2004 Page 1 of 1 10 CITY OF NEWPORT BEACH CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE I hereby certify that in the performance of the work for which this Agreement is entered into, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws of the State of California. . Executed on this 1 day of J-0�1� , 2011, at Newport Beach, California. (Signature) [4,E/k/+ k C [a s s >M,G ki L41 s� (Consultant's name and title) PROOF OF INSURANCE Interinsumnce Exchange Of the Automobile Club NAIC A: 15598. Named Insured Policy Number. 6 GLASSMAN, KEITH AND TOZER, SANAH 9 g - Egedive Date: 06-29-11_ _. Eptiralimi Date: 116-29-12 TNa poM.T provides at mat me nmr mn amounts of fiaNliN insmaasro wM1iired byrbe CAV CODE SECTON 16056 for ana spooncad cles and named bared and may provitle s xa9e for mar .. aeon fed elharyabMss.pay nyp%dad Wthe.'maufanea adiw. ,.. F. KEITH GLASSMAN DA I S C00% rCW CITY OF NEWPORT BEACH �-' Recreation & Senior Services Department INDEPENDENT CONTRACTOR AGREEMENT This Independent Contractor Agreement ( "Agreement ") is made and entered into as of October 1, 2010 by and between the City of Newport Beach, a California Municipal Corporation and Charter City ( "City"), and Keith Glassman, a ( "Contractor") to provide the classes or programs in Fitness ( "Class" or "Program ") hereby agreed upon, as scheduled and described in the Newport Navigator and /or OASIS News, which is incorporated 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 30th day of September 2011 unless terminated earlier as provided herein. 2. COMPENSATION City shall pay Instructor within twenty one (21) business days after the last Class meeting. City shall pay the Instructor an amount equal to seventy percent (70 %) of the amount of the total enrollment fees collected, minus the non - resident fee and a five dollar and no /100 ($5.00) per person administration fee for each Class held. City may renegotiate compensation with Contractor anytime during the term of this Agreement, during the period that the Class is conducted should Contractor fail to perform any of the terms contemplated herein. The City pays Contractors electronically; the Contractor shall complete and return with the contract documents the "Direct Deposit Authorization Form." 3. DUTIES OF CITY A. Registration. City shall register all participants for classes and shall collect all enrollment fees. Contractor shall not accept enrollment fees directly from a participant unless the City approves, in advance and in writing, the acceptance of enrollment fees by the Contractor. Contractors shall only collect material fees that are pre- approved by the City and published in advance in the Newport Navigator and/or the OASIS News (if applicable). Such material fees shall be collected by Contractor at the first class meeting. B. Publicity. City shall provide publicity for the Class in the Newport Navigator (published on a quarterly basis) and /or the OASIS News (published on a monthly basis). City shall have the sole discretion to decide what information will be included in the Newport Navigator and/or the OASIS News about the Class and the Contractor. Publicity may also include flyers created by the City or the Contractor. Contractor created flyers must be approved in writing by the City before distribution. C. Class Facility. City shall provide a location for the Class without charging Contractor any rental fees, unless otherwise agreed by the parties. The Contractor will request dates and times for the Classes; the City will inform the Contractor if the facility is available. It is the Contractor`s sole responsibility to request these dates /times, the City will not schedule the Contractors Classes for them. D. Refund Processing. City shall provide refunds to participants when: I. The participant drops the Gass before the second class meeting; ii. The participant drops a one (1) day or more workshop five (5) business days before the workshop begins; or iii. The Gass is canceled by the City or Contractor. In this instance, the Contractor must provide the City with all required paperwork. E. Class Roster, Sign -Out and Attendance Sheets. City shall provide class rosters, sign -out sheets and attendance sheets to Contractor online via http:// newportbeachca .gov /index.aspx?page =1432. Contractor is responsible for requesting a log -in and password from the City. 4. CONTRACTOR DUTIES A. Contractors. Contractor hereby certifies that he /she or any contractor, 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. Contractor is responsible for all class curriculum development. City staff must approve in writing all assigned contractors, representatives and employees prior to any of them performing any services under this Agreement. The City requires the Contractors and all representatives and employees of the Contractor to be fingerprinted prior to performing services under this Agreement in accordance with Section 8 below. A current roster of Contractors, representatives, and employees must be provided prior to City approval of new contractors, representatives and employees. All Contractors must be able to provide proof of legal right to work in the United States. Contractor is responsible Independent Contractor Agreement Page '2 for training, supervising, evaluating, scheduling, and any other requirements by law for all contractors, representatives, and employees B. Representafives /Employees. Contractor shall provide the City with the Name(s), Address(es) and Phone Number(s) of all representatives or employees who will be providing any services pursuant to this Agreement. All representatives or employees must comply with the fingerprint policy (Section 8). {PPllease initial the statement that applies: ! I [will not be using representatives or employees. I will be using representatives or employees. Attached please find as Exhibit A, and incorporated herein by reference the full names, addresses and phone numbers of all representatives or employees who will be providing any services pursuant to this Agreement. Contractor shall not subcontract or assign any portion of the rights, obligations or duties required under this Agreement, without first obtaining prior written approval from the City. Subcontracts, if any, shall contain a provision making them subject to all provisions of this Agreement. C. Supplies/Equipment. Contractor shall be responsible for providing all supplies, equipment, personnel, materials, and any additional publicity desired for the class, at Contractor's sole expense. Contractor shall also be responsible for repairing and maintaining all equipment and supplies in good working condition. D. Anti - Discrimination Laws. Contractor 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 Contractor 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. Contractor shall, where applicable, conform to the requirements of the Americans with Disabilities Act in the performance of this Agreement. E. Class Size. Contractor shall determine the minimum and maximum number of participants required for each class to ensure the quality and, safety of the class. Contractor or Contractor's authorized representative is required to attend the first Class meeting of all Class offerings advertised in the Newport Navigator and /or OASIS News unless Contractor cancels the Class three (3) business days prior to the start date, with the prior written approval of City. In the event of such Independent Contractor Agreement Page 3 approved cancellation, Contractor 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 shall be cancelled and the Contractor shall not be compensated for attending the first meeting or for any cancelled Class. Contractor 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 shall 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 between City and Contractor. 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. F. Use of Non -City Facilities for Classes. If Contractor desires to conduct the Class at his/her place of business, or some other non City-owned site or facility, Contractor must: 1. 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. G. Absences. Contractor shall obtain permission from City one (1) week prior to any planned absence from the class. In the event of illness, Contractor is required to notify City and Participants twelve (12) hours prior to any class cancellation. City urges Contractor to get a substitute, whenever possible, instead of cancelling Classes. Contractor shall obtain City's prior written approval of any substitute Contractor. Any substitute contractor, representative or employee must have completed a criminal background check pursuant to Paragraph 8 prior to teaching any City programs or Classes. When cancelling a Class, Contractor shall contact all participants as soon as possible. H. Contact Information. Contractor 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. Contractor Informational Meeting. Contractor or Contractor's authorized representative or employee shall attend the Annual Contractor Informational Meeting that will be held in Insert Month & Year ie. October 2011. J. Camp Participant Emergency Waiver Form Requirements. All Contractors who offer camps shall require all participants to complete and return to Contractor, or Independent Contractor Agreement Page 4 his/her designee on or before the first day of camp a City issued "Emergency Contact Information Form ". K. Sign -Out Sheets. All Camp Contractors with participants ages 10 years and younger, must have a legal guardian sign out each Class participant after each Class. Sign out sheets along with Attendance sheets are available to the Contractor online via http:// newi)ortbeachca .cov/index.asnx?pa(ie =1432. L. Other Requirements. Contractors 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 Gasses or create a public disturbance/nuisance. viii. Close and secure the room or building at the end of each Class. ix. Turn off any lights, heat, air conditioning, or other utilities when Class is finished. X. Schedule make -up Classes in advance. A. Complete and return the quarterly "Contract Class Schedule" requested by the City if Contractor wishes to be a part of the marketing materials. xii. Know facility rules and regulations and provide pertinent information (i.e. refunds) to participants. xiii. Pay a $20 lost key /replacement fee when Contractor requests replacement key. xiv. Abide by all City policies and procedures including, but not limited to, the requirements set forth in the Newport Navigator and OASIS News and the Contractor Handbook which is attached hereto and incorporated by this reference. M. Contractor Photo ID Badge. Contractors and their employees/representatives are required to wear a City provided Contractor Photo ID Badge at all times while engaging in services for the City. Contractor shall be required.to pay five dollars and no /100 ($5.00) for any lost/replacement Contractor Photo ID Badge. Contractor Photo ID Badges are distributed upon renewal of Agreement with City. Independent Contractor Agreement Page 5 5. INDEPENDENT CONTRACTOR The parties intend and agree that at all times during the performance of services under this Agreement; Contractor shall act as an Independent Contractor and shall not be considered an agent or employee of City. As such, Contractor 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. Contractor 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 Contractor other than as provided herein. City reserves the right to employ other independent contractors and Contractors who teach the same or similar classes. City shall provide Contractor with IRS 1090 or other applicable IRS forms at the end of the calendar year for all fees paid to Contractor. 6. INSURANCE- SENIOR FITNESS AND DANCE CLASSES ONLY A. General Liability Insurance. Contractor 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 Management or their designee prior to the first Class/day of instruction. Contractor 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 a Contractor 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 thirty (30) day notice of cancellation (ten (10) day written notice for non - payment of premium) to the City of Newport Beach Recreation & Senior Services Department, at the following address: P.O. Box 1768/ 3300 Newport Boulevard, Newport Beach, CA 92658. B. Workers' Compensation Insurance. By executing this Agreement, Contractor certifies that Contractor 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. Contractor shall carry the insurance or provide for self - insurance required by California law to protect said Contractor from claims under the Workers' Compensation Act. Independent Contractor Agreement Page 6 C. Automobile Liability Coverage. Contractor shall maintain automobile insurance covering bodily injury and property damage for all activities of the Contractor arising out of or in connection with work to be performed under this Agreement, including coverage for any owned, hired, non -owned or rented vehicles, in an amount not less than one million dollars ($1,000,000) combined single limit for each occurrence s or aJ k- r (L s b, mend Please initial the statement that applies: Contractor is providing a copy of the General Liability Insurance with Additional Insured Endorsement that meets the above requirements. Contractor shall be utilizing the City provided insurance through Southern California Municipal Athletic Federation ( "SCMAF ") and will pay all required fees billed on a quarterly basis by the City. 1 have reviewed the Contract Contractor Handbook for complete information. Please note that SCMAF does not provide coverage for Worker's Compensation or Automobile Insurance Liability. 7. COMPLIANCE WITH ALL LAWS Contractor, 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 Contractors and their employees, agents and representatives must submit to and pass a criminal background investigation by providing a complete set of fingerprints to the City at least thirty (30) calendar days prior to teaching, substituting for contractor or assisting with any Class. Such Contractors and their employees, agents and representatives are required to submit fees in the amount of up seventy three dollars and no /100 ($73) 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 may be required to be updated every five (5) years. 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, Contractor agrees to the provisions of this Paragraph. Independent Contractor Agreement Page 7 9. TRANSPORTING OF MINOR PARTICIPANTS Unless the Program specifically involves travel or transportation of minors to an offsite location, Contractor, or Contractor'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, Contractor 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, Contractor 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 Division at 949 - 795 -2381 (Monday through Friday, 5 to 9pm, and Saturday and Sunday, gam to 5pm.) During all other hours, Contractor shall contact the Watch Commander at the Newport' Beach Police Department for assistance at 949 - 644 -3730. 10. CONFIDENTIALITY; OWNERSHIP OF DOCUMENTS All Class rosters, participant addresses and contact information, and any other such information or documents compiled by City and provided to Contractor, shall remain the property of City. Contractor shall not release such information to others without the prior written authorization by City. Contractor 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 Contractor solely for administration of Classes and performing City business. Contractor will take reasonable steps consistent with the law to prevent distribution of such Information. Contractor's obligations under this paragraph shall survive the termination of this Agreement. 11. USE OF NAMES AND LOGOS; ADVERTISING, PRESS RELEASES AND PUBLICITY Contractor shall not include City's name, logos or insignia, or photographs of the Class site or participants, in any publicity pertaining to Contractor's services or Class in any magazine, trade paper, newspaper, radio or television production, Internet, or other printed or electronic medium without the prior written consent of City and participants. 12. BUSINESS LICENSE Newport Beach Municipal Code Chapter 5.04 provides that every business operating in the City must obtain a business license prior to conducting business in the City, and pay the required business license fee. This ordinance applies to businesses operating at commercial or residential locations within the City, or using a City of Newport Beach address or P.O. Box for receiving mail. The City Business License Fee is an annual tax, due every twelve (12) months. Contractor 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 Independent Contractor Agreement Page 8 Hall. In certain circumstances, Contractor 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 Contract. All Contractors must have a valid business license. 13. INDEMNIFICATION General. Contractor shall indemnify, defend 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 Contractor, his or her employees, representatives, officers and agents in the course of performing services under this Agreement; however, Contractor shall not be required to indemnify City from any claim arising from the sole negligence or willful misconduct of the Indemnified Parties. Intellectual Property. Contractor 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 Contractor of the legally protected rights of any third parties, with respect to works performed, logos displayed, or written or digital materials provided by Contractor 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 Contractor 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 Contractor to obtain the appropriate license to perform the material prior to the public performance. 14. 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 Contractor. In the event of termination under this Section, City shall pay Contractor on a prorated basis for any Classes or Programs that were actually taught by Contractor, if any, up to the effective date of termination. 15. CONTROLLING LAW AND VENUE -The laws of the State of California shall govern this Agreement and all matters relating to it. Any action brought relating to this Agreement shall be adjudicated in a court of competent jurisdiction in the County of Orange. Independent Contractor Agreement Page 9 16. AMENDMENTS This Agreement may be modified or amended only by a written document executed by both Contractor and City and approved as to form by the City Attorney. 17. INTERPRETATION The terms of this Agreement shall be construed in accordance with the meaning of the language used and shall not be construed for or against either party by reason of the authorship of this Agreement or any other rule of construction which might otherwise apply. 18. INTEGRATED CONTRACT This Agreement represents the full and complete understanding of every kind or nature whatsoever between the parties, and all preliminary negotiations and agreements are merged herein. No verbal agreement or implied covenant shall be held to vary the provisions herein. 19. SEVERABILITY If any term or portion of this Agreement is held to be invalid, illegal, or otherwise unenforceable by a court of competent jurisdiction, the remaining provisions of this Agreement shall continue in full force and effect. 20. WAIVER A waiver by either party of any breach, of any term, covenant or condition contained herein shall not be deemed to be a waiver of any subsequent breach of the same or any other term, covenant or condition contained herein, whether of the same or a different character. 21. CLAIMS The Contractor and the City expressly agree that in addition to any claims filing requirements set forth in the Contract and Contract documents, the Contractor shall be required to file any claim the Contractor may have against the City in strict conformance with the Government Tort Claims Act (Government Code sections 900 et seq.). Independent ConGctor Agreement page 10 IN WITNESS WHEREOF, the parties have caused this Agreement to be executed on the day and year first written above. APPROVED AS TO FORM: CITY OF NEWPORT BEACH, OFFICE OF THE CITY ATTORNEY A Municipal Corporation By'. My As eA Rome p�, ura Detwei , Director Assistant yAttomey ` "1�Ip ecreation&Senior Services ATTEST: ��PORr By. 0.4 Leilani Brown, City Clerk G CONTRACTOR: �CIFgpN�P BY: 4A wI' .. Mvr Print Name and Title: tf(n Signature Date I rhe By: Print Name and Title: Signature Date Attachments: Exhibit A: Represenatives and/or Employees of Contractor Independent Contractor Agreement Page it CITY OF NEWPORT BEACH CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE I hereby certify that in the performance of the work for which this Agreement is -- Y _ entered into I sha!l not employ anperson in. any manner so as to beconle�_� _ subject to the Workers' Compensation Laws of the State of California. A C�� Executed on this f- day of �Q ; ft ^�w'203,0, at Newport Beach California. (Signature) (Consultant's name and title) RECREATION & SENIOR SERVICES CERTIFICATE OF INSURANCE CHECKLIST City of Newport Beach This checklist is comprised of requirements as outlined by the City of Newport Beach. Date Received: 09/09/2010 Dept./Contact Received From: Teri Craig Date Completed: 09/09/2010 Sent to: Teri Craig By: Michelle Ross Company/Person required to have certificate: Keith Glassman I. GENERAL LIABILITY A. INSURANCE COMPANY: Philadelphia Indemnity Ins. Co. B. AM BEST RATING (A-: VII or greater): "A+°°(XIV) C. ADMITTED Company (Must be California Admitted): Is Company admitted in California? ® Yes ❑ No D. LIMITS (Must be $1 M or greater): What is limit provided? $1,000,000 E. PRODUCTS AND COMPLETED OPERATIONS (Must include): Is it included? (completed Operations status does not apply to Waste Haulers) ® Yes ❑ No F. ADDITIONAL INSURED WORDING TO INCLUDE (The City its officers, officials, employees and volunteers): Is it included? ❑ Yes ® No G. PRIMARY & NON-CONTRIBUTORY WORDING (Must be included): Is it included? ❑ Yes ® No II. AUTOMOBILE LIABILITY A. PROOF OF INSURANCE PROVIDED ® Yes ❑ No III. WORKERS' COMPENSATION B. INSURANCE COMPANY: No Employees per Teri Craig C. AM BEST RATING (A-: VII or greater): D. LIMITS: Statutory E. WAIVER OF SUBROGATION (To include): Is it included? ❑ Yes ❑ No F. IF NO EMPLOYEES — EXEMPTION FORM SIGNED ❑ Yes ❑ No HAVE ALL ABOVE REQUIREMENTS BEEN MET? IF NO, WHICH ITEMS NEED TO BE COMPLETED? Approved: Michelle Ross Agent of Brown & Brown Broker of record for the City of Newport Beach Date 09/09/2010 ❑ Requires approval/exception/waiver by Risk Management B&B initials Comments: Approved: Risk Management Date ACORDM. CERTIFICATE OF LIABILITY INSURANCE DAT (NMN MC/YYYY) MAXACER Mm;WUIM SFMlms)<aura FITNESS PFD WELWESS WAR 8TE MAVENUE. NtTE NO LINA BEACH CA MOTS miscellany MONT THIS CERiIFIGAR IS WINDS AS A MATRR OFINFORWTIOX ONLY ANO CONFERS NO RIGHTS ARCO ME CERTIFICATE HOLO MMAN CERTIFICATE VMS NOT MEW. E%1EN00R ALTER ME COVERAGE AFFORDED BY WE POUCHES BELOW. NSORERSPFFORDINGCOVERAGE AMOCO lmsu O ILgIROBnnen NBVIEMh samewpble Instantly halwann CmmgM ims NWB: MyURERC: NSJRFN D: xsmER e HE FCIJCILS Qk ACURM'CE Me PLO BEJAN MWE BEEN IS M TO THE INSURED NAMED ABOVE FDA ME POLICY PENOO wgCPT EO. NKyW1THGUMKMQ Y REQUIREMENT. TERM OR PoxpIN)p OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIN CERTIFICATE MY BE ISSUED OR Y PERI THE INSURANCE AFFORDED BY ME POLICIES CESCIEIBED HEREIN IS SUBIECT TO AL- ME TRANS, E%0.110 AND CONDITIONS OF SUCH POLICIES, AW NE MQMTS SHOWN MAY HAVE BEEN PEAKED BY PAN) CLUBS. GANGtLLNI HUN Th, Cl"ewyn Bee& AMOULD ANY OF THE ABUTSIMM MALICHAS BE CANCELLED BEFORE THE wLTR Elw nfl EXPIRATION DATE THEREOF. THE MSUING INSURER WILL ENDEAVOR TO MAIL 30 A 1C EXFIULLLBBIIJTY JL NFACVLGFNERAL LMBIIT' MB E �CCVR % RLOFES mLNBB.mRSw LOOP Newlaml Blvd. (ANONRWS BRUME 0 HOCCURRENCE 1.000.00 manna) RPS f100A0 MC.UP( wspewn) S3.B0 &LL NJURY 1.000.000 QIERALAGGREGAM 3.000.000 HL AGGREGATE LIME APPLIES PER: W C — LI -PREM- RCOJCLBCOMP.OPMSG. 3.000.00 Any{) fmoonGlr.. AtleMMn: VTOMOwLE LNBILRY Y "UNTO ovmEDMlroa CHEWIJL ALRD IREOANOa -0WREUAUTOB INEDMI ELIMR aaudem0 0DILY INJURY rmrson) DILYINIURY Pssd6n11 OFERTY CNMGE Psasxm0 6 WHILRY AUTOUTHERTHAN gILYFA FCGCEM EA ACC pQY: AGG %CESSIUNBR LABILItt :IDGGSUR DAIMSMADE EOUCTIBIE ETENIN BACHOCCURAMENCE IMAHEGATE RKERS COMPENSATION AND EMPLOYERS' LUBILATY nd, NEI PROACK0,51 mem TATkUTORV TAR ALERSI THER,naeV OESCRPTION OFL 10 CLUSICMS ADDED BY ENDORSE It is uncommoe and agnea that the following anal a City W IMwPoaI Beaab, As oMmrt, offil emplByea act v uM am added as an addlmal Nwntl but only as ,space Ne olwnllon, M the nantllI except Mat Uablllly meaning from Me enameled Interne ads ro lige Nmery and NanConldbubry. LooaBam OASIS Sector Centel, NO PRIT"I n AWI Comm Del Mar. IN, OERTIFIGAI t HILUM GANGtLLNI HUN Th, Cl"ewyn Bee& AMOULD ANY OF THE ABUTSIMM MALICHAS BE CANCELLED BEFORE THE The CTy IM NK . aMSMa. amplyara aro MUMaers EXPIRATION DATE THEREOF. THE MSUING INSURER WILL ENDEAVOR TO MAIL 30 Primary and NmtmlrWlrry EMavowd RAYS WRTTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT LOOP Newlaml Blvd. FHLVRE TO CO SO BHVL IMPOSE NO OBLIGATION OR LUBILNY OF MY AND UPON NenWrIBUCA G.9M83 HE WSVRER WE AGEMB OR REPRESENTATIVES AUTHORIZED REPRESENTAl1VE Any{) fmoonGlr.. AtleMMn: AC0RO25(20312) CD«ificaleC 84562 AGGRO CORPORATION 19M POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 26 D7 04 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 I Name Of Additional Insured Persons) Or Organization(s) I The City of Newport Beach, The City its officers, officials, employees and volunteers, Primary and Non -Contributory Endorsement 3300 Newport Blvd. Newport Beach, CA, 92663 Information required to complete this Schedule, if not shown above, will be shown In the Declarations. Section II —Who Is An Insured is amended to include as an additional insured the person(s) or organizagon(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf. A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © 160 Properties, Inc., 2004 Page 1 of 1 PROOF OF INSURANCE Interinsurence Exchange of the Automobile Club Named Insured Policy Number: GLASSMAN, KEITH AND TOZER, SARAH Effeclive Data 06-29-10 Expiration Date: 0629-11 This ylicy provides at seat the minimum amounts of liablily insurance required by the CA VEH CODE SECTION 18056 for The specified