2019-20 Bilhartz Desert Ins (Volunteer) - Medicare Infota
MEMORANDUM
TO: Christina T. Calderon, Community Resources Manager
FROM: Caroline Doran, Community Resources Specialist
DATE: October 23, 2019
RE: Brian Bilhartz Insurance, Volunteer Organization Agreement 2019
Attached for your signature is an agreement with Bilhartz Insurance offering Medicare
information to the Community.
Please sign the attached agreement for processing and distribution.
Requesting dg,gartment_shall check and attach the items below as
aupro ri :
N/A Contract payments will be charged to account number:
N/A Amount of Agreement, Amendment, Change Order, etc.: $
N/A A Conflict of Interest Form 700 Statement of Economic Interests from Consultant(s) is
attached with
no reportable interests in LQ or reportable interests
N/A A Conflict of Interest Form 700 Statement of Economic Interests is not required because this
Consultant does not meet the definition in FPPC regulation 18701(2).
Authority_to-execute this agreement is based upon:
N/A Approved by the City Council on
N/A City Manager's signature authority provided under Resolution No. 2019-021 for budgeted
expenditures of $50,000 or less. This expenditure is $ and authorized by
Director
N/A Initial to certify that 3 written informal bids or proposals were received and considered in
selection
The followinci required documents are attacled to the agreement:
X n�s]urance cert7i"I'les as required by the agreement (approved by Rlsk Manager on
C_ �%�J i It[:)
N/A Performance bonds as required by the agreement (originals)
N/A City of La Quinta Business License number
N/A A requisition for a Purchase Order has been prepared (amounts over $5,000)
Revised May 2017
VOLUNTEER ORGANIZATION
SERVICE AGREEMENT
Our organization, Bilhartz_Desert Instirance Agency, will provide volunteers to
perform only the services as outlined in the attached scope of work for the City of
La Quinta ("City"). We understand that we will not be compensated for our work and
we will complete our organization volunteer duties in a responsible manner. If we
decide to discontinue our organization volunteer services, our contact person
Adam Leis will notify Caroline Doran, City designee.
We understand and agree that:
No one in the group is to appear for volunteer service under the influence
of any drugs or alcohol.
• Our organization will provide the City with a roster of individual participants
including the names and hours worked.
Our organization will report any injuries sustained by participants during
their volunteer activities to Caroline Doran, City designee immediately upon
occurrence.
' Our organization is responsible for directly supervising the activities of all the
individuals in our group who will be doing volunteer work, and therefore, in
consideration of our organization and members being permitted to perform
services on City property, our organization agrees to defend, indemnify, and
hold harmless the City and its officials, employees, and agents from any
damage claim or lawsuit for injury, illness, damage or other loss of any kind
to anyone including members of our organization that might arise out of our
activities or the actions of any individuals of our group, except for injuries or
damages caused by the sole negligence of the City.
" Our organization has commercial general liability insurance of at least one
million dollars to cover our activities. A copy of the certificate of insurance, the
addmtje+ .L.C7 an "arl rEihirtnBk ire ei._r_n rl II
7 i
arrd-eattached prior to the start
of any activity.
The City may terminate this agreement at any time without cause, and we
agree that we are volunteering our services at will and may be asked to
discontinue such without prior notice or reason.
This agreement .will be in effect for the duration of our volunteer services or one year,
whichever is less, beginning on this date.
Dated this 24 day of October, 2019.
CITY OF LA QUINTA, 8ilriartz Desert Insurance AgencY—
a li rnia Municip 1 C ooration Name of Organization
RISTINA CALDERON, Authorized Signature on behalf of
Community Resources Manager Organization
City of La Quinta, California
Brian Bilhartz
Dated:
Printed Name
President
Title
ATTEST: 42376 Klondike Way Indio922C3
Address
MONIKA RAD VA, Cit Clerk
La Quinta, California
APPROVED AS TO FORM:
THAI PHAN, Acting Assistant City Attorney
City of La Quinta, California
W
CALIFORNIA
bri.a n� tyilha rtz.iasu rance.co ca—..
Email Address
760-459-9617 _
Phone Number
Attachment
Scope of Work
Bilhartz Insurance will provide Free Medicare Health Insurance information and
answer the community's questions about Medicare plans.
From: Yourpolicy@insurance.hiscox.com (v
Subject: Your Hiscox policy documents
Date: October 17, 2019 at 10:43 AM
To: Brian@ bilhartzinsurance. corn
Cc: NBS@nationwide.com, Steve (2—Ddesertins.corn
ACCW& CERTIFICATE OF LIABILITY INSURANCE °AtEptA°Gr.TT
10,17.2019
THS CERTIFICATE 18 ►S;SUED AS A MATTER OF INfORMATIOM ONLY AND CONFERS NO FIGHTS UPON THE CERTIFICATE HOLDER_ THIS
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