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2018-19 Medeiros, Joy (Instructor) - Tai Chi Chuan ClassesW �W ■ ■ d:1'�1211Q I I & TO: Frank J. Spevacek, City Manager FROM: Christina T. Calderon, Community Resources Manager DATE: August 10, 2018 RE: Joy Medeiros, Fitness Classes, #AGR422601-18, Instructor Attached for your signature is an agreement with independent contracted instructor Joy Medeiros for (Tai Chi Chuan) class(s). Please sign the attached agreement(s) and return to the City Clerk for processing and distribution. Requesting department shall check and attach the items he(ow as appropriate: X Contract payments will be charged to account number: 101-0000-42214 X Amount of Agreement, Amendment, Change Order, etc: 70% of fees are paid to instructor 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). Au1b9rity_t_a ex9cut0 this oureement is based upon: X Approved by the City Council on ApOV8 20 :? X City Manager's signature authority provided under Resolution No. 2015-045 for budgeted expenditures of $50,000 or less. This expenditure is $ and authorized by contract approved by N/A Initial to certify that 3 written informal bids or proposals were received and considered in selection The following rewired documents are attached to the agreement: X Insurance certificates as required by the agreement (approved by Risk Manager on date) N/A Performance bonds as required by the agreement (originals) X City of La Quints Business License number LIC-763761 Expires 3/31/2019 N/A A requisition for a Purchase Order has been prepared (amounts over $5,000) I N/A A copy of this Cover Memo has been emailed to Finance (Sandra) Revised May 2017 3-3 ta a�Kra City of La Quinta -- GLI offheDESGRT — Community Services Department Contract # 422601-18 INSTRUCTOR AGREEMENT This INSTRUCTOR AGREEMENT is hereby formed on JULY 1, 2018 through JUNE 30, 2019 between the CITY OF LA QUINTA, COMMUNITY RESOURCES DEPARTMENT ("CITY") and JOY MEDEIROS, a person or business engaged in offering services ("CONTRACTOR") for Contractor's Provision of Services to the City. CITY AND CONTRACTOR MUTUALLY AGREE AS FOLLOWS: 1. SCOPE OF WORK. The scope of work is described as: FITNESS (TAI CHI CHUAN) classes held at a City of La Quinta facility. The scope of work includes all goods and actions necessary to complete the task CONTRACTOR has been hired to perform, whether specifically included in the scope of work or not. Specific dates and times for contracted work will be requested by lettef, to CONTRACTOR from CITY on a bi-annual basis. Work proposals, once approve y CITY will be attached as exhibits to this INSTRUCTOR AGREEMENT. (initials) {1 2. COMPENSATION. CONTRACTOR shall be paid for services performed under this INSTRUCTOR AGREEMENT as follows: CONTRACTOR shall recommend fees to be charged by CITY. Such fees shall be paid directly to CITY. CITY shall maintain written records of gross receipts and shall submit such records to CONTRACTOR upon request. CONTRACTOR shall be compensated based on the following: STANDARD SESSIONS. CITY shall pay 70% of gross receipts collected to CONTRACTOR as compensation based upon the records and shall retain the remaining 30% for the use of public facilities for such services. This compensation shall be the total compensation for services, including out-of-pocket costs. CITY shall pay no other compensation to CONTRACTOR. Payments will be made to CONTRACTOR after each session of work is completed as defined in Section 1, SCOPE OF WORK and will follow the approved annual payroll calendar. DROP -IN SESSIONS. CITY shall pay 70% of gross fees to CONTRACTOR as compensation based upon the records and shall retain the remaining 30% for the use of public facilities for such services. This compensation shall be the total compensation for Rev May 2015 1 services, including out-of-pocket costs. CITY shall pay no other compensation to CONTRACTOR. Payments will be made to CONTRACTOR after each session of work is completed as defined in the SCOPE OF SERVICES and will follow the approve3d annual payroll calendar. 3. INDEPENDENT CONTRACTOR. This INSTRUCTOR AGREEMENT calls for the performance of the services of CONTRACTOR as an independent contractor and not as an employee of CITY. Neither CITY nor any of its employees shall have any control over the manner, mode, or means by which CONTRACTOR or its agents, perform the services required herein, except as otherwise set forth herein. CONTRACTOR shall perform all services required herein as an independent contractor of CITY and shall remain at all times as to CITY a wholly independent contractor with only such obligations as are consistent with that role. CONTRACTOR shall have no power to incur any debt, obligation, or liability on behalf of CITY. CONTRACTOR shall not at any time or in any manner represent that it or any of its agents or employees are agents or employees of CITY. CONTRACTOR and any of its agent, and subcontractors providing services under this INSTRUCTOR AGREEMENT shall not qualify for or become entitled to any compensation, benefit, or any incident of employment by CITY, including but not limited to eligibility to enroll in the California Public Employees Retirement System ("PERS") as an employee of CITY and entitlement to any contribution to be paid by CITY for employer contributions and/or employee contributions for PERS benefits. CONTRACTOR agrees to pay all required taxes on amounts paid to CONTRACTOR under this INSTRUCTOR AGREEMENT, and to indemnify and hold CITY harmless from any and all taxes, assessments, penalties, and interest asserted against CITY by reason of the independent contractor relationship created by this INSTRUCTOR AGREEMENT. CITY shall have the right to offset against the amount of any compensation due to CONTRACTOR under this INSTRUCTOR AGREEMENT any amount due to CITY from CONTRACTOR as a result of CONTRACTOR's failure to promptly pay to CITY any reimbursement or indemnification arising under this paragraph. 4. INDEMNIFICATION. To the fullest extent permitted by law, CONTRACTOR shall indemnify, protect, defend (with counsel selected by City) and hold harmless CITY and any and all of its officials, employees and agents ("Indemnified Parties") from and against any and all liability, claims, suits, actions arbitration proceedings, administrative proceedings, regulatory proceedings, losses, liabilities of every kind, nature, and description, damages, injury (including, without limitation, injury to or death of CONTRACTOR or of any subcontractor) costs and expenses of any kind, whether actual, alleged or threatened, including, without limitation, incidental and consequential damages, actual attorneys' fees incurred by CITY, court costs, interest, defense costs including fees of expert contractors or expert witnesses incurred in connection therewith and any other costs or expenses of any kind whatsoever incurred in relation to, as a consequence of, or arising out of or in any way attributable in whole or in part to the performance of this INSTRUCTOR AGREEMENT by Rev May 2015 2 CONTRACTOR or by any individual or entity for which CONTRACTOR is legally liable, including but not limited to agents or subcontractors of CONTRACTOR.. All obligations under this provision are to be paid by CONTRACTOR as CITY incurs them. Without affecting the rights of CITY under any provision of this INSTRUCTOR AGREEMENT, CONTRACTOR shall not be required to indemnify and hold harmless CITY for liability attributable to the active negligence of CITY, provided such active negligence is determined by contract between the parties or by the findings of a court of competent jurisdiction. In instances where CITY is shown to have been actively negligent and where CITY's active negligence accounts for only a percentage of the liability involved, the obligation of CONTRACTOR will be for that entire portion or percentage of liability not attributable to the active negligence of CITY. PRnmPT mnTTrr roK1TParTr)R nnraac to nm%iirin immarfinta notice to CITY of any claim or loss against CONTRACTOR arising out of the work performed under this INSTRUCTOR AGREEMENT. CITY assumes no obligation or liability by such notice, but has the right (but not the duty) to monitor the handling of any such claim or claims if they are likely to involve CITY. 5. CANCELLATIONS/CHANGES. CITY RESPONSIBILITY. CITY will contact CONTRACTOR and all program participants if CITY cancels or changes a program from original approved schedule based on zero enrollments, minimum student requirement not met, or if use of facility becomes unavailable. CITY reserves the right to change original approved schedule of program if the facility becomes unavailable. CITY will attempt to re- locate said program to another suitable facility if one is ova'1laW.,• .f there are no available facilities, CITY will cancel said prograrvr and coordinate with CONTRACTOR to schedule a make-up date. +i (initials) ` CONTRACTOR RESPONSIBILITY. CONTRACTOR will contact CITY as defined in the NOTICE section in advance to notify of any cancellations or changes from original approved schedule if said program is cancelled or changed by CONTRACTOR. CONTRACTOR will be solely responsible to contact any and all participants o' � program. Programs that are cancelled or changed by CONT4�' OR must be made up in a timely manner as approved by CITY. (initials) 6. INSURANCE. It is to be understood that CONTRACTOR is working under a contractual obligation as specified in this INSTRUCTOR AGREEMENT and is responsible as a self-employed person to remit any Federal or State Income Taxes, and to provide for his/her own Worker's Compensation, Disability Insurance, Unemployment Insurance coverage, Social Security, Liability Rev May 2015 3 Insurance and other such coverage, as applicable, in the amounts and under the conditions as set forth below. A. Commercial General Liability Insurance using Insurance Services Office "Commercial General Liability" policy form CG 00 01, with an edition date prior to 2004, or the exact equivalent. Coverage for an additional insured shall not be limited to its vicarious liability. The insurance policy shall contain a severability of interest clause providing that the coverage shall be primary for losses arising out of Contracting Party's performance hereunder and neither City nor its insurers shall be required to contribute to any such loss. Defense costs must be paid in addition to limits. Limits shall be no less than $1,000,000 per occurrence for all covered losses and no less than $2,000,000 general aggregate. 6.1 CONTRACTOR agrees to provide evidence of the insurance required herein, satisfactory to CITY, consisting of. (a) certificate(s) of insurance evidencing all of the coverages required and, (b) an additional insured endorsement to CONTRACTOR's Commercial general liability policy using ISO Form CG 20 10 with an edition date prior to 1988, which form shall include coverage for completed operations and, The additional insured endorsement shall expressly name CITY, its officers, and employees as additional insureds on the policy (ies) as to commercial general liability coverages, and completed operations coverages, with respect to liabilities arising out of CONTRACTOR's performance of the services under this INSTRUCTOR AGREEMENT. 6.2 CONTRACTOR shall provide written notice to CITY within ten (10) working days if. (1) any of the required insurance policies is terminated; (2) the limits of any of the required polices are reduced; or (3) the deductible or self - insured retention is increased. In the event any of said policies of insurance are cancelled, CONTRACTOR shall, prior to the cancellation date, submit new evidence of insurance in conformance with this Section 6 to CITY. The procuring of such insurance or the delivery of policies or certificates evidencing the same shall not be construed as a limitation of CONTRACTOR's obligation to indemnify CITY, its officers, employees, contractors, subcontractors, or agents. 7. BUSINESS LICENSE. CONTRACTOR will be required to obtain a City of La Quints Business License within thirty (30) calendar days of this signed INSTRUCTOR AGREEMENT. A copy of the current La Quinta Business License must be provided to the Community Services Department within five (5) business days of receipt. S. COMPLIANCE WITH LAW. All services rendered hereunder shall be provided in accordance with all ordinances, resolutions, statutes, rules, regulations, and laws of CITY and any Federal, State, or local government agency of competent jurisdiction. Rev May 2015 9. COVENANT AGAINST DISCRIMINATION. CONTRACTOR covenants that, by and for itself, its heirs, executors, assigns, and all persons claiming under or through them, that there shall be no discrimination against or segregation of, any person or group of persons on account of race, color, creed, religion, sex, marital status, national origin, disability, or ancestry in the performance of this INSTRUCTOR AGREEMENT. 10. NO ASSIGNMENT. CONTRACTOR shall not, under any circumstances, assign this INSTRUCTOR AGREEMENT or its rights or duties without prior written authorization fra ITY. Should such authorization be granted, CONTRACTOR agrees to infra y subcontractor of all the stipulations of this INSTRUCTOR AGREEMENT; (initials) r V Please list any/all subcontractors you may hire for the term of this INSTRUCTOR AGREEMENT. Name Address Phone Number Subcontractors listed above have been approved by CITY to perform the scope of work, as provided in Section 1. Additional subcontractors will require prior written approval from CITY. 11. TERMINATION. It is understood that CONTRACTOR will perform all services set forth herein in a good and workable manner. CITY reserves the right to terminate services for any reason, including, but not limited to, insufficient number of participants or unavailability of facilities. In such circumstances, CITY shall not be liable for compensation or damages to CONTRACTOR for remainder of this INSTRUCTOR AGREEMENT. 12. NOTICE. Notice shall be deemed given when CONTRACTOR contacts CITY COMMUNITY RESOURSES COORDINATOR or COMMUNITY SERVICES SUPERVISOR in person, via telephone call, email, faxed with a fax return, or seventy-two (72) hours after deposit in the United States mail postage prepaid, return receipt requested, addressed as follows: CONTRACTOR: Joy Medeiros 60240 Desert Shadows Drive La Quinta, CA 92253 CITY: Community Resources Department City of La Quinta La,Ouinra, CA 92253 '; : (initials) Rev May 2015 13. DOCUMENTS. Any documents and marketing materials created by CONTRACTOR under this INSTRUCTOR AGREEMENT shall be submitted to CITY for approval prior to distribution. 14. MISCELLANEOUS. This INSTRUCTOR AGREEMENT is the only agreement between CONTRACTOR and CITY and may be amended in writing and agreed upon by both parties. No waiver of any term or condition of this INSTRUCTOR AGREEMENT shall be a continuing waiver thereof. IN WITNESS WHEREOF, the parties hereto have caused this INSTRUCTOR AGREEMENT to be executed the day and year as first stated above. CITY OF LA QUINTA, COMMUNITY RESOURCES DEPARTMENT ("CITY") APPR By: 711& Chr4eo Calderon, Community Resources Manager Joy Medeiros ("CONTRACTOR") 60240 Desert Shadows Drive La Quinta, CA 92253 760.771.5187 c Rev May 2015 POLICY CHANGE DOCUMENT POLICY NO: CHANGE # 2 CHANGE EFFECTIVE: 01/06/2018 PH PK1761395-000 Philadelphia Indemnity Insurance Company PRODUCER: Maguire Insurance Agency, Inc. NAMED INSURED: Joy Medeiros MAILING ADDRESS 60240 Desert Shadows Dr La Quinta, CA 92253- POLICY PERIOD: FROM 01/06/2018 TO 01/06/2019 at 12:01 A.M. Standard Time at your mailing address shown above. DESCRIPTION: In consideration of the premium reflected, the policy is amended as indicated below: Adding Additional Insured: City of La Quinta 78-495 Calle Tampico La Quinta, CA 92253 Added CG 20 26 form as it applies. Total Annual Total Prorate Additional/Return Premium $0.00 Additional/Return Premium $0.00 Total Annual Total Prorate Additional/Return Additional/Return Tax/Surcharge/Fee $0.00 Tax/Surcharge/Fee Page 1 of 1 $0.00 AC " PRODUCER Maguire Insurance Agency, Inc. FWI 1 Bala Plz Ste 100 Bala Cynwyd, PA 19004--1401 610-617.7900 INSURED Joy Medeiros 60240 Desert Shadows Dr La Quinta, CA 92253- COVERAGES CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/07/2019 THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE INSURER A: Philadelphia Indemnity Insurance Companv INSURER B: _ INSURER C: - INSURER D: INSURER E: NAIC 11 18058 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERIFICATION MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE IMM/DD/YYYY DATE (MM/DD/YYYY) LIMITS A X GENERAL LIABILITY PHPK1761395- 01/06/2019 01/06/2020 EACH OCCURENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY 001 AGE E PREMISES Ea omurramcel $100,000 CLAIMS MADE �X OCCUR MED EXP (Any one person) $2,500 PERSONAL&ADV INJURY $2,000,000 X PROFESSIONAL LIABILITY GENERAL AGGREGATE $4,000,000 PRODUCTS-COMP/OP AGG $4,000,000 GENT AGGREGATE LIMIT APPLIES PER: X POLICY PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (EA accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT ' OTHER THAN EA ACC ANY AUTO AUTO ONLY: AGG EXCESS / UMBRELLA LIABILITY EACH OCCURENCE OCCUR ❑. CLAIMS MADE AGGREGATE DEDUCTIBLE RETENTION COMPENSATIONWORKERS A EMPLOYERS' LIABILITY Y N ANY PROPRIETOR PARTNER/EXECUTIVE H TORY LIMITS ER EL. EACH ACCIDENT OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA AMPLOYEE (Mandatory in NH) IW descrlhe under SPECIAL P ROVIMONS below E.L DISEASE -POLICY LIMIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS It is understood and agreed that the following entity is added as an additional insured but only with respect(s) to the operations of the named insured except that liability resulting from the additional insured's sole negligence. CERTIFICATE HOLDER CANCELLATION City of La Quinta 78495 Calle Tampico La Quinta„ CA 92253- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/01) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PHPK1761395-001 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 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 Organization(s): City of La Quinta 78495 Calle Tampico La Quinta, CA 92253- Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(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: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 PI-GL-005 (07/12) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization (Additional Insured): City of La Quinta Effective Date: 01/06/2019 SECTION If — WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the endorsement Schedule, but only with respect to liability for "bodily injury," "property damage" or "personal and advertising injury" arising out of or relating to your negligence in the performance of "your work" for such person(s) or organization(s) that occurs on or after the effective date shown in the endorsement Schedule. This insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured), except for loss resulting from the sole negligence of that person or organization. This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or "occurrence" we cover for this Additional Insured. The Additional Insured's limits of insurance do not increase our limits of insurance, as described in SECTION III — LIMITS OF INSURANCE. All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission p d CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DD/YYYY) 08/09/2019 PRODUCER THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION Maguire lrsamnce Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 27201 Puerta Real Ste 200 877, 38 7459 CA 92ev1-a3a9 877,438,7459 HOLDER. THIS CERTIFICATE DOES NOT AMMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NA_ICif_ INSURED _ _ _ INSURER A: Phlladel Joy Medeiros INSURER B' 60240 Desert Shadows Dr La Quinta, CA 922S3- INSURER C: ' INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERIFICATION MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADO'L POUCY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE.0F INSURANCE POLICY NUMBER DATEIMM/DDM'YY) DATEIMM OD YYY LIMITS A X GENEML UABILITY PHPK1761395- 01/06/2018 01/06/2019 EACH OCCURENCE S2,000,000 PAEMeTrES r�K $100,000 COMMERCIAL GENERAL LIABILITY G00 MEDEXP(Anypnepe6 .I S2,500 CLAIMS MADE OCCUR IX PERSONAL d ADV INJURY 52.000.000A-0n0.000 LIABILITY GENFRAL AGGREGATE SPROFESSIONAL PRODUCTS—COMP/OP AGG S4,0001000 GEN'LAGGREGATE LIMITAPPLIES PER: % POLICY 71 PROJECT F LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (EA accident) BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per perwo) BODILY INJURY HIRED AUTOS NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE UABIUTY AUTO ONLY — FA ACCI DENT OTHER THAN EA ACC ANV AUTO AUTO ONLY: AGG EXCESS / UMBRELLA UABILITY EACH OCCURENCE AGGREGATE OCCUR ❑ CLAIMS MADE DEDUCTIBLE RETENTION EMPLOYERS LIABILITY Y N TORY LIMITS EA ANY PROAItlETpN/PARTNER/EXECUTIVE L7FFLCERIAIEAdBER E]I{LUDED? E,L EACH ACCIDENT E L. DISEASE —EA AMPLOYEE (Mandatory In NHI Il yyrC describe under SPECfALPROVISIONS blow ` E.L, DISEASE — POLICY LI MIT OTHER DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS It is understood and agreed that the following entity is added as an additional insured but only with respect(s) to the operations of the named Insured except that (lability, resulting from the additional insured's sale negligence. This insurance is primary, with any insurance or self-insurance program maintained by the name of person or urganizatlun listed being nun -contributing exceptirg loss resulting from the sole negligence of the name of person or arganization listed. CERTIFICATE HOLDER CANCELLATION City of La Quinta 78495 Calle Tampico L. Quint., CA 922S3-2939 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25 (2009/01) C 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). ACORD 25 (2009/01) POLICY NUMBER: PHPK1761395-000 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 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 Organization(s): City of La Quinta 78495 Calle Tampico La Quinta CA 92253-2839 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(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: 1. In the performance of your ongoing operations; or 2.. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less_ This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1