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AVMP / City Birthday Audio Visual 17ta Qa�( rev 1 11 M '."' N ,I " 1 - MEMORANDUM TO: Chris Escobedo, Community Resources Director FROM: Jaime Torres, Management Assistant DATE: April 25, 2017 RE: Agreement with Audio Visual Meeting Professionals (AVMP) Attached for your signature is THE SHORT FORM SERVICES AGREEMENT for audio services for the picnic and birthday celebration on Saturday, April 29, 2017. Please sign the attached agreement(s) and return to the City Clerk for processing and distribution. Requesting department shall check and attach the items below as appropriate: X Contract payments will be charged to account number: 101-3003-60149 AGR2017-0026 X Amount of Agreement, Amendment, Change Order, etc.: $940.50 NA A Conflict of Interest Form 700 Statement of Economic Interests from Consultant(s) is attached with no reportable interests in LQ or reportable interests NA 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 Dept. Dlrsignature authority provided under Resolution No. 2015-045 for budgeted expenditures of $50,000 or less. This expenditure is $9,900 and authorized by contract approved by Council. NA Initial to certify that 3 written informal bids or proposals were received and considered in selection The following required documents are attached to the agreement: X Insurance certificates as required by the agreement Approved by Pam Nieto On 04/24/17 NA Performance bonds as required by the agreement (originals) X City of La Quinta Business License number LIC-763133 NA Purchase Order number t(VQ�r� --- GEM of the DESERT CITY OF LA QUINTA SHORT -FORM SERVICES AGREEMENT ($25,000 OR LESS) 1. PARTIES AND DATE. This Agreement is made and entered into this 18 day of April, 2017, ("Effective Date") by and between the City of La Quinta, a Municipal Corporation and Charter City organized under the Constitution and laws of the State of California with its principal place of business at 78-495 Calle Tampico, La Quinta, CA ("City") and. Audio Visual Meeting Professionals (AVMP), an Audio Visual service provider with its principal place of business at 79125 Corporate Way #662, La Quinta, CA ("Vendor"). City and Vendor are sometimes individually referred to as "Party" and collectively as "Parties" in this Agreement. 2. TERMS AND CONDITIONS. The Parties shall comply with the terms and conditions in the attached Exhibit "A" 3. SCOPE AND SCHEDULE OF SERVICES. Vendor shall provide to City the services pursuant to the date(s) and schedule(s) described in accordance with the schedule set forth in Exhibit "B". 4. TERM. The term of this Agreement shall be for a one day event on April 29, 2017 unless earlier terminated as set forth in the attached Terms and Conditions. This Agreement may not extend beyond a period of five (5) years, unless under the City's Fiscal Policies and Procedures this Agreement is exempt from the five (5) year limitation. 5. COMPENSATION. Vendor shall receive compensation for services rendered under this Agreement at the rates and schedule set forth in the attached Exhibit "C" but in no event shall Vendor's compensation exceed Nine -Hundred Forty dollars and Fifty cents ($940.50) per the City Picnic 2017 event (April 29, 2017) without written amendment. 6. FORCE MAJEURE. The time period specified for performance of the services rendered pursuant to this Agreement shall be extended because of any delays due to unforeseeable causes beyond the control and without the fault or negligence of Vendor including, but not restricted to, acts of God or of the public enemy, fires, earthquakes, floods, epidemic, quarantine restrictions, riots, strikes, freight embargoes, acts of any governmental agency other than City, and unusually severe weather, if Vendor shall within ten (10) days of the commencement of such delay notify the City in writing of the causes of the delay. The City shall ascertain the facts and the extent of delay, and extend the time for performing the Services for the period of the forced delay when and if in their judgment such delay is justified, and the City's determination shall be final and conclusive upon the parties to this Agreement. Extensions to time periods for performance of services, which are determined by the City to be justified pursuant to this Section, shall not entitle the Vendor to additional compensation unless City expressly agrees to an increase in writing. 7. INSURANCE. In accordance with Section 4 of Exhibit "A", Vendor shall, at its expense, procure and maintain for the duration of the Agreement such insurance policies as checked below and provide proof of such insurance policies to the City. Vendor shall obtain policy endorsements on Commercial General Liability Insurance that name Additional Insureds as follows: The City of La Quinta, its officers, officials, employees and agents. Commercial General Liability Insurance: Z $1,000,000 per occurrence/$2,000,000 aggregate OR ❑ $2,000,000 per occurrencel$4,000,000 aggregate. ® Additional Insured Endorsement naming City of La Quinta (above) Automobile Liability: M $1,000,000 combined single limit for bodily injury and property damage. Workers' Compensation: Statutory Limits / Employer's Liability $1,000,000 per accident or disease. ® Workers' Compensation Endorsement with Waiver of Subrogation Professional Liability (Errors and Omissions): ❑ Errors and Omissions liability insurance with a limit of not less than $1,000,000 per claim. IN WITNESS WHEREOF, each of the Parties has caused this Agreement to be executed on the day and year first above written. CITY OF LA QUINTA Digitally signed by Frank J. Spevacek i DN: cn=Frank J. Spevacek, -City of La Quinta, ou=City Manager, email=fspevacek@la- quinta.org, c=US By: Date: 2017.04.25 15:25:54-07'00' STAFF NAME: Frank J. S'pevacek, City Manager STAFF TITLE: aty of La Quinta, California Required for over $5,000: By: DEPARTMENT DIRECTOR/MANAGER APPROVED AS TO FORM: WILLIAM H. IHRKE, City Attorney City of Lo Quinta, California .2 -2 �vr�y VENDOR NAME ' _ /� ✓ OWNER/OFFICER NAME OWNER/OFFICER TITLE OWNERIOFFICER NAME OWNER/OFFICER TITLE ATTEST: A SUSAN MAYSELS,`City Clerk City of La Quinta, California 2 EXHIBIT "A" TERMS AND CONDITIONS 1. Compensation. Vendor shall be paid on a time and materials or lump sum basis, as may be set forth in Exhibit "C", within 30 days of completion of the Work and approval by the City. 2. Compliance with Low. Vendor shall comply with all applicable laws and regulations of the federal, state and local government. Vendor shall assist the City, as requested, in obtaining and maintaining all permits required of Vendor by Federal, State and local regulatory agencies. Vendor is responsible for all costs of clean up and/or removal of hazardous and toxic substances spilled as a result of his or her Work. 3. Standard of Care. The Vendor shalt perform the Work in accordance with generally accepted professional practices and principles and in a manner consistent with the level of care and skill ordinarily exercised by members of the profession practicing under similar conditions. 4. Insurance. The Vendor shall take out and maintain, during the performance of all work under this Agreement: A. Commercial General Liability Insurance in the amounts specified in Section 6 of the Agreement for bodily injury, personal injury and property damage, at least as broad as Insurance Services Office Commercial General Liability coverage (Occurrence Form CG 0001), and if no amount is selected in Section 6 of the Agreement, the amounts shall be $1,000,000 per occurrence/$2,000,000 aggregate; B. Automobile Liability Insurance for bodily injury and property damage including coverage for owned, non -owned and hired vehicles, of at least $1,000,000 per accident for bodily injury and property damage, at least as broad as Insurance Services Office Form Number CA 0001 (ed. 6/92) covering automobile liability, Code 1 (any auto); C. Workers' Compensation in compliance with applicable statutory requirements and Employer's Liability Coverage of at least $1,000,000 per accident or disease. Vendor shall also submit to City a waiver of subrogation endorsement in favor of city, and D. Professional Liability (Errors and Omissions) coverage, if checked in section 6 of the Agreement, with a limit not less than $1,000,000 per claim and which shall be endorsed to include contractual liability. Insurance carriers shall be authorized by the Department of Insurance, State of California, to do business in California and maintain an agent for process within the state. Such insurance carrier shall have not less than an "A"; "Class VII" according to 26529.0000019101737.2 A-1 the latest Best Key Rating unless otherwise approved by the City. S. Indemnification. The Vendor shall indemnify and hold harmless the City, its Council, members of the Council, agents and employees of the City, against any and all claims, liabilities, expenses or damages, including responsible attorneys' fees, for injury or death of any person, or damage to property, or interference with use of property, or any claim of the Vendor or subcontractor for wages or benefits which arise in connection with the performance of this Agreement, except to the extent caused or resulting from the active negligence or willful misconduct of the City, its Council, members of the Council, agents and employees of the City. The foregoing indemnity includes, but is not limited to, the cost of prosecuting or defending such action with legal counsel acceptable to the City and the City's attorneys' fees incurred in such an action. 6. Laws and Venue. This Agreement shall be interpreted in accordance with the laws of the State of California. If any action is brought to interpret or enforce any term of this Agreement, the action shall be brought in a state or federal court situated in the County of Riverside, State of California. 7_ Termination. The City may terminate the services procured under this Agreement by giving 10 calendar days written notice to Vendor. In such event, the City shall be immediately given title and possession to any original field notes, drawings and specifications, written reports and other documents produced or developed for the services. The City shall pay Vendor the reasonable value of services completed prior to termination. The City shall not be liable for any costs other than the charges or portions thereof which are specified herein. Vendor shall not be entitled to payment for unperformed services, and shall not be entitled to damages or compensation for termination of work. Vendor may terminate its obligation to provide services under this Agreement upon 30 calendar days' written notice to the City only in the event of City's failure to perform in accordance with the terms of this Agreement through no fault of Vendor. $. Agreement Terms. Nothing herein shall be construed to give any rights or benefits to anyone other than the City and the Vendor. The unenforceability, invalidity or illegality of any provision(s) of this Agreement shall not render the other provisions unenforceable, invalid or illegal. Notice may be given or delivered by depositing the some in any United States Post Office, certified mail, return receipt requested, postage prepaid, addressed to the parties to the addresses set forth in the Agreement. Vendor shall not assign, sublet, or transfer this Agreement or any rights under or interest in this Agreement without the written consent of the City, which may be withheld for any reason. Vendor is retained as an independent contractor and is not an employee of the City. No employee or agent of Vendor shall become an employee of the City. The individuals signing this 26529.00000\9101737.2 A_2 Agreement represent that they have the authority to sign on behalf of the parties and bind the parties to this Agreement. This is an integrated Agreement representing the entire understanding of the parties as to those matters contained herein, and supersedes and cancels any prior oral or written understanding or representations with respect to matters covered hereunder. This Agreement may not be modified or altered except in writing signed by both parties hereto. AVMP 79125 Corporate Way #6612 La Quinta, CA 92248 US (760) 969-6008 PROPOSAL AL ADDRESS Jaime Torres City of La Quinta 78495 Calie Tampico La Quinta, CA 92253 EVENT DATE 4/29/2017 DESCRIPTION Shure SM 58 DI Box For Guitar 12 Channel Mackie Audio Mixer EV Powered Speaker Labor 7am-2:30pm Delivery Discount 10% Equipment EXHIBIT B SCOPE AND SCHEDULE OF SERVICES LOCATION AND TIME Civic Center Park 9am-1 pm TOTAL Accepted By Accepted Date EO# City Picnic AVIVIP Audio Ysuai MW V.ju #'rofe5sinna9s PROPOSAL # 79373 DATE 03/29/2017 QTY RATE AMOUNT 4 35.00 140.00 1 30.00 30.00 1 100.00 100.00 2 75.00 150.00 7.50 65.00 487.50 1 75.00 75.00 1 -42.00 -42.00 $940.50 EXHIBIT "C" COMPENSATION FOR SERVICES In consideration of the foregoing Recitals and the covenants and ,promises hereinafter contained, and for good and valuable consideration, the sufficiency and receipt of which are hereby acknowledged, the parties hereto agree as follows: 1. Compensation for services is amended to read as follows: Compensation for services described in Exhibit "B" to be made upon the completion of the event (1:00 p.m. on 4/29/2017) regardless of rain or shine in the amount of Mine -Hundred Forty Follars and Fifty Cents ($940.50). In all other respects, the Original Agreement shall remain in effect. C-1 CERTIFICATE OF LIABILITY INSURANCE 4/17/2017E(MM/) 017 F'o THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Athos Insurance Services, LLC P.O. Box 61102 CONTACT NAME: Any Representative ac,Nr o, Ext : 626 716 9800 C, No : FAX 626 701 5047 ADDRESS: service@athosinsurance.com Pasadena, CA 91116 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: United States Fire Insurance INSURED INSURERB: Atlantic Specialty Insurance Company AVMP Inc. INSURERC: 79125 Corporate Way #6612 INSURER D : La Quinta, CA 92248 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2,000,000 X COMMERCIAL GENERAL LIABILITY A CLAIMS -MADE Fx I OCCUR X SRPG-101-0716/ USS336846 3/4/2017 12:01 AM 3/4/2018 12:01 AM PERSONAL & ADV INJURY $1,000,000 EACH OCCURRENCE $1,000,000 FIRE DAMAGE (Any one fire) $300,000 GEN'L AGGREGATE LIMIT APPLIES PER: MED EXP (Any one person) $5,000 X POLICY ECT LOC $ AUTOMOBILE LIABILITY COMBwED Ea SINGLE LIMIT accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ HIRED AUTO NON -OWNED AUTOS q PROPERTY DAMAGE Per accident) $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DIED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N WC STATU- TORY LIMITS OTH- ER $ ssss ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 4/1/2017 4/1/2018 Limit Description Supplement B Inland Marine Coverage 790011744-0004-26526 12:01:00 12:01:00 Deductible $250.00 AM PST AM PST Options Supplement DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of La Quinta, its officers, officials, employees, agents, and volunteers are named as Additional Insured and Loss Payee. Theft From Unlocked Vehicle Warranty Exclusion Applies — This means there is NO Coverage for Theft From an Unlocked Vehicle. There is no coverage for Rented Autos. CERTIFICATE HOLDER CANCELLATION City of La Quinta, its officers, officials, employees, agents & volunteers SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 78495 Calle Tampico ACCORDANCE WITH THE POLICY PROVISIONS. La Quinta, CA 92253 AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD XCORP05P(TION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION Policy Number: SRPG-101-0716/USS336846 Insured: AVMP 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, its officers, officials, employees, agents, and volunteers 78495 Calle Tampico La Quinta, CA 92253 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 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 of 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 © ISO Properties, Inc., 2004 Page 1 of 1 13 IIC� VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE 6ATC(MMODNYYYI 6-�04111702017 THIS CrERTIMCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERT[F[C.ATE HOLDEN, TKIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND. EXTEND OR ALTER THE COVERAGE AI=FORI]I;p BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5), AUTHORIZED RURESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, This farm is used to report coverages prov[ded to a single specific vehicle or equipment. Do net use this form tO repnrt liability Coverage ProvIdL-d to multiPlo vohicles under a Single policy. IJ'se ACORD 25 for that purpose. PROPU G ER c0riTACT r NAME; C laudia € iral a S1I3[0hIrM Carmen E Contmms PHONE I...-347-153[) IFA C. fLA,'C, N@. ERGS. ow 81709 dr. Oarreon Sivd_, Suite 06 E4AAr1 .. ADDRESS: Indite, CA 92201 PRODUCER — CLrST¢M�R NSURERIS,j AFFORDING COVERA13E HAIL N WguREr1 INSUREHA, Slate, Farrel Mut;jal ,%utomobile Insurance Cmmparl 251 (8 hlihafll 4Vrlsrn INSURER 8 51925 PtiYerTelda V+II�}[� sINSURERC ! s _ La Qulnia, CA 92253 _ Ir:S LIHEF F' DESCRIPTION OF VEHICLE OR EQUIPMENT — �YF-.A,R MAKE.' MAk-rFFArrTURER MODEL HODY TYPE I VEMCL E IDENTI FICATION N LIM DER 2Ci1)5 CwMC 35Q0 Bai{Trk 1G9JG31U35i242449 DESCRIPTION VEi1C1yjTQuWMENTVALUE SPRJALNUM13ER - - COVERAGES CERTIFICATE NUMBER'. REVISION NUMBER: THIS IS '*J CE.�—IF 3 THAT iriE POLICY(IES) OF INSURANCE I-.^7 T ED BELOW 1A3HAVE BEEN ISSUED TO THE INSUIiEi).1LAME} ABf)V'IE FOR THE POLICY PERIOp( ) INDiC7e I EO, NOTWITHSTANOING ANY RFQUIR,EM NT, TERM ()R rONDIPION OF ANY CONTRACT OR OTHER 00C UMENT WITH RF;SPEC:T TO WHICH THIS CERT'FiCATF Iw1AY BE 1,5SUED OR MAY PERTAIN, THE INSURANCE AFFORDED.BY THE POLICY IES) DFSCR-BED HFRIEIN ISrARE SUBJECT TO ALL -HE T EI{t+aS, EXCLUSIONS ANL) CONDITIONS OF SUCH POLiCYNF.S) INSR!OMD1, ! POLICY EFFECT€VE. I POLICY EXPIRATION LTR INSR➢; 'TYPE Or INS URAN" POLICY NLINHER DATE (MwDDNYVYj DATE (MIN,IDDFYYY7I LIMITS / VEH0121-6 i °FlFILITY r_0L1RINFD,.3iNr _LLIMIT € 1j [j �j{jIj 6G01Y INJURY r Par penal* € 3�154194•AD5-55 01JQSP2C}17 C}1�05,"2�}17 EP0U!1_Y IVAURY{Pw aarllor'P) 3 PROPERTY DAMAGE S. GENE LIARILITY I EACHOCCURE,4CE S dIBOIJRRFSrs...t f.;ENERALAGGRFCfA1C $ FICLAIMS. PbloF t INSk L= I POLICY EFFEC" POLICY E%PIRATIO N LTR PAYEE TYPE or- Ia5U RANCE POLICY NLIMI3ER DATE (MPIODlYYYY} DAY E {IVIIWDDL YYYI Glldlrs 1 DEDUCTIBLE YsH CCL_ISION I L ^Ij ❑ ACV C1 nraREEG FJ.TT € LJIiLT ❑ ❑ STA7FD AMi S OEp VEr+CGV7 VFHEAC — "°-- ❑ h,C4f _ ACREzO AF.TT S LY>tfT ❑ I -I STATF13AMI- S DED EQUIPMENT I ❑ACV ❑ AZREM AMT HAE.q;. BROAD' LIMIT m RC D STATI D AMT € SPECIAL a I PrWARK54INCLUMUG SPCGIAL CONUMONS i OTHER COV€RAQES} rALiacn ACORD -at, Addiiirarlej Remarks Scnatlula, if mprey 6ki3oe i9Taquimd) ADDITIONAL. INTEREST CANCELLATION Sel+act one at the ipllowing: SHOULD ANY OF THE ABOVE DESCRIBED PULIGIEE BE CANCELLED I k� �IkdIIIUI I er ret4 Gcrcntnd rryp.I r 3s G rn zldrd po :he, Pdr Iosl GSteQ Ysren dy P + ru rrlber{el. BEFp#E THE EXPIFIATIIbN GATE THEREOF. NOTICE WILL BE k r4�Erty1 c9rlhrss horny rllrr Js��sJ [ie admnay rorww lmibtw Wow to lhapoW-pI*&) DELIVERED IN ACCORDANCE WITH THE POLICY PRoVI$rnNs. lislec Nreni. .hY rx7llrj=r14R�'s . _ VrHIC[E7EQUIPMENT JNTERE$y: � I.:EASEbv FINANCED orscRjFwNOFTHE A31101-4ALINTEREST NAME AND ADDFIESE OF ADDITIOKALINSERE$Y i A IRTIQNA L IN5URED �I LOSS PAYEE Oty Of La ❑Uinta LENDER'S LOSS PAYEE I {pears, C]ff0als_ ElmpbynvAG and Agents LOAN a LFASE NUMBER AUTHO o #f RESENTA — 0 1997-2015 ACORM CORPORATEION, ALIT rights rem ACORD 23 (2G161d3) The ACORD nime and logo are regislered marks of ACORD lIX9361 142M7A 01-2B-!LtJB CERTHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-12-2017 CITY OF LA QUINTA SP 78495 CALLE TAMPICO LA QUINTA CA 92253-2839 CROUP: POLICY NUMBER: 9202444-2017 CERTIFICATE 10: 2 CERTIFICATE EXPIRES: 01-04-2018 01-04-2017/01-04-2018 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE # 1 DATED 01-06-2017 This is t❑ certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2017-01-12 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF LA QUINTA ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2017-01-06 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF LA QUINTA EMPLOYER AVMP SP 79125 CORPORATE WAY #6812 LA QUINTA CA 92248 [TIT,CS] (REv.7-2014) PRINTED : 01-12-2017 _ TEENDORSEMENT AGREEMENT COMPENSATION WAIVER OF SUBROGATION FUND 9202444-17 NEW SP HOME OFFICE SAN FRANCISCO PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC EFFECTIVE JANUARY 6, 2017 AT 12.01 A.M. STANDARD TIME OR THE TIME INDICATED AT AND EXPIRING JANUARY 4, 2018 AT 12.01 A.M. PACIFIC STANDARD TIME AVMP 79125 CORPORATE WAY #6612 LA QUINTA, CA 92248 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF LA QUINTA WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, AVMP IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER, IT -IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS -OF SUCH -- EMPLOYEES SHALL BE INCREASED BY 03%. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAAN FRANCISCO: JANUARY 10, 2017 2570 AUTHORIZED REPRESENT iVf PRESIDENT AND CEO SCIF FORM 10217 IRFV,7-20141 OLD DP 217