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Insurance Certificates 2017/18 World Triathlon Corporation DBA IronmanClient#: 18607 WORLDEND ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/03/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS OR ALTER THE COVERAGE AFFORDED BY THE POLICIES CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED must be endorsed. If SUBROGATION IS WAIVE°, subject to A statement on this certificate does not confer rights to the IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pallcy(ies) the terms and conditions of the policy, certain policies may require an endorsement. certificate holder in lieu of such endorsement(s). PRODUCER Bouchard Insurance, Inc. 101 N Starcrest Dr. Clearwater, FL 33765 727 447-6481 CONTACT NAME. PHONE 727 447-6481 FAX 727 449-1267 (AIC, No, so 727 No): ADDRL SS cicerts@bouchardInsurance.com ADDRE INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Philadelphia Indemnity Ina Co 18058 INSURED World Endurance Holdings Inc; World Triathlon Corporation; dba Ironman 3407 W Drive MLK Blvd, Suite 100 Tampa, FL 33607 INSURER B : Continental Casualty company 20443 '1 INSURER C: INSURER D: 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 SUER (WVp POLICY NUMBER A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE n OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY © PRO- . LOC Y I Y PHPK1630346 POLICY EFF (MMiDD/YYYY) 04/01/2017 (MM.. 04/01/2018 EACH OCCURRENCE LIMITS $1,000,000 PREMISES fEO a RENTED $100,000 MED EXP (Any one person) $5 000 PERSONAL & ADV INJURY $1.000.000 GENERAL AGGREGATE $3,000,000 PRODUCTS - COMP/OP AGG $3,000,000 A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED AUTOS x HIRED AUTOS x SCHEDULED AUTOS NON -OWNED AUTOS Y I Y X UMBRELLA LIAB EXCESS LIAB OCCUR X , CLAIMS -MADE DEP xi RETENT ON 510,000 B WORKERS COMPENSATION ANO EMPLOYEERRS' LIABILITY Y / N NY PROPRIE OFFICER/MEMBER PEXCLUDED7 ECUTIVE (Mandatory in NH] If yes, describe under DESCRIPTION OF OPERATIONS below N NIA Y PHPK1630346 PHUB577758 6018545149 04/01/2017 04/01/2018 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE JP accident) $ 04/01/2017 04/01/2018 EACH OCCURRENCE AGGREGATE $20,000,000 $20,000,000 08/31/2017 08/31/2018 X WC STATU- TORY LIMITS OTH ER E.L. EACH ACCIDENT $1,000,000 E.L DISEASE - EA EMPLOYEE $1,000.000 E -L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) ** Workers Comp Information ** Other States Coverage - Policy# 6018545149 Blanket Waiver of Subrogation except for states of KY, NH, NJ, WI. California Workers Comp - (See Attached Descriptions) 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, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S790949/M751224 JESWI DESCRIPTIONS (Continued from Page 1) B 6018545152 Effective Date: 08/31/2017 Expiration Date: 08/31/2018 WC Each Accident Limit: $1,000,000 WC Policy Limit: $1,000,000 WC Each Employee Limit: $1,000,000 Certificate holder is additional insured as respects General Liability and Auto Liability only if required by written contract, and subject to the terms, conditions and limits as specified in the policy. Waiver of subrogation applies in favor of certificate holder as respects General Liability and Auto Liability only if required by written contract, and subject to the terms, conditions and limits as specified in the policy. Coverage is primary as respects to General Liability and non-contributory as subject to the terms, conditions and exclusions of your policy. SAGITTA 25.3 (2010/05) 2 of 2 #S790949/M751224 NAMED INSURED: World Endurance Holdings Inc; World POLICY NUMBER: PHPK1630346 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED 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): Location(s) Of Covered Operations Where required by Written Contract 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; 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. CG 20 10 07 04 B. With respect lo the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring alter: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. © ISO Properties, Inc., 2004 Page 1 of 1 0 CALIFORNIA FORM 700 PAIR POLITICAL PRACTICES COMMISSION A PUBLIC DOCUMENT Please type or pont in ink STATEMENT OF ECONOMIC INTERESTS COVER PAGE Date Initial Filing Received (,Meer f..r, (,,.y NAME OF FILER (LAST) (FIRST) Houston Sabrina (MIDDLE) Nicole 1. Office, Agency, or Court Agency Name (Do not use acronyms) IRONMAN Division, Board, Department, District, if applicable Your Position Race Director ► If filing for multiple positions, list below or on an attachment. (Do not use acronyms) Agency: Position. 2. Jurisdiction of Office (Check at least one box) ❑ State 0 Judge or Court Commissioner (Statewide Jurisdiction) ❑ Multi -County 0 County of ❑ City of ❑x Other 3. Type of Statement (Check at least one box) ❑ Annual; The period covered is January 1, 2016, through 0 Leaving Office: Date Left _J—J December 31, 2016. (Check one) -or- The period covered is _J --J through December 31, 2016. ❑ Assuming Office: Date assumed _1—J 0 The period covered is January 1, 2016, through the date of leaving office. •or - O The period covered is t_J through the date of leaving office. ❑ Candidate: Election year and office sought, if different than Part 1 4. Schedule Summary (must complete) ► Total number of pages including this cover page: Schedules attached ❑ Schedule A-1 - Investments – schedule attached ❑ Schedule A-2 - Investments – schedule attached ❑ Schedule B - Real Property – schedule attached -or- 0 None - No reportable interests on any schedule ❑ Schedule C - Income, Loans, & Business Positions – schedule attached ❑ Schedule D - Income – Gifts – schedule attached ❑ Schedule E • Income – Gifts – Travel Payments – schedule attached 5. Verification MAILING ADDRESS STREET (Busznass of Agency Address Recommended - Public Document) 3407 W. Martin Luther King Blvd STE 100 Tampa CITY STATE DP CODE FL 33607 DAYTIME TELEPHONE NUMBER ( 760 ) 703-1200 E MAIL ADDRESS sabrina.houston@ironman.com I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained herein and in any attached schedules is true and complete. I acknowledge this is a public document. I certify under penalty of perjury under the laws of the State of Califomia that - oregoing is true and co Date Signed 01/05/2018 Signature (monlb day, year) (Rattle oripiieny sued stamen, OM your ruing olaaal.) FPPC Form 700 (2016/2017) FPPC Advice Email: advice@fppc.ca.gov FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca,gov taatist — GEM a/rheDESERT — MEMORANDUM TO: Frank J. Spevacek, City Manager FROM: Lisa Chaudhry, Administrative Technician DATE: January 3, 2018 RE: Host Venue Agreement between World Triathlon Corporation and cities Indian Wells and La Quinta Attached for your signature is the Host. Venue Agreement between World Triathlon Corporation and cities Indian Wells and La Quinta for three IRONMAN® 70.3 annual events to take place in 2018, 2019 and 2020. 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: 2018 event - $37,500 in 101-1007-60536 $37,500 in 101-3003-60149 2019 & 2020 events - $75,000 per year in 101-3003-60149 _X_ Amount of Agreement, Amendment, Change Order, etc.: $225,000 for 3 years ($75,00 per year) 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: _X_ Approved by the City Council on December 19. 2017 _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 required documents are attached to the agreement: _X_ Insurance certificates as required by the agreement (approved by Risk Manager on N/A Performance bonds as required by the agreement (originals) X City of La Quinta Business License number LIC -765435 Exp. 1/31/2019 _X_ A requisition for a Purchase Order has been prepared (amounts over $5,000) date) Revised May 2017