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Live Well Clinic/Wellness Center B-12 Shots 16INDEMNITY AND HOLD HARMLESS AGREEMENT This Indemnity Agreement and Hold Harmless ("Agreement") is hereby entered into by the Chy ot'La Quinta (1­CitY")and Live Well Clinic ("Agency") as of' January 19, 26�1 6, RECITALS AThe Agency has proposed to provide Vitamin B 12 injections weekly on Friday s to members of the corrununity at the I_a Quinta Wellness Center (-Services"). 13: The Ciry wishes to have Agency provide the, Services tea !,LeqJor citizens and residents/non-residents of the _community-. NOW. THEREFORE, in consideration of perfomiance by the parties of the ToUttlel, promises, covenants. and conditions herein contained, the parties agree as follows: Section I The foregoing Recitals are true and correct and are hereby incorporated. herein by this reference and -are expressly made a part of this Agreement. Section 2 ')j 4- Agency shall defend. indemnity and hold harmless the City and its officers, employees., and agents (collectively, -Intlernnified Parties") from and against any and all of claims. causes of action. obligations, losses£ liabilities, judgments, or damages, including reasonable attorneys' fees and costs of litigation (collectively "Clainis") arising out of and/or in any ,vay relating to the Agency's activities in the performance of the Services described in this Agreement, or to the Ageney"s acts and/or omissions in pjoviding or administering the sanw, excepting only those claims, actions, obligations, losses, liabilities, judgments, or damages negligence, arising out of the sole active I negligence or willful misconduct of the Indemnified Parties. 2.2 lit the event the Indemnified Parties are made a party to any action, lawsuit. or other adversarial proceeding alleging negligent or wrongful conduct on the part cif the Agency, the Agency shall provide a defense to the Indemnified Parties. or at the City's option, reimburse the Indemnified Parties on an ongoing monthly basis their costs of defense, including reasonable attorneys' fees, iricurrea in defense of such Claims. 231 In addition, the Agency shall be obligated to promptly pay any final judgment or portion thereof rendered against the Indemnified Parties. Section 3 lickh,ed 5-29-12 71.1 Prior to the execution and throughout the duration of th.i., shall maintain insurance in conformance with the requirements set I may use existing coverage to comply with these, requirements. If t1j does not meet the requirements set fanth here. Agency shall have Agency acknowledges that the insurance coverage and policy 1i r Section 3,1 constitute the tnininium arnount of coverage requh proceeds in excess of the limits and coverage required in this Aga applicable to a given loss, will be available to City in the event of A areement. kgreenient. Agency rth below. A(,-zency it existing coverkge amended to do so. its set forth in this d . Any, insurance :!ment and which is loss covered by this Agency shall provide the following types arid amounts of insurance-. ACommercial General Liability Insurance using Insurance Services Office "Commercial General Liability" policy forin 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. 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. B. Workers' Compensation on a state -approved policy foam providing statutory benefits as required by lave with employer's liability limits no less than $1,000,000 per accident for all covered losses. E Professional Liability or Errors and Omissions Insurance as appropriate shall be written on a policy fbim coverage specifically desigired to protect against acts. errors or omissions of the consultant and "Covered Professional Services" as designated in the policy must specifically include work perforined under this agreement. The policy firnit shall be no less than $1,000,000 per claim and in the aggregate. The policy must "pay on behalf of' the insured arid must include a provision establishing the insurer's duty to defend. The policy retroactive date shall be on or before the effective date of this agreement. 3.2 Agency agrees to provide evidence of the insurance required herein, satisfactory tag the City, consisting of. (a) certificate(s) of insurance evidencing all of the coverages required and, (b) an additional insured endorsement tea Agency's Commercial general liability policy using ISO Forin CG 120 10 with an edition date prior to 1988, which lortri shall include coverage for completed operations. The additional insured endorsement shall expressly, name the City, its officers, and employees as additional insureds on the policy lies) as to commercial general liability, coverages. and completed operations coverages. with respect, to liabilities arising out of Agency's performance of the Services under this Agreement, ,3.3 Proof of compliance with these insurance requirements. consisting of ends rsernents and certificates of insurance ', shall be delivered to City prior to Agency commencing performance of any of the Services described in this Agreement. Rv,�,scd 5-29-12 LIVE WELL CLINIC ppy �+ti'5' .w d ZW.� ) t c y . 04�g r Its: Naturopathic Doctor CITY O L UINg`�r� ¢A Digitally signed by Frank J.Spevacek DN serialNumber— 7 n6l5nh01202cvmj, <US si Calfo a La Qu to-Frank va J Sp cek, cn:Fra kJ Spevacek ,-,�..�---- I ---�r�zo�#6::83�@20"09'- Frank J. Spevacek, City Manager APPROVED ASTO FORM: ATTEST: Digitally signed by Susan Maysels DN:serial Number j4r7lllgtppsr45f, '. `""> c=US, st=California, I=La: Quinta, o—Susan Maysels, cn Susan Maysels - - Date: 2016.03.0216:37:43 08'00' Susan Maysels, City Clerk William H. lhrke, City Attomey Revised 5- r•:s7.1: ACCA?EIII CERTIFICATE OF LIABILITY INSURANCE .1 DATE (IIIIII/DD11ITI F) 02/09/2016 BELOW.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 - OF DOES NOT• • -+ - - 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 r PRODUCERONTACT « DOUG MOTZ D• • • ••.: PHONE 61 fl f f •f 4• 43875 Washington St Ste H ADDRESS: iinotzf#lf�riiers,,;.kweit.coii,, Palm Desert CA 92211-8249 INSURED LIVE WELL CLINIC 78900 AVENUE 47 STE 102 LA QUINTA CA 92253 COVERAGES CERTIFICATE NUMBER: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : INSURER B : INSURERC: Mid Century Insurance Company 21687 INSURER D : INSURER E : • 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 C GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR Y N 605437959 02/11/2016 02/11/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 75,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC JECT PRODUCTS - COMP/OP AGG $ 1,000,000 $ C AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 605437959 02/11/2015 02/11 /2016 CEa OMBINED accidentSINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A WC STATU- OTH- TORY LIMITS I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 78900 AVENUE 47 STE 102, LA QUINTA, CA 92253 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF LA QUINTA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN COMMUNITY SERVICES DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIONS. 78495 CALLE TAMPICO LA QUINTA CA 92253 AUTHORIZED REPRESENTATIVE DOUGLAS W MOTZ ACORD 25 (2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: BUS|NESSOVVNERSPOL|CY Designation of Premises (Part Leased tmYOuY 70V0OAVENUE 47S7Bl02,LA0DINTA.CAo2253 Name of Person or Organization (Additional Insured):CITY OF LA0UINT&ITS OFFICERS AND EMPLOYEES Additional Premium: A. The following is added to Paragraph C. WHO IS AN INSURED in the Buoineoaownero Liability Coverage Form: 4. The person or organization shown in the Schedule is also an inaured, but only with re- spect to liability arising out of the owneruhip, maintenance or use of that part of the prem- ises leased toyou and shown inthe Schedule. B. The following exclusions are added: This insurance does not apply to: 1. Any "occurrence" that takes place after you cease tobomtenant inthe premises described inthe Schedule. 2. Structural ahuratonn, new construction or demolition operations performed by orfor the person or organization designated in the Schedule. *Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declara- tions. BP04O2 01 87 Copyright, Insurance Services Dffioo. Inc., 1095. 1991 Page 1 of 0 i MMM ORIM41110M. a I. Named Insured Mailing Address FUND, SONJA(PTR)& FUNG, SONJA (PTR) & ORTV- NICHOLE (PTR) 78900 AVENUE 47 STE 102 LA QUINTA CA 922532070 1,co Entity: 01ndividual FLI Partnership EXorporation, E]Other ipm Niq Yem WESTERN-WCC �sm—nq Offim 805-583-7000 M Rmi Ksk fidewfien No. W"i r O. ON FILE Fedual lderdffimfion No. Fedad Iden No. 0 - 00 Total Deposit premium $---SEE-J.MNI1CFL- Prior Yea's Deposit $---5EE-DffOICE-' Other (redits Balance Due Classification of Operations Code No. , Premium Basis' IRa Estimated Per$ 100 ua Total Annl of Rcmu- E "AmEffiFffl Inforlination below SEE CLASSIFICATION OF OPERATIONS SCHEDULE Your Workersr Compensation premium may be'subI to midterm adunexpired term of your poticy, because the Insurance commissioner of Califtmia has Ow authority to d!ja rates. This Is R4t An InvoM Move Minimum Total Estimated Annual Premium $ 2,573.00 Premium $ 650.00 Expense Constant $ 200.00 (Included in Total Estimated Annual Premium) Agent: DOUGLAS MOTZ Agent Phone: 760-200-0270 Countersigned W Al A 0-m Authorized Reresentative D 1 Mul Roorict @ Naftnfi [omal on &npenswion Irsurmwo, Co*iUM 1987, used Aith "do Pfon. p 5"] 62 2ND IDMON 4-14 (61622DI PAGE I Of 2 S66162-102 ADMIRAL INSURANCE COMPANY PROFESSIONAL LUBILITY POLICY A STOCK COINVANLY DECLARATIONS (herein called "the corl (CLAIMS -MADE FORM) Policy No.: E0000023317-03 Renewal/Rewrite of: E0000023317-02 "Named InsureT',and MailiLa.Address,_ LIVE WELL NATUROAT HIC CLINIC, A PROFESSIONAL CORPORATION DBA: LIVE WELL CLINIC 78900 AVENUE 47, SUITE 102 LA QUINTTA, CA 92253 "POLICY PERIOD": From 07/28/2015 io 07/28/2016 At 12:01 A.M. Standard Time at the address ofthe"Warned Trisured" as stated herein In consideration of the payment of premium, in reliance upon the statements herein or attached hereto, and subject to all of the terms of this policy, the Company agrees with the "Named Imured" as follows: Item 1: '-Named Insured's" Business: Naturopathic Physician Services including Tra•ining Services, of Students Item 11: Limit-, of Liability: S t,000,000 Each "Claim" per Scheduled Physician $3,000000 Aggregate per Scheduled Physician $1,000,000 Each "Claiin"for all other "Insureds" and the"Named Insured" S3,000,000 Aggregate for all other "Insureds" and the "Named Insured" $9,00U00 Policy Aggregate Item ITT: Deductible: No Deductible Applies Item IV: Retroactive Date: 07/28/2012 Item V: Premium: St0,600.00 Not Subject to Audit 50.00 Terrorism Premium $10,600.00 To Premium Item VI ! Form.-, attached at inception: See Schedule of Forms AT 00 19 03 98 Except to such extent as may otherwise be provided herein, the coverage of this policy is limited generally to liability for only those claims that are first made against the insured while the policy is in force, Please review the policy carefully and discuss the coverage thereunder wdh your insurance agent or broker A SIGNED COPY OF THE ``NAMED INSURED'S" APPLICATION FOR THIS POLICY IS MADE APART HEREOF, AT INCEPTION. /-7 Countersigned On- 07!28/2015 By. -4 J At: Seattle, WA T Authorized Representative T7111110, DE 2029 07,03 6t BERKLEY COMPANY, TO: Frank J. Spevacek, City Manager msmlg�� Attached • • signature is the agreement with Live Well Clinic for weekly Vitamin B-12 injections to members of the community. Please sign the attached agreement(s) and return it to the City Clerk for processing and distribution.