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ED Relocation AssistanceAGREEMENT FOR PROFESSIONAL SERVICES FOR RELOCATION ASSISTANCE SERVICES This Agreement is made and entered into this qTN day of KaRCN . 2015, by and between the CITY OF SAN RAFAEL (hereinafter " C I T Y "), and KATHY WOOD, dba KATHY WOOD &ASSOCIATES, a sole proprietorship (hereinafter "C O N T R A C T O R"). RECITALS WHEREAS, CITY is investigating the desirability of acquiring through eminent domain all or a portion of a parcel of improved real property located in the City of San Rafael, County of Marin, State of California, designated as Assessor's Parcel No. 014-132-10, and commonly known as 750 Grand Avenue (hereafter, the "Property"); and W H E R E AS, a business entity known as Marin Auto Group is currently and has been for many years doing business on the Property; and WHEREAS, if C I T Y were to acquire the Property, Marin Auto Group would be required to relocate its operations to another site; and W H E R E AS, C I T Y desires to obtain advice and assistance with relocating the Marin Auto Group business in the event C I T Y proceeds to acquire the Property; AGREEMENT N 0 W, T H E R E F O R E, the parties hereby agree as follows: PROJECT COORDINATION. A. CITY'S Project Manager. The Economic Development Coordinator is hereby designated the PROJECT MANAGER for the C I T Y, and said PROJECT MANAGER shall supervise all aspects of the progress and execution of this Agreement. B. CONTRACTOR'S Project Director. CONTRACTOR shall assign a single PROJECT DIRECTOR to have overall responsibility for the progress and execution of this Agreement for C 0 N T R A C T 0 R. Kathy Wood is hereby designated as the PROJECT DIRECTOR for CONTRACTOR. Should circumstances or conditions subsequent to the execution of this Agreement require a substitute PROJECT DIRECTOR, for any reason, the C O N T R A C T O R shall notify the C I T Y within ten (10) business days of the substitution. 2. DUTIES OF CONTRACTOR. CONTRACTOR shall perform the duties and/or provide services as set forth in the CONTRACTOR'S Scope and Budget for Relocation Assistance Services attached hereto as Exhibit A and incorporated herein by reference. 0 �G Rev. Date: 1l30?14 1 3. COMPENSATION. For the fall performance of the services described herein by C 0 N T R A C T 0 R, C I T Y shall pay CONTRACTOR as set forth in the CONTRACTOR's Scope and Budget for Relocation Assistance Services attached hereto as Exhibit A and incorporated herein by reference, in a not -to - exceed amount of $9,500.00. Payment will be made upon receipt by PROJECT MANAGER of itemized invoices submitted by C 0 N T R A C T 0 R. 4. TERM OF AGREEMENT. The term of this Agreement shall be for three (3) months commencing on the date of this Agreement. Upon mutual agreement of the parties, and subject to the approval of the City Manager the term of this Agreement may be extended for an additional period of three (3) months. TERMINATION. A. Discretionary. Either party may terminate this Agreement without cause upon thirty (30) days written notice mailed or personally delivered to the other party. B. Cause. Either party may terminate this Agreement for cause upon fifteen (15) days written notice mailed or personally delivered to the other party, and the notified party's failure to cure or correct the cause of the termination, to the reasonable satisfaction of the party giving such notice, within such fifteen (15) day time period. C. Effect of Termination. Upon receipt of notice of termination, neither party shall incur additional obligations under any provision of this Agreement without the prior written consent of the other. D. Return of Documents. Upon termination, any and all CITY documents or materials provided to CONTRACTOR and any and all of CONTRACTOR's documents and materials prepared for or relating to the performance of its duties under this Agreement, shall be delivered to C I T Y as soon as possible, but not later than thirty (3 0) days after termination. 6. OWNERSHIP OF DOCUMENTS. The written documents and materials prepared by the C 0 N T R A C T 0 R in connection with the performance of its duties under this Agreement, shall be the sole properly of C I T Y. C I T Y may use said property for any purpose, including projects not contemplated by this Agreement. 7. INSPECTION AND AUDIT. Upon reasonable notice, CONTRACTOR shall make available to CITY, or its agent, for inspection and audit, all documents and materials maintained by CONTRACTOR in connection with its performance of its duties under this Agreement. CONTRACTOR shall fully cooperate Rev. date: 130114 with C I T Y or its agent in any such audit or inspection. 8. ASSIGNABILITY. The parties agree that they shall not assign or transfer any interest in this Agreement nor the performance of any of their respective obligations hereunder, without the prior written consent of the other party, and any attempt to so assign this Agreement or any rights, duties or obligations arising hereunder shall be void and of no effect. 9. INSURANCE. A. Scope of Coverage. During the term of this Agreement, CONTRACTOR shall maintain, at no expense to C I T Y, the following insurance policies: 1. A commercial general liability insurance policy in the minimum amount of one million dollars ($1,000,000) per occurrence/two million dollars ($2,000,000) aggregate, for death, bodily injury, personal injury, or property damage. 2. An automobile liability (owned, non -owned, and hired vehicles) insurance policy in the minimum amount of one million dollars ($1,000,000) dollars per occurrence. 3. If any licensed professional performs any of the services required to be performed under this Agreement, a professional liability insurance policy in the minimum amount of one million dollars ($1,000,000) per occurrence/two million dollars ($2,000,000) aggregate, to cover any claims arising out of the CONTRACTOR's performance of services wider this Agreement. Where C 0 N T R A C T 0 R is a professional not required to have a professional license, CITY reserves the right to require CONTRACTOR to provide professional liability insurance pursuant to this section. 4. If it employs any person, CONTRACTOR shall maintain worker's compensation and employer's liability insurance, as required by the State Labor Code and other applicable laws and regulations, and as necessary to protect both CONTRACTOR and CITY against all liability for injuries to C 0 N T R A C T 0 R's officers and employees. CONTRACTOR'S worker's compensation insurance shall be specifically endorsed to waive any right of subrogation against C IT Y. B. Other Insurance Requirements. The insurance coverage required of the CONTRACTOR in subparagraph A of this section above shall also meet the following requirements: 1. Except for professional liability insurance, the insurance policies shall be specifically endorsed to include the CITY, its officers, agents, employees, and volunteers, as additionally named insureds under the policies. 2. The additional insured coverage under CONTRACTOR'S insurance policies shall be primary with respect to any insurance or coverage maintained by C I T Y and shall Rev. date: 130114 3 not call upon C I T Y's insurance or self-insurance coverage for any contribution. The "primary and noncontributory" coverage in CONTRACTOR'S policies shall be at least as broad as ISO form CG20 01 04 13. 3. Except for professional liability insurance, the insurance policies shall include, in their text or by endorsement, coverage for contractual liability and personal injury. 4. The insurance policies shall be specifically endorsed to provide that the insurance carrier shall not cancel, terminate or otherwise modify the terms and conditions of said insurance policies except upon ten (10) days written notice to the PROJECT MANAGER. 5. If the insurance is written on a Claims Made Form, then, following termination of this Agreement, said insurance coverage shall survive for a period of not less than five years. 6. The insurance policies shall provide for a retroactive date of placement coinciding with the effective date of this Agreement. 7. The limits of insurance required in this Agreement may be satisfied by a combination of primary and umbrella or excess insurance. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary and noncontributory basis for the benefit of C IT Y (if agreed to in a written contract or agreement) before CITY'S own insurance or self-insurance shall be called upon to protect it as a named insured. 8. It shall be a requirement under this Agreement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be available to CITY or any other additional insured party. Furthermore, the requirements for coverage and limits shall be: (1) the minim -um coverage and limits specified in this Agreement; or (2) the broader coverage and maximum limits of coverage of any insurance policy or proceeds available to the named insured; whichever is greater. C. Deductibles and SIR's. Any deductibles or self-insured retentions in C 0 N T R A C T 0 R's insurance policies must be declared to and approved by the PROJECT MANAGER and City Attorney, and shall not reduce the limits of liability. Policies containing any self-insured retention (SIR) provision shall provide or be endorsed to provide that the SIR may be satisfied by either the named insured or C I T Y or other additional insured party. At C I T Y's option, the deductibles or self-insured retentions with respect to C IT Y shall be reduced or eliminated to C I T Y's satisfaction, or C 0 N T R A C T 0 R shall procure a bond guaranteeing payment of losses and related investigations, claims administration, attorney's fees and defense expenses. D. Proof of Insurance. CONTRACTOR shall provide to the PROJECT MANAGER all of the following: (1) Certificates of Insurance evidencing the insurance coverage required in this Agreement; (2) a copy of the policy declaration page and/or endorsement page listing all policy endorsements for the commercial general liability policy, and (3) excerpts of policy language or specific endorsements evidencing the other insurance Rev. date: 1/30/14 4 requirements set forth in this Agreement. CITY reserves the right to obtain a full certified copy of any insurance policy and endorsements from CONTRACTOR. Failure to exercise this right shall not constitute a waiver of the right to exercise it later. The insurance shall be approved as to form and sufficiency by PROJECT MANAGER. 10. INDEMNIFICATION. A. Except as otherwise provided in Paragraph B., CONTRACTOR shall, to the fullest extent permitted by law, indemnify, release, defend with counsel approved by C I T Y, and hold harmless CITY, its officers, agents, employees and volunteers (collectively, the "City Indemnitees"), from and against any claim, demand, suit, judgment, loss, liability or expense of any kind, including but not limited to attorney's fees, expert fees and all other costs and fees of litigation, (collectively "CLAIMS"), arising out of CONTRACTOR'S performance of its obligations or conduct of its operations under this Agreement. The C 0 N T R A C T 0 R's obligations apply regardless of whether or not a liability is caused or contributed to by the active or passive negligence of the City I ndemnitees. However, to the extent that liability is caused by the active negligence or willful misconduct of the City Indemnitees, the C O N T R A C T O R's indemnification obligation shall be reduced in proportion to the City Indemnitees' share of liability for the active negligence or willful misconduct. In addition, the acceptance or approval of the C 0 N T R A C T 0 R's work or work product by the C I T Y or any of its directors, officers or employees shall not relieve or reduce the C 0 N T R A C T 0 R's indemnification obligations. In the event the City Indemnitees are made a party to any action, lawsuit, or other adversarial proceeding arising from CONTRACTOR'S performance of or operations under this Agreement, CONTRACTOR shall provide a defense to the City Indemnitees or at CITY'S option reimburse the City Indemnitees their costs of defense, including reasonable attorneys' fees, incurred in defense of such clavms. l'..°a.,.. B. Where the services to be provided by C 0 N T R A C T 0 R under this Agreement are design professional services to be performed by a design professional as that term is defined under Civil Code Section 2782.8, C 0 N T R A C T 0 R shall, to the fullest extent permitted by law, indemnify, release, defend and hold harmless the City Indemnitees from and against any CLAIMS that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of CONTRACTOR in the performance of its duties and obligations under this Agreement or its failure to comply with any of its obligations contained in this Agreement, except such CLAIM which is caused by the sole negligence or willful misconduct of C I T Y. C. The defense and indemnification obligations of this Agreement are undertaken in addition to, and shall not in any way be limited by, the insurance obligations contained in this Agreement, and shall survive the termination or completion of this Agreement for the full period of time allowed by law. 11. NONDISCRIMINATION. C 0 N T R A C T 0 R shall not discriminate, in any way, against any person on the basis of age, sex, race, color, religion, ancestry, national origin or disability in connection with or related to the performance of its duties and obligations under this Agreement. Rev. date: 1130/14 12. COMPLIANCE WITH ALL LAWS. CONTRACTOR shall observe and comply with all applicable federal, state and local laws, ordinances, codes and regulations, in the performance of its duties and obligations under this Agreement. C O N T R A C T O R shall perform all services under this Agreement in accordance with these laws, ordinances, codes and regulations. CONTRACTOR shall release, defend, indemnify and hold harmless C I T Y, its officers, agents and employees from any and all damages, liabilities, penalties, fines and all other consequences from any noncompliance or violation of any laws, ordinances, codes or regulations. C I T Y and C O N T R A C T O R do not intend, by any provision of this Agreement, to create in any third party, any benefit or right owed by one party, under the terms and conditions of this Agreement, to the other party. 14. NOTICES. All notices and other communications required or pennitted to be given under this Agreement, including any notice of change of address, shall be in writing and given by personal delivery, or deposited with the United States Postal Service, postage prepaid, addressed to the parties intended to be notified. Notice shall be deemed given as of the date of personal delivery, or if mailed, upon the date of deposit with the United States Postal Service. Notice shall be given as follows: TO C I TY's Project Manager: TO C 0 N T R A C T 0 R's Project Director: 15. INDEPENDENT CONTRACTOR. Thomas Adams, Economic Development Coordinator City of San Rafael 1400 Fifth Avenue P.O. Box 151560 San Rafael, CA 94915-1560 Kathy Wood Kathy Wood & Associates 215 Caledonia Street, #303 Sausalito, CA 94965 For the purposes, and for the duration, of this Agreement, CONTRACTOR, its officers, agents and employees shall act in the capacity of an Independent Contractor, and not as employees of the CITY. CONTRACTOR and CITY expressly intend and agree that the status of CONTRACTOR, its officers, agents and employees be that of an Independent Contractor and not Rev. date: U30/14 that of an employee of C I T Y. 16. ENTIRE AGREEMENT -- AMENDMENTS,. A. The terms and conditions of this Agreement, all exhibits attached, and all documents expressly incorporated by reference, represent the entire Agreement of the parties with respect to the subject matter of this Agreement. B. This written Agreement shall supersede ally and all prior agreements, oral or written, regarding the subject matter between the C 0 N T R A C T 0 R and the C I T Y. C. No other agreement, promise or statement, written or oral, relating to the subject matter of this Agreement, shall be valid or binding, except by way of a written amendment to this Agreement. D. The terms and conditions of this Agreement shall not be altered or modified except by a written amendment to this Agreement signed by the C 0 N T R A C T 0 R and the C I T Y. E. If any conflicts arise between the terms and conditions of this Agreement, and the terms and conditions of the attached exhibits or the documents expressly incorporated by reference, the terms and conditions of this Agreement shall control. 17. SET-OFF AGAINST DEBTS.. C 0 N T R A C T 0 R agrees that C I T Y may deduct from any payment due to CONTRACTOR wider this Agreement, any monies which CONTRACTOR owes CITY under any ordinance, agreement, contract or resolution for any unpaid taxes, fees, licenses, assessments, unpaid checks or other amounts. 18. WAIVERS. The waiver by either party of any breach or violation of any term, covenant or condition of this Agreement, or of any ordinance, law or regulation, shall not be deemed to be a waiver of any other term, covenant, condition, ordinance, law or regulation, or of any subsequent breach or violation of the same or other term, covenant, condition, ordinance, law or regulation. The subsequent acceptance by either party of any fee, performance, or other consideration which may become due or owing under this Agreement, shall not be deemed to be a waiver of any preceding breach or violation by the other party of any term, condition, covenant of this Agreement or any applicable law, ordinance or regulation. 19. COSTS AND ATTORNEY'S FEES. The prevailing party in any action brought to enforce the terms and conditions of this Agreement, or arising out of the performance of this Agreement, may recover its reasonable costs (including claims administration) and attorney's fees expended in connection with such action. Rev. date: 130/14 20. CITY BUSINESS LICENSE / OTHER TAXES. CONTRACTOR shall obtain and maintain during the duration of this Agreement, a CITY business license as required by the San Rafael Municipal Code C 0 N T R A C T 0 R shall pay any and all state and federal taxes and any other applicable taxes. C I T Y shall not be required to pay for any work performed under this Agreement, until CONTRACTOR has provided CITY with a completed Internal Revenue Service Form W-9 (Request for Taxpayer Identification Number and Certification). 21. APPLICABLE LAW. The laws of the State of California shall govern this Agreement. I N W I T N E S S W H E R E 0 F, the parties have executed this Agreement as of the day, month and year first above written. CITY OF SAN RAFAEL NANCY MACKLE, City Manager ESTI IF,'R C. BEIRNE, City Clerk APPROVED AS TO FORM: Rev. date: 1/30114 KATHY WOOD & ASSOCIATES, CONTRACTOR ByJ_. — WOOD, O ger— 01THIHMI SCOPE AND BUDGET FOR RELOCATION ASSISTANCE SERVICES CITY OF SAN RAFAEL SUBJECT PROPERTY: 750 GRAND AVENUE, SAN RAFAEL, CA APN 14-132-10 The following scope and budget for relocation assistance services is based upon a preliminary field review of the subject property and information provided by Tom Adams, Economic Development Coordinator for the City of San Rafael. Marin Auto Group currently leases the subject property for its used -car sales business. The scope and budget addresses the work required to relocate the business should the City of San Rafael purchase the property for its Grand Avenue Pedestrian and Bicycle Bridge Project. All relocation services will be provided in compliance with the Uniform Relocation assistance and Real Property Acquisition Act of 1970, as amended and appropriate state and federal guidelines. Phase 1 0 Relocation Impact Statement $2,300 Prepare summary relocation report using information gathered in the field, market research of available relocation sites, interview with the business owner and summary of relocation benefits and guidelines. Cost estimate to relocate business included. (Estimate 20 hours @ $115/hr - billed as lump sum) Page 1 kathy wood + associates 215 caledonia street, #303 sausalito, ca 94965 * General Relocation Consulting Scope and Budget for Relocation Assistance Services $1,450 Attend meetings with client agency, advisory and general consulting services. (Estimate 10 hours @ $145/hr. - billed hourly) • Relocation Assistance Services for one (1) business $5,750 1. Prepare relocation forms, brochure, and notices in compliance with state and/or federal guidelines*; 2. Provide advisory assistance to business; 3. Provide business with referrals to replacement locations; 4. Assist business with obtaining moving bids and preparing inventory of personal property; S. Provide explanation of relocation benefits; 6. Preparation and filing of claims forms; 7. Assistance with preparing appeal, if required; 8. Prepare 90 -day notice as necessary; 9. Maintain relocation file with diary entries; 10.Coordination with FF&E appraiser and/or goodwill appraiser, as needed. (Estimate a total of 50 hours @ $115/hr - billed hourly) Page 2 kathy wood + associates 215 caledonia street, #303 sausalito, ca 94965 SUMMARY Phase 1 Costs Phase 2 Costs Scope and Budget for Relocation Assistance Services $3,750 $5,750 TOTAL COSTS FOR RELOCATION SERVICES: $9.500 This is a not -to -exceed figure and all rates are inclusive of mileage And any other miscellaneous expenses including photocopying, mail.etc. *It is our understanding that federal funds will be used on this project and therefore, federal regulations and guidelines will apply. kathy wood + associates 215 caledonia street, #303 sausalito, ca 94965 WOODKA1 OP ID: JM CERTIFICATE OF LIABILITY INSURANCE I DATE( 02!122!201512015 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(les) 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 Stanley McDonald Agency IL Inc 2018 State Road P.O. Box 1446 La Crosse, WI 54602-1446 James R. Mc Donald INSURED Kathy Wood & Assoc Kathy Wood 215 Caledonia Street, #303 Sausalito, CA 94965 CONTACT NAME: James R. Mc Donald PHONE, C No. Ertl: 608-788-6160 ADDRESS: INSURER(S) AFFORDING COVERAGE INSURERA: Hartford Casualty Insurance Co INSURER B: United National Insurance Co. INSURER C : INSURER D : INSURER E: INSURER F : (A(C, No): 608-788-7012 NAIC 129424 i 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 IIS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AUUL Sutfh POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MWDONYYY) (MWDDIYYYYI I II-11WTS COMMERCIAL GENERAL LIABILITY 41SBAF08617 X Business Owners .................. . J9 ................. T L.................J'' u..r:''�'w AUTOMOBILE LIABILITY taY9"; +�fJift'ri UMBRELLA LIAB EXCESS LIAS I(--{I1,'A 11,45 02/16/2014 02/16/2015 I UAMAGE TO RENTED d"REMI,Mf.:::S (Ea a'Jcclurrenm-'.: ) MED EXP (Any one IPers n) PERSONALS ADW II JVJ42'r s" GENERAL AGGRI C4ATE. U'S' - C.CPmpQP J.',' "G `(U CONIHIN C ;"IYGV d...lE LIM'r (Ea accuclenul YNJUF,Y jeer ppr9ion) BODILY 6NJI.JRYf (Por va cidr?ni.) FROPF.RTY 1DAYM..RkGE& (Fer I IEA.:II V r.:7c ^:::1 URRENC E I T DED I I RETEI'JJ )'`u ;{ 1 1 ,y; WORKERS IFR. LITH AND EMPLOYERS' LIABILITY V AoUIE h.IR ANY RROPRIETOR/PARTNf,,..1.'� N h'"^ :'lJ)hrlF.:. / 14_ h..4C::19 ACCOMP, COY -1,.:.:ER/MEMBER EX;"V.II,I'I'"al"c:i(.^r` N / A Mandato In NH O::Jl:yk"..4,t. EA.�Rlll.t?'n' .G'wI (Mandatory 1 It rvaa, describe under [;ilw..SCRIPTION OF OPERAT Ih�in•6�`'f I'.��ol����„° I L;T L. If.71�,V.i:.tt ,l - I t)p...lr;;'Y 1...Iak0Y.i.. I ! B Prof Liability ME00815508 07/24/2014 07/24/2015 Per Claim Claims Made RETRO DATE: 7/21/2006 Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required) City of San Rafael, its officers, agents, employees and volunteers are additional insured A.T.I.M.A on above policy #41 SBAF08617 per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER City of San Rafael 1400 Fifth Avenue PO Box 151560 San Rafel, CA 94915-1560 ACORD 25 (2014/01) CANCELLATION 1,000,00 1,000,00 10,000 1,000,00 2,000,00 2,000,00 1,000:00a 2,000,00 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 O 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THE it HARTFORD Select Customer Insurance Center 8711 UNIVERSITY EAST DRIVE CHARLOTTE NC 28213 Policyholder, please callus at: (866) 467-8730 Agent, please callus at: (866) 467 8730 INSURANCE ENDORSEMENT ATTACHED *** PLEASE REVIEW THE CHANGE *** Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have questions or need to make further changes: Policyholder, please callus at: (866) 467-8730 Agent, please callus at: (866) 467-8730 between 8 A. M. and 6 P.M. EASTERN TIME The premium billing will be mailed to you separately. You can expect to receive it soon. Thank you for allowing us to service your business needs. STANLEY MCDONALD AGCY IL, INC/PHS THE HARTFORD SELECT CUSTOMER INSURANCE CENTER The Hartford Hartford Fire Insurance Company and its Affiliates One Hartford Plaza, Hartford, Connecticut 06155 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional Conditions: A. If this policy is cancelled by the Company, other than for non-payment of premium, notice of such cancellation will be provided at least thirty (30) days in advance of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. B. If this policy is cancelled by the company for non- payment of premium, or by the insured, notice of such cancellation will be provided within ten (10) days of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) on file with the agent of record or the Company will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to this policy's term. Failure to provide such notice to the certificate holder(s) will not amend or extend the date the cancellation becomes effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon the Company or its agents or representatives. Form SS 12 23 06 11 Page 1 of 1 0 2011, The Hartford THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGE This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below: Policy Number: 41 SBA F08617 DV Named Insured and Mailing Address; KATHY WOOD & ASSOCIATES 215 CALEDONIA ST STE 303 SAUSALITO CA 94965 Policy Change Effective Date: 02/16/15 Policy Change Number: 003 Effective hour is the same as stated in the Declarations Page of the Policy. Agent Name: STANLEY MCDONALD AGCY IL, INC/PHS Code: 715004 POLICY CHANGES: SENTINEL INSURANCE COMPANY, LIMITED ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING STATEMENT.IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW, AMOUNTS. THIS IS NOT A BILL. NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE ADDITIONAL INSURED(S) ARE ADDED THE FOLLOWING ARE ADDITIONAL INSURED FOR BUSINESS LIABILITY COVERAGE IN THIS POLICY. LOCATION 002 BUILDING 001 PERSON/ORGANIZATION: SEE FORM IH 12 00 FORM NUMBERS • ENDORSEMENTS REVISED AT ENDORSEMENT ISSUE, PRO RATA FACTOR: 1.000 Form SS 12 11 04 05 T Page ool (CONTINUED ON NEXT PAGE) Process Date: 0 3 / 0 4 / 15 Policy Effective Date: 02/16, 15 Policy Expiration Date: 02/16/16 POLICY CHANGE (Continued) Policy Number: 41 SBA F08617 Policy Change Number: 0 0 3 IH12001185 ADDITIONAL INSURED - PERSON ORGANIZATION FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE: SS 12 23 06 11 Form SS 1211 04 05 T Page 002 Process Date: 0 3 / 0 4 / 15 Policy Effective Date: 02/16/15 Policy Expiration Date: 02 / 16 / 16 POLICY NUMBER: 41 SBA F08617 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CITY OF SAN RAFAEL, ITS OFFICERS, EMPLOYEES AND VOLUNTEERS PO BOX 151560 SAN RAFAEL, CA 94915 Form IH 12 00 11 85 T SEQ. NO. 0 0 i Printed in U.S.A. Page 'J 01 Process Date: 03/04/15 Expiration bate: 02/16/16 (b) Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by you, any of your "employees", "volunteer workers", any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). b. Real Estate Manager Any person (other than your "employee" or "volunteer worker"), or any organization while acting as your real estate manager. c. Temporary Custodians Of Your Property Any person or organization having proper temporary custody of your property if you die, but only: (1) With respect to liability arising out of the maintenance or use of that property; and (2) Until your legal representative has been appointed. d. Legal Representative If You Die Your legal representative if you die, but only with respect to duties as such. That representative will have all your rights and duties under this insurance. e. Unnamed Subsidiary Any subsidiary and subsidiary thereof, of yours which is a legally incorporated entity of which you own a financial interest of more than 50% of the voting stock on the effective date of this Coverage Part. The insurance afforded herein for any subsidiary not shown in the Declarations as a named insured does not apply to injury or damage with respect to which an insured under this insurance is also an insured under another policy or would be an insured under such policy but for its termination or upon the exhaustion of its limits of insurance. 3. Newly Acquired Or Formed Organization Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain financial interest of more than 50% of the voting stock, will qualify as a Named Insured if there is no other similar insurance available to that organization. However: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; and BUSINESS LIABILITY COVERAGE FORM b. Coverage under this provision does not apply to: (1) "Bodily injury" or "property damage" that occurred; or (2) "Personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. 4. Operator Of Mobile Equipment With respect to "mobile equipment" registered in your name under any motor vehicle registration law, any person is an insured while driving such equipment along a public highway with your permission. Any other person or organization responsible for the conduct of such person is also an insured, but only with respect to liability arising out of the operation of the equipment, and only if no other insurance of any kind is available to that person or organization for this liability. However, no person or organization is an insured with respect to: a. "Bodily injury" to a co -"employee" of the person driving the equipment; or b. "Property damage" to property owned by, rented to, in the charge of or occupied by you or the employer of any person who is an insured under this provision. 5. Operator of Nonowned Watercraft With respect to watercraft you do not own that is less than 51 feet long and is not being used to carry persons for a charge, any person is an insured while operating such watercraft with your permission. Any other person or organization responsible for the conduct of such person is also an insured, but only with respect to liability arising out of the operation of the watercraft, and only if no other insurance of any kind is available to that person or organization for this liability. However, no person or organization is an insured with respect to: a. "Bodily injury" to a co -"employee" of the person operating the watercraft; or b. "Property damage" to property owned by, rented to, in the charge of or occupied by you or the employer of any person who is an insured under this provision. 6. Additional Insureds When Required By Written Contract, Written Agreement Or Permit The person(s) or organization(s) identified in Paragraphs a. through f. below are additional insureds when you have agreed, in a written Form SS 00 08 04 05 Page 11 of 24 BUSINESS LIABILITY COVERAGE FORM contract, written agreement or because of a (e) Any failure to make such permit issued by a state or political inspections, adjustments, tests or subdivision, that such person or organization servicing as the vendor has be added as an additional insured on your agreed to make or normally policy, provided the injury or damage occurs undertakes to make in the usual subsequent to the execution of the contract or course of business, in connection agreement, or the issuance of the permit. with the distribution- or sale of the A person or organization is an additional products; insured under this provision only for that (f) Demonstration, installation, period of time required by the contract, servicing or repair operations, agreement or permit. except such operations performed Howe er, no such person or organization is an at the vendor's premises in connection with the sale of the i iii nal insured under this provision if such aid ie product; person or organization is included as an additional insured by an endorsement issued (g) Products which, after distribution by us and made a part of this Coverage Part, or sale by you, have been labeled including all persons or organizations added or relabeled or used as a as additional insureds under the specific container, part or ingredient of any additional insured coverage grants in Section other thing or substance by or for F. — Optional Additional Insured Coverages. the vendor; or a. Vendors (h) "Bodily injury" or "property Any person(s) or organization(s) (referred to damage" arising out of the sole negligence of the vendor for its below as vendor), but only with respect to own acts or omissions or those of "bodily injury" or "property damage" arising its employees or anyone else out of "your products" which are distributed acting on its behalf. However, this or sold in the regular course of the vendor's exclusion does not apply to: business and only if this Coverage Part provides coverage for "bodily injury" or (i) The exceptions contained in "property damage" included within the Subparagraphs (d) or (f); or "products -completed operations hazard". (ii) Such inspections, adjustments, (1) The insurance afforded to the vendor tests or servicing as the vendor is subject to the following additional has agreed to make or normally exclusions: undertakes to make in the usual This insurance does not apply to: course of business, in connection with the distribution (a) "Bodily injury" or "property or sale of the products. damage" for which the vendor is (2) This insurance does not apply to any obligated to pay damages by insured person or organization from reason of the assumption of whom you have acquired such products, liability in a contract or agreement. or any ingredient, part or container, This exclusion does not apply to entering into, accompanying or liability for damages that the containing such products. vendor would have in the absence of the contract or agreement; b. Lessors Of Equipment (b) Any express warranty (1) Any person or organization from unauthorized by you; whom you lease equipment; but only with respect to their liability for "bodily (c) Any physical or chemical change injury", "property damage" or in the product made intentionally "personal and advertising injury" by the vendor; caused, in whole or in part, by your (d) Repackaging, except when maintenance, operation or use of unpacked solely for the purpose of equipment leased to you by such inspection, demonstration, testing, person or organization. or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; Page 12 of 24 Form SS 00 08 04 05 (2) With respect to the insurance afforded to these additional insureds, this insurance does not apply to any "occurrence" which takes place after you cease to lease that equipment. c. Lessors Of Land Or Premises (1) Any person or organization from whom you lease land or premises, but only with respect to liability arising out of the ownership, maintenance or use of that part of the land or premises leased to you. (2) With respect to the insurance afforded to these additional insureds, this insurance does not apply to: (a) Any "occurrence" which takes place after you cease to lease that land or be a tenant in that premises; or BUSINESS LIABILITY COVERAGE FORM e. Permits Issued By State Or Political Subdivisions (1) Any state or political subdivision, but only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit. (2) With respect to the insurance afforded to these additional insureds, this insurance does not apply to: (a) "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the state or municipality; or (b) "Bodily injury" or "property damage" included within the "products - completed operations hazard". f. Any Other Party (b) Structural alterations, new (1) Any other person or organization who construction or demolition is not an insured under Paragraphs a. operations performed by or on through e. above, but only with behalf of such person or respect to liability for "bodily injury", organization. "property damage" or "personal and d. Architects, Engineers Or Surveyors advertising injury" caused, in whole or (1) Any architect, engineer, or surveyor, but in part, by your acts or omissions or only with respect to liability for "bodily the acts or omissions of those acting injury", "property damage" or "personal on your behalf: and advertising injury" caused, in whole (a) In the performance of your or in part, by your acts or omissions or ongoing operations; the acts or omissions of those acting on (b) In connection with your premises your behalf: owned by or rented to you; or (a) In connection with your premises; (c) In connection with "your work" and or included within the "products - (b) In the performance of your completed operations hazard", but ongoing operations performed by only if you or on your behalf. (i) The written contract or written (2) With respect to the insurance afforded agreement requires you to to these additional insureds, the provide such coverage to following additional exclusion applies: such additional insured; and This insurance does not apply to (ii) This Coverage Part provides "bodily injury", "property damage" or coverage for "bodily injury" or "personal and advertising injury" "property damage" included arising out of the rendering of or the within the "products - failure to render any professional completed operations hazard". services by or for you, including: (2) With respect to the insurance afforded (a) The preparing, approving, or to these additional insureds, this failure to prepare or approve, insurance does not apply to: maps, shop drawings, opinions, "Bodily injury", "property damage" or reports, surveys, field orders, "personal and advertising injury" change orders, designs or arising out of the rendering of, or the drawings and specifications; or failure to render, any professional (b) Supervisory, inspection, architectural, engineering or surveying architectural or engineering services, including: activities. Form SS 00 08 04 05 Page 13 of 24 BUSINESS LIABILITY COVERAGE FORM (a) The preparing, approving, or failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs or drawings and specifications; or (b) Supervisory, inspection, architectural or engineering activities. The limits of insurance that apply to additional insureds are described in Section D. -- Limits Oflnsurance. How this insurance applies when other insurance is available to an additional insured is described in the Other Insurance Condition in Section E. — Liability And Medical Expenses General Conditions. No person or organization is an insured with respect to the conduct of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. D. LIABILITY AND MEDICAL EXPENSES LIMITS OF INSURANCE 1. The Most We Will Pay The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 2. Aggregate Limits The most we will pay for: a. Damages because of 'bodily injury" and "property damage" included in the "products -completed operations hazard" is the Products -Completed Operations Aggregate Limit shown in the Declarations. b. Damages because of all other 'bodily injury", "property damage" or "personal and advertising injury", including medical expenses, is the General Aggregate Limit shown in the Declarations. This General Aggregate Limit applies separately to each of your 'locations" owned by or rented to you. "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway or right-of-way of a railroad. This General Aggregate limit does not apply to "property damage" to premises while rented to you or temporarily occupied by you with permission of the owner, arising out of fire, lightning or explosion. 3. Each Occurrence Limit Subject to 2.a. or 2.b above, whichever applies, the most we will pay for the sum of all damages because of all "bodily injury", "property damage" and medical expenses arising out of any one 'occurrence" is the Liability and Medical Expenses Limit shown in the Declarations. The most we will pay for all medical expenses because of "bodily injury" sustained by any one person is the Medical Expenses Limit shown in the Declarations. 4. Personal And Advertising Injury Limit Subject to 2.b. above, the most we will pay for the sum of all damages because of all "personal and advertising injury" sustained by any one person or organization is the Personal and Advertising Injury Limit shown in the Declarations. 5. Damage To Premises Rented To You Limit The Damage To Premises Rented To You Limit is the most we will pay under Business Liability Coverage for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, lightning or explosion, while rented to you or temporarily occupied by you with permission of the owner. In the case of damage by fire, lightning or explosion, the Damage to Premises Rented To You Limit applies to all damage proximately caused by the same event, whether such damage results from fire, lightning or explosion or any combination of these. 6. How Limits Apply To Additional Insureds The most we will pay on behalf of a person or organization who is an additional insured under this Coverage Part is the lesser of: a. The limits of insurance specified in a written contract, written agreement or permit issued by a state or political subdivision; or b. The Limits of Insurance shown in the Declarations. Such amount shall be a part of and not in addition to the Limits of Insurance shown in the Declarations and described in this Section. Page 14 of 24 Form SS 00 08 04 05 BUSINESS LIABILITY COVERAGE FORM This Paragraph f. applies separately to you and any additional insured. 3. Financial Responsibility Laws a. When this policy is certified as proof of financial responsibility for the future under the provisions of any motor vehicle financial responsibility law, the insurance provided by the policy for "bodily injury" liability and "property damage" liability will comply with the provisions of the law to the extent of the coverage and limits of insurance required by that law. b. With respect to "mobile equipment" to which this insurance applies, we will provide any liability, uninsured motorists, underinsured motorists, no-fault or other coverage required by any motor vehicle law. We will provide the required limits for those coverages. 4. Legal Action Against Us No person or organization has a right under this Coverage Form: a. To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b. To sue us on this Coverage Form unless all of its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured; but we will not be liable for damages that are not payable under the terms of this insurance or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claimant's legal representative. 5. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this policy to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom a claim is made or "suit" is brought. 6. Representations a. When You Accept This Policy By accepting this policy, you agree: (1) The statements in the Declarations are accurate and complete; (2) Those statements are based upon representations you made to us; and (3) We have issued this policy in reliance upon your representations. b. Unintentional Failure To Disclose Hazards If unintentionally you should fail to disclose all hazards relating to the conduct of your business at the inception date of this Coverage Part, we shall not deny any coverage under this Coverage Part because of such failure. 7. Other Insurance If other valid and collectible insurance is available for a loss we cover under this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is primary except when b. below applies. If other insurance is also primary, we will share with all that other insurance by the method described in c. below. b. Excess Insurance This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis: (1) Your Work That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (2) Premises Rented To You That is fire, lightning or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (3) Tenant Liability That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occupied by you with permission of the owner; (4) Aircraft, Auto Or Watercraft If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Section A. — Coverages. (5) Property Damage To Borrowed Equipment Or Use Of Elevators If the loss arises out of "property damage" to borrowed equipment or the use of elevators to the extent not subject to Exclusion k. of Section A. — Coverages. Page 16 of 24 Form SS 00 08 04 05 (6) When You Are Added As An Additional Insured To Other Insurance That is other insurance available to you covering liability for damages arising out of the premises or operations, or products and completed operations, for which you have been added as an additional insured by that insurance; or (7) When You Add Others As An Additional Insured To This Insurance That is other insurance available to an additional insured. However, the following provisions apply to other insurance available to any person or organization who is an additional insured under this Coverage Part: (a) Primary Insurance When Required By Contract This insurance is primary if you have agreed in a written contract, written agreement or permit that this insurance be primary. If other insurance is also primary, we will share with all that other insurance by the method described in c. below. (b) Primary And Non -Contributory To Other Insurance When Required By Contract If you have agreed in a written contract, written agreement or permit that this insurance is primary and non-contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance. Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured. When this insurance is excess, we will have no duty under this Coverage Part to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. BUSINESS LIABILITY COVERAGE FORM When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self- insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Method Of Sharing If all the other insurance permits contribution by equal shares, we will follow this method also. Under this approach, each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 8. Transfer Of Rights Of Recovery Against Others To Us a. Transfer Of Rights Of Recovery If the insured has rights to recover all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. This condition does not apply to Medical Expenses Coverage. b. Waiver Of Rights Of Recovery (Waiver Of Subrogation) If the insured has waived any rights of recovery against any person or organization for all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, we also waive that right, provided the insured waived their rights of recovery against such person or organization in a contract, agreement or permit that was executed prior to the injury or damage. Form SS 00 08 04 05 Page 17 of 24 BUSINESS LIABILITY COVERAGE FORM F. OPTIONAL ADDITIONAL INSURED COVERAGES If listed or shown as applicable in the Declarations, one or more of the following Optional Additional Insured Coverages also apply. When any of these Optior7.,a(.., Addjtior]al Insured Coverages apply, ,aragraph 6. (Additional Insureds When Required by Written Contract, Written Agreement or Permit) of, Section C., Who Is An Insured, does not apply mto the, person or organization shown in the Declarations. These coverages are subject to the terms and conditions applicable to Business Liability Coverage in this policy, except as provided below: 1Additional Insured - Designated Person Or .... Organ 'zation WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organization(s) shown in the Declarations, 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: a. In the performance of your ongoing "°o , rat"ions; or b. In connection with your premises owned by or rented to you. 2. Additional Insured - Managers Or Lessors Of Premises a. WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organization(s) shown in the Declarations as an Additional Insured - Designated Person Or Organization; but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Declarations. b. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: (1) Any 'occurrence" which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. 3. Additional Insured - Grantor Of Franchise WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organization(s) shown in the Declarations as an Additional Insured - Grantor Of Franchise, but only with respect to their liability as grantor of franchise to you. 4. Additional Insured - Lessor Of Leased Equipment a. WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organization(s) shown in the Declarations as an Additional Insured — Lessor of Leased Equipment, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). b. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any 'occurrence" which takes place after you cease to lease that equipment. 5. Additional Insured - Owners Or Other Interests From Whom Land Has Been Leased a. WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organization(s) shown in the Declarations as an Additional Insured — Owners Or Other Interests From Whom Land Has Been Leased, but only with respect to liability arising out of the ownership, maintenance or use of that part of the land leased to you and shown in the Declarations. b. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: (1) Any 'occurrence" that takes place after you cease to lease that land; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. 6. Additional Insured - State Or Political Subdivision — Permits a. WHO IS AN INSURED under Section C. is amended to include as an additional insured the state or political subdivision shown in the Declarations as an Additional Page 18 of 24 Form SS 00 08 04 05 Feb 12 2015 12:06PM INSURRNCE OFFICE 415-507-0006 P.1 ac CERTIFICATE OF LIABILITY INSURANCEDATE 02/1MI/2015 �✓'' I 02/12/2015 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the berms 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 1 CONTACT O ATS T DAVID BAREILLES INSURANCE PHONE 707_257-2803 I FAX C IAM. Not: 1732 JEFFERSON STREET E-MAIL ADDRESS: SUITE 3 I INSURER(S1 AFFORDING COVERAGE MAIC d NAPA CA 94556 I INsuRERA: PROGRESSIVE/UNITED FIN CAS INSURED INSURER B: KATHY WOOD INSU RE R C KATHY WOOD & ASSOCIATES INSURER D: 215 CALEDONIA STREET SUITE 303 INSURER E: SAUSALITO, CA. 94965 I INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THF,T 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR IMSD Y" POLICY NUMBER IMMA30NYM IMMIDonrf ) LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE S CLAIMS -MADE 7 OCCUR DAMAGE TO RENTED I PREMISES lEa occurrence) S MED EXP (Anyone person) $ jI I PERSONAL & ADV INJURY $ GEN'LAGGREGATE LIMI AP PLIES PER: GENERAL AGO REt,;A7E $ POLICY LII JECT 7 LOC PRODUCTS-COMPIOPAGG S OTHER. $ AUTOMOBILELUIBILnY06526336-7 06526336-7 D2-14-15 08-14-151 fEaaaecdentl LE LIMIT 100000 ANY AUTO 1 BODILY INJURY (Per person) $ _ A AUTOS JEO AlfTC6U�0 BODILY INJURY (Per accident) $ NON -OWNED HIREDAUTOS PROPERTY DAMAGE $ I AUTOS IParacddentl S UMBRELLALIABOCCUR HCLAIMS-MADE +I I EACH OCCURRENCE 5 EXCESS LIAB AGGREGATE $ DED I, 1 RETENTON$ $ WORKERS COMPENSATION I PER I ETH AND EM PLOVERS' LIABI LITY Y I N ANY PROPRIETOR/PARTNERtFXECU' LITE I OFFICERIMEMBER EXCLUDED? N I A (Mandalory In NH) E L. EACH ACCIDENT $ I EL. DISEASE - EA EMPLOYEd $ Ryes, destriba under DESCRIPTION OF OPERATIONS below E L. M SEASE - POLICY LIMIT I $ DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (ACORD 101, AddRlonal Remarks Schedule, maybe attached if more space Is requlred) Additional Insured under this policy to include the City, its officers, agents, employees, and volunteers. CERTIFICATE HOLDER CITY OF SAN RAFAEL SAN RAFAEL, CA. 94901 CANCELLATION SHOULD ANY OF TH9JeeVZ DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO BITE VEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE YfITH THE PQ ICV PROVISIONS. @U98-2014 ACORD CORPORATION. All rights reserve, ACORD 26 (2014/01) The ACORD name and logo are registered marks of ACORD DAVID BAREILLES 35 MITCHELL BLVD #1 SAN RAFAEL, CA 94903 1-415.472-3443 Certificate of Insurance PR99REENME fa Policy number. 06526336-9 Underwritten by: United Financial Casualty Company March 5, 2015 Page I of I Certificate Holder Insured Agent . .... ....... . . .... . ..... ... ...... .. ...... Additional Insured KATHY WO OD ........ DAVID . BARE I I . LLE I S CITY OF SAN RAFAEL 387 COUNTY VIEW DR 35 MITCHELL BLVD #1 PO BOX 151560 MILL VALLEY, CA 94941 SAN RAFAEL, CA 94903 SAN RAFAEL, CA 94915 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s) indicated. This Certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements, and conditions of these policies. Policy Effective Date: Feb 14, 2015 Policy Expiration Date: Aug 14, 2015 insurance coverage(s) Limits Bodily Injury/Property Damage $1 000 000 Combined Sin le Limit .. ............ Uninsured/Underinsured Motorist $100,000/$300,000 Description of LocationNehicles/Special Items Scheduled autos only i6i6*1466�*�E66'1 k&iiii�A'lil-8'ii ... *-1 1111­­'1*1"'­-11111­ '11 —," * .... * ... —'— ....... ---- ............. * .............. Comprehensive $1,000 Ded Collision $1,000 Ded w/Waiver We will endeavor to provide at least 10 days notice of cancellation to the certificate holder, but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. Certificate number 06415AO9336 Please be advised that additional insureds and loss payees will be notified in the event of a mid-term cancellation. )Pr, �-.- Form 5241 (10/02) PROFESSIONAL SERVICES AGREEMENT/CONTRACT COMPLETION CHECKLIST AND ROUTING SLIP Below is the process for getting your professional services agreements/contracts finalized and executed. Please attach this "Completion Checklist and Routing Slip" to the front of your contract as you circulate it for review and signatures. Please use this form for all professional services aLyreements/contracts (not just those requiring City Council approval). This process should occur in the order presented below. Step Responsible Department 1 City Attorney 2 Contracting Department 3 Contracting Department 4 City Attorney 5 City Manager / Mayor / or Department Head 6 City Clerk Description Review, revise, and comment on draft agreement. Forward final agreement to contractor for their signature. Obtain at least two signed originals from contractor. Agendize contractor -signed agreement for Council approval, if Council approval necessary (as defined by City Attorney/City Ordinance'''). Review and approve form of agreement; bonds, and insurance certificates and endorsements. Agreement executed by Council authorized official. City Clerk attests signatures, retains original agreement and forwards copies to the contracting department. ...................... To be completed by Contracting Department: Completion Date j g,, j Pro ect Mana er: �`� � GLtr-L� Pro ect Name: 94Z�-4 Agendized for City Council Meeting of (if necessary): If you have questions on this process, please contact the City Attorneys Office at 485-3080. :': Council approval is required if contract is over $20,000 on a cumulative basis. DAVID BARE LLES 35 MITCHELL BLVD #1 SAN RAFAEL. CA 94903 1.415.472-3443 Certificate of Insurance Certificate Holder Additional Insured CITY OF SAN RAFAEL PO BOX 151560 SAN RAFAEL, CA 94915 Insured KATHY WOOD ................... 387 COUNTY VIEW DR MILL VALLEY, CA 94941 Policy number. 06526336-9 Underwritten by: United Financial Casualty Company March 5, 2015 Pagel of 1 MAR 2 4 2015 Time: City Clerk's Office City of San Rafael Agent .................... ... DAVID BAREILLES 35 MITCHELL BLVD #1 SAN RAFAEL, CA 94903 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s) indicated. This Certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements, and conditions of these policies. Poli Effective Date :................... ................................... ry Feb 14,2b15PoWicy ExpVration pate: Aug 14, 2015 11 Insurance coverages) Limits Bodily Injury/Property Damage $1,000,000 Combined Single limit ...,. ...... .. Uninsured/Underinsured Motorist $100,000/$300,000 Description of LocationNehicles/Special litems Scheduled autos only 2010 A ACCO HONDRp1HGCP2F82AAi61822 Comprehensive $1,000 Ded Collision $1,000 Ded w/Waiver We will endeavor to provide at least 10 days notice of cancellation to the certificate holder, but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. Certificate number 06415AO9336 Please be advised that additional insureds and loss payees will be notified in the event of a mid-term cancellation. Form 5241 (10102)