HomeMy WebLinkAboutCM MCCMC Legislative Analysis Activities 2015AGREEMENT FOR PROFESSIONAL SERVICES
This Agreement is made and entered into this .22►To4 day of December 2015, by and
between the CITY OF SAN RAFAEL (hereinafter "CITY"), and SUZANNE CREEKMORE
(hereinafter "CONTRACTOR").
RECITALS
WHEREAS, the Cities and Towns of Marin County, by and through the Marin County
Council of Mayors and Councilmembers ("MCCMC"), desire to retain CONTRACTOR to
provide legislative analysis activities on their behalf, and
WHEREAS, CONTRACTOR has the training and experience to provide, and is willing to
provide, legislative analysis activities and actions on behalf of the MCCMC Legislative Committee;
and
WHEREAS, CITY has agreed to be the lead agency for the purpose of entering into an
agreement with CONTRACTOR to provide such legislative analysis; and
WHEREAS, the MCCMC members have agreed to jointly fund this agreement.
AGREEMENT
NOW, THEREFORE, the parties hereby agree as follows:
1. PROJECT COORDINATION.
A. CITY. The City Manager shall be the representative of the CITY for all purposes
under this Agreement. The City Manager is hereby designated the PROJECT MANAGER for the
CITY, and said PROJECT MANAGER shall supervise all aspects of the progress and execution of
this Agreement.
B. CONTRACTOR. CONTRACTOR shall assign a single PROJECT DIRECTOR
to have overall responsibility for the progress and execution of this Agreement for
CONTRACTOR. Suzanne Creekmore 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 CONTRACTOR shall
notify the CITY within ten (10) business days of the substitution.
2. DUTIES OF CONTRACTOR.
CONTRACTOR shall perform the duties and/or provide services as described in Exhibit
"A" attached and incorporated herein.
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3. DUTIES OF CITY.
CITY shall pay the compensation as provided in Paragraph 4.
4. COMPENSATION.
For the full performance of the services described herein by CONTRACTOR, CITY shall
pay CONTRACTOR no more than $7,000 for work completed over a full year, billed by
CONTRACTOR over ten (10) months in equal monthly payments of $700.
CONTRACTOR understands and agrees that it shall not incur any additional expenses on
behalf of CITY, the Cities and Towns of Marin County or the MCCMC, and that CITY, the
MCCMC and the Cities and Towns of Marin shall not be responsible for any obligations of an
employer. Specifically, CONTRACTOR shall furnish her own means of transportation (when not
required by CITY to travel), miscellaneous supplies and incidental expenses.
Payment will be made monthly upon receipt by PROJECT MANAGER of invoice and
monthly report of activities submitted by CONTRACTOR.
5. TERM OF AGREEMENT.
The term of this Agreement shall be for (1) year commencing on January 1, 2016 and
ending on December 31, 2016. The schedule of work is to be set by the MCCMC Chair with input
by the CONTRACTOR. Upon mutual agreement of the parties, and subject to the approval of the
City Manager, the term of this Agreement shall be extended for an additional period of (1) year.
6. 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 CITY as soon as possible, but not later than thirty (30) days after termination.
7. OWNERSHIP OF DOCUMENTS.
The written documents and materials prepared by the CONTRACTOR in connection with
the performance of its duties under this Agreement shall be the sole property of CITY. CITY may
use said property for any purpose, including projects not contemplated by this Agreement.
8. 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
with CITY or its agent in any such audit or inspection.
9. 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.
10. INSURANCE.
A. During the term of this Agreement, CONTRACTOR shall maintain, at no expense
to CITY, the following insurance policies:
1. An automobile liability insurance policy, for owned, non -owned, and hired
vehicles, in the minimum amount of one million ($1,000,000) dollars per occurrence.
B. The insurance coverage required of the CONTRACTOR in Subparagraph A above,
shall also meet the following requirements:
1. The general liability insurance shall include, in its text or by endorsement,
coverage for contractual liability.
2. The general liability insurance policies shall be endorsed to name the CITY,
its officers, agents, employees, and volunteers, as additionally named insureds under the policies,
and to provide that the insurance shall be primary with respect to any insurance or coverage
maintained by CITY and shall not call upon CITY's insurance or coverage for any contribution.
3. CONTRACTOR shall provide to City's PROJECT MANAGER, (a)
Certificates of Insurance evidencing the insurance coverage required herein, and (b) text from the
insurance policies or the endorsements as specified in Subparagraphs B(1) and B(2).
4. The insurance policies shall 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 City's 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 insurance shall be approved as to form and sufficiency by PROJECT
MANAGER and the City Attorney.
C. 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 CONTRACTOR's officers and employees.
D. Any deductibles or self-insured retentions in CONTRACTOR's insurance policies
must be declared to and approved by the City's Risk Manager and the City Attorney. At CITY's
option, the deductibles or self-insured retentions with respect to CITY shall be reduced or
eliminated to CITY's satisfaction, or CONTRACTOR shall procure a bond guaranteeing payment
of losses and related investigations, claims administration, attorney's fees and defense expenses.
11. INDEMNIFICATION.
A. Except as provided in Paragraph B., CONTRACTOR shall indemnify, release,
defend and hold harmless CITY, its officers, and employees, against any claim, demand, suit,
judgment, loss, liability or expense of any kind, including attorney's fees, arising out of or
resulting in any way, in whole or in part, from any acts or omissions, intentional or negligent, of
CONTRACTOR or CONTRACTOR's officers, agents and employees in the performance of
their duties and obligations under this Agreement.
B. Where the services to be provided by CONTRACTOR 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, CONTRACTOR shall, to the fullest extent permitted by law,
indemnify, release, defend and hold harmless CITY, its officers, and employees, against any
claim, demand, suit, judgment, loss, liability or expense of any kind, including attorney's fees,
that arises out of, pertains to, or relates to the negligence, recklessness, or willful misconduct of
CONTRACTOR in the performance of its duties and obligations under this Agreement.
12. NONDISCRIMINATION.
CONTRACTOR 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.
13. 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. CONTRACTOR shall perform all services under this Agreement in accordance with
these laws, ordinances, codes and regulations. CONTRACTOR shall release, defend, indemnify
and hold harmless CITY, 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.
14. NO THIRD PARTY BENEFICIARIES.
CITY and CONTRACTOR 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.
15. NOTICES.
All notices and other communications required or permitted 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 CITY: Jim Schutz
Project Manager
City of San Rafael
1400 Fifth Ave. (P.O. Box 151560)
San Rafael, CA 94915-1560
TO CONTRACTOR: Suzanne Creekmore
Project Director
3 Marsh Road
Tiburon CA 94920
17. INDEPENDENT CONTRACTOR.
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
that of an employee of CITY.
5
18. 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 any and all prior agreements, oral or written,
regarding the subject matter between the CONTRACTOR and the CITY.
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 CONTRACTOR and the CITY.
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.
19. SET-OFF AGAINST DEBTS.
CONTRACTOR agrees that CITY may deduct from any payment due to
CONTRACTOR under 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.
20. 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.
21. 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.
6
22. CITY BUSINESS LICENSE/ OTI 1ER TAXES.
CONTRACTOR shall obtain and maintain during the duration of this Agreement, a CITY
business license as required by the San Rafael Municipal Code. CONTRACTOR shall pay any
and all state and federal taxes and any other applicable taxes. CITY 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).
23. APPLICABLE LAW.
The laws of the State of California shall govern this Agreement.
IN WITNESS WHEREOF, the parties have executed this Agreement as of the day, month
and year first above written.
CITY OF SAN RAFAEL
JIM C TZ, City ag r
ATTEST:
ESTHER C. BEIRNE, City Clerk
APPROVED AS TO FORM:
ROBERT F. EPSTEIN 'City Ado . ey
CONTRACTOR
N U.ZQY1V1� CXe�k.YY10Y�i
Title: PYOJW Evectar
MCCMC LEGISLATIVE COMMITTEE
Legislative Analyst Duties
Updated November 2013
Attend Monthlv MCCMC Lezislation Committee meeting. The meetings are
currently the fourth Monday of the month 8:00 am at San Rafael City hall.
General duties of the Leeislative Analvst:
• Keeping abreast of legislation & ballot measures
• Preparing Committee Agenda
• Distributing supporting documents or web links
• Drafting position letters for Committee Chair
• Liaison with local office of the Marin Assembly member and Senator
• Liaison with Congressional representatives
Azenda Preparation and Distribution
■ Prepare list of potential bills of interest with League position and position of Marin
County and/or Marin Town/City. Responsibility: League rep for League bills and
lobbyist for non League bills.
■ Using above bill list, prepare the draft agenda in conjunction with the Lobbyist,
League Rep, and committee chair. Include when appropriate requests from assembly
member or senate staff for a position. The agenda should include information on
priority bills or "hot" bills, which require urgent action, along with bill titles and
descriptions, summaries (if available), legislator's fact sheets from the authors of the
bill, as well as League Committee analyses or the LAO analysis(if available) and a
URL for full text of bills on-line.
■ Gather information on upcoming League & MCCMC meetings to be included on
agenda.
■ Forward draft agenda: 10 calendar days prior to the meeting to the Chair for review
agenda & approval.
■ Send out final agenda via e-mail to Committee Distribution List week before the
meeting is ideal, but last minute legislative action often delays the distribution until
the Thurs before the meeting. Emailed packet includes the agenda, bill summaries,
urls to full text, and other documentation described above.
■ Keep the distribution list update. The list includes committee voting members
(representatives from the council of Marin cities, League representative, usually the
North Bay Public Affairs manager of the League of CA Cities, Marin legislative
aides, lobbyist, San Rafael City Manager, County administrator, and others who may
be interested.
■ Attend monthly meetings and prepare notes of the meeting. Notes include brief
summaries of the pro/con discussion and any position taken by vote of committee on
bills or relevant matters. Copies of the notes are sent to the chair.
■ Keep and update a spreadsheet of bills, positions, dates position taken, amendments
to the bills or changes of position. Distribute to committee periodically. Set up
meeting location and phone connection to lobbyist.
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Exhibit A
Letters in Support/Opposition
■ Research and prepare draft letters for approval by the Chair. Letters should include
Marin specific information where material. Contact staff regarding potential impact
on individual city/town. Contact Marin County legislative staff when necessary.
Letters can be prepared using the League or the Lobbyist template when consistent
with the position of the committee. Staff will obtain templates and dispatch it to the
Chair for signature within 3 working days.
■ Initial position letters will be sent out to the legislators no later than S calendar days
after the meeting, or sooner for urgency matters, if at all possible. Follow up letters.
requested when a bill on which the committee has taken a position is sent to another
committee or house in the legislature, should be sent out within 2 days of the request.
■ Obtain chairs signature in letters.
■ Prepare PDF of signed letter and distribute to author of the bill and chair of the
committee hearing the bill, with ccs to local Assembly Member and Senator, League
of California Cities, MCCMC lobbyist. If the bill is still controversial when it
reaches the governor's desk, a letter is sent to the governor. All letters send should be
cc'd to the chair.
■ Committee positions on initiatives that have qualified for the ballot should also be
provided to Initiative author or committee.
■ The Lobbyist or League Representative are sources for contact information for the
relevant legislators and other designated recipients.
■ Keep a file of all final, signed letters.
Liaison with Elected officials in Sacramento and Washineton
■ Regular contact with local offices of Assembly member and Senator
■ Contact with CA Congressional representatives when necessary
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 arofessional
services agreements/contracts (not just those requiring City Council approval).
This process should occur in the order presented below.
Step Responsible Description Completion
Department Date
1 City Attorney Review, revise, and comment on draft
agreement.
2 Contracting Department Forward final agreement to contractor for
their signature. Obtain at least two signed ('
originals from contractor.
3 Contracting Department Agendize contractor -signed agreement for
Council approval, if Council approval
necessary (as defined by City Attorney/City
Ordinance*).
4 City Attorney Review and approve form of agreement; �f /
bonds, and insurance certificates and e�T
endorsements. l�
5 City Manager / Mayor / or I Agreement executed by Council authorized
Department Head official.
6 City Clerk City Clerk attests signatures, retains original
agreement and forwards copies to the
contracting department.
To be completed by Contracti rg Department:
Project Manager: IM°°..... &WV_Project Name:
Agendized for City Council Meeting of (if necessary):
FPPC: ,"c eck if require
If you have questions on this process, please contact the City Attorney's Office at 485-3080.
* Council approval is required if contract is over $20,000 on a cumulative basis.
Suzanne J. Creekmore
3 Marsh Road, Tiburon, California 1415.686.31571 suzannejcreekmore@gmail.com
December 7, 2015
Jim Schutz
City Manager
City of San Rafael
1400 Fifth Avenue
San Rafael, CA 94901
Dear Jim,
Please find enclosed two copies of the signed Professional Services Agreement. I am in the
process of acquiring a business license with the City of San Rafael as well as additional coverage for
my automobile liability insurance policy as required by the agreement. I will provide you with copies
of the certificates once I receive them.
Thank you,
Suzanne Creekmore
Sincerely,
n
Suzanne Creekm
Esther Beirne
From:
Lauren Crandell
Sent:
Wednesday, January 06, 2016 8:34 AM
To:
Esther Beirne
Subject:
FW: PSA
Hi Esther,
Do you have any recommendations for Suzanne (new MCCMC Leg Analyst)? Any help would
be much appreciated. Thanks!
Best,
24w4en e&acn&u
Admin. Asst. to the City Manager
City of San Rafael
(415) 485-3056
II �uVll'u9111"'ll. II "II IId,,;llld.'�I,uuV'.'Ilu.^W" "NhV.�IVII""� e dtl1�Y:"
From: Suzanne Creekmore [mailto:suzannejcreekmore@gmail.com]
Sent: Tuesday, January 05, 2016 6:24 PM
To: Lauren Crandell
Subject: Re: PSA
Ili Lauren,
Thank you for providing the executed contract. The insurance provided by my carrier does not meet the
requirements outlined in the contract. I've contacted several other carriers regarding the general liability
requirements but am having difficulty finding one that offers contractual liability. Would you have any
suggestions or know of someone that I can speak with that can provide further information on the insurance
requirements?
Thank you,
Suzanne
On Mon, Jan 4, 2016 at 1:49 PM, Lauren Crandell < V I a II ii u u u "u 1. u u u � II ! 0 1 a tl n! . o u i o :.11 u c � p � tl II °> wrote:
Hi Suzanne,
The execute PSA is attached. Please let us know when we can expect your certificate of
insurance. Thank you!
4
0
Best,
Admin. Asst. to the City Manager
City of San Rafael
From: Suzanne Creekmore [mailto i I
Sent: Wednesday, December 09, 2015 1:35 PM
To: Lauren Crandell
Subject: Re: PSA
Hi Lauren,
I'll send the completed W-9 by mail this evening. The signed agreements were mailed yesterday and I will
provide copies of the business license and insurance certificates once I receive them.
Thank you,
Suzanne
On Wed, Dec 9, 2015 at 1:OO PM, Lauren Crandell <I > wrote:
Hi Suzanne,
I just realized that we'll also need a W-9 from you in order to set you up as a vendor. If you
could please send that over, I'd appreciate it. Thanks!
PA
® DATE (MMIDD/YYYY)
AC�
CERTIFICATE OF LIABILITY INSURANCE I 01/20/2016
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 CONTACT
NAME:
HO
Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA P Ntjo,,Ext : (888) 202-3007 LAC No
520 Madison Avenue E-MAIL contact@hiscox.com
32nd Floor INSURERIS) AFFORDING COVERAGE NAIC #
New York, NY 10022 INSURERA: Hiscox Insurance Company Inc 10200
INSURED INSURER B:
SUZANNE CREEKMORE INSURER C:
3 MARSH RD INSURER D:
INSURER E:
BELVEDERE TIBURON CA 94920 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.
LTR INSD A, WVD POLICY NUMBER (MM/DDY/YYYYI ..
X LIABILITY
TYPE OF INSURANCE POLICY EXP
INSR ADDUSUBR { (MM/DD/YYYYI LIMITS
EACH OCCURRENCE $ 11000,000
COMCLAIMS-MADEE 'X OCCUR DAMAGE TOItENTED
PREMISE$ jEa occurrence] $ 100,000
MED EXP (Anyone person) $ 5,000
A UDC -1686303 -CGL -16 01/19/2016 01/19/2017 PERSONAL BADVINJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER„ GENERAL AGGREGATE $ 2,000,000
X' POLICY ' PRO -
POLICY PRODUCTS - COMP/OP AGG $ SIT Gen. Agg.
OTHER
AUTOMOBILE LIABILITY
ANY AUTO
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CERTIFICATE HOLDER
CANCELLATION
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
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
COMBINED SINGLE LIMIT
$
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DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Addltlonal Remarks Schedule, maybe attached if more space Is required)
CERTIFICATE HOLDER
CANCELLATION
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
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
DATE (MMIDD/YYYY)
ACOR" CERTIFICATE OF LIABILITY INSURANCE
01/20/2016
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 CONTACT
NAME:
Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CAONNo
(888) 202-3007 sac N
520 Madison Avenue
ADDRESS: contact@hiscox.Com
.. _ ..........
32nd Floor
INSURERISI AFFORDING COVERAGE
NAIC #
New York, NY 10022
INSURER A: Hiscox Insurance Company Inc
10200
INSURED
INSURER B
SUZANNE CREEKMORE
INSURER C:
3 MARSH RD
INSURER D
INSURER 9:
BELVEDERE TIBURON CA 94920
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 ADDL'SUBR',
POLICY EFF Y POLICY EXP
LTR TYPE OF INSURANCE IN$D WVD i POLICY NUMBER
IMM/DD/YYYYI IMM/DD/YYYYI , LIMITS
X COMMERCIALGENERAL LIABILITY
EACHCCURRENCE $
1,000,000
.........._ ..
i' AMAGE TO RENTED
D ii
CLAIMS MADE X OCCUR
PREMISES fEa occurrence) I $
100,000
MED EXP (Any one person) $
51000
A Y UDC -1686303 -CGL -16
01/19/2016 01/19/2017 I PERSONAL &ADV INJURY $
1,000,000
GEN'L AGGREGATE LIMIT PLIES PER:,
GENERAL AGGREGATE $
2,000,000
PRO-
X I JECT LOC
f
PRODUCTS„- COMP/OP AGG $
SIT Gen. Agg.
OTHER:
$
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
I
ANY AUTO
BODILY INJURY Per person) $
{ ALL OWNED SCHEDULED
AUTOS AUTOS
BODILYINJURY(Per accident
( ) $
NON -OWNED
PR®PERTY DAMAGE $
HIRED AUTOS AUTOS
V
_[Per accident)
$
UMBRELLA LIAB I OCCUR
EACH OCCURRENCE } $
EXCESS LI AR CLAIMS -MADE
AGGREGATE
¢ i, I
DED I „ RETENTION $
¢
$
'WORKERS COMPENSATION
`
"PER OTH-
AND EMPLOYERS' LIABILITY Y / N
I STATUTE ER
ANYPROPRIETOR/PARTNERIEXECUTIVE _""'
OFFICERIMEMBEREXCLUDED? N I A
E,L EACH ACCIDENT $
(Mandatory in NH)
E L. DISEASE. EA EMPLOYEEI $
If yes„ describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT , $
DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required)
CERTIFICATE HOLDER CANCELLATION
CITY OF SAN RAFAEL AND ANY OFFICERS AGENTS AND VOLUNTEERS
1400 5TH AVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
SAN RAFAEL, CA 94915 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
I
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