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HomeMy WebLinkAboutCC Resolution 13474 (Telecommunications License Agr.)RESOLUTION NO. 13474 RESOLUTION OF THE CITY COUNCIL OF THE CITY OF SAN RAFAEL APPROVING AND AUTHORIZING THE CITY MANAGER TO EXECUTE THE FIRST AMENDMENT TO TELECOMMUNICATIONS LICENSE AGREEMENT WITH T - MOBILE WEST LLC WHEREAS, the City of San Rafael and Pacific Bell Wireless, LLC entered into a Telecommunications License Agreement, dated November 10, 1999, for the use of San Rafael Fire Department's training tower for the installation of wireless telecommunications antenna and related facilities; and WHEREAS, the term of the Telecommunications License Agreement between City of San Rafael and Pacific Bell Wireless has been extended on a monthly basis since it expired on November 10, 2009; and WHEREAS, T -Mobile West LLC is now the successor -in -interest to Pacific Bell Wireless, LLC; and WHEREAS, in consideration of an increased monthly license fee, the City of San Rafael and T -Mobile West LLC desire to enter into an amendment to the Telecommunications License Agreement and to extend the term through December 31, 2017, with an option to renew for an additional five year term. NOW THERFORE, BE IT RESOLVED that the San Rafael City Council authorizes and empowers the City Manager of the City of San Rafael to execute in the name of the City of San Rafael the First Amendment To Telecommunications License Agreement in a form approved by the City Attorney. BE IT FURTHER RESOLVED that the City Council of the City of San Rafael finds that the action taken by this Resolution is not subject to the California Environmental Quality Act (CEQA), pursuant to Article 5, Section 15061(b) (3) of the CEQA Guidelines, because there is no possibility that it will have a significant effect on the environment as provided by CEQA. The City Clerk is hereby directed to file the necessary Notice of Exemption as provided under CEQA. I, ESTHER C. BEIRNE, Clerk of the City of San Rafael, hereby certify that the foregoing Resolution was duly and regularly introduced and adopted at a regular meeting of the City Council of said City held on Monday, the 17th day of December, 2012 by the following vote, to wit: AYES: COUNCILMEMBERS: Connolly, Heller, McCullough & Mayor Phillips NOES: COUNCILMEMBERS: None ABSENT: COUNCILMEMBERS: None E 161 S C. BLIRNE, City Clerg E) 01UGINAL Market: San Francisco Site ID: BA00350A Name: San Rafael Fire House FIRST AMENDMENT TO TELECOMMUNICATONS LICENSE AGREEMENT This First Amendment to Telecommunications License Agreement ("First Amendment") is entered into as of this / 7 day of z9 r rrr�r , , 2012, by and between the CITY OF SAN RAFAEL, a municipal corporation (hereinafter "City") and T -MOBILE WEST LLC, a Delaware limited liability corporation, as successor -in - interest to Pacific Bell Wireless, LLC, a Nevada limited liability company ("Licensee"). WHEREAS, City and Licensee entered into that certain Telecommunications License Agreement, dated November 10, 1999 ("License Agreement") for use of a portion of the City's property commonly known as 210 Third Street, San Rafael, California (AP No. 014-101-11 previously known as AP No. 014-101-07) (the "Premises"); and WIIEREAS, the parties desire to reaffirm, reinstate and amend the terms of the License Agreement in certain respects, and to extend the term of this License Agreement through December 31, 2017, with an option to renew for an additional five (5) year term; NOW THEREFORE, for good and valuable consideration the receipt and sufficiency of which are hereby acknowledged, the parties agree to amend the License Agreement as of the date first written above as follows: 1. Section 1 is deleted in its entirety and replaced in full with the following: "l. License City hereby grants a non-exclusive license to Licensee for the term of this Agreement, to use that portion of the City's property known as the Fire Department Training Tower, located at 210 Third Street (AP No. 014-101- 11), as depicted in "Revised Exhibit A" attached hereto (the "License Area"), for the Uses specified hereafter. City further grants to Licensee a non- exclusive license for ingress and egress to License Area across the aforementioned City property seven (7) days a week, twenty-four (24) hours a day, and for the installation and maintenance of underground utility wires, cables, conduits and other telecommunication facilities, as specified on "Revised Exhibit A". All references herein to the Exhibit A shall hereafter refer to and mean the Revised Exhibit A. All installation and maintenance activities shall be at Licensee's sole cost and expense, pursuant to plans approved in advance in writing by the City. The license granted herein is subject to the terms, covenants and conditions hereinafter set forth, and Licensee covenants, as a material part of the consideration for this license, to keep and perform each and every term, covenant and condition of this License Agreement." - I - 11910py L15- Market: San Francisco Site ID: BA00350A Name: San Rafael Fire House 2. Section 2 of the License Agreement entitled, "Uses" is hereby amended by replacing Licensee's permitted operating frequencies for transmitting and receiving radio communication signals with the following (from 1710 MHz through 2155 MHz). 3. Section 4 is deleted in its entirety and replaced in full with the following: "4. Term Subject to the termination provisions in Paragraph 15 hereafter, the term of this License Agreement shall extend through December 31, 2017 ("Initial Term"), provided that this License Agreement shall automatically be extended for one (1) additional five (5) year period (the "Renewal Term") on the same terms and conditions as set forth herein, unless Licensee has given City notice in writing of Licensee's intention not to extend this License Agreement at least thirty (30) days prior to expiration of the Initial Term. The Initial Term and the Renewal Term are collectively referred to herein as the "Term". Notwithstanding the foregoing, and in addition to as otherwise set forth herein, City shall have the right to rescind the Renewal Term by giving Licensee written notice no later than twelve (12) months prior to the expiration of the Initial Term. In such event, the effective date of termination shall be 11:59 PM on December 31, 2017." 4. Section 5 is deleted in its entirety and replaced in full with the following: 465. License Fee Effective upon the first day of the month following the month in which the Amendment is fully executed, Licensee agrees to pay City as a License Fee on or before the first day of each month during the term of this License Agreement, the monthly sum of Two Thousand Two Hundred and 00/100 Dollars ($2,200.00) ("Base Fee"). This fee shall be paid to the City of San Rafael Finance Department, 1400 Fifth Avenue (P.O. Box 151560), San Rafael, CA 94915. The Base Fee shall be increased annually hereafter every June 1 st, by three and one-half percent (3.5%) from the preceding year." 5. Section 15 is deleted in its entirety and replaced in full with the following: "15. Termination a. This License Agreement may be terminated by either party for cause, for failure to comply with any covenant condition or term hereof by the other party, which failure is not cured within thirty (30) days of receipt of written notice of default. -2- Market: San Francisco Site ID: BA00350A Name: San Rafael Fire House b. Licensee may terminate this License Agreement if Licensee determines the Licensee Area is inappropriate or unnecessary for Licensee's operations due to economic or technical reasons upon one hundred eighty (180) days prior written notice. c. City may terminate this License Agreement upon one hundred eighty (180) days prior written notice in the event the License Area is reasonably required for use by City in providing public safety and/or emergency response services. d. During the Renewal Term, City may terminate this License Agreement without cause upon twelve (12) months prior written notice." 6. Section 20 is deleted in its entirety and replaced in full with the following: "20. Notices All notices and other communications required or permitted to be given under this License Agreement, including any notices 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 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: Fire Chief City of San Rafael 1039 C Street San Rafael, CA 94901 To Licensee: T -Mobile West LLC c/o T -Mobile USA, Inc. 12920 SE 38th Street Bellevue, WA 98006 Attn: Lease Compliance/BA00350A 7. The terms and conditions of the License Agreement are incorporated herein by this reference, and capitalized terms used in this First Amendment shall have the same meanings such terms are given in the License Agreement unless otherwise specifically defined herein. Except as specifically set forth herein, this First Amendment shall in no way modify, alter or amend the remaining terms of the License Agreement, all of which are ratified by the parties and shall remain in full force and effect. To the extent there is any conflict between the terms and conditions of the License Agreement and this First Amendment, the terms and conditions of this First Amendment will govern and control. - 3 - Market: San Francisco Site ID: BA00350A Name: San Rafael Fire House 8. The persons who have executed this First Amendment represent and warrant that they are duly authorized to execute this First Amendment in their individual or representative capacity as indicated. IN WITNESS WHEREOF, the parties have executed this First Amendment as of the day, month and year first hereinabove written. CITY: CITY OF SAN RAFAEL 'yLov-c-f4 Nancy Mackll, City Manager ATTEST: LICENSEE: T; MOBILE WEST L /� Print Name: Daniel Paul Area UM=, Network Eng -OPS Title: -V'1 c:Esther C. Beirne, City ClerkC')t'6d APPROVED AS TO FORM: Robert F. Epstein, City Attorney -4- T -Mobile rqW9fgpprp al Kevin Brinkley Market: San Francisco Site ID: BA00350A Name: San Rafael Fire House REVISED EXHIBIT A FIRST AMENDMENT TO TELECOMMUNICATONS LICENSE AGREEMENT [see attached Site Plan Zon Architects dated 11/12/12] -5� San Rafael Harbor SF -350-02 TELECOMMUNICATIONS LICENSE AGREEMFM This Telecommunications License Agreement is entered into as of the ,Y,4y of November, 1999, by and between the CITY OF SAN RAFAEL, a municipal corporation (hereinafter "City") and PACIFIC BELL WIRELESS, LLC, a Nevada Limited Liability Company qualified to do business in California ("Licensee'). The parties agree as follows: City hereby grants a non-exclusive license to Licensee for the term of this Agreement, to use that portion of the City's property known as the Fire Department Training Tower, located at 210 Third Street (AP No. 014-101-07), as depicted in Exhibit "A" attached hereto (the "License Area"), for the Uses specified hereafter. City further grants to Licensee a non-exclusive license for ingress and egress to the License Area across the aforementioned City property seven (7) days a week, twenty-four (24) hours a day, and for installation and maintenance of underground utility wires, cables, conduits and other telecommunication facilities, as specified on Exhibit "A." All installation and maintenance activities shall be at Licensee's sole cost and expense, pursuant to plans approved in advance in writing by the City. The license granted herein is subject to the terms, covenants and conditions hereinafter set forth, and Licensee covenants, as a material part of the consideration for this license, to keep and perform each and every term, covenant and condition of this License Agreement. Licensee shall use the License Area for the sole purpose of constructing, maintaining, securing and operating a wireless telecommunications antenna and related facilities, including an equipment cabinet to be located in the Training Tower, in order to transmit and receive radio communication signals on various frequencies (between 1870 and 1965 MHz) , in compliance with the approved site plans and related drawings on file with the City Community Development Department, and the conditions of approval contained in the City's Environmental and Design Review Permit ED99-55 (collectively the "Telecommunications Facilities'). The Telecommunications Facilities may be modified upon written approval of the City, and obtaining any necessary City permits. Construction and operation of the Telecommunications Facilities shall be at Licensee's sole expense. Licensee shall keep the License Area free from hazards or risk to the public health, safety or welfare. This License Agreement is subject to Licensee obtaining all governmental licenses, permits and approvals required by federal, state or local governmental agencies, DUPLICATE ORIGINAL 0 40 enabling Licensee to construct and operate the Telecommunications Facilities in the License Area as described herein. City agrees, at no expense to City, to cooperate with Licensee in making application for and obtaining all necessary approvals. 4. Term. Subject to the termination provisions in Paragraph 15 hereafter, the term of this License Agreement shall be for ten (10) years commencing upon the date first hereinabove written. License Fee. Licensee agrees to pay City as a License Fee in advance on or before the first day of each month during the term of this License Agreement, the sum of One Thousand Dollars ($1,000.00) ("Base Fee'). The fee shall be paid to City of San Rafael Fire Department, 1039 C Street, San Rafael, CA 94901. The Base Fee shall be adjusted annually on the anniversary of the License Agreement to the extent of any percentage change which has occurred in the Consumer Price Index (All Items, Base 1982-84= 100) as published by the U. S. Department of Labor's Bureau of Labor Statistics for All Consumers for the San Francisco -Oakland -San Jose Metropolitan area (hereinafter "CPI"). The rental adjustment shall be calculated by multiplying the Base Fee in effect for the preceding year by a fraction, the denominator of which is the CPI in effect in the calendar month fourteen months prior to the anniversary date, and the numerator of which is the CPI in effect two full months prior to the anniversary date. In no event shall the Base Fee be adjusted by less than an increase of 3.5 % from the preceding year. • �•• •�.• •! .! As additional consideration for this License Agreement, Licensee agrees to reimburse City for the cost to purchase two (2) Pacific Bell Wireless PCS telephones, tip to $150 per telephone. Licensee shall reimburse City for City's telephone purchase cost within thirty-five (35) days of receipt of City's invoice. 7. bterference wig City Telecommunications. Licensee agrees that its operation of the Telecommunications Facilities authorized herein shall not cause any direct or indirect interference with the operation of the City's own telecommunication facilities, as they now exist or may hereafter exist. In the event of any such interference, Licensee shall correct said interference to the satisfaction of City, within twelve (12) hours of City's written or telephonic notice to Licensee. In the event that Licensee is unable to correct such interference to City's satisfaction within such time period, Licensee shall cease its operation of the Telecommunication Facilities at the end of such time period until the cause of such interference is corrected to .City's satisfaction. In addition, prior to making any equipment or frequency changes, Licensee shall submit plans for said changes to City for its review and approval. Licensee agrees to fund any studies required to ensure that any contemplated changes will be compatible with the City's telecommunications facilities. 8. ,Acceptance of Condition of License Area. Licensee shall accept use of the License Area in an "as is" condition, with no warranty, express or implied, as to the condition of the License Area, including its suitability for the use intended by Licensee. 9. Utilities. Licensee shall pay the cost of all electrical utilities supplied to the License Area and used by Licensee in connection with the Transmission Facilities. Licensee shall be solely responsible for the installation, maintenance, and repair of metering equipment in the License Area to separately measure these utility services. 10. Insnectioy, City shall be entitled to enter the License Area at any time to inspect the Telecommunication Facilities for compliance with the terms of this Agreement, and with all applicable Federal, state, and local governmental regulations. 11. Citv Retentioli of Rights, City retains the right to use the License Area during the term of this Agreement for any purpose that does not interfere with Licensee's use of the License Area as provided herein. 12. Surrender. Upon expiration or termination of this Agreement, Licensee at its sole cost and expense, shall remove its equipment, restore the License Area to its original condition, and vacate the License Area. Should Licensee fail to restore the License Area to a condition satisfactory to City, City may perform such work or have such work performed by others and Licensee shall immediately reimburse City for all direct and indirect costs associated with such work upon receipt of an invoice for such costs. 13. Assignment. The rights granted to Licensee under this License Agreement are personal to Licensee, and Licensee shall not assign or transfer, in whole or in part, any of its rights under this License Agreement without the advance written approval of City. 14. Taxes. Licensee shall pay all personal property taxes, real property taxes, fees and assessments which may at any time be imposed or levied by any public entity and attributable to the Telecommunication Facilities authorized herein. 15. Termination. This License Agreement may be terminated by either party (1) for cause, for failure to comply with any covenant, condition or term hereof by the other party, which failure is not cured within thirty (30) days of receipt of written notice of default, (2) without cause, upon one hundred and eighty two (182) days advance written notice to the other party. Licensee shall indemnify, release, defend and hold harmless City, its officers, agents, employees, and volunteers, against any claim, demand, suit, judgment, loss, liability or expense of any kind, including attorney's fees and administrative costs, arising out of or resulting in any way, in whole or in part, from any acts or omissions, intentional or negligent, of Licensee or Licensee's officers, agents or employees in the performance of their duties and obligations under this License Agreement. 17. Insurance. A. During the term of this Agreement, Licensee shall maintain, at no expense to City, the following insurance policies: 1. A comprehensive general liability insurance policy in the minimum amount of one million ($1,000,000) dollars per occurrence 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 ($1,000,000) dollars per occurrence; B. The insurance coverage required of the Licensee by section 17. A., shall also meet the following requirements: 1. The insurance shall be primary with respect to any insurance or coverage maintained by City and shall not call upon City insurance or coverage for any contribution; 2. The insurance policies shall be endorsed for contractual liability and personal injury; 4 3. The insurance policies shall be specifically endorsed to include the City, its officers, agents, employees, and volunteers, as additionally named insureds under the policies. 4. Licensee shall provide to City's Risk Manager, (a) Certificates of Insurance evidencing the insurance coverage required herein, and (b) specific endorsements naming City, its officers, agents, employees, and volunteers, as additional named insureds under the policies. 5. 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 thirty (30) days written notice to City's Risk Manager. 6. 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; 7. The insurance policies shall provide for a retroactive date of placement coinciding with the effective date of this Agreement; 8. The insurance shall be approved as to form and sufficiency by the City's Risk Manager and the City Attorney. C. If it employs any person, Licensee, 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 Licensee and City against all liability, for injuries to Licensee's officers and employees. D. Any deductibles or self-insured retentions in Licensee'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 Licensee shall procure a bond guaranteeing payment of losses and related investigations, claims administration, attorney's fees and defense expenses. 18. Compliance With Laws. Licensee 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. 19. No Third Parly neficiaries. City and Licensee 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. 5 20. 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: Fire Chief City of San Rafael 1039 C Street San Rafael, CA 94901 and, with respect to insurance issues: City Risk Manager City Of San Rafael 1400 Fifth Avenue (P.O. Box 151560) San Rafael, CA 94915-1560 To Licensee: Pacific Bell Wireless, LLC 4420 Rosewood Drive Building 2, 3' Floor Pleasanton, CA 94588 Attention: PBW Property Manager Telephone: 800-958-8009 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 Licensee 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 Licensee 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. 22. Waivers. The waiver by either party of any breach or violation of any tern, 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 tern, condition, covenant of this Agreement or any applicable law, ordinance or regulation. 23. Costs and AttorKvs' 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. 25. ApRlicable 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 PACIFIC BELL WIRELESS, LLC ROD GOULD, City Manager ATTEST: ACORO® CERTIFICATE OF LIABILITY INSURANCE 5/1/2013 12/3//201DATE(IV2012 YYYY) `� 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 COVET— " cr%mnen RV THF POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If! the terms and conditions of the policy, certain policies may require an endorsement. A statement on this i certificate holder In lieu of such endorsement(s). ';� CONTACT PRODUCER -Z�f•7 �. Lockton Companies,LLC-1 St. Louis NAME: — —1 Three City Place Drive, Suite 900 PHONE St. Louis MO 63141-7081 EE-IL-MANo.�x Z L (314) 432-0500 ADDRESS: d / INSURER(Sy AFFORDI l INSURER A: XL Select Insuranc- INSURED T -Mobile USA, Inc. INSURER B: Gireenwich_ TnSn1'anr e.. C'.nmpony 1358772 Its Subsidiaries and Affiliates INSURER c: National Union Fire Ins Co Pittsburgh PA 12920 SE 38th Street INSURER D: Bellevue WA 98006 INSURERE: 2232i- 19445 INSURER F: COVERAGES TMOBI 22374CERTIFICATE NUMBER: 12090822 REVISION NUMBER: XXI—xxXX 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. INSIR LTR TYPE OF INSURANCE AINSR�WVD POLICY NUMBER UBR POLICY EFF POLICY EXP LIMITS (MMIDD/YYYY) (MMIDD/YYYY) B GENERAL LIABILITY Y Y RGD500025901 58/2012 5/1/2013 f-ACtl qfj jFFjF D s 1000.000 .X MMERCIALGENERii BILITY CLAIMS -MADE I }x VOCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 1 PRO- - X LOC B AUTOMOBILE LIABILITY B X ANY AUTO y Y RAD500025701 AOS RAD500025801 MA ALL OWNED SCHEDULED -� AUTOS AUTOS NON -OWNED HIRED AUTOS P AUTOS C X UMBRELLA LIAB)( OCCUR Y C EXCESS LIAB CLAIMS -MADE C DED X RETENTIONS Wd b(ERS COMPENSATION A AND EMPLOYERS' LIABILITY A ANY PROPRIETOR/PARTNER'EXECUTIVE Y I N OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below 5' 13273159 SIR applies per policy terms & conditions N RWD5000301 AOS RWR5000302 WI A PREMISES (Ea occurrence) MED EXP (Anv one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG S 1,000,000 S 5-000 $ 1,000,000 S 2.000.000 $ ?.000.000 S 5/1/212 5/1/2013 CUMtlINtU SINULL LIMII 5/1/2012 5/1/2013 (Ea accident) S(�(jQ BODILY INJURY (Per person) S jZ �xx BODILY INJURY (Per accident) S XXXX)�( PROPERTY DAMAGE (Peraccidentl S XXXXXXX S XXXXXXX 5/1/2012 5/1/2013 EACH OCCURRENCE S 5,000,000 AGGREGATE S 5.000-000 Sxxxxxxx 5/1/2012 5/1/2013 X ITORY LIMITSI I ER 5/1/2012 5/1/2013 E.L. EACH ACCIDENT S 1 000.000 E.L. DISEASE - EA EMPLOYEE S 1,000.000 E.L. DISEASE- POLICY LIMIT S 1.000.000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) The Certificate Holder and other entities defined are additional insureds on a primary and non-contributory basis under general liability and arc additional insured under automobile liability as required by written contract. Waiver of Subrogation applies under general liability and automobile liability as required by written contract. **Sec Attached Endorsements** Site ID:BA00350A Site Natne:SF350 Fire House art Site Address: 210 3rd Street San Rafael, CA 9.1901 CERTIFICATE HOLDER CANCELLATION See Attachments SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 12090822 AUTHORIZED REPRESENTATIVE City of Sri Rafael 1039 C Street San Rafael CA 94901 ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ©1 0 ACORD ORATION. All rights reserved ENDORSEMENT # 002 This endorsement, effective on May 1, 2012 at 12:01 A.M. standard time, forms a part of Policy No.RAD500025701 of Greenwich Insurance Company issued to T -MOBILE USA, INC. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SECTION II A.1. WHO IS AN INSURED is amended to include as an insured any person or organization for whom you have agreed under contract or agreement to provide Insurance. However, the Insurance provided shall not exceed the scope of coverage and/or limits of this policy. Notwithstanding the foregoing sentence, in no event shall the insurance provided exceed the scope of coverage and/or limits required by said contract or agreement. All other terms and conditions remain unchanged. (Authorized Repreynta�!4e) MANUS © 2011 X.L. America, Inc. All Rights Reserved. May not be copied without permission. ENDORSEMENT # 004 This endorsement, effective 12:01 a.m., December 18, 2012 forms a part of Policy No.RAD500025701 issued to T -MOBILE USA, INC. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT In the event coverage is cancelled for any statutorily permitted reason, other than nonpayment of premium, advanced written notice will be mailed or delivered to person(s) or entity(ies) according to the notification schedule shown below: Number of Days Name of Person(s) or Entity(ies) Mailing Address: Advanced Notice of Cancellation: I I City of San Rafael I San Rafael, California I 30 All other terms and conditions of the Policy remain unchanged. shl--a� (Authorized Repten 6tive) IXI 405 0910 © 2010 X.L. America, Inc. All Rights Reserved. May not be copied without permission. POLICY NUMBER: RAD500025701 COMMERCIAL AUTO CA 04 44 03 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: T -MOBILE USA, INC. Endorsement Effective Date: May 1, 2012 SCHEDULE Name Of Person(s) Or Organization(s): Where required by written contract or agreement executed prior to loss (except where not permitted by law). Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer of Rights of Recovery Against Others To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the 'loss" under a contract with that person or organization. CA 04 44 03 10 Miscellaneous Attachment: M461535 Certificate ID: 12090622 Page 1 of 1 ENDORSEMENT # 022 This endorsement, effective 12:01 a.m., May 1, 2012 forms a part of Policy No.RGD500025901 issued to T -MOBILE USA, INC. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED — WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under all coverage parts. COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE FORM RAILROAD PROTECTIVE LIABILITY COVERAGE FORM Section II — WHO IS AN INSURED is amended to include as an Insured any person or organization for whom you have agreed under written contract or agreement to provide insurance. However, the insurance provided shall not exceed the scope of coverage and/or limits of this policy. Notwithstanding the foregoing sentence, in no event shall the insurance provided exceed the scope of coverage and/or limits required by said contract or agreement. All other terms and conditions remain the same. (Authorized Representative) MANUS © 2011 X.L. America, Inc. All Rights Reserved. May not be copied without permission. ENDORSEMENT # 026 This endorsement, effective 12:01 a.m., December 18, 2012 forms a part of Policy No.RGD500025901 issued to T -MOBILE USA, INC. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT In the event coverage is cancelled for any statutorily permitted reason, other than nonpayment of premium, advanced written notice will be mailed or delivered to person(s) or entity(les) according to the notification schedule shown below: Name of Person(s) or Entity(les) I City of San Rafael I I I I Number of Days Mailing Address: Advanced Notice of Cancellation: San Rafael, California 30 All other terms and conditions of the Policy remain unchanged. (Authorized Repk!94ative) IXI 405 0910 © 2010 X.L. America, Inc. All Rights Reserved May not be copied without permission. Notice of Exemption 4 l (P! 5x Form D To: Office of Planning and Research P.O. Box 3044. Room 212 Sacramento, CA 95812-3044 From: (Public Agenc)) City of San Rafael P.O. Box 151560 San Rafael, CA 94915-1560F Li ; _ County Clerk (Address) County of MARIN PEP, IS 2012 RICHARD N. U.Pi SON lvt IN COUNTY ' .1-E =tK Bl:.�R'N=wt'oKJ. Dleputy Project Title: Amendment to T -Mobile West LLC Telecommunications License Agreement Project Location - Specific: City Fire Station #2 located at 210 3rd Street, San Rafael, CA 94901. Fire Station #2 located at the corner of 3rd and Union Streets Project Location City: SAN RAFAEL Project Location County: MARIN Description of Nature, Purpose and Beneficiaries of Project: Amendment to Telecommunications License Agreement to extend the term for allowing currently -installed wireless communication facilities on the fire station training tower. Term of agreement amendment would permit the currently -installed facilities through December 31, 2017. Name of Public Agency Approving Project: Name of Person or Agency Carrying Out Project: CITY OF SAN RAFAEL JOHN LIPPITT, DEPUTY FIRE MARSHAL Exempt Status: (check one) ❑ Ministerial (Sec. 21080(b)(1); 15268); ❑ Declared Emergency (Sec. 21080(b)(3); 15269(a)); ❑ Emergency Project (Sec. 21080(b)(4); 15269(b)(c)); © Categorical Exemption. State type and section number: ❑ Statutory Exemptions. State code number: Reasons why project is exempt: 15061(B)(3)- GENERAL RULE EXEMPTION Project is limited to an amendment to an existing, executed license agreement that would extend the use of the station training tower for telecommunication facilities. The project proposes not physical improvements that would have the potential to result in any physical changes in the environment. Lead Agency PAUL JENSEN 415.485.5064 Contact Person: Area Code/Telephone/Extension: If filed by applicant: 1. Attach certified document of exemption finding. 2. Has a Notice of Exemption been filed by the public agency approving the project? © Yes ❑ No Signature: Mu' 4L Q Date: December 18, 2012 Title: Community Development Director ja Signed by Lead gency Date received for filing at OPR: NAA )C Signed by Applicant 28d�C-�— Revised 2005