HomeMy WebLinkAboutED 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
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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)