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Department of Transportation-2014-21 i 08-SBd-215-PM 1.2/1.9 In the City of Grand Terrace on Route 215 From 0.1 mile south of Barton Road to 0.1 mile north of Newport Ave FREEWAY AGREEMENT THIS AGREEMENT, made and entered into on this 29 day of .)V YI C , 20 ILi , by and between the STATE OF CALIFORNIA, acting by and through the Department of Transportation (herein referred to as "STATE"), and the City of Grand Terrace (herein referred to as "CITY"), WITNESSETH: WHEREAS, the highway described above has been declared to be a freeway by Resolution of the California Transportation Commission on August 20, 1953; and WHEREAS, STATE and the County of San Bernardino have entered into a Freeway Agreement dated June 7, 1954, relating to the portion of State Highway Route 215 between Riverside county line and Colton Avenue; and WHEREAS, STATE and San Bernardino County Transportation Authority (herein referred to as "SANBAG") entered into a Cooperative Agreement dated May 30, 2012 for the Plans, Specifications and Estimate and Right of Way Phases of the I-215/Barton Road Interchange Project; and WHEREAS, CITY has subsequently annexed certain areas including portions of such freeway covered by said Freeway Agreement dated June 7, 1954 with the County of San Bernardino; and WHEREAS, a plan map for such freeway has been prepared showing the proposed plan of the STATE as it affects streets of the CITY; and WHEREAS, it is the mutual desire of the parties hereto to enter into a new Freeway Agreement in accordance with the revised plan of said freeway; NOW, THEREFORE, IT IS AGREED: 1. This Agreement supersedes that portion of said Freeway Agreement dated June 7, 1954, from 0.1 mile south of Barton Road to 0.1 mile north of Newport Avenue. 1 AY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP INSD WVD POLICY NUMBER (MMIDDIYYYYI (MM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) S 100,000 MED EXP(Any one person) S 5,000 A N UDC-1969289-CGL-19 05/06/2019 05/06/2020 PERSONAL S Arm INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ SIT Gen.Agg OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY $ AUTOS ONLY AUTOS (Peraccident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y 1 N ANYPROPRIETOR/PARTNERIEXECUTNE OFFICEREMBEREXCLUDED? N I A E.L.EACH ACCIDENT IM $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Photography and Video Services CERTIFICATE HOLDER CANCELLATION City of Grand Terrace 22795 Barton Rd SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Grand Terrace CA 92313 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 2. CITY agrees and consents to the closing of CITY streets, relocation of CITY streets, construction of frontage roads and other local streets, and other construction affecting CITY streets, all as shown on the plan map attached hereto, marked Exhibit A, and made a part hereof by this reference. 3. The obligations of STATE and CITY or CITY's agent(s) with respect to the funding and construction of the freeway project will always be dealt with in separate Cooperative Agreement(s), if any. The parties responsible for the construction of the freeway shall make any changes affecting CITY streets only in accordance with the plan map attached hereto, marked Exhibit A. 4. The obligations of STATE and CITY or CITY's agent(s)with respect to the acquisition of the rights of way required for the construction, reconstruction, or alteration of the freeway and CITY streets, frontage roads, and other local roads will always be dealt with in separate Cooperative Agreement(s), if any. 5. It is understood between the parties that the rights of way may be acquired in sections or units, and that both as to the acquisition of right of way and the construction of the freeway project,the obligations of STATE and CITY or CITY's agent(s) hereunder shall be carried out at such time and for such unit or units of the project as funds are budgeted and made lawfully available for such expenditures. 6. CITY will accept control and maintenance over each of the relocated or reconstructed CITY roads, any frontage roads, and other local roads constructed as part of the project, on receipt of written confirmation that the work thereon has been completed, except for any portion which is adopted by STATE as a part of the freeway proper. If acquired by STATE, CITY will accept title to the portions of such roads lying outside the freeway limits upon relinquishment by STATE. 7. This Agreement may be modified at any time by the mutual consent of the parties hereto, as needed to best accomplish, through STATE and CITY cooperation, the completion of the whole freeway project for the benefit of the people of the STATE and CITY. 2 E TO RENTED PREMISES(Ea occurrence) S 100,000 MED EXP(Any one person) S 5,000 A N UDC-1969289-CGL-19 05/06/2019 05/06/2020 PERSONAL S Arm INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ SIT Gen.Agg OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY $ AUTOS ONLY AUTOS (Peraccident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y 1 N ANYPROPRIETOR/PARTNERIEXECUTNE OFFICEREMBEREXCLUDED? N I A E.L.EACH ACCIDENT IM $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Photography and Video Services CERTIFICATE HOLDER CANCELLATION City of Grand Terrace 22795 Barton Rd SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Grand Terrace CA 92313 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their respective duly authorized officers. STATE OF CALIFORNIA CITY OF GRAND TERRACE Department of Transportation MALCOLM DOUGHERTY Director, Department of sportation Wilt/10 By: By : IF:v* W TI OTHY RAGGS WALT STANCKIEWITZ Chief Design Engineer Mayor APPROVED AS TO FORM: APPROVED AS TO FORM: ,&-e-te-4 A rney(State) Attorney (City) 3 AYES: Council Members Allen, Hussey, Robles; Mayor Pro Tem Wilson; Mayor McNaboe NOES: None. ABSENT: None ABSTAIN: None. Executed this 27th day of February 2020, at Grand Terrace, California. Debra L. Thomas �� .` City Clerk ;y1,...„0.4 ebra L. Thomas City Clerk _ - -- • ... • \. C O L T O N �� %i� ,a� —,�-2 0 4. co,�Kc �.� �� EXHIBIT A �,��-"'off 4 ,,,a U__I____1\ ` ll- fit✓t ��6+tt° \ ��,a�ac' \ -CZ___/ \Nil_ --::-3 ----\\--- \ ,....------:--s---- 1 ___,____-< :v ) \__-.-7\ \_,--- -----... *a Rive, —=--� \\ C O L T O N �.y �+ N°aa lmr 7 C cr`� ��`�is -_____ _I sa^` -' rasa/ r r— \�F ----- _ , ar �� • ,„� LIMIT OF AGREEMENT --- =_ l _ \; \ \N\' S` RTE 215 PM 1.9 • LIMJ-T F AGREEMENT \Vy 1� '� .41 /R'P 21 PM 1.2 a rF na • v 6 $ m } t vivlMr6°Fes- I , cii 7_1N \---%--------- 10 T. �' E Sant / �0 140�Pv a 9 f `p/ ` �v t°nftr Or ^'o- a '''.4 \ . o 5 U'y/ \ To C � �C \ \ —<:7,73 ,., x , ,Rci\.. \, N4 �� R %' a� v‘°aka ? ,9% N,,,o,.,, ,,„: NN...N \\% '''''k'9''.' LEGEND . ?- o ��i // i ii.\ ( \-c.-\ ,4,..___,.,,,,,,,,c,„....)„,„„-\ FREEWAY 8 CONNECTIONS ? IIMIE ICALTRANS JURISDICTION) t, a's \At �\ ~_ STATE OF CALIFORNIA INTERCHANGE . �-� DEPARTMENT OF TRANSPORTATION SEPARATION \ D sr. } ?\''''.a ` ( 08-SBD-215 PM 1.2/1.9 FREEWAY :: S l,LAR. OON - \ \ ,� " ®ROAD OR STREET TO DE CONSTRUCTED. �� A\\ --------- IN CITY OF GRAND TERRACE RECONSIRUCTES,OR RELOCATED 1000 500 0 1000 2000 ON ROUTE 215 FROM 0.1 MILE SOUTH OF BARTON ROAD "` AND TERMINUS CONSTRUCTION AS NECESSARY -- TO 0.1 MILE NORTH OF NEWPORT AVENUE SCALE IN FEET IN SAN BERNARDINO CO. PM 1.2/1.9 00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ SIT Gen.Agg OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY $ AUTOS ONLY AUTOS (Peraccident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y 1 N ANYPROPRIETOR/PARTNERIEXECUTNE OFFICEREMBEREXCLUDED? N I A E.L.EACH ACCIDENT IM $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Photography and Video Services CERTIFICATE HOLDER CANCELLATION City of Grand Terrace 22795 Barton Rd SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Grand Terrace CA 92313 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD art 'STATE OF CALIFORNIA—CALIFORNIA STATE TRANSPORTATION AGENCY EDMUND G.BROWN Jr..Governor DEPARTMENT OF TRANSPORTATION RECEIVED loT DISTRICT 8 AGREEMENTS(MS 1231) 464 WEST 4TH STREET,6TH FLOOR DEC 0"9 2014 SAN BERNARDINO,CA 92401-1400 Serious drought. PHONE(909)383-4068 Community Development Help save water! FAX(909)383-6938 Department December 4, 2014 Ms. Sandra Molina 08-SBd-215-PM 1.2/1.9 Community Development Director In the City of Grand Terrace City of Grand Terrace On Route 215 From 0.1 mile south of 22795 Barton Road Barton Road to 0.1 mile north of Grand Terrace, CA 92313 Newport Ave Dear Ms. Molina: Enclosed for your records is one (1) executed Freeway Agreement between the California Department of Transportation and the City of Grand Terrace for the above-referenced project. If you need more information,please contact me at(909) 383-4068. Sinc-rely, l DENISE CRAIG Office Chief Agreements Enclosure c: Joe Meraz, Program/Project Management "Provide a safe,sustainable,integrated and efficient transportation system to enhance California's economy and livability" —<:7,73 ,., x , ,Rci\.. \, N4 �� R %' a� v‘°aka ? ,9% N,,,o,.,, ,,„: NN...N \\% '''''k'9''.' LEGEND . ?- o ��i // i ii.\ ( \-c.-\ ,4,..___,.,,,,,,,,c,„....)„,„„-\ FREEWAY 8 CONNECTIONS ? IIMIE ICALTRANS JURISDICTION) t, a's \At �\ ~_ STATE OF CALIFORNIA INTERCHANGE . �-� DEPARTMENT OF TRANSPORTATION SEPARATION \ D sr. } ?\''''.a ` ( 08-SBD-215 PM 1.2/1.9 FREEWAY :: S l,LAR. OON - \ \ ,� " ®ROAD OR STREET TO DE CONSTRUCTED. �� A\\ --------- IN CITY OF GRAND TERRACE RECONSIRUCTES,OR RELOCATED 1000 500 0 1000 2000 ON ROUTE 215 FROM 0.1 MILE SOUTH OF BARTON ROAD "` AND TERMINUS CONSTRUCTION AS NECESSARY -- TO 0.1 MILE NORTH OF NEWPORT AVENUE SCALE IN FEET IN SAN BERNARDINO CO. PM 1.2/1.9 00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ SIT Gen.Agg OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY $ AUTOS ONLY AUTOS (Peraccident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y 1 N ANYPROPRIETOR/PARTNERIEXECUTNE OFFICEREMBEREXCLUDED? N I A E.L.EACH ACCIDENT IM $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Photography and Video Services CERTIFICATE HOLDER CANCELLATION City of Grand Terrace 22795 Barton Rd SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Grand Terrace CA 92313 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD . . RESOLUTION 2014-016 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF GRAND TERRACE APPROVING A NEW FREEWAY AGREEMENT BETWEEN THE STATE OF CALIFORNIA, ACTING BY AND THROUGH THE DEPARTMENT OF TRANSPORTATION AND THE CITY OF GRAND TERRACE AND MAKING A FINDING THAT THE AGREEMENT AND THE PROJECT WILL NOT HAVE A SIGNIFICANT IMPACT ON THE ENVIRONMENT WHEREAS, Interstate 215 traverses the City of Grand Terrace from the Riverside County Line to just north of Newport Road; WHEREAS, the City incorporated in 1978 and included said portion of Interstate 215 covered by a Freeway Agreement dated June 7, 1954 with the County of San Bernardino; WHEREAS, a plan map for such freeway has been prepared showing the proposed plan of the State of California as it affects streets of the City of Grand Terrace; WHEREAS, an Initial Study with Negative Declaration/Environmental Assessment with Finding of No Significant Impact was prepared for the Interstate 215/Barton Road Interchange Project, which was circulated for public review from November 27, 2013 through December 30, 2013; WHEREAS, On March 5, 2014, the California Department of Transportation approved the Initial Study with Negative Declaration/Environmental Assessment with Finding of No Significant Impact and adopted the Negative Declaration and Finding of No Significant Impact for the Interstate 215/Barton Road Interchange Project, and identified Modified Alternative 7 as the Preferred Alternative for the project; and WHEREAS, on June 24, 2014, the City Council considered the Freeway Agreement at a public meeting in which public comment was held and heard in compliance with the California Department of Transportation requirements and Streets and Highways Code section 100.22; WHEREAS, it is the mutual desire of the parties hereto to enter into a new Freeway Agreement in accordance with the revised plan of said freeway; Page 1 of 4 -- IN CITY OF GRAND TERRACE RECONSIRUCTES,OR RELOCATED 1000 500 0 1000 2000 ON ROUTE 215 FROM 0.1 MILE SOUTH OF BARTON ROAD "` AND TERMINUS CONSTRUCTION AS NECESSARY -- TO 0.1 MILE NORTH OF NEWPORT AVENUE SCALE IN FEET IN SAN BERNARDINO CO. PM 1.2/1.9 00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ SIT Gen.Agg OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY $ AUTOS ONLY AUTOS (Peraccident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y 1 N ANYPROPRIETOR/PARTNERIEXECUTNE OFFICEREMBEREXCLUDED? N I A E.L.EACH ACCIDENT IM $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Photography and Video Services CERTIFICATE HOLDER CANCELLATION City of Grand Terrace 22795 Barton Rd SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Grand Terrace CA 92313 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD J . I , • NOW THEREFORE, BE IT RESOLVED THAT THE CITY COUNCIL OF THE CITY OF GRAND TERRACE DOES RESOLVE, DETERMINE, FIND AND ORDER AS FOLLOWS: Section 1. The City Council finds that all of the above recitals are true and correct and are incorporated herein by reference. Section 2. Based on the aforementioned Initial Study and Negative Declaration/Environmental Assessment, the City Council finds that the approval of the Freeway Agreement regarding the Interstate 215/Barton road Interchange Project will not have a significant impact on the environment. Section 3. The City Council hereby approves the new Freeway Agreement attached hereto as Exhibit 1. Section 4. The City Council hereby authorizes the Mayor to execute the Freeway Agreement. PASSED, APPROVED AND ADOPTED by the City Council of the Grand Terrace at a regular meeting held on the 24th day of June, 2014. Walt Stanckiewitz Mayor ATTEST: 4l li l�97, Deh A. Harrington Interim City Clerk APPROVED AS TO FORM (c.4.2--->)-- b"---- deN--- ttorney Page 2 of 4 of Transportation approved the Initial Study with Negative Declaration/Environmental Assessment with Finding of No Significant Impact and adopted the Negative Declaration and Finding of No Significant Impact for the Interstate 215/Barton Road Interchange Project, and identified Modified Alternative 7 as the Preferred Alternative for the project; and WHEREAS, on June 24, 2014, the City Council considered the Freeway Agreement at a public meeting in which public comment was held and heard in compliance with the California Department of Transportation requirements and Streets and Highways Code section 100.22; WHEREAS, it is the mutual desire of the parties hereto to enter into a new Freeway Agreement in accordance with the revised plan of said freeway; Page 1 of 4 -- IN CITY OF GRAND TERRACE RECONSIRUCTES,OR RELOCATED 1000 500 0 1000 2000 ON ROUTE 215 FROM 0.1 MILE SOUTH OF BARTON ROAD "` AND TERMINUS CONSTRUCTION AS NECESSARY -- TO 0.1 MILE NORTH OF NEWPORT AVENUE SCALE IN FEET IN SAN BERNARDINO CO. PM 1.2/1.9 00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- X POLICY JECT LOC PRODUCTS-COMP/OP AGG $ SIT Gen.Agg OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY $ AUTOS ONLY AUTOS (Peraccident) HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y 1 N ANYPROPRIETOR/PARTNERIEXECUTNE OFFICEREMBEREXCLUDED? N I A E.L.EACH ACCIDENT IM $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Photography and Video Services CERTIFICATE HOLDER CANCELLATION City of Grand Terrace 22795 Barton Rd SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Grand Terrace CA 92313 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD