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DATA• 4600 Campus Drive, Suite 200
TICKET YK. Newport Beach, CA 92660
888-752-0512
www.DataTicket.com
Scope of Service and Performance Agreement
These services are provided by:
Data Ticket Inc.
a California Corporation
4600 Campus Drive, Suite 200
Newport Beach, California 92660
(hereinafter sometimes referred to as "COMPANY")
FOR:
THE CITY OF GRAND TERRACE
22795 BARTON ROAD
GRAND TERRACE, CALIFORNIA 92313
(hereinafter sometimes referred to as "AGENCY").
Data Ticket, Inc. intends to provide for the processing of bails, fines and forfeiture
thereof, in connection with the issuance of administrative citations pursuant to AGENCY
municipal code, other debts as specified by the AGENCY and for the issuance of
parking citations pursuant to the laws of the State of California.
ARTICLE I - CITATION PROCESSING
1.1 Referral and Reconciliation: COMPANY shall receive and process citations from
AGENCY. COMPANY will provide a reconciliation of the number of citations received
from AGENCY.
1.2 Determination of Processable Citations: COMPANY shall screen each citation
referred to it by the AGENCY to determine if the citation is processable. If the citation is
determined by COMPANY to be unprocessable (e.g., essential processing information
is missing), COMPANY shall return the citation to AGENCY for clarification. COMPANY
will be paid the contractual rate hereinafter provided, for citations properly returned to
the AGENCY as unprocessable.
1.3 Collection and deposit of funds: A direct deposit system shall be employed for all
funds received for payment of citations. The AGENCY shall have the choice of jointly
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DATA■ 4600 Campus Drive, Suite 200
TICKET�" Newport Beach, CA 92660
888-752-0512
www.DataTicket.com
owning a bank account with the COMPANY or directing the COMPANY to deposit into
an AGENCY account. Deposits shall be made directly into the account by the
COMPANY for the collecting AGENCY, with the exception of credit card payments
made using VISA, MasterCard and Discover cards belonging to the COMPANY. These
payments will be directly deposited into an account held by the COMPANY. Credit card
payments are reconciled and remitted on a monthly basis to the AGENCY, but tracked
on the citation management software on a daily basis. Citations paid by credit card are
marked "paid" real-time immediately upon authorization, thus affording the citizen the
opportunity to make payment at any time and have the payment recognized
immediately.
1.4 PAYMENT: If the COMPANY deposits into an AGENCY account, the COMPANY
will invoice the AGENCY for services rendered. Payment in full shall be due within thirty
(30) days after which interest shall be accrued at the rate of 10% (or lower if any
statutes, rules or regulations prohibit this rate). If the COMPANY deposits into an
account held jointly between the AGENCY and the COMPANY, the COMPANY shall
reconcile the account the month following the banking activity, disperse all revenue due
the AGENCY, the COMPANY, any tax liability and all refunds and send all supporting
documentation to the AGENCY for its records.
1.5 Identification of Registered Vehicle Owners: COMPANY shall exert best efforts to
obtain the name and address of the registered vehicle owner from the California State
Department of Motor Vehicles (DMV) and DMV'S nationwide, for each vehicle for which
a parking citation has been issued. COMPANY shall follow all procedures specified by
the DMV, and be consistent with the California Vehicle Code and DMV'S nationwide,
when identifying registered vehicle owners.
1.6 Verification of Ownership: COMPANY shall take reasonable measures to identify
and verify registered vehicle owners. Such measures will take into consideration factors
such as issuance of new license plates; address changes; license plate transfers to
other vehicles; name changes; and the validity of plates and registration during specific
time periods applicable to individual cases.
1.7 Delinauencv Notices for Administrative Citations: In accordance with AGENCY
ordinance, delinquency notices will be sent to citizens who are not in compliance and
have not paid the fines in full. These notices will indicate future actions to be taken in
order to collect the fines owed the Agency.
1.8 Franchise Tax Board Interface: The Franchise Tax Board Interagency Intercept
Program will be used as the next collection step in the process. A notice merging all
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DATA. 4600 Campus Drive, Suite 200
TICKET Yx. Newport Beach, CA 92660
888-752-0512
www.DataTicket.com
debts owed the AGENCY will be sent to the citizen showing the total amount due the
AGENCY for Administrative and/or Parking Citations and demanding payment. If
payment is not received in full, social security numbers will be attached to each debt
and the debt will be placed with the Franchise Tax Board for collections.
1.9 Delinquency Notices for Parking Citations: In accordance with State law,
COMPANY will generate and mail (presorted, first-class postage) a delinquency notice
to all identified registered owners of vehicles who fail to pay their parking citation fines
or to post bail in the required manner. The mailed notice will include all information
required by the California Vehicle Code, including, but not limited to, the following:
A. The parking citation issuance date and number;
B. The consequences of nonpayment (i.e., a hold on the vehicle
registration and the imposition of penalties, towing, or issuance of a
possible warrant for their arrest; and
C. The amount of fines and fees due and payable
D. Affidavit of Non-Ownership
1.10 Registration Holds: The COMPANY will provide the system and procedures and
will interface with the California State Department of Motor Vehicles to place a hold on
vehicle registrations having unpaid parking fines and fees due against those vehicles in
accordance with the California Vehicle Code and any other applicable State and local
laws. The notification will be given within a reasonable period of time after issuance of
a delinquency notice. The period of time will not exceed the time limits provided by
state and local law.
1.11 Removal of Registration Holds: COMPANY will provide the system and
procedures and will interface with the California State Department of Motor Vehicles to
remove registration holds when a registered vehicle owner satisfies the entire amount of
parking citation fines, penalties, and fees due against the vehicle and establishes such
payment to the satisfaction of COMPANY.
1.12 Contested Citations: In the event a vehicle registered owner disputes the liability
for the outstanding parking citation, COMPANY will advise the registered vehicle owner
of his/her right to request an administrative review/hearing/court appearance. All
contested citations will be forwarded to the reviewing agency, hearing administrator or
Court within the prescribed time period so that the matter can be adjudicated. (CVC
40200.7 &40215 or Municipal Code).
1.13 Administrative Review and Hearing: The COMPANY may schedule administrative
reviews/hearings to respond to citizens wishing to contest their citations and offers the
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DATA• 4600 Campus Drive, Suite 200
TICKET` Newport Beach, CA 92660
888-752-0512
www.DataTicket.com
option to perform and administer those reviews and hearings. The COMPANY will
provide a web site for appeal and toll-free numbers for contestants, correspond with
contestants and notify them of decisions; maintain records of dispositions and appeal
paperwork and refer all paperwork to Court as required. The COMPANY shall not be
responsible for the AGENCY'S failure to provide correct or timely infraction information.
The AGENCY shall be responsible to pay the $25.00 court-filing fee if the review and
administrative hearing decisions are overturned by the court.
1.14 Citations Disposed of by Hearing/Court: The COMPANY may be required, as a
result of court action, to reduce or cancel, on an individual basis, citations which have
been referred to it. COMPANY shall be paid the contractual rate hereinafter provided
for processing the citation regardless of the outcome of court action. COMPANY will
maintain records indicating any reduction or cancellation of parking citations as a result
of review/hearing/court action. Citations that are dismissed as a result of
review/hearing/court decision will have the dismissal processed by the COMPANY
promptly after receipt from the review/hearing/court.
1.15 Suspension of Processing: COMPANY will suspend processing on any citation
referred to it for processing upon written notice to do so by an authorized officer of the
AGENCY. COMPANY will promptly return any citation or facsimile properly requested
by the AGENCY. COMPANY will maintain records indicating any suspension of citation
as a result of AGENCY'S request. COMPANY shall be paid the contractual rate
hereinafter provided for processing the citations suspended by the AGENCY.
1.16 Payments by U.S. Mail: It is the citizen's responsibility to ensure that payments
are received on or before the date due. The date received by the COMPANY will be the
criteria to establish any delinquent fees due.
1.17 Citation System Master File Update: COMPANY will regularly update the citation
master file for new citations, payments, reductions, cancellations, dismissals and any
other pertinent data.
ARTICLE II - PAYMENT PROCESSING
2.1 Disposition Processing: COMPANY will maintain all citation dispositions for a
minimum of two (2) years. Closed citations will remain on-line for a minimum of two (2)
years for research and statistical purposes.
2.2 Payments Processing: COMPANY shall process citation payments on a regular
basis. Payments shall be immediately posted in one (1) of three (3) following
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DATA le 4600 Campus Drive, Suite 200
TICKET Yr. Newport Beach, CA 92660
888-752-0512
www.DataTicket.com
categories:
"Regular Payments" are citations with the correct amount due, paid on or before the
due date. This includes payments properly complying with the first Courtesy Notice.
"Partial Payments" are citations paid after the due date or those where payment is
less than the total amount of due. .
"Appeal Requests" including payment are all requests for administrative/court
hearings. These requests are sorted so that the payment submitted is immediately
posted, an appeal hold is placed on the citation and if needed the original citations and
backup documents are retrieved for the appeal to be heard.
2.3 Miscellaneous Letters Processing: COMPANY will receive and review all
miscellaneous correspondence. These are generally letters requesting meter checks,
refunds, voids, or otherwise setting forth complaints. These letters will be researched
by COMPANY and may be forwarded to the AGENCY for proper follow-up.
2.4 Batchinq Procedures: COMPANY shall maintain effective procedures of internal
control. Such procedures shall involve reconciliation of all payments received using
generally accepted accounting principles. After proper reconciliation, deposit slips shall
be prepared for and deposits made at the appropriate bank, including an itemized listing
of all batch numbers included in the deposit. The batch of citation payment
documentation shall then be stored in a file room, for a period of two (2) years.
2.5 Cash Payments: COMPANY shall maintain an effective method of handling cash
payments. All cash received through the mail, shall be logged in a cash journal.
Thereafter, effective internal control procedures shall be implemented to reconcile such
payments using generally accepted accounting principles.
2.6 Deposits: All deposits shall be made daily, subject to regular banking hours.
Deposits shall be itemized and detailed information will be captured regarding submitted
funds. Deposit slips shall be prepared in duplicate, allowing one (1) copy for the bank
and one (1) copy for the COMPANY. If the bank account is held jointly, COMPANY
shall perform all reconciliation, refunds and cut all checks. This information shall be
available for AGENCY review. Deposits shall be directly deposited into the AGENCY'S
designated bank account, either jointly held with the COMPANY or individually held by
the AGENCY. If the AGENCY holds the account individually, it will supply deposit slips
and an endorsement stamp to COMPANY. In this case, COMPANY shall only have the
capability to make deposits on behalf of the AGENCY.
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DATA • 4600 Campus Drive, Suite 200
TICKET Yr Newport Beach, CA 92660
888-752-0512
www.DataTickel.com
2.7 Revenue Report: A monthly revenue report will list all revenues received during the
preceding month. This report will also provide information regarding the AGENCY'S
responsibility to the County for the Jail and Court fund as required by Sections 40200.3
(a) of the California Vehicle Code and any other relevant taxes due.
ARTICLE III —WEB SITE
3.1 Citation Management Web Site: The COMPANY offers a web site for AGENCY
review of its database, including all citations and information relating to changes in
status.
3.2 Citizen Web Site Access: When the AGENCY has web site access, citizens who
receive citations will be able to access the web site to review their individual citations,
pay on-line and appeal on-line.
3.3 Web Site Interaction: The web site may be "view only" or "interactive", for the
AGENCY depending on requirements of the AGENCY.
3.4 Web Site Reports: Web site reports are available to the AGENCY on a daily, (24/7)
schedule.
3.5 Web Site Use: User ID's and passwords will be assigned to the AGENCY.
ARTICLE IV - GENERAL
4.1 Public Inquiries: The COMPANY will respond to reasonable inquiry by telephone or
letter of a non-judicial nature. Inquiries of a judicial nature will be referred to the
AGENCY for determination.
4.2 COMPANY Limitations: COMPANY will not take legal action or threaten legal action
in any specific case without AGENCY'S prior approval.
4.3 Use of Approved Forms: AGENCY shall have the right to reasonable approval of all
forms, delinquency notices, and correspondence sent by the COMPANY. These must
conform to State and local law.
4.4 Books and Records: COMPANY will maintain adequate books or records for
parking citations issued within the AGENCY'S jurisdiction and referred to COMPANY for
processing. Such books or records, and related computer processing data, shall be
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DATA. 4600 Campus Drive, Suite 200
ITIhhC\\K/1 Newport Beach, CA 92660
TICKET'
888.752-0512
www.DataTicket.com
available for reasonable inspection and audit by AGENCY at the COMPANY'S location
at reasonable times upon adequate prior notice to COMPANY.
4.5 Ownership: All reports, information, and data, including but not limited to computer
tapes, discs, or files furnished or prepared by the COMPANY or its subcontractor
(collectively the "Materials") are and shall remain exclusively the sole property of
COMPANY, and the AGENCY shall acquire no right or title to said Materials. All
computer software and systems, related automated and manual procedures,
instructions, computer programs, and data storage media containing same, and written
procedures performed hereunder (collectively the "System") are and shall remain
exclusively the sole property of COMPANY, and the AGENCY shall acquire no right or
title to said Systems.
4.6 Property of AGENCY: All documents, records, discs, files and tapes supplied by
AGENCY to COMPANY in performance of this contract are agreed to be and shall
remain the sole property of AGENCY. COMPANY agrees to return same promptly to
AGENCY no later than sixty (60) days following notice to the COMPANY. The
AGENCY shall make arrangements with COMPANY for the transmission of such data to
the AGENCY upon payment to COMPANY of any open invoices and the cost of copy
and delivery of such information from COMPANY'S computer facilities to AGENCY'S
designated point of delivery.
4.7 Confidentiality: In order to enable COMPANY to carry out its work hereunder, to
some extent it will have to impart to the AGENCY'S employees information contained in
the Materials and Systems (collectively the "CONFIDENTIAL DATA"). The AGENCY
agrees that information contained in the data that was marked in writing as
"CONFIDENTIAL", "PROPRIETARY" or similarly, so as to give notice of its confidential
nature, when submitted to the AGENCY by COMPANY shall be retained by AGENCY in
the strictest confidence and shall not be used or disclosed in any form except when
required to do so by law, including but not limited to, Public Records Act Requests,
subpoenas and in accordance with paragraph 4.8 herein below. If the COMPANY
desires to contest any disclosure required by law, it may do so at its own expense. The
AGENCY recognizes that irreparable harm could be occasioned to COMPANY by
disclosure of CONFIDENTIAL DATA, which is related to its business, and that
COMPANY may accordingly seek to protect such CONFIDENTIAL DATA by enjoining
disclosure.
4.8 Consent For Disclosure: No report, information, data, files, or tapes furnished or
prepared by COMPANY or its subcontractors, successors, officers, employees,
servants, or agents shall be made available to any individual or organization without the
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DATA 4600 Campus Drive, Suite 200
TICKET YK. Newport Beach, CA 92660
888-752-0512
www.DataTicket.com
prior written approval of AGENCY other than individuals or organization who are
reasonably necessary to properly effectuate the terms and conditions of this agreement.
This Non-Disclosure obligation shall survive the Termination of this Agreement.
4.9 COMPANY Files: COMPANY shall maintain master files on citations referred to it
for processing under this Agreement. Such files will contain records of payments,
dispositions, and any other pertinent information required to provide a reasonable audit
trail.
4.10 Storage for AGENCY:
A. COMPANY agrees to store original citations for the current year, plus
two (2) years, at which time they will be returned or to AGENCY or
shredded. COMPANY will have such information available on the
citation management system for a reasonable time period to permit
AGENCY retrieval of such information. AGENCY relieves COMPANY
of all liability costs associated with data released by AGENCY to any
other person or entity using such data.
B. Subsequent to the termination of the contract, COMPANY will return a
file containing all data belonging to the AGENCY.
ARTICLE V—ADDITIONAL SERVICES
5.1 Other Collections: COMPANY shall retain a percent of payments for delinquent
citations that have been processed in accordance with the current Agreement, and meet
the following criteria:
A. Delinquent parking citations: those citations so designated by the
AGENCY, for which the California State Department of Motor Vehicles
registration hold has been placed or dropped because of a transfer of
ownership or non-renewal of registration or a registration hold has not
been placed, but the normal daily processing cycle is complete.
B. Citations with out-of-state license plates that have gone through the first
courtesy notice process without payment.
C. Any other problem or special citations that the AGENCY so
designates and refers to COMPANY under this Agreement.
5.2 Postal Rate Increase: The COMPANY will maintain auditable records to document
the COMPANY'S actual postage costs associated with the mailing of delinquency
notices for unpaid citations and for other mailings related to the processing of
correspondence. If there is a postal increase, that increase will be invoiced effective on
DATA II
4600 Campus Drive, Suite 200
TICKET YK, Newport Beach, CA 92660
888-752-0512
www.DataTicket.com
the date that the postal rate increase goes into effect.
ARTICLE VI - REPORTS
6.1 Periodic Reports: COMPANY will submit reports to AGENCY the month following
the month in which activity has been reported. The reports will track activities relating to
performance under this Agreement. Among the reports which COMPANY may/will
generate are the following:
A. Report of Revenue Collected for Period
B. Report for Citations Issued for Period
C. A balanced summary report for issuing AGENCY providing the status of
all citations at the beginning of the period, current period activity, and at
the end of the period.
a A report for issuing AGENCY identifying registered vehicle owners with
five (5) or more outstanding parking citations.
E. A report for issuing AGENCY identifying the citations issued, location,
violation by each officer.
6.2 Annual Reports: Annually, COMPANY shall comply with CVC 40200.3 (b)
ARTICLE VII -TERM OF CONTRACT AND ADDITIONAL SERVICES
7.1 Term and Renewals: This Agreement shall be for an initial period of five (5) years,
commencing as of the last date of signature. Unless notice of termination is made in
writing by either party to the other no less than sixty (60) days prior to the end of the
scheduled term, this Agreement shall automatically renew for subsequent one (1) year
periods. In conjunction with this automatic extension of the terms of this Agreement,
COMPANY may give notice of reasonable price adjustments for its processing services.
The AGENCY has thirty days to respond in writing to the purposed increase. Unless
AGENCY gives notice in writing of its rejection of these price adjustments, the term shall
be extended with these price adjustments as stated. If the AGENCY gives notice of its
rejection of these price adjustments, unless there is a further written Agreement
between the parties, the term of the Agreement shall not be extended and the
Agreement shall terminate.
7.2 Cancellation: Any time during the term of this Agreement, AGENCY may terminate
or cancel this Agreement with a thirty (30) day written Notice of Termination for cause or
with a sixty (60) day written Notice of Termination without cause. The COMPANY shall
have thirty (30) days to cure any material breach or defect set forth in the written notice
of Termination for cause provided by AGENCY.
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DATA MI 4600 Campus Drive, Suite 200
TICKET Newport Beach, CA 92660
688.752-0512
www.DataTicket.com
7.3 Exclusivity: AGENCY agrees to utilize only the services of COMPANY during the
term of this Agreement for the processing of the citations referred to above. AGENCY
agrees during the term of the Agreement to not directly or indirectly assist a competitor
of COMPANY in the performance of the services provided by COMPANY under this
Agreement.
7.4 Cost: Please see Cost Proposal for all associated costs.
ARTICLE VIII -CLAIMS AND ACTIONS
8.1 AGENCY Cooperation: In the event any claim or action is brought against
COMPANY relating to COMPANY'S performance or services rendered under this
Agreement, COMPANY shall notify the AGENCY, in writing, within ten (10) days, of said
claim or action.
8.2 Hold Harmless: COMPANY AND AGENCY agree to the following hold harmless
clauses.
A. COMPANY agrees to indemnify, defend, and hold harmless the AGENCY and its
officers and employees against all claims, demands, damages, costs, and liabilities
arising out of, or in connection with, the performance by COMPANY or AGENCY or any
of their officers, employees, or agents under this AGREEMENT, excepting only loss,
injury, or damage caused solely by the negligent acts or omissions of AGENCY or any
of its officers or employees.
B. AGENCY agrees to indemnify, defend, and hold harmless the COMPANY and
its officers and employees against all claims, demands, damages, costs, and liabilities
for loss, injury, or damage caused solely by the negligent acts or omissions of AGENCY
or any of its officers or employees arising out of, or in connection with, the performance
by AGENCY or any of its officers or employees under this AGREEMENT, excepting
only loss, injury, or damage caused solely by the negligent acts or omissions of
COMPANY or any of its officers or employees.
8.3 PERS ELIGIBILITY INDEMNITY. In the event that the Company or any employee,
agent, or subcontractor of the Company providing services under this Agreement claims
or is determined by a court of competent jurisdiction or the California Public Employees
Retirement System ("PERS") to be eligible for enrollment in PERS as an employee of
the City, Company shall indemnify, defend, and hold harmless City for the payment of
any employee and/or employer contributions for PERS benefits on behalf of Company
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DATA II 4600 Campus Drive, Suite 200
TICKET Yx. Newport Beach, CA 92660
888-752-0512
www.DataTicket.com
of its employees agents, or subcontractors, as well as for the payment of any penalties
and interest on such contributions, which would otherwise by the responsibility of City.
Notwithstanding any other agency, state or federal policy, rule, regulation, law or
ordinance to the contrary, Company and any of its employees, agents, and
subcontractors providing service under this Agreement shall not qualify for or become
entitled to, and hereby agree to waive any claims to, any compensation, benefit, or any
incident of employment by City, including but not limited to eligibility to enroll in PERS as
an employee of City and entitlement to any contribution to be paid by City for employer
contribution and/or employee contributions for PERS benefits.
ARTICLE IX -SUBCONTRACTORS AND ASSIGNMENTS
9.1 Subcontracting: COMPANY is authorized to engage subcontractors, as permitted
by law at COMPANY'S own expense, subcontractors shall be deemed agents of
COMPANY.
9.2 Assignments: All assignments by the company are invalid without the prior written
consent of the AGENCY. It is understood and acknowledged by the parties that the
COMPANY is uniquely qualified to perform the services in this agreement.
ARTICLE X - INDEPENDENT COMPANY
10.1 COMPANY'S Relationship: COMPANY'S relationship to AGENCY in the
performance of this Agreement is that of an independent COMPANY. Personnel
performing services under this Agreement shall at all times be under COMPANY'S
exclusive direction and control and shall be employees of COMPANY and not
employees of the AGENCY. COMPANY shall pay all wages and salaries and shall be
responsible for all reports and obligations respecting them relating to social security,
income tax withholding, unemployment compensation, worker's compensation, and
similar matters. Neither COMPANY nor any officer, agent, or employee of COMPANY
shall obtain any right to retirement benefits or other benefits which accrue to employees
of AGENCY, and COMPANY hereby expressly waives any claim it might have to such
rights.
ARTICLE XI - INSURANCE
11.1 Insurance Provisions: COMPANY shall provide and maintain at its own expense
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DATA■ 4600 Campus Drive, Suite 200
TICKET Yc. Newport Beach, CA 92660
888-752-0512
www.DataTicket.com
during the term of this Agreement, the following policy or policies of insurance covering
its operations hereunder. Such insurance shall be provided by insurer(s) satisfactory to
the AGENCY and certificates of such insurance shall be delivered to the AGENCY on or
before the effective date of this Agreement. Such certificates shall specifically identify
this Agreement and shall not be canceled, reduced in coverage or limits or non-renewed
except after thirty (30) days written notice has been given to the AGENCY.
A) Comprehensive general liability insurance covering bodily and personal
injury and property damage. Limits shall be in an amount of not less
than one million ($2,000,000) dollars per occurrence. Such insurance
policies shall name the AGENCY, its officers, agents and employees,
individually and collectively, as additionally insured. Such coverage for
additional insured shall apply as primary insurance and any other
insurance or self-insured retention maintained by the AGENCY its
officers, agents and employees shall be excess only and not
contributing with insurance provided under said policy.
B) Comprehensive automobile liability owned, non-owned and hired
vehicles with not less than one million ($1,000,000) dollars combined
single limit, per occurrence for property damage and for bodily injury or
death of persons. Such insurance shall include the same additional
insured and cancellation notice provisions as specified above and may
be combined with the comprehensive general liability coverage required
above.
C) Throughout the period of Agreement, COMPANY, at its sole cost, shall
maintain in full force and affect a policy of workers' compensation
insurance covering all of its employees as required by the labor code of
the State of California.
ARTICLE XII — ENTIRE AGREEMENT
12.1 Integrated Agreement: This contract is intended by the parties as a final expression
of their Agreement and also as a complete and exclusive statement of the terms thereof,
any prior oral or written Agreement regarding the same subject matter notwithstanding.
This Agreement may not be modified or terminated orally and no modification or any claim
or waiver of any of the provisions shall be effective unless in writing and signed by both
parties.
12.2 Law Applicable: This Agreement shall be construed in accordance with the Laws of
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DATA le 4600 Campus Drive, Suite 200
Newport Beach, CA 92660
TICKET"'
888-752-0512
www.DataTicket.com
the State of California.
12.3 Notice to Parties: Any notice required under this Agreement to be given to either
party may be given by depositing in the United States mail, postage prepaid, first-class,
addressed to the following:
AS TO THE AGENCY:
THE CITY OF GRAND TERRACE
22795 BARTON ROAD
GRAND TERRACE, CALIFORNIA 92313
AS TO THE COMPANY:
DATA TICKET, INC.
A California Corporation
4600 CAMPUS DRIVE, STE 200
NEWPORT BEACH, CALIFORNIA 92660
IN WITNESS WHEREOF, the parties hereto have entered into this Agreement as of the
day and year last written below.
AGENCY: THE CITY OF GRAND TERRACE COMPANY: DATA TICKET, INC.
Signature: 1 & Signature:
Print Name: Betsy M. Adams Print Name: I
Title: City Manager Title: \IU-3S l_.'! a
Date: July 9, 2013 Date: -�c L * 2 a-0
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NATIONWIDE MUTUAL INSURANCE COMPANY RENEWAL
1100 LOCUST ST DEPT 1100
DES MOINES, IA 50391-2000
DECLARATIONS
Policy Number: ACP CPP 7815904526 COMMERCIAL PROPERTY
Named Insured: GRAND TERRACE LIONS CLUB
Mailing 22421 BARTON RD# 403
Address: GRAND TERRACE
CA 92313-5008
Agent: RICK LEE MCKENNA 84-17403
Address: YUCAIPA CA 92399
Policy Period: This policy is effective from 12/07/12 to 12/07/13 12:01 A.M.
Standard time at the above mailing address.
This policy is subject to the following forms. Forms specific to a certain building or
item can be found with the specific building and item information on the following pages.
FORM DATE PREM FORM DATE PREM FORM DATE PREM
CP0010 0607 0 CP0140 0706 0 CP1032 0808 0
CP1270 0996 0 CP7067 0194 0 IL0017 1198 0
IL0102 0505 0 IL0935 0702 0 IN7406 0107 0
13614 1185 0 IN5017 0593 0 IN7589 1011 0
IN7591 1011 0
Mortgagee and loss payee information - See schedules CP-DM and CP-DL
Replacement or
Renewal Number ACP CPP 7815373393
Countersigned By
Date Authorized Representative
Premium for Certified Acts of Terrorism $ 0.00
Total Agent Commission $ 82.50
Total Annual Premium $ MIN 550.00
Total Policy Premium $ MIN 550.00
CP-D (10-98)
DIRECT BILL EMH232 12310 COMM 150 AGENT COPY ACP CPP 7815904526 857545592 78 0022069
V
NATIONWIDE MUTUAL INSURANCE COMPANY
COMMERCIAL PROPERTY SCHEDULE REFERENCE PAGE
Policy Number: ACP CPP 7815904526 Policy Period: From 12/07/12 To 12/07/13
Named Insured: GRAND TERRACE LIONS CLUB
Loc. Bld. Item Address/Description Limit Premium
TOTAL POLICY PREMIUM $ 550.00
POLICY WIDE OPTIONAL COVERAGES
MINIMUM PREMIUM $ 466.00
1 22130 BARTON RD
GRAND TERRACE CA
Protection Class: 05
1 LIONS CLUB
1 PERSONAL PROPERTY $ 20,000
GROUP 1 $ 33.00
GROUP 2 $ 7.00
SPECIAL - CAUSE OF LOSS $ 44.00
CP-DR (10-89)
0001 12310 AGENT COPY ACP CPP 7815904528 857545592 78 0022070
V
NATIONWIDE MUTUAL INSURANCE COMPANY
COMMERCIAL PROPERTY SCHEDULE
Policy Number: ACP CPP 7815904526 Policy Period: From 12/07/12 To 12/07/13
Named Insured: GRAND TERRACE LIONS CLUB
"'"" Premise No 01 "" Total Premium $ 84.00
Address: 22130 BARTON RD
City: GRAND TERRACE State: CA Zip Code: 92313-5003
Description: CLUB
FORM DATE PREM FORM DATE PREM FORM DATE PREM
xxxx xxxx xxxx xxxx xxxx xxxx xxxx xxxx xxxx
CP7100 0405 0 IL0104 0907 0 IL0270 0811 0
IL0952 0308 0 IN0001 0605 0 10940 0789 0
xxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxxxxxxx xxx xx xxxxxxxxxxxxxxxxxxx xx xxxxxxxxxxxx xx
"' Building No 01 " Total Premium $ 84.00
Occupancy Group - SERVICE
Description: LIONS CLUB
Construction Type: FRAME
FORM DATE PREM FORM DATE PREM FORM DATE PREM
xxxx xxxx xxxx xxxx xxxx xxxx xxxx xxxx xxxx
CP0299 0607 0
Coverages Provided
xxxxxxxxxxxxxxxxxx xxx xxxxxxxxxxxxxxx xxx xxx xx xxxxxxxxxxxxxxxxx xxx xxxxxxxxxxxx xxxxx
Limit of Causes of
Item Coverage Insurance Loss Form Coinsurance Deductible Premium
01 PERS PROP $ 20,000 SPECIAL 90% 500 84.00
Description:PERSONAL PROPERTY/CONTENTS
Optional Coverages:
Replacement Cost
FORM DATE PREM FORM DATE PREM FORM DATE PREM
xxxx xxxx xxxx xxxx xxxx xxxx xxxx xxxx xxxx
CP0449 1205 0 CP1030 0607 0 - -
xxxxxxxxx xxx xxx xx xxxxxxxxxxxxxxxxx xx xxxxxxxxxxxxxxxxxxxx xxx xxxxxxxxxxx xxx xxx xxxxx
CP-DS (10-89) -0001 12310 AGENT COPY ACP CPP 7815904526 857545592 78 0022071
� V
NATIONWIDE MUTUAL INSURANCE COMPANY
COMMERCIAL PROPERTY FORMS AND ENDORSEMENTS
Policy Number: ACP CPP 7815904526 Policy Period: From 12/07/12 To 12/07/13
Named Insured: GRAND TERRACE LIONS CLUB
Form Date Title
CP0010 0607 BUILDING AND PERSONAL PROPERTY COVERAGE FORM
CP0140 0706 EXCLUSION OF LOSS DUE TO VIRUS OR BACTERIA
CP0299 0607 CANCELLATION CHANGES
CP0449 1205 CALIFORNIA CHANGES REPLACEMENT COST
CP1030 0607 CAUSES OF LOSS-SPECIAL FORM
CP1032 0808 WATER EXCLUSION ENDORSEMENT
CP1270 0996 JOINT OR DISPUTED LOSS AGREEMENT
CP7067 0194 COMMERCIAL PROPERTY CONDITIONS
CP7100 0405 PROPERTY AMENDATORY ENDORSEMENT
IL0017 1198 COMMON POLICY CONDITIONS
IL0102 0505 CALIFORNIA CHANGES-ACTUAL CASH VALUE
IL0104 0907 CALIFORNIA CHANGES
IL0270 0811 CALIFORNIA CHANGES- CANCELLATION AND NONRENEWAL
IL0935 0702 EXCLUSION OF CERTAIN COMPUTER-RELATED LOSSES
IL0952 0308 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM
IN0001 0605 CONSUMER COMPLAINTS AND INFORMATION
IN5017 0593 IMPORTANT NOTICE FOR RENEWAL POLICIES
IN7406 0107 IMPORTANT FLOOD INSURANCE NOTICE
IN7589 1011 DATA BREACH RESOLUTION SERVICES
IN7591 1011 LIFESTAGES IDENTITY MANAGEMENT AND RESOLUTION SERVICES
10940 0789 CA INSURANCE GUARANTEE ASSN
13614 1185 SPECIAL CONTINUATION PROVISION
CP-DF (10-89)
0001 12310 AGENT COPY ACP CPP 7815904526 857545592 78 0022072
(1r) (i
Allied
Insurance
a Nationwide'company 0
On Your Side'
rn
e3e Ia Pz /
GRAND TERRACE LIONS CLUB r-
22421 BARTON RD # 403
GRAND TERRACE, CA 92313-5008
PLEASE KEEP THIS FOR YOUR RECORDS
We are pleased to serve your business insurance needs. Our company is committed to
providing you high quality insurance protection and superior service.
If you should have any questions about your insurance portfolio or if you wish to make a
change to your policy, please contact your agent.
IMPORTANT INFORMATION ABOUT YOUR POLICY....
Please spend a few minutes to read and understand your policy. Some items to which you
should pay special attention are as follows:
• Special Required State Notices.These notices,when included, point out specific
items concerning your policy.We urge you to read them.
• Declarations Page.This shows such information as your name, address,the
coverages provided,the policy term, policy limits, list of coverage forms,premium
amounts,and other individualized information.
• Coverage and Endorsement Forms. This is the section of your policy which
provides policy and coverage information. Please read it carefully. (fl
POLICY NUMBER BILLING ACCOUNT NUMBER
ACP 78-1-5904526 857545592
N
Your Commercial Insurance Portfolio o)
Courtesy of :
AGENCY - CA- 17403
RICK LEE MCKENNA
PO BOX 4
YUCAIPA CA 92399-0004
AGENCY PHONE # 909-499-4285
.8 DIRECT BILL LANY 110612 AGENT COPY ACP 78-1-5904526 78 0022081
Allied
Insurance IN 74 42 03 07
a Nationwidecompany
On Your Side*
******* IMPORTANT INSURANCE INFORMATION *******
Please read this Notice carefully. No coverage is provided by this notice nor can it be construed to replace any
provision of your policy. You should read your policy and review your declarations page for complete information
on the coverages you are provided. If there is any conflict between the policy and this notice,the provisions of the
policy shall prevail.
CONSUMER REPORT INQUIRY NOTICE
Consumer reports, including credit history may have been ordered from a consumer reporting agency to
underwrite and/or rate your insurance policy.You have the right to access this information and request correction
of any inaccuracies.Your consumer reports, including your credit history are not affected in any way by our
inquiry.
We are committed to respecting your privacy and safeguarding your personal information.
IN 7442 00 07 Page 7 of
ACP 78-15904526 LANY 12310 AGENT COPY IN7442930700 0002 78 0022062
V
Allied
Insurance
a Nationwide company
On Your Side
ALLIED COM-PAK SUMMARY
PRINTED 1110612012 1100 LOCUST ST DEFT 1100
DES MOINES, IA 50391-2000
Number: ACP 7815904528 Effective from 12/07/2012 to 12107/2013
Named Insured: GRAND TERRACE LIONS CLUB
Mailing Address: 22421 BARTON RD p 403
GRAND TERRACE,CA 92313-5000
Agency Name: RICK LEE MCKENNA 84 17403 78
Agency Address: YUCAIPA CA 92399-0004 (909)499-4285
Division Program Total Premium Commission
A COMMERCIAL GENERAL LIABILITY(NATIONWIDE) $1 ,728.00 $259.20
B COMMERCIAL PROPERTY(NATIONWIDE) $550.00 $82.50
Not a bill.Your bill is sent separately.
Al
Estimated Total Premium: $ 2,278.00
Estimated Total Commission: 341.70
This Com-Pak is a ponrono of individual policies which serves to combine
various insurance coverages written under a group of separate conVeds
of insurance.
DIRECT BILL EMH232 LANY 2012310 AGENT COPY ACP 7815904526 78 0022063
PAKSUM 0108
V 11
IN 72 39 01 08
NOTICE OF TERRORISM INSURANCE COVERAGE
NOTICE — DISCLOSURE OF PREMIUM
Applies to all Commercial Policies, except for Farmowners Multiperil, Business Auto,
Crime, and Workers Compensation
(This disclosure notice does not provide coverage, and it does not replace any
provisions of your policy.You should read your policy for complete information on the
coverages you are provided. If there is any conflict between the policy and this notice,
the provisions of the policy shall prevail.)
Coverage for acts of terrorism is included in your policy. You are hereby notified that under the
Terrorism Risk Insurance Act, as amended in 2007, the definition of act of terrorism has
changed. As defined in Section 102(1) of the Act: The term "act of terrorism" means any act
that is certified by the Secretary of the Treasury — in concurrence with the Secretary of State,
and the Attorney General of the United States —to be an act of terrorism; to be a violent act or
an act that is dangerous to human life, property, or infrastructure; to have resulted in damage
within the United states, or outside the United States in the case of certain air carriers or
vessels or the premises of a United Sates mission; and to have been committed by an
individual or individuals as part of an effort to coerce the civilian population of the United Sates
or to influence the policy or affect the conduct of the United States Government by coercion.
Under your coverage, any losses resulting from certified acts of terrorism may be partially
reimbursed by the United States Government under a formula established by the Terrorism
Risk Insurance Act, as amended. However, your policy may contain other exclusions which
might affect your coverage, such as an exclusion for nuclear events. Under the formula, the
United States Government generally reimburses 85% of covered terrorism losses exceeding
the statutorily established deductible paid by the insurance company providing the coverage.
The Terrorism Risk Insurance Act, as amended, contains a $100 billion cap that limits U.S.
Govemment reimbursement as well as insurer's liability for losses resulting from certified acts
of terrorism when the amount of such losses exceeds $100 billion in any one calendar year. If
the aggregate insured losses for all insurers exceed $100 billion, your coverage may be
reduced.
The portion of your annual premium that is attributable to coverage for acts of terrorism is $0,
and does not include any charges for that portion of losses covered by the United States
Government under the Act.
IN 72 39 01 08 Page 1 of 1
DIRECT BILL EMH232 LANY 2012310 AGENT COPY ACP 7815904526 78 0022064
ire
NATIONWIDE MUTUAL INSURANCE COMPANY 17403
1100 LOCUST ST DEPT 1100 RENEWAL
DES MOINES, IA 50391-2000
COMMERCIAL GENERAL LIABILITY DECLARATIONS
Policy Number: ACP GLO 7815904526
Named Insured: GRAND TERRACE LIONS CLUB
Address: 22421 BARTON RD# 403
GRAND TERRACE CA 92313-5008
Agent: RICK LEE MCKENNA 84-17403-000
Address: YUCAIPA CA 92399
Policy Period: From 12/07/12 to 12/07/13 12:01 A.M. standard time at the address of the named insured as stated
herein.
In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the
insurance as stated in this policy.
LIMITS OF INSURANCE
GENERAL AGGREGATE LIMIT (other than products-completed operations) $ 2,000,000
PRODUCTS-COMPLETED OPETIONS AGGREGATE LIMIT $ 2,000,000
PERSONAL AND ADVERTISING INJURY LIMIT $ 1,000,000
EACH OCCURRENCE LIMIT $ 1,000,000
DAMAGE TO PREMISES RENTED TO YOU LIMIT (any one premises) $ 100,000
MEDICAL EXPENSE LIMIT (any one person) $ 5,000
Retroactive Date (CG0002 only)
The Named Insured is: NON-PROFIT ORG
Business of the Named Insured is: LIONS CLUB
Audit Period:
ENDORSEMENTS ATTACHED TO THIS POLICY
SEE COMMERCIAL GENERAL LIABILITY FORMS AND ENDORSEMENTS SCHEDULE
TOTAL ADVANCE PREMIUM $ 1,728.00
Replacement or
Renewal Number ACP GLO 7815373393
Countersigned By
Authorized Representative
GL-D (10-98)
DIRECT BILL LANY 12311 Comm.1500 AGENT COPY ACP GLO 7815904526 857545592 78 0022065
V (111
NATIONWIDE MUTUAL INSURANCE COMPANY
1100 LOCUST ST DEPT 1100
DES MOINES, IA 50391-2000
COMMERCIAL GENERAL LIABILITY SCHEDULE
Policy Number: ACP GLO 7815904526
Item No., Location Code Premium Rates Advance Premium
and Description No. Basis
of Hazards OTHER PR/CO OTHER PR/CO
001A CA-006 41668 AREA PER THOUSAND SQ. FT.
CLUB-CIVIC SERVICE 6,900 250.470 $1,728 --
OR SOCIAL - HAVING
BUILDINGS OR PREM-
ISES OWNED OR LEASED
PRODUCTS-COMPLETED
OPERATIONS ARE
SUBJECT TO THE
GENERAL AGGREGATE
LIMIT -- NOT-FOR-
PROFIT ONLY
CG2002
22130 BARTON RD
GRAND TERRACE
CA923135003
Total Advance Other and PR/CO $1,728
TOTAL ADVANCE PREMIUM $1,728
NOTE: For classes based on payroll each Executive Officer, Sole Proprietor or Partner may be subject to a fixed
amount.
GL-DS (12-93)
DIRECT BILL LANY 12311 AGENT COPY ACP GLO 7015904526 857545592 78 0022066
V i
NATIONWIDE MUTUAL INSURANCE COMPANY
1100 LOCUST ST DEPT 11
DES MOINES, IA 50391-2000
COMMERCIAL GENERAL LIABILITY FORMS AND ENDORSEMENTS
Number: ACP GLO 7815904526 Period: From 12/07/12 To 12/07/13
Named Insured: GRAND TERRACE LIONS CLUB - -
Form Date Title
CG0001 1207 COMMERCIAL GENERAL LIABILITY COVERAGE FORM
CG0068 0509 RECORDING AND DISTRIBUTION OF MATERIAL OR INFORMATION IN VIOLATION OF LAW EXCL
CG2002 1185 ADDITIONAL INSURED- CLUB MEMBERS
CG2144 0798 LIMITATION OF COVERAGE TO DESIGNATED PREMISES OR PROJECT
CG2147 1207 EMPLOYMENT- RELATED PRACTICES EXCLUSION
CG2155 0999 TOTAL POLLUTION EXCLUSION WITH A HOSTILE FIRE EXCEPTION
CG2167 1204 FUNGI OR BACTERIA EXCLUSION
CG2170 0108 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM
CG3234 0105 CALIFORNIA CHANGES
CG7023 1096 EXCL-ASBESTOS, ELECTRO-MAGNETIC RADIATION, LEAD AND RADON
CG7033 0393 TWO OR MORE COVERAGE FORMS OR POLICIES ISSUED BY US CG7306 0909 CALIFORNIA DEFINITIONS -AUTO AND MOBILE EQUIPMENT
GL2199 0600 EXCLUSION - SUBSIDENCE OF LAND
IL0017 1198 COMMON POLICY CONDITIONS
IL0021 0908 NUCLEAR ENERGY LIABILITY EXCLUSION
IL0270 0811 CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL
13614 1185 SPECIAL CONTINUATION PROVISION
IMPORTANT NOTICES
IN5017 0593 IMPORTANT NOTICE FOR RENEWAL POLICIES
IN7203 0402 IMPORTANT NOTICE TO POLICYHOLDERS- CG2155
GLDF (02-93)
DIRECT BILL LANY 12311 AGENT COPY ACP GLO 7815904528 857545592 78 0022087
CG 21 44(07-98) -
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
LIMITATION OF COVERAGE TO DESIGNATED PREMISES OR
PROJECT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART.
SCHEDULE
Premises:
ALL LOCATIONS SPECIFICALLY INSURED ON THE POLICY
Project:
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.)
This insurance applies only to "bodily injury," "property damage," "personal and advertising injury' and medical ex-
penses arising out of:
1. The ownership, maintenance or use of the premises shown in the Schedule and operations necessary or
incidental to those premises; or
2. The project shown in the Schedule.
Copyright, Insurance Services Office, Inc., 1997
CG 21 44 (07-98)
ACP GLO 7815904526 LANY 12311 AGENT COPY 78 0022088
40 i
August 6, 2013
Marjorie A Fleming
Data Ticket, Inc.
4600 Campus Drive, Suite 200
Newport Beach, CA 92660
Re: Scope of Service and Performance Agreement
Dear Ms. Fleming:
Enclosed please find two original Scope of Service and Performance
Agreements between the City of Grand Terrace and Data Ticket, Inc.
Both agreements have been signed by the City Manager. Please sign
both agreements and keep one for your records and return the other
copy to me as soon as possible. Once we are in receipt of the fully
executed agreement we can proceed.
If you have any questions, please contact me at 909 430-2230 or by
email at tmartinez(a'tcityofgrandterrace.orq.
Sincerely,
OTracey M inez
City Clerk
Enclosures
Civic Center, 22795 Barton Road, Grand Terrace, California, 92313-5295
(909) 824-6621 Fax (909) 783-7629 or (909) 783-2600
4 j
Client#:12154 DATTI
ACORDTM CERTIFICATE OF LIABILITY INSURANCE 0e01/20D3 YI
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Ashbrook-Clevidence,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
3000 W.MacArthur Blvd.,#320 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
License 80188788 Santa Ana,CA 92704 NSURERS AFFORDING COVERAGE NAILf
INSURED NSURERA Hartford Casualty Ins.Co.
Data Ticket,Inc.dba: Revenue Experts NSURER B: State Compensation Ins Fund
4600 Campus Drive#200 NSURER C: Continental Casualty Co
Newport Beach,CA 92660 NSUXERD:
NSURER E:
COVERAGES
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 CR
MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
%SR'Dot POLICY EFFECTIVE POLICY EXPIRATION LIMITSLW AS TYPE OF INSURANCE POLICY NUMBER DATE IFIMNONY/ PATE MMTGFIYI
A GENERAL LIABILITY 57SBAIA9147 11/01/12 11/01/13 EACH OCCURRENCE 82,000,000
X COMMERCIAL GENERAL LIABILITY PRRFMRESIOFAEmwEmnoel 5300,000
CLAIMS MADE O OCCUR MED EXP(Any one person) 510,000
PERSONAL BADV INJURY 32,000,DOO
—
GENERA.AGGREGATE 0,000,000
GEEHL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPNP AGG 54,000,000
I
POLICY n J�C n LOC —
A AUTOMOBILE LIABILITY 575BAIA9167 11/01/12 11/01/13 COMBINED SINGLE LIMIT $p,000,000
_ANY AUTO (Ea welded)
_ RLOWXEDAUttIS BODILY INJURY S
SCHEDULED AUTOS (Par person)
X HIRED AUTOS BODILY INJURY S
X NON-OWNED AUTOS (Pvemdem°
(Per PROPERTY
P PERTY DAMAGEWan° S
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT
RAW AUTO OTHER THAN EA ACC
AUTO ONLY: ARG
A EXCESSAMBRELLA LNZILnY 575BAIA9147 11/01/12 11/01/13 EACH OCCURRENCE 1,000,000
A'OCCUR ❑CLAIMS MADE AGGREGATE 1,000,000
DEDUCTIBLE
RETENTION 310000
B WORKERS COMPENSATION AND 90657312013 07/12/13 07/12/14 X TregIMRS PR
EMPLOYERS'LIABILITY EL.EACH ACCIDENT 1,000,000
ANY PROPRIETOR/PARTNER/EXECUTIVE
OyFFFIICERMEMSER EXCLUDED? EL.DISEASE-EA EMPLOYEE 1,000,000
SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 1,000,000
C OTHER Professional 287188360 11/01/12 11/01/13 $2,000,000 Limit
Liability(E&0) $10,000 Retention
Claims Made
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
The City of Grand Terrace,its'officers,agents and employees are included as additional insured as
respects to the general liability and automobile liability as per the attached verbiag(room the policy,
including primary and non-contributory,as their interest may appear.
CERTIFICATE HOLDER CANCELLATION *10 Days for Non-Payment
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
City of Grand Terrace DATE THEREOF,ME ISSUING INSURER WILL ENDEAVOR TO MAIL ,ID DAYS WRITTEN
ATTN: Barrie Owens NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL
22795 Barton Road MPOSE NO OBLIGATION OR UPSET,'OF ANY KIND UPON ME INSURER,ITS AGENTS OR
Grand Terrace,CA 92313 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
PF.t-NT
ACORD 25(2001/08)1 of 2 1025482/M25481 SXL a ACORD CORPORATION 1988
4 a
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer,and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25.5(2001108) 2 of 2 ft825482)11A25481
40 a
•
BUSINESS LIABILITY COVERAGE FORM
F. OPTIONAL ADDITIONAL INSURED 3. Additionallnsured-GrantorOfFranchise
COVERAGES WHO IS AN INSURED under Section C. is
amended to Include as an additional Insured
If listed or shown as applicable In the Declarations, the person(s) or organization(s) shown in the
one or more of the following Optional Additional• Declarations as an Additional Insured
Insured Coverages also apply. When any of these Grantor Of Franchise, but only with respect to
Optional Additional Insured Coverages apply, _. • --their Debility as grantor of franchise to you.
Paragraph 6. (AddContract
iInsureds Whe Required 4. Additional Insured --Lessor. Of Leased _
• by Written Contract, Written Agreement or Permit) Equipment
of Section C.,Who Is An Insured,does not apply
to the person or organization shown in the a. WHO IS AN INSURED under Section C.is
•
Declarations. •These coverages are subject to-the - amended to include' as an additional
terms and.conditions applicable to Business Insured the person(s) or Organization(s) -
Liability' Coverage In this policy, except es shown in the Declarations as an Additional
provided below: Insured — Lessor of Leased Equipment
!1. Additional Insured -Designated Person Or but only with respect to liability for'bodily
l..d Injury', 'property damage' or 'personal
Organization and advertising Injury caused,in whole or
• WHO IS AN•INSURED under Section C. Is • in part,by your maintenance, operation or
• ' .amended to'Include as•an additional Insured - use of:equipment leased to you by such •
• the person(s) or organization(s) shown'In the person(s)of organization(s).
Declarations, but only with respect to liability b. With respect to the Insurance afforded to
for 'bodily and ads sing'pro injury"
"d caused Inorthese additional•insureds, this insurance •
• whole
or part, by advertising t s caused, does not applyto oceurrence'which
t h a or in mis io your acts or acting on your or takes place. r you cease to lease that
the acts or omissions of those on - . equipment
behalf:
a. In the performance, of your ongoing 5. Additional Insured - Owners Or Other
operations;or Interests From Whom, Land Has Been
b. In connection-with your premises owned • Leased
. - -by or rented to you. . ' a. WHO IS AN INSURED under Section C.is .
2. Additional Insured - Managers Or Lessors amended to Include as an additional
Of Premises •
Insured the person(s) or organbration(s)
shown In the Declarations as an Additional
• a. WHO IS AN INSURED under Section C.Is • . Insured—Owners Or Other Interests From
. . emended to Include as an additional insured. • • Whom Land Has Been Leased, but•only-
. the person(s)or orgentzation(s)shown in the, with respect to liability arising'out of the
. 'Dederaticns as as Add lnonal Insured - . ownership,maintenance cruse of that part
. Designated Person Or Organization;but only- . . •of the land leased to you and shown in the
with respect to natality arising out of the .. • Declarations.
ownership,maintenance or use of that pert of •
b. With respect to the Insurance afforded to
the premises leased to you and shown in the these additional insureds, the following
Declarations. • • • additional exclusions apply:
b. With respect to the Insurance afforded to • This insurance does not apply to:
: these additional Insureds, the following • (I) My 'occurrence' that takes place
additional exclusions apply: after you cease to lease that land;or
This insurance does not apply to: (2) Structural -alterations, new
. (1) 'Any 'occurrence' which takes place - - - construction or demolition operations
after you cease to be a tenant in that• performed by or'.on behalf of such
premises; or person or organization.
(2) Structural alterations, new 6. Additional Insured - State ' Or Political
construction or demolition operations
Subdivision—.Permits
performed ganizization.or on behalf of such a. WHO IS AN INSURED under Section C.is
personn or orrga amended to include as an additional
insured the state or political subdivision
shown in the Declarations as an Addit_r:_.
Page 18 of 24 Form SS 10 03 04 05
V i,
•
BUSINESS LIABILITY COVERAGE FORM -
This Paragraph f. applies separately to (3) We have issued this policy in reliance
you and any additional Insured. upon your representations.
3. Financial Responsibility Laws b. Unintentional Failure To Disclose
a. When this policy is certified as proof of Hazards - - -
financial responsibility for the future under If unintentionally you should fail to disclose
the provisions of any motor vehicle • all hazards relating to the conduct of your
financial responsibility law, the insurance business at the Inception date of this
provided by the policy for 'bodily injury". • Coverage Part, we shall not deny any
liability and 'property damage" liability will coverage under this Coverage Part comply with the provisions of the law to- because of such failure.
the extent of the coverage and limits of - T.. Other Insurance
insurance required by that law. •
If other valid and collectible insurance is
b. With respect to 'mobile equipment" to available for a loss we cover under 'this
which this insurance applies, we will Coverage Part, our obligations are limited as
provide any liability, uninsured motorists, follows:
underinsured motorists, no-fault or other a. Primary Insurance
coverage required by any motor vehicle
law. We will provide the required limits for This insurance is primary except when b.
those coverages. - below applies. If other insurance is also •
4. Legal Action Against Us - primary, we will share with all that other
insurance by the method described in c.
No person or organization has a right under this Coverage Form:
b. Excess Insurance
a. To join us as a party or otherwise bring us This insurance is excess over anyof the
. into a "suit" asking for damages from an
Insured;or other Insurance,whether primary,excess,
b. To sue us on this Coverage Form unless contingent or on any other basis:
all of its terms have been fully complied • (1) Your Work
with. •
That is Fire, Extended Coverage,
A person or organization may sue us to recover Builder's Risk, Installation Risk--or
ion an agreed settlement or on a final judgment similar coverage for"your work";
against an insured; but we MI not be liable for (2) Premises Rented To You
damages that are not payable under the terms of That is fire, lightning or explosion
this Insurance or that are in excess of the Insurance for premises rented to you
applicable limit of insurance. An agreed or temporally occupied by you with
settlement means a settlement and release of permission of the owner,
liability signed by us, the Insured and to Tenant Liability
claimant or the claimant's legal representative. (3)5. Separation Of Insureds - That is insurance purchased by you to
cover your liability as a tenant for
Except with respect to the Limits of Insurance, "property damage"to premises rented
and any rights or duties specifically assigned to you or temporarily occupied by you
in this policy'to the first Named Insured, this with permission of the owner,
insurance applies: •
(4) Aircraft,Auto Or Watercraft
a. As if each Named Insured were the only
Named Insured;and If the loss arises out of the maintenance
b. Separately to each insured against whom or use of aircraft,'autos"or watercraft to
a claim is made or'suit'is brought. the extent not subject to Exclusion g. of
Section A.—Coverages.
a. Representations (5) Property Damage To Borrowed
a. When You Accept This Policy Equipment Or Use Of Elevators
By accepting this policy,you agree: If the loss arises out of "property
(1) The statements in the Declarations damage" to borrowed equipment or
are accurate and complete; the use of elevators to the extent not
(2) Those statements are based upon subject to Exclusion k.of Section A.—
representations you made to us;and Coverages.
Page16 of24 Form SS00080405
a
BUSINESS LIABILITY COVERAGE FORM
(6) When You Are Added As An When this insurance is excess over other
Additional Insured To Other insurance, we will pay only our share of
Insurance the amount of the loss, if any, that
That is other insurance available to exceeds the sum of:
you covering liability for damages (1) The total amount that all such other
arising out of the premises or Insurance would pay for the loss in the
operations,or products and completed absence of this Insurance;and
operations, for which you have been - (2) The total of all deductible and self-
added as an additional insured by that - insured amounts under all that other
Insurance;or insurance.
(7) When You Add Others As An - We w81 share the remaining loss,if any,with
Additional Insured To This any other insurance that is not described in
Insurance this Excess Insurance provision and was not
That is other insurance available to an bought specifically to apply in excess of the
additional insured. - Limits of Insuance shown in The
However, the following provisions Declarations of this Coverage Part.
apply to other Insurance available to c. Method Of Sharing
any person or organization who Is an If all the other Insurance permits
additional insured under this Coverage contribution by equal shares,we will follow
Part - this method also. Under this approach,
(a) Primary Insurance When each Insurer contributes equal amounts
Required By Contract until it has paid its applicable limit of
This insurance is primary if you insurance or none of the loss remains,
have agreed in a written contract, whichever comes first
written agreement or permit that If any of the other insurance does not permit
this Insurance be primary. If-other contdbullon by equal shares, we wil
insurance Is also primary, we will contribute by limits. Under this method,each
share with all that other insurance insurer's share is based on the ratio of its
by the method described in-e. applicable limit of insurance to the total
below. applicable limits of insurance of all insurers.
(b) Primary And Non-Contributory 8. Transfer Of Rights Of Recovery Against
To Other Insurance When Others To Us
Required By Contract a. Transfer Of Rights Of Recovery
If you have agreed in a written If the insured has rights to recover all or
contract, written agreement or - part of any payment, including
permit that this insurance is Supplementary Payments, we have made
primary and non-contributory with under this Coverage Pad,those rights are
the additional insured's own transferred to us. The insured must do
insurance, this insurance is nothing after loss to impair them. At our
primary and we will not seek request, the insured will bring "sur" or
contribution from that other transfer those rights to us and help us
insurance. enforce them. This condition does nct
Paragraphs(a)and (b)do not apply to apply to Medical Expenses Coverage.
other insurance to which the additional Waiver Of Rights Of Recovery (Waiver
insured has been added as an Of Subrogation)
additional Insured. If the insured has waived any rights of
When this insurance is excess, we will recovery against any ,person or
have no duty under this Coverage Part to organization for all or part of any payment,
defend the insured against any"suit"if any Including Supplementary Payments, we
other insurer has a duty to defend the have made under this Coverage Part, we
insured against that,"suit". If no other also waive that right, provided the insured
insurer defends, we will undertake to do waived their rights of recovery against
so, but we will be entitled to the insured's such person or organization in a contract,
rights against all those other insurers. agreement or permit that was executed
prior to the injury or damage.
Form SS00080405 Page17 of2d