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HomeMy WebLinkAboutA8893 - Sean BulmerCITY OF PALM SPRINGS INDEPENDENT CONTRACTOR AGREEMENT FOR INSTRUCTORS FY 2021-2022 THIS INDEPENDENT CONT CTOR AGREE ENT FOR INSTRUCTORS ("Agreement") is made and entered into this day of 2021, by and between _Sean Bulmer ("Contractor"), and the City of Palm Springs (the "City"). The City and Contractor are sometimes individually referred to as "Party" and collectively as "Parties" in this Agreement. 1. RECITALS A. City is a public agency of the State of California in need of professional services for the following City -sponsored special event: (Tennis Instructor for Summer Camp) B. Contractor is an independent contractor and possessed the necessary qualifications to provide such services. C. The Parties desire by this Agreement to establish the terms for City to retain Contractor to provide the services described herein. 2. PURPOSE: The City hereby engages Contractor for the purpose of providing (Tennis Instructor) instruction, as further detailed in the Scope of Work attached hereto as Exhibit "A" and incorporated herein by reference (the "Services"). Contractor shall complete the Services in a skillful and competent manner, in accordance with all applicable laws, rules and regulations, and in accordance with the terms of this Agreement. Contractor shall perform such other duties as are customarily performed by one holding such position in other same or similar businesses or enterprises as that engaged in by the City. 3. TERM: The term of this Agreement shall begin on (June 14, 2021) and shall expire on (July 30, 2021), unless earlier terminated as provided in this Agreement. 4. INDEPENDENT CONTRACTOR The Parties intend and agree that at all times during the performance of services pursuant to this Agreement, Contractor is and shall be acting as an independent contractor. Contractor understands and acknowledges that in entering into this Agreement Contractor is an Independent Contractor and not an employee of the City and is not eligible for any benefits of City employment. Contractor further understands and acknowledges that City does not maintain any Workers' Compensation, accident or any type of insurance coverage for Independent Contractors. City shall not be liable for any payment or compensation in any form to Contractor other than as provided for herein. Other than the use of the facility, Instructor shall be responsible to use his or her own tools, supplies and equipment consistent with Section 6 herein and is responsible to determine the method and manner of instruction consistent with Section 2 herein. 5. EQUIPMENT AND LABOR: Contractor shall furnish all tools, equipment, apparatus, supplies, and materials ("Supplies and Equipment") required for performance of the Services, unl 1 Contractor's initi 55575.18185\33964072.1 otherwise mutually agreed by the City. Contractor assumes all risk of loss, damage, or harm to the Supplies and Equipment arising in connection with the Services or this Agreement. 6. COLLECTION OF FEES: Fees shall be collected by the City through set registration procedures implemented by designated City staff ("Registration Fees"). Contractor is not authorized to collect Registration Fees on behalf of the City. However, in some instances, additional fees for supplies and/or materials necessary for the participation in and the completion of the class, program, camp, activity, etc. may be imposed by Contractor and are not considered Registration Fees and therefore will not be collected by the City. These fees will be collected by and paid directly to the Contractor/Instructor. COMPENSATION: A. CITY agrees to pay INSTRUCTOR for the performance of Services on the following terms: 1. Flat fee $ 2. Hourly fee $ 3. Contingent fee $ per 4. Other 75% of fees collected B. All compensation shall be paid at the end of the each month, in accordance to the payroll schedule. C. INSTRUCTOR shall not be entitled to any additional compensation. 8. PAYMENT: The compensation provided in Paragraph 7 of this Agreement shall be paid upon satisfactory completion of the Services. The Department of Parks and Recreation will provide Contractor with a printed report from Activenet. Activenet report will state the number of people registered for the program and the amount of money collected. Contractor will approve record and the Finance Department will process for payment. 9. SUBCONTRACTORS: In the event Contractor will not be able to teach class due to illness or any other reason, Contractor shall implement the following procedure: a. Contractor shall procure a substitute contractor equally or better qualified and acceptable to the City to instruct class at the prescribed time and place. Subcontractors must meet the criminal background screening and fingerprinting requirements according to California Public Resources Code Section 5164. All substitute contractors must be approved by the Department of Parks and Recreation prior to providing services. b. All subcontracts shall contain a provision making them subject to all applicable terms and conditions of this Agreement. A copy of all subcontracts shall be provided to the City within fifteen (15) days of subcontract execution. c. Contractor shall notify assigned designated staff regarding the substitute's name, qualifications, address, and phone information. Payment of all subcontractors shall be the responsibility of Contractor. d. If a substitute cannot be procured, the class will be canceled and a make-up class added to the end of the session. Contractor shall be responsible for notifying the students of the cancellation. 2 Contractor's initials. 55575.18185' 33964072.1 10. SUPERVISION: Contractor shall establish appropriate rules for participation in the Services and shall assume responsibility for student discipline to ensure adequate protection of students and facility. Contractor agrees to work with assigned City staff to maintain accurate enrollment records. 11. FACILITY: The City shall be responsible for providing a suitable facility for the conduct of the Services (the "Facility"), unless otherwise noted under the "Special Arrangements" provision of this Agreement. Contractor shall pay the City for any and all costs associated with using the Facility. As part of the Services, Contractor shall be solely responsible for setting up the Facility for instruction and maintaining the Facility in a clean, safe, and orderly manner. Contractor shall be responsible for cleaning and/or restoring the Facility to its usual condition following each class session. City representatives shall at all times have access to the Facility, whenever Services are in progress, to monitor programs for quality. 12. CONDUCT: Contractor understands that the City is a public entity under the laws of the State of California, and that the City's purpose in engaging Contractor is to provide its residents with recreational activities in a manner that will foster a sense of community, security, fun, and fair play. Contractor agrees to conduct himself/herself in a manner that will further these goals. Contractor further acknowledges that failure to do so may result in immediate termination of this Agreement. 13. COORDINATION OF SCHEDULE: Contractor agrees to coordinate with the City specified time(s) and date(s) for the Services in order to avoid conflict of use. Dates and times shall be contingent upon Facility availability due to holidays and events. It is agreed that the resolution of any conflict is at the sole discretion of the City Manager or his/her designee. Coordination is for the sole purpose of coordinating City's sponsored event schedule and not to determine the method or means of performing the Contractor's services. 14. PUBLICITY: Contractor shall not advertise, print, or publish any promotional materials in connection with the Services without the prior written approval of the City Manager or his/her authorized representative. The City reserves the right to broadcast, televise, and photograph the Services for the purpose of advertising. 15. CONTRACTOR REPRESENTATIONS AND ACKNOWLEDGMENTS: By signing this Agreement, Contractor represents and acknowledges: a. That the information provided by the Contractor in the Contract Class/Program Proposal ("Proposal") and this Agreement is true and correct to the best of Contractor's knowledge. Contractor further understands and agrees that any material misrepresentation may result in the immediate cancellation of this Agreement without prior notice or right of appeal. b. That the City will fingerprint all prospective instructors and substitute instructors for the Recreation Department who may have supervisory or disciplinary authority over minors, pursuant to Public Resources Code section 5164, prior to the commencement of instruction. Contractor understands the City will submit the fingerprints to the Department of Justice to obtain summary criminal history information on all such prospective instructors, as authorized by California Penal Code section 1105.3 Contractor understands that, as authorized by California Public Resources Coc ( 3 Contractor's initi 55575.1818533964072.1 section 5164, the City will refrain from hiring any prospective instructor whose criminal summary record shows a conviction for any offense specified by that section. c. Contractor understands that a background investigation may be conducted in order to verify Contractor's responses in the Proposal and/or Agreement and to otherwise obtain information as to Contractor's character, reputation, personal characteristics, work habits, academic credentials, job performance, experience and/or criminal history from various private and public sources, along with other public records available. Contractor further understands that this investigation may involve an "investigative consumer report" that may include information as to Contractor's character, general reputation, or personal characteristics, obtained through personal interviews with neighbors, friends, associates and/or others who may have knowledge of such items of information. Contractor understands that Contractor has a right within a reasonable period of time to request a complete and accurate disclosure of the nature and scope of the investigative consumer report. Contractor recognizes, however, that such disclosure will not include the names of sources, the information obtained, nor a copy of the investigative consumer report. 16. HOLD HARMLESS AND INDEMNIFICATION: Contractor shall defend, indemnify, and hold harmless the City, its officials, officers, agents, employees, and volunteers ("Indemnified Parties") free and harmless from any and all claims, demands, causes of action, costs, expenses, liability, loss, damage, or injury in law or equity to property or persons, including wrongful death, in manner arising out of our incident to any alleged acts, omissions, or willful misconduct of Contractor, its employees, agents, consultants, contractors, and volunteers arising out of or in connection with the performance of the Services or this Agreement, including without limitation the payment of all consequential damages and attorney's fees and other related costs and expenses. Contractor shall pay and satisfy any judgement, award, or decree that may be rendered against the Indemnified Parties, or any of them, in any such suit, action, or other legal proceeding. Contractor shall reimburse the Indemnified Parties for any and all legal expenses and costs incurred by any of them in connection therewith or in enforcing the indemnity herein provided. Contractor's obligation to indemnify shall not be restricted to insurance proceeds, in any, received by the Indemnified Parties. Such indemnification shall cover death or bodily injury to any person; injury to, loss, or theft of property, injury arising from the furnishing or use of any copyrighted or uncopyrighted composition, secret process, or patented or unpatented invention, or any other type of injury, whether such injury or damage occurs on or off City property. This provision shall survive any expiration or termination of this Agreement. 17. RELEASE OF LIABILITY; WAIVER OF CLAIMS: a. Contractor fully releases, waives all claims against and discharges the City, its officials, officers, directors, employees, agents, contractors and volunteers ("Released Parties") from any and all claims, actions, debts and liabilities for damages which Contractor or any of its subcontractors or related parties ("Contractor Parties") now have or in the future may have against the Released Parties for any injuries, loss through theft, or damage to property suffered by the Contractor Parties by reason of performance of the Services, this Agreement, or by reason of the presence on City premises or in City facilities in conjunction with the performance of the Services. Contractor assumes full responsibility for any injuries, damages or losses that Contractor or the Contractor 4 Contractor's ini ' I 5 5575. l 8185',33964072.1 Parties may incur in performing this Agreement, regardless of any negligence on the part of the Released Parties. b. This waiver and release specifically constitutes a waiver of each and all of the provisions of California Civil Code section 1542. With respect to the matters released hereunder, Contractor waives any rights or benefits that he or she might otherwise have under California Civil Code section 1542, or any other similar law. California Civil Code section 1542 provides: "A general release does not extend to claims that the creditor or releasing party does not know or suspect to exist in his or her favor at the time of executing the release and that, if known by him or her, would have materially affected his or her settlement with the debtor or released party." c. Contractor has read and understands that the above waiver and release will prevent the Contractor or the Contractor's estate from recovering damages in the event of bodily injury, death, or damage to property. Nevertheless, Contractor executes this Agreement freely and voluntarily and agrees that it will be binding upon the Contractor and the Contractor's heirs, assigns, successors, and legal representatives. Contractor shall not allow any Contractor Parties to participate in the Services unless and until such Contractor Parties have executed a waiver and release containing the terms above. The above waiver and release shall survive any expiration or termination of this Agreement. 18. INSURANCE: The CITY reserves the right to require INSTRUCTOR to maintain insurance for the duration of this Agreement. Insurance requirements, if any, are attached as Exhibit "B" and incorporated herein by reference. INSTRUCTOR shall provide CITY with proof of insurance prior to the commencement of Services. 19. ASSUMPTION OF RISK: It is understood that Contractor and any subcontractor of Contractor are not covered by the City's Worker's Compensation Insurance and, therefore, perform the Services at their own risk. The City shall not be liable for any personal injuries incurred during the performance of the Services or this Agreement. Any substitute or subcontractor for Contractor shall not be a volunteer and shall not be considered an employee of Contractor. If Contractor has employees, Contractor shall be required to provide Worker's Compensation Insurance as required by the State of California Employer's Liability Insurance. This provision shall survive any expiration or termination of this Agreement. 20. TUBERCULOSIS SCREENING: If the Services involve park, playground, recreational centers used for recreational purposes by the City, and if the Services will include being in contact with children, prior to commencing performance of the Services, Contractor shall provide to the City a certificate showing that within the last two years the Contractor has been examined and has been found to be free of communicable tuberculosis. 21. GENERAL COMPLIANCE WITH LAWS. Contractor shall comply with all federal, state, and local laws, statutes, rules and regulations in any manner affecting the performance of the Services or this Agreement. 5 Contractor's initi 55575.18185' 33964072.1 AlAI&k— 22. AMERICANS WITH DISABILITIES ACT: Contractor agrees that he or she shall make every attempt to accommodate people with physical and/or mental disabilities. Contractor shall not discriminate on the basis of such disabilities. 23. GOVERNING LAW: This Agreement shall be interpreted in accordance with the laws of the State of California. Venue shall be in Riverside County, California. 24. ATTORNEY FEES: In the event of litigation between the Parties, the prevailing Party shall be entitled to recover all reasonable costs incurred, including reasonable attorney's fees, as determined by the court. 25. BUSINESS LICENSE: Contractor shall obtain and follow all business license requirements as outlined in City Municipal Code Chapter 3.40. All business license requirements must be met prior to approval of this Agreement. 26. MODIFICATION: No amendment or modification of this Agreement is valid unless made in a writing signed by both Parties to this Agreement. 27. NON -ASSIGNMENT: Contractor shall not have any right to assign and/or transfer his or her rights and/or obligations under this Agreement without the prior written consent of the City. 28. DEFAULT: Failure to comply with any of the terms and/or conditions of this Agreement shall constitute default by the Contractor. 29. TERMINATION: This Agreement may be terminated for convenience by the City upon thirty (30) days written notice to Contractor. The City shall have the right to immediately terminate this Agreement for cause, without prior notice, and without penalty or liability on the part of the City. Termination for cause shall be made by written notice setting forth the effective date of termination. 30. NOTICE: Any notice required to be given pursuant to this Agreement may be personally served on the Parties or may be served by certified mail, return receipt request, to the Parties signing this Agreement, at the addresses specified on the signature page. 31. ENTIRE AGREEMENT: This Agreement constitutes the entire agreement between the parties concerning the subject manner hereof and supersedes all agreements, representations, statements, promises, and understandings, whether oral or written, with respect to the subject matter hereof. 32. SEVERABILITY: In the event any terms or condition of this Agreement shall be held to be invalid and unenforceable by a court of competent jurisdiction, the other terms and conditions of this Agreement shall be valid and binding on the Parties hereto. The unenforceability, invalidity or illegality of any provision(s) of this Agreement shall not render the other provisions unenforceable, invalid or illegal. Waiver by any Party of any portion of this Agreement shall not constitute a waiver of any other portion thereof. 33. SPECIAL ARRANGEMENTS: Special arrangements may be further detailed in Exhibit "A". 34. NON-EXCLUSIVE AGREEMENT: Contractor is not in an exclusive Agreement with the City and is free to perform the same or similar services for others without restriction by the City. 6 Contractor's initials: 55575.1818 5'133964072.1 [Signatures on following page] 55575.18 185\33964072.1 Contractor's initia IN WITNESS WHEREOF, the Parties hereto have executed this Agreement as of the day and year last written below. CONTRACTO In R P�124i ur Date) (P int or T e Contractor Name and Title) (Social Security or Tax ID Number) 1 �- (City of Palm Springgss-Business License Number) (Street Address, City, State, Zip Code) pAti �, (Phone Number) � I�+� pv i CITY OF PALM SPRINGS By: (Si at re of Facility Supervisor and Date) �� I (City Facility Assignment nd Phone umber) ( I ature of Manager and te) u (Signatu of Director and Date) APPROVE S TO FORM Cit omey Date Z I NOTE: This agreement is valid only for the facility assignment identified above. 8 Contractor's i 55575. 18185.33964072. 1 EXHIBIT A SCOPE OF WORK [INSERT DESCRIPTION OF THE SERVICES] COMMUNITY INVOLVEMENT: Contractor shall perform/participate in (2} City -sponsored special events during the term of this Agreement. A. CITY seeks to provide Tennis instruction services. INSTRUCTOR shall perform all necessary and appropriate services consistent with Tennis_("Services"). Services are detailed in Exhibit 'A" attached hereto and incorporated herein by reference. B. Services shall be performed at the -Palm Springs High School ("Facilities"). C. INSTRUCTOR warrants that he/she is qualified to provide CITY with Services and holds all necessary certifications and licenses. D.INSTRUCTOR warrants that he/she will personnel, and other such necessities that safe, competent, and professional manner. provide all necessary supplies, equipment, enable him/her to perform the Services in a E. INSTRUCTOR shall perform the Services in a manner consistent with industry standards and the expectations of a reasonable person. 9 Contractor's initial 55575.18185%133964072.1 NFHS Coaches Association PO BOX 690 • INDIANAPOLIS, INDIANA 46206 - 317-972-6900 FF Coaches Association FOR INSURANCE INFORMATION Membership Card Sean Anthony Bulmer Membership ID 3794789 seanbulmer@me.com Valid until 02/22/2022 o.: ' o Scan the QR code or visit www.dissingerreed.com/national- M � federation -of -state -high -school - associations/ NFHS, PO Box 690, Indianapolis, IN 46206 Phone 317-972-6900 1 Fax 317-822-5700 REMOVE CARD - FOLD IN HALF X cut Dear NFHS Member Congratulations on making an important professional choice by becoming a member of the NFHS Coaches Association. The NFHS Coaches Association has more than 25,000 coaches who, like you, have joined an organization dedicated to that professional development and recognition of coaches throughout the United States. The mission of the NFHS Coaches Association is to enhance the professional development of all high school sports coaches in order to improve interscholastic athletics in America. Membership Benefits Insurance Coverage Insurance coverage includes: • Excess General liability; Additional Umbrella coverage for coaches who have earned the Accredited Interscholastic Coach (AIC) credential - go to www.nfhslearn.com for more information on AIC • Excess Accident Medical • Accidental Death and Dismemberment • Covered coaches are those who are individual members of the NFHS Coaches Association or members through a state coaches' association that has 100% membership in the NFHS Coaches Association • Coverage applied to all levels of coaching (youth, recreational, adult and collegiate) in sports recognized by the state high school association NOTE: For more detailed insurance information, visit www.dissingerreed.com/national- federation-of- state -high -school -associations/ Awards Program National awards and recognition for state, sectional and national levels, plus NFHS Coach Citation. Award recipients are nominated by their respective state associations. NFHS Rules Members receive access to the NFHS Rules App, which includes all NFHS Rules Books. For more information, visit www.nfhs.org/eruies. NFHS Committees Eligible for representation on NFHS sport rules committees and standing committees. Nominations are submitted to the NFHS by the coach's state high school association Rental Car Discounts National Car Rental www.nationalcar.com 800-227-7368 Contract ID XZ08037 Enterprise Rent-A-Car www.enterprise.com 800-593-0505 Corporate No. XZ08037 PIN No. NAT Cynthia Alvarado From: Taroli Tennis <tarolitennis@gmail.com> Sent: Friday, April 16, 2021 11:17 AM To: Cynthia Alvarado Subject: Volunteer interest application E Apologies for the subpar handwriting. Yes, I'm dyslexic AND left handed! SLAND IS ACORD,CERTIFICATE OF LIABILITY INSURANCE DATE( 5/27//72YYYY) 7/21 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(ies) must have ADDITIONAL INSURED provisions or 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 K & K Insurance Group, Inc. CoTCT NAME: SPORTS P.O. Box 2338 Fort Wayne, In 46801 A/C No.Ext: 800-441-3994 FAX A/C No: 260-459-5120 ADDRESS: KK.SPORTS@KANDKINSURANCE.COM ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC d INSURER A: SCOTTSDALE INSURANCE COMPANY 41297 INSURED NATIONAL FEDERATION OF STATE HIGH INSURER B: MISC./ONE-OFF SURPLUS LINES D/B/A NFHS INSURER C: SCHOOL ASSOCIATIONS INSURERD: 690 WEST WASHINGTON STREET INDIANAPOLIS, IN 46206 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 2030359 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MWDD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR 12 : 01 12 : 01AM EACH OCCURRENCE 2000000 DAMAGE TO RENTED PREMISES Ea one nce 500000 MED EXP (Any one person) 5000 Owners & Contractors Y N KRS0008464500 7/01/2C 7/01/21 PERSONAL BADV INJURY 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PROJECT L:]LOC GENERAL AGGREGATE 5000000 RPOLICY PRODUCTS-COMP/OPAGG 5000000 Part L 1 Liab 1000000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea Accident BODI LY INJURY (Per person) ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS BODILY INJURY (Per accident) HIRED AUTOS ONLY NON -OWNED AUTOS ONLY PROPERTY DAMAGE Per accident UMBRELLA X OCCUR EACH OCCURRENCE 1000000 X AGGREGATE B EXCESS CLAIMS -MADE OEX7001039001 12:01 7/01/2 12:01AM 7/01/21 DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER -STATUE OTHER ANY PROPRIETOR/PARTNER/ E.L. EACH ACCIDENT EXECUTIVEOFFICER/MEMBER EXCLUDED? N/A E.L. DISEASE - EA EMPLOYEE (Mandatory in NH) ff yes, describe under E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SEXUAL ABUSE/MOLESTATION $1,000,000 PER OCC/$2,000,000 AGG. NFHS COACH: SEAN BULMER - MAVERICK TENNIS. CERTHOLDER IS AN ADDT'L INSURED W/RESPECT THE OPERATIONS OF THE NAMED INSURED. CERTIFICATE HOLDER CANCELLATION CITY OF PALM SPRINGS 3200 EAST TAHQUITZ PALM SPRINGS, CA 92262 ACORD 25 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE gELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. l A AUTHORIZED © 1988-2015ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SLANDIS ACORD., CERTIFICATE OF LIABILITY INSURANCE DATE(M 7/07/2YYY) 7/21 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(ies) must have ADDITIONAL INSURED provisions or 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 K & K Insurance Group, Inc. NAME: P.O. Box 2338 Fort Wayne, In 46801 A/C No.Ext; 000-000-0000 A/C No; 000-000-0000 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: SCOTTSDALE INSURANCE COMPANY 41297 INSURED NATIONAL FEDERATION OF STATE HIGH INSURERB: D/B/A NFHS INSURER C: SCHOOL ASSOCIATIONS INSURERD: 690 WEST WASHINGTON STREET INSURERE: INDIANAPOLIS, IN 46206 INSURER F: COVERAGE5 CERTIFICATE NUMBER: 2034292 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MMMD LIMITS A }{ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 12 : 01 12 : 01AM EACH OCCURRENCE 1000000 DAMAGE TO RENTED PREMISES Ea occurrence 500000 MED EXP (Any one person) 5000 Owners & Contractors Y N KRS0008857200 7/01/2 7/01/22 PERSONAL dADV INJURY 1000000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5000000 PROJECT F_]LOC RPOLICY PRODUCTS-COMP/OPAGG 5000000 Part Lgl Liab 1000000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea Accident BODILY INJURY ( Per person) ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS BODILY INJURY Per accident ( ) HIRED AUTOS ONLY NON -OWNED AUTOS ONLY PROPERTY DAMAGE Per accident UMBRELLA LIAB X OCCUR EACH OCCURRENCE 1000000 X AGGREGATE inannnn A EXCESS LIAB CLAIMS -MADE XKS0008857400 12:01 7/01/2 12:01AM 7/01/22 DED r7 RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y f N PER -STATUE I OTHER ANY PROPRIETOR/PARTNER/ ❑ EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) N/A E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE ff yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SEXUAL ABUSE/MOLESTATION $1,000,000 PER OCC/$2,000,000 AGG. NFHS COACH: SEAN BULMER - MAVERICK TENNIS. CERTHOLDER IS AN ADDT'L INSURED W/RESPECT THE OPERATIONS OF THE NAMED INSURED. - SEE ADDENDUM - CERTIFICATE HOLDER CANCELLATION CITY OF PALM SPRINGS PO BOX 2743 PALM SPRINGS, CA 92262 ATTN: CITY CLERK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. REPRESENTATIVE AUUKU 15 (ZU1ti/UJ) ©1988-2015ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: KRS 88572-00 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations City of Palm Springs PO Box 2743 Palm Springs, CA 92262 Attn: City Clerk Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of 'your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 0413 ACORDTM AGENCY CUSTOMER ID: LOC # CERTIFICATE: 2034292 DATE ISSUED: ADDITIONAL REMARKS SCHEDULE AGENCY K & K INSURANCE GROUP, POLICY NUMBER GL KRS0008857200 EX XKS0008857400 CARRIER SEE ACORD 25 7/07/21 Page I— of 1 NAMED INSURED INC. NATIONAL FEDERATION OF STATE HIGH D/B/A NFHS SCHOOL ASSOCIATIONS 690 WEST WASHINGTON STREET INDIANAPOLIS, IN 46206 NAIC CODE THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE 30-DAY NOTICE OF CANCELLATION APPLIES. PRIMARY/NON-CONTRIBUTORY APPLIES. ACORD 101 (2008101) C 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD