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Home My WebLink AboutA9117 - AVIATRIX COMMUNICATIONS LLCCONTRACT ABSTRACT Contract/Amendment Name of Contract: Company Contact: Summary of Services: Contract Price: Contract Term: Public Integrity/ Business Disclosure Forms: Email: Contract Administration Lead Department: Contract Administrator/ Ext: Funding Source: Contract Approvals Council/City Manager Approval Date: Agreement Number: Amendment Number: Contract Compliance Exhibits: Signatures: Insurance: Bonds: Business License: Solicitation / 3 Quotes: Sole Source / Co-Op: CoOp Agmt #:________________ CoOp Name: ________________ CoOp Pricing:________________ Submitted on: By: Aviatrix Communications, LLC Katie Franco Jones katie@aviatrix communications.com N/A N/A N/A Attached Attached N/A N/A N/A Daniel Meier / 3806 4157020.50145 Attached N/A - Not going to CC Attached A9117 2 June 1, 2022 - August 31, 2023 $180,000 + $16,600 = $196,600 Branding and Website Development Aviation N/A June 1, 2023 Christina Brown DocuSign Envelope ID: C0670FB6-DE1A-4CC6-89FE-EF2DDA51780D Page 1 of 5 AMENDMENT NO. 2 TO THE AVIATRIX COMMUNICATIONS, LLC AGREEMENT NO. A9117 BETWEEN THE CITY PALM SPRINGS AND AVIATRIX COMMUNICATIONS, LLC 1.Parties and Date. This Amendment No. 2 to the Aviatrix Communications, LLC Agreement is made and entered into as of June 1, 2023, by and between the City of Palm Springs (“City”) and Aviatrix Communications, a California Limited Liability Company with its principal place of business at 11162 Caminito Vista Pacifica, San Diego, CA 92131 (Contractor). City and Contractor are sometimes individually referred to as “Party” and collectively as “Parties.” 2.Recitals. 2.1 Agreement. The City and Contractor have entered into an agreement entitled Aviatrix Communications, LLC dated June 1, 2022 (Agreement) for the purpose of Airport brand and website development for the Palm Springs International Airport (Airport). Contract Term: June 1, 2022 through May 31, 2023; Contract Price: $149,000. 2.2 Amendment No.1. On September 15, 2022, Parties entered into Amendment No. 1 to revise the scope of services and add $31,000, for a new total not to exceed of $180,000. 2.3 Amendment No.2. The City and Contractor desire to amend the Agreement to revise the scope of services, increase the compensation, and extend the term.’ 2.4 Amendment Authority. This Amendment No. 2 is authorized pursuant to Section 3.3 of the Agreement. 3.Terms. 3.1 Section 3.1 Compensation of Contractor. Section 3.1 of the Agreement is hereby amended in its entirety to read as follows: “Contractor shall be compensated and reimbursed for the services rendered under this Agreement in accordance with the schedule of fees set forth in Exhibit “A”. The total amount of Compensation shall not exceed $196,600.” 3.2 Section 4.4 Term. Section 4.4 of the Agreement is hereby amended in its entirety to read as follows: “Unless earlier terminated in accordance with Section 4.5 of the Agreement, this Agreement shall continue in full force and effect for a period of fourteen months, commencing on June 1, 2022, and ending on August 31, 2023, unless extended by mutual written agreement of the Parties.” 3.3 EXHIBIT “A” Scope of Services. Add Exhibit “A2” attached hereto and incorporated herein by reference. DocuSign Envelope ID: 7F065292-8FD6-4962-A730-C710265D76E8DocuSign Envelope ID: C0670FB6-DE1A-4CC6-89FE-EF2DDA51780D Page 2 of 5 3.4 Continuing Effect of Agreement. Except as amended by this Amendment No. 2, all other provisions of the Agreement remain in full force and effect and shall govern the actions of the parties under this Amendment No. 2. From and after the date of this Amendment No. 2, whenever the term “Agreement” or “Contract” appears in the Agreement, it shall mean the Agreement as amended by this Amendment No. 2. 3.5 Adequate Consideration. The Parties hereto irrevocably stipulate and agree that they have each received adequate and independent consideration for the performance of the obligations they have undertaken pursuant to this Amendment No. 2. 3.6 Severability. If any portion of this Amendment No. 2 is declared invalid, illegal, or otherwise unenforceable by a court of competent jurisdiction, the remaining provisions shall continue in full force and effect. 3.7 Counterparts. This Amendment No. 2 may be executed in duplicate originals, each of which is deemed to be an original, but when taken together shall constitute but one and the same instrument. [SIGNATURES ON FOLLOWING PAGE] DocuSign Envelope ID: 7F065292-8FD6-4962-A730-C710265D76E8DocuSign Envelope ID: C0670FB6-DE1A-4CC6-89FE-EF2DDA51780D Page 3 of 5 SIGNATURE PAGE TO AGREEMENT NO. A9117 BY AND BETWEEN THE CITY OF PALM SPRINGS AND AVIATRIX COMMUNICATIONS, LLC. IN WITNESS WHEREOF, the Parties have executed this Agreement as of the dates stated below. CONTRACTOR: By: _____________________________________ By: _________________________________________ Signature Signature (2nd signature required for Corporations) Date: Date: CITY OF PALM SPRINGS: APPROVED BY CITY COUNCIL: Date: N/A Item No. N/A APPROVED AS TO FORM: ATTEST: By: ___________________________ By: _______________________________ City Attorney City Clerk APPROVED: By: _______________________________ Date: City Manager – over $50,000 Deputy/Assistant City Manager – up to $50,000 Director – up to $25,000 Manager – up to $5,000 DocuSign Envelope ID: 7F065292-8FD6-4962-A730-C710265D76E8 5/30/2023 DocuSign Envelope ID: C0670FB6-DE1A-4CC6-89FE-EF2DDA51780D 6/9/2023 Page 4 of 5 EXHIBIT “A2” CONTRACTOR’S SCOPE OF SERVICES/WORK Including, Schedule of Fees And Schedule of Performance DocuSign Envelope ID: 7F065292-8FD6-4962-A730-C710265D76E8DocuSign Envelope ID: C0670FB6-DE1A-4CC6-89FE-EF2DDA51780D Page 5 of 5 Service: Launch a new website and brand for the Palm Springs International Airport. As well as producing physical materials needed to launch the Airports brand, which include exploring materials, securing vendor quotes and coordinating with the Airports selected vendor to produce the materials. Scope: • Review, Research, and Revise Existing Website Content: 10 Hours • Research, Write, and Revise New Website Content: 25 Hours • Research, Design, and Produce Materials for Launch: 48 Hours Materials: • In-Terminal Graphics • Promotional Items • Business Cards • Promotional Banners Fees: • Review, Research, and Revise Existing Website Content - $2,000 • Research, Write, and Revise New Website Content - $5,000 • Research, Design, and Produce Materials for Launch - $9,600 • Additional Services Outside the Scope listed will be billed at an hourly rate of $200 • Airport is responsible for actual third-part vendor and production costs • The project will not exceed $16,600 without written consent from the Airport Completion Date: • July 2023 Additional: Final products created by the Contractor for the public facing website will be entirely owned by the City. DocuSign Envelope ID: 7F065292-8FD6-4962-A730-C710265D76E8DocuSign Envelope ID: C0670FB6-DE1A-4CC6-89FE-EF2DDA51780D Scope of Work For the Palm Springs International Airport WEBSITE CONTENT AND BRAND LAUNCH SUPPORT Aviatrix Communications LLC (“Consultant”) proposes to provide the following scope of work for the Palm Springs International Airport (“Client”) to support the Client’s website development. The Consultant can complete all the work listed below when requested by the Client. Additional project-related outreach not specifically listed in this scope of work can be accomplished at the Consultant’s hourly rate. DELIVERABLES and process The Palm Springs International Airport is set to launch a new website and brand this summer. In order to accommodate a July launch, the Client is seeking support in revising and developing website content, as well as producing materials needed to successfully roll out the brand to the public. Aviatrix Communications will proofread and update all existing website content and prepare it for use on the new site. Consultant will also develop original content for all requested new website pages. Consultant will confirm external links and third-party hours of operation, create fresh content that informs website users, and craft all copy to boost search engine optimization. Content will be written with the end-user in mind, and will avoid acronyms, jargon, and overly complex terminology. Client will review and approve content before the website goes live. Consultant will also research and produce physical materials needed to launch the Client brand. This work includes exploring materials, securing vendor quotes, and coordinating with the Client-selected vendor to produce the materials. Materials include but are not limited to in-terminal graphics, promotional items, business cards, and promotional banners. Client is responsible for actual third-party vendor and production costs. Consultant estimates that the project can be completed as follows: • Review, Research, and Revise Existing Website Content: 10 hours • Research, Write, and Revise New Website Content: 25 hours • Research, Design, and Produce Materials for Launch: 48 hours DocuSign Envelope ID: C0670FB6-DE1A-4CC6-89FE-EF2DDA51780D PRICING The Consultant will provide the above work at the rate listed below. ITEM RATE Review, Research, and Revise Existing Website Content $2,000 Research, Write, and Revise New Website Content $5,000 Research, Design, and Produce Materials for Launch $9,600 Hourly rate for additional content development $200 The project will not exceed a cost of $16,600 without written consent from Client. BILLING AND CONDITIONS The Consultant will invoice the Client upon approval of the completed brand launch in July 2023. Should the Client request additional services outside the scope of this contract, the Client will be billed at the hourly rate listed above. All payments, reimbursements, and additional hourly rates will be made payable to Aviatrix Communications LLC and are due net 30 days after receipt of invoice. Additional Terms and Conditions Approved Contractor Travel to be Paid by Client Consultant travel is not a part of this scope of work. If requested to participate in person, the Client will reimburse the Consultant for the cost of overnight travel. Travel expenses include reasonable hotel rooms, gas, and meals. Mileage reimbursement will be calculated using the IRS allowable rate for the year incurred. Any overnight travel by the Consultant for this project, and the Consultant’s estimated travel expenses, must be approved by the Client in advance. Copyright The final products created by the Consultant will be entirely owned by the Client, for whatever uses it deems necessary. However, the Consultant reserves the right to use elements in their work history and future business solicitations. DocuSign Envelope ID: C0670FB6-DE1A-4CC6-89FE-EF2DDA51780D signatures If the Client agrees to the terms above for the Website Content Development project, please sign and return to the Consultant. This Agreement will be effective April 17, 2023 (the “Effective Date”) and expire August 31, 2023. _____________________________________ _____________________________________ Daniel Meier Deputy Director of Aviation, Marketing & Air Service Palm Springs International Airport Kathryn Franco Jones Owner Aviatrix Communications, LLC Date: ________________________________ Date: ________________________________ DocuSign Envelope ID: C0670FB6-DE1A-4CC6-89FE-EF2DDA51780D SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS AUTOSAUTOSNON-OWNEDHIRED AUTOS SCHEDULEDALL OWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD MTTU Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA 520 Madison Avenue 32nd Floor New York, New York 10022 (888) 202-3007 contact@hiscox.com Hiscox Insurance Company Inc 10200 Aviatrix Communications, LLC 11162 Caminito Vista Pacifica San Diego, CA 92131 City Of Palms Springs 3400 East Tahquitz Way Palm Springs, CA 92262 City Of Palms Springs, its officials, employees, and agents are named as additional insured and this insurance is primary and non contributory subject to policy te rms and conditions. Should any of the policy be cancelled before expiration date thereof the issuing company will mail in 30 days notice to certificate holder name d. 05/20/202405/20/2023P100.278.588.5Y X A X X Each Claim: $ 1,000,000 Aggregate: $ 1,000,000 Professional LiabilityA 05/20/202405/20/2023P100.276.953.5Y 1,000,000 100,000 5,000 0 2,000,000 S/T Gen. Agg. 04/05/2023 DocuSign Envelope ID: C0670FB6-DE1A-4CC6-89FE-EF2DDA51780D 0 Berkshire Hathaway Direct Insurance Company 10391 05/27/2023 A N9WC446313 05/25/2023 05/25/2024 The County of San Mateo 555 County Center 5th Floor Redwood City, CA 94063 X 1,000,000 1,000,000 1,000,000 N 0 0 0 0 0 Aviatrix Communications 11162 Caminito Vista Pacifica San Diego, CA 92131 BIBERK P.O. Box 113247 Stamford, CT 06911 Professional Liability (Errors & Omissions): Claims-Made Per Occurrence/ Aggregate 203-654-3613844-472-0967 customerservice@biBERK.com The City of Palms Springs 3400 E Tahquitz Canyon Way Ste.1 City of Palm Spring , CA 92262 A Blanket Waiver of Subrogation exists on this policy as it pertains to worker's compensation. (see endorsement attached) X DocuSign Envelope ID: C0670FB6-DE1A-4CC6-89FE-EF2DDA51780D 1.00 Blanket Waiver - Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. All CA Operations N9WC446313 DocuSign Envelope ID: C0670FB6-DE1A-4CC6-89FE-EF2DDA51780D DocuSign Envelope ID: C0670FB6-DE1A-4CC6-89FE-EF2DDA51780D City Clerk Form Updated 7/21/2021 CONTRACT ABSTRACT Contract prepared by: ____________________________________________________ Submitted on: __________________ By: __________________________________ Note: _________________________________________________________________ Contract Compliance Exhibits: Yes Signatures: Yes Insurance: Yes Bonds: Yes Contract Approvals Council/ Community Redevelopment Agency Approval Date: __________________________ Agenda Item No./ Resolution No.: _______________________________________________ Agreement No: _____________________________________________________________ Contract Administration Lead Department: ___________________________________________________________ Contract Administrator: _______________________________________________________ Contract Company Name: __________________________________________________________ Company Contact: _________________________________________________________ Summary of Services: ______________________________________________________ Contract Price: ____________________________________________________________ Funding Source: ___________________________________________________________ Contract Term: ____________________________________________________________ Munis Contract Number: _____________________________________________________ No NoNo No Aviatrix Communications Katie Franco - (760) 717 1888 katie@aviatrixcommunications.com Branding and Website Development (A9117) - Amendment No. 1 at $31,000 4157020.50145 Contract - June 1, 2022 - May 31, 2023 - Amendment No. 1 - Effective September 15, 2022 103384 Aviation Harry Barrett / Daniel Meier Amendment to Agreement No. A9117 Nadia. P. Seery 11/08/22 Christina Brown 4 4 4 4 DocuSign Envelope ID: 91095792-C85F-421F-8420-1BA8EC207B70 Page 1 of 3 Revised: 2.9.22 AMENDMENT NO. 1 TO CONTRACT SERVICE AGREEMENT No. A9117 BETWEEN THE CITY PALM SPRINGS AND AVIATRIX COMMUNICATIONS, LLC 1. Parties and Date. This Amendment No. 1 to the Contract Services Agreement is made and entered into as of this 15th day of September, 2022, by and between the City of Palm Springs City Aviatrix Communications, LLC, a California Limited Liability Corporation with its principal place of business at 11162 Caminito Vista Pacifica, San Diego, CA 92131 (Contractor ). City and Contractor 2. Recitals. 2.1 Agreement. The City and Contractor have entered into a Contract Services Agreement dated June 1, 2022, for the purpose of retaining the services of Contractor to provide branding and website development for the Palm Springs International Airport. 2.2 Amendment. The City and Contractor desire to amend the Agreement to revise the scope of services and increase compensation. 2.3 Amendment Authority. This Amendment No. 1 is authorized pursuant to Section 3.3 of the Agreement. 3. Terms. 3.1 Section 1.1 Scope of Services of the Agreement is hereby amended to include services described in Exhibit A1 attached hereto and incorporated herein by reference. 3.2 Section 3.1 Compensation of Contractor of the Agreement is hereby amended to include compensation described in Exhibit A1 attached hereto and incorporated herein by reference in an additional amount not to exceed $31,000. 3.3 Continuing Effect of Agreement. Except as amended by this Amendment No. 1, all other provisions of the Agreement remain in full force and effect and shall govern the actions of the parties under this Amendment No. 1. From and after the date of this Amendment No. 1, whenever appears in the Agreement, it shall mean the Agreement as amended by this Amendment No.1. 3.4 Adequate Consideration. The Parties hereto irrevocably stipulate and agree that they have each received adequate and independent consideration for the performance of the obligations they have undertaken pursuant to this Amendment No. 1. 3.5 Severability. If any portion of this Amendment No. 1 is declared invalid, illegal, or DocuSign Envelope ID: 91095792-C85F-421F-8420-1BA8EC207B70 Page 2 of 3 Revised: 2.9.22 otherwise unenforceable by a court of competent jurisdiction, the remaining provisions shall continue in full force and effect. 3.5 Counterparts. This Amendment No. 1 may be executed in duplicate originals, each of which is deemed to be an original, but when taken together shall constitute but one and the same instrument. [SIGNATURES ON FOLLOWING PAGE] DocuSign Envelope ID: 91095792-C85F-421F-8420-1BA8EC207B70 Page 3 of 3 Revised: 2.9.22 SIGNATURE PAGE TO AMENDMENT NO. 1 TO AGREEMENT A9117 BY AND BETWEEN THE CITY OF PALM SPRINGS AND AVIATRIX COMMUNICATIONS, LLC IN WITNESS WHEREOF, the Parties have executed this Agreement as of the date first stated above. CONTRACTOR: By: _______________________________________By: _________________________________________ Kathryn Franco Jones Signature Owner (2nd signature required for Corporations) Date:Date: CITY OF PALM SPRINGS: APPROVED BY CITY COUNCIL: Date: N/A Item No. APPROVED AS TO FORM: ATTEST: By: ___________________________ By: _______________________________ City Attorney City Clerk APPROVED: By: _______________________________ Date: Interim City Manager N/A DocuSign Envelope ID: 91095792-C85F-421F-8420-1BA8EC207B70 11/15/2022 DocuSign Envelope ID: 91095792-C85F-421F-8420-1BA8EC207B70 DocuSign Envelope ID: 91095792-C85F-421F-8420-1BA8EC207B70 DocuSign Envelope ID: 91095792-C85F-421F-8420-1BA8EC207B70 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS AUTOSAUTOSNON-OWNEDHIRED AUTOS SCHEDULEDALL OWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD MTTU Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA 520 Madison Avenue 32nd Floor New York, New York 10022 (888) 202-3007 contact@hiscox.com Hiscox Insurance Company Inc 10200 Aviatrix Communications, LLC 11162 Caminito Vista Pacifica San Diego, CA 92131 City Of Palms Springs 3400 East Tahquitz Way Palm Springs, CA 92262 City Of Palms Springs are named as additional insured and this insurance is primary and non contributory subject to policy terms and conditions. 05/20/202305/20/2022P100.278.588.4Y X A X X Each Claim: $ 1,000,000 Aggregate: $ 1,000,000 Professional LiabilityA 05/20/202305/20/2022P100.276.953.4Y 1,000,000 100,000 5,000 0 2,000,000 2,000,000 04/05/2022 DocuSign Envelope ID: 91095792-C85F-421F-8420-1BA8EC207B70 Included Berkshire Hathaway Direct Insurance Company 10391 06/07/2022 The City of Palm Springs 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 X X X N9BP000312 07/14/2021 07/14/2022A 5,000 2,000,000 50,000 4,000,000 4,000,000 Aviatrix Communications 11162 Caminito Vista Pacifica San Diego, CA 92131-3301 BIBERK P.O. Box 113247 Stamford, CT 06911 Professional Liability (Errors & Omissions): Claims-Made Per Occurrence/ Aggregate 203-654-3613844-472-0967 customerservice@biBERK.com Primary and Non-Contributory endorsement is included on the general liability policy (see endorsement attached) The City of Palm Springs are listed under a blanket waiver of subrogation is included on the worker’s compensation policy (see endorsement attached) X 10,000 X X 3,000,000 3,000,000A N9UM000328 07/14/2021 07/14/2022 1,000,000 1,000,000 1,000,000 X A N X N9WC485649 05/25/2022 05/25/2023 X Primary and Non Contributory DocuSign Envelope ID: 91095792-C85F-421F-8420-1BA8EC207B70 06/07/2022 Berkshire Hathaway Direct Insurance Company X X * * * ALS up to 12 months. 0 007/14/2021 07/14/2022 The City of Palm Springs 3200 E Tahquitz Canyon Way Palm Springs, CA 92262 N9BP000312 Bldg #001: Public Relations (Office) - 6517107 Location: 11162 Caminito Vista PacificaSan Diego, CA 92131-3301 n/a n/a n/a Aviatrix Communications 11162 Caminito Vista Pacifica San Diego, CA 92131-3301 BIBERK P.O. Box 113247 Stamford, CT 06911 541820 250 (203) 654-3613 salessupport@biberk.com (844) 472-0967 DocuSign Envelope ID: 91095792-C85F-421F-8420-1BA8EC207B70 BUSINESSOWNERS BP 14 88 07 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BP 14 88 07 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 PRIMARY AND NONCONTRIBUTORY – OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM The following is added to Paragraph H. Other Insurance of Section III – Common Policy Conditions and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: 1. The additional insured is a Named Insured under such other insurance; and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. DocuSign Envelope ID: 91095792-C85F-421F-8420-1BA8EC207B70 DocuSign Envelope ID: 91095792-C85F-421F-8420-1BA8EC207B70 1.00 Blanket Waiver - Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. All CA Operations N9WC485649 DocuSign Envelope ID: 91095792-C85F-421F-8420-1BA8EC207B70 DocuSign Envelope ID: 91095792-C85F-421F-8420-1BA8EC207B70 DocuSign Envelope ID: 91095792-C85F-421F-8420-1BA8EC207B70 City Clerk Form Updated 7/21/2021 CONTRACT ABSTRACT Contract prepared by: ____________________________________________________ Submitted on: __________________ By: __________________________________ Note: _________________________________________________________________ Contract Compliance Exhibits: Yes No Signatures: Yes No Insurance: Yes No Bonds: Yes No Contract Approvals Council/ Community Redevelopment Agency Approval Date: __________________________ Agenda Item No./ Resolution No.: _______________________________________________ Agreement No: _____________________________________________________________ Contract Administration Lead Department: ___________________________________________________________ Contract Administrator: _______________________________________________________ Contract Company Name: __________________________________________________________ Company Contact: _________________________________________________________ Summary of Services: ______________________________________________________ Contract Price: ____________________________________________________________ Funding Source: ___________________________________________________________ Contract Term: ____________________________________________________________ Munis Contract Number: _____________________________________________________ Aviatrix Communications LLC Katie Franco Airport Brand and Website Development $149,000 4157020-50145 June 1, 2022 - June 1, 2023 Vendor No. 103384 Aviation Harry Barrett, Jr./ Daniel Meier May 26, 2022 1H A9117 Procurement 6/7/22 Christina Brown ✔ ✔ ✔ ✔ 33 3+3 3 3333 33 3 3 33 E E E E !E -<((5(6>E 0=E 5#&(E #6&E (6>(<(&E 06>7E 76E ?6(E E E $DE #6&E $(>B((6E >.(E 0>DE 7)E #45E :<06-=E #E #40)7<60#E %.#<>(<E %0>DE #6&E 5?60%0:#4E %7<:7<#>076E 0>DE #6&E @0#><0CE 755?60%#>076=E E #E #40)8<60#E050>(&E 0#$040>DE7<:7<#>076E 76><#%>7< E 0>DE #6&E 76><#%>7<E#<(E 06&0@0&?#44DE<()(<<(&E>7E#=E#<>DE#6&E#<(E%744(%>0@(4DE<()(<<(&E>7E#=E>.(E#<>0(= E E 0>DE <(;?0<(=E >.(E =(<@0%(=E 7)E #E $<#6&06-E #6&E B($=0>(E &(@(47:(<E )9<E >.(E#45 :<06-=E6>(<6#>076#4E0<:7<>E<71(%> 76><#%>7<E .#=E =?$50>>(&E >7E 0>DE #E :<7:7=#4E >7E :<7@0&(E $<#6&06-E #6&E B($=0>( &(@(47:5(6>E?6&(<E>.(E>(<5=E7)E>.0=E-<((5(6> #=(&E 76E 0>=E (C:(<0(6%(E (&?%#>076E ><#0606-E #6&E <(:?>#>076E 76><#%>7<E0= ;?#40)0(&E#6&E&(=0<(=E>7E:<7@0&(E>/(E6(%(==#<DE=(<A0%(=E>7E0>DE)9<E >.(E<72(%> 0>DE&(=0<(=E>7E<(>#06E>.(E=(<A0%(=E7)E76><#%>7<E)9<E >.(E<72(%> "E E06E%76=0&(<#>076E 7)E>.(E:<750=(=E #6&E5?>?#4E 7$40-#>076=E %7@(6#6>=E #6&E %76&0>076=E %76>#06(&E .(<(06E #6&E 7>.(<E @#4?#$4(E %76=0&(<#>076E >.(E <(%(0:>E #6&E =?,0%0(6%DE7)EB.0%.E#<(E.(<($DE#%367B4(&-(&E >.(E #<>0(=E#-<((E#=E )8447B=E 3 3 3 !+,#3 +$3 #.&!#/3 6E %75:40#6%(E B0>.E #44E >(<5=E #6&E %76&0>076=E 7)E >.0=E -<((5(6>E 76><#%>7<E =.#44E :<7@0&(E =(<@0%(=E >7E 0>DE #=E &(=%<0$(&E 06E >.(E %7:(E 7)E (<@0%(= "7<3E #>>#%.(&E >7E >.0=E -<((5(6>E #=E C.0$0>E E #6&E 06%7<:7<#>(&E .(<(06E $DE <()(<(6%(E >.(E(<A0%(=E7<E"7<3 E C.0$0>EE 06%4?&(=E>.(E #-<((&E?:76E =%.(&?4(E7)E :(<)7<5#6%(E #6&E >.(E =%.(&?4(E 7)E )((= E 76><#%>7<E B#<<#6>=E >.#>E>.(E (<@0%(=E =.#44E $(E :(<)7<5(&E06E#E %75:(>(6>E :<7)(==076#4E #6&E =#>0=)#%>7<DE 5#66(<E%76=0=>(6>E B0>.E >.(E4(@(4E 7)E %#<(E #6&E =3044E 7<&06#<04DE (C(<%0=(&E $DE .0-.E ;?#40>DE (C:(<0(6%(&E #6&E B(44E ;?#40)0(&E 5(5$(<=E7)E>.(E :<7)(==076E%?<<(6>4DE :<#%>0%06-E?6&(<E=0504#<E%76&0>076= E 6E>.(E (@(6>E7)E #6DE 06%76=0=>(6%DE$(>B((6E>.(E >(<5=E %76>#06(&E06E>.(E %7:(E 7)E (<@0%(= "7<3E#6&E >.(E >(<5=E =(>E )7<>.E06E>.0=E-<((5(6>E>.(E >(<5=E =(>E )8<>.E06E>.0=E-<((5(6>E =.#44E -7@(<6 E 3 +),(& *!#32&0%3 23 76><#%>7<E=.#44E%75:4DEB0>.E#44E#::40%#$4(E )(&(<#4E=>#>(E #6&E47%#4E4#B=E=>#>?>(=E#6&E7<&06#6%(=E #6&E#44E4#B)?4E 7<&(<=E<?4(=E #6&E<(-?4#>076=E B.(6E :(<+7<506-E >.(E (<A0%(= E 76><#%>7<E =.#44E $(E 40#$4(E )7<E #44E @074#>076=E 7)E =?%.E 4#B=E #6&E <(-?4#>076=E 06E%766(%>076E B0>.E >.(E (<@0%(=E#6&E >.0=E-<((5(6> E 3 &!#*/#/3 *"3 #-)&0/3 76><#%>7<E =.#44E 7$>#06E #>E 0>=E=74(E %7=>E #6'E (C:(6=(E =?%.E40%(6=(=E :(<50>=E#6&E#::<7@#4=E#=E 5#DE$(E <(;?0<(&E$DE4#BE )7<E >.(E:(<*7<5#6%(E7)E >.(E(<@0%(=E<(;?0<(&E $DE>.0=E -<((5(6> E 3 )&(& -&132&0%3+-'3 DE(C(%?>06-E>.0=E-<((5(6>E76><#%>7<EB#<<#6>=E>.#>E0>E .#=E%#<()?44DE%76=0&(<(&E .7BE >.(E "7<3E =.7?4&E$(E :(<)7<5(&E #6&E)?44DE ?6&(<=>#6&=E>.(E !"#"$% & %' '(')(' *" % & ''+*",- % .% & / / / 0 '''')(1(' ')(1('2''' '''''' 2'''' 1'''''' 1'''''' 3' +45 676 1) *' 89%:+ ; 7 <= 3> 7 ( '3213?1131)3') @9 +456 EXHIBIT "B" Primary and Non-Contributory endorsement is included on the general liability policy (see endorsement attached) The City of Palm Springs are listed under a blanket waiver of subrogation is included on the worker’s compensation policy (see endorsement attached) X 10,000 X X 3,000,000 3,000,000A N9UM000328 07/14/2021 07/14/2022 1,000,000 1,000,000 1,000,000 X A N X N9WC485649 05/25/2022 05/25/2023 X Primary and Non Contributory !"#"$%& ' ( ( )' "* + + ," % -' .,"/0 % 1% -' 2 -3456-7- 89:;< ) 5 ; ; & .7= *9* + 3 , <+> < 8:<+; -'' ?66!* 8>++:+; BUSINESSOWNERS BP 14 88 07 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BP 14 88 07 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 PRIMARY AND NONCONTRIBUTORY – OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM The following is added to Paragraph H. Other Insurance of Section III – Common Policy Conditions and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: 1. The additional insured is a Named Insured under such other insurance; and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. ! SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must KDYH $'',7,21$/ ,1685(' SURYLVLRQV RUbe 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS AUTOSAUTOSNON-OWNEDHIRED AUTOS SCHEDULEDALL OWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (201/0) © 1988-201 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD ::5 Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA 520 Madison Avenue 32nd Floor New York, New York 10022 (888) 202-3007 contact@hiscox.com Hiscox Insurance Company Inc 10200 Aviatrix Communications, LLC 11162 Caminito Vista Pacifica San Diego, CA 92131 City Of Palms springs 3400 East Taquitz Way Palm Springs, CA 92262 Additional Insured City Of Palm Springs 05/20/202305/20/2022P100.278.588.4 X A X X Each Claim: $ 1,000,000 Aggregate: $ 1,000,000Professional LiabilityA 05/20/202305/20/2022P100.276.953.4 1,000,000 100,000 5,000 0 2,000,000 2,000,000 04/05/2022 Aviatrix Communications 11162 Caminito Vista Pacifica San Diego, CA 92131 N9WC485649 - Insured's Copy !" !" # $%&&'( )*+,-./0 1 # ,' 23 24* 1 # 5 * )* $ ,!0606! 778 9 5:))1 # 5$ #$%&&'&()*+,--. /" 444(&;8<(9= 4 2 25 4 )# 5#2 2 5)* )*2) # )#, *#5)* )) * ) # 01 2 3$%&&'&()*+,-( !"#$ % %&'()*'& + %&,-.&(/ %%$0//.)'1 % 2 "0/1 3 ! 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" & '345 4 35 #* ? ?! ", ? , ' $ ' % & 4? @5 ! "# $# A / & 6 ' $ ! WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 04 10 A (Ed. 01-18) ESTIMATED ANNUAL PREMIUM ENDORSEMENT—CALIFORNIA The premium with respect to the insurance provided by this policy by reason of the designation of California in item 3 of the Information Page is subject to experience modification. Your experience modification, when issued, will be effective on ____________________, your rating effective date determined by the Workers’ Compensation Insurance Rating Bureau of California (WCIRB) in accordance with California law. Pending the issuance of your experience modification by the WCIRB, the estimated annual premium shown below is based on an estimated experience modification. The estimated annual premium will be revised when the WCIRB issues your applicable experience modification. ESTIMATED ANNUAL PREMIUM $ ____________________ NOTE: THE ESTIMATED ANNUAL PREMIUM MAY BE INCREASED WHEN THE WCIRB ISSUES THE EXPERIENCE MODIFICATION APPLICABLE TO THIS POLICY. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Insurance Company Countersigned By 05/25/2022 542.00 05/25/2022 N9WC485649 Call 1-844-472-0967. Sometimes, all the resources available to you are meaningless without a little assistance. From helping you access those tools to providing some consultation on industry safety practices, we encourage our policyholders to contact us! We can help you implement safety practices that make a difference. Loss Control Need Personalized Assistance? Safety benefits everyone – you, your employees, and your customers. Therefore, we provide you with a wealth of resources to assist you in making your operation as safe as possible. One of the most effective ways we have found to put loss control services at your fingertips is through our partnership with The Training Network, which has over 30 yearsexperienceprovidinghigh-qualitysafetyprograms. As a policyholder benefit, you have access to The Training Network NOW – one of the largest online safety-training libraries on the market today. The 350+ training modules include videos as well as accompanying end-of-course quizzes and other instructional materials – such as Leaders’ Guides and Completion Certificates – to facilitate yourtrainingsessions. At biBERK, we offer a wide range of loss control resources and professional support at no additional charge. From online safety videos and downloadable educational flyers and policy-specific recommendations, we can help “a little” or “a lot” depending upon the needandlevelofinterestfromourpolicyholders. Asaninsurer,werecognizethatoneofthebestwaystoprotectyouisby helping to prevent losses from occurring. While all claims cannot be eliminated(accidentshappen!),certainproactivelosscontrolmeasures can reduce the likelihood or the frequency/severity of occurrences. In otherwords,safetyreallydoesmatter. The library includes safety topics of common interest such as: back safety, safety leadership for supervisors, sage electrical practices, injury prevention for food service, landscape power tool safety, hazard communications, construction safety, distracted/defensive driving, trenching and shoring safety, computer workstation safety, and many more. Selectvideosaredesignedformobilesdevices,andanumberof titlesarealsoavailableinSpanish. Toaccesstheonlinelibrary,gotothewebaddressbelowandenterthelistedemailandpassword: www.biberk.com/loss-control Need assistance getting started? Simply contact us at 844-472-0967 or salessupport@biberk.com with any coverage-relatedquestions. email-policyholder@bhins.com password-6 afety 32/,&<+2/'(5',6&/2685( 127,&(2)7(5525,60 ,1685$1&(&29(5$*( &RYHUDJHIRUDFWVRIWHUURULVPLVLQFOXGHGLQ\RXUSROLF\<RXDUHKHUHE\QRWLILHGWKDWWKH 7HUURULVP5LVN,QVXUDQFH$FWDVDPHQGHGLQGHILQHVDQDFWRIWHUURULVPLQ6HFWLRQ RIWKH$FW7KHWHUP³DFWRIWHUURULVP´PHDQVDQ\DFWRUDFWVWKDWDUHFHUWLILHGE\WKH 6HFUHWDU\RIWKH7UHDVXU\²LQFRQVXOWDWLRQZLWKWKH6HFUHWDU\RI+RPHODQG6HFXULW\DQGWKH $WWRUQH\*HQHUDORIWKH8QLWHG6WDWHV²WREHDQDFWRIWHUURULVPWREHDYLROHQWDFWRUDQDFW WKDWLVGDQJHURXVWRKXPDQOLIHSURSHUW\RULQIUDVWUXFWXUHWRKDYHUHVXOWHGLQGDPDJHZLWKLQ WKH8QLWHG6WDWHVRURXWVLGHWKH8QLWHG6WDWHVLQWKHFDVHRIFHUWDLQDLUFDUULHUVRUYHVVHOVRU WKHSUHPLVHVRID8QLWHG6WDWHVPLVVLRQDQGWRKDYHEHHQFRPPLWWHGE\DQLQGLYLGXDORU LQGLYLGXDOVDVSDUWRIDQHIIRUWWRFRHUFHWKHFLYLOLDQSRSXODWLRQRIWKH8QLWHG6WDWHVRUWR LQIOXHQFHWKHSROLF\RUDIIHFWWKHFRQGXFWRIWKH8QLWHG6WDWHV*RYHUQPHQWE\FRHUFLRQ8QGHU \RXUFRYHUDJHDQ\ORVVHVUHVXOWLQJIURPFHUWLILHGDFWVRIWHUURULVPPD\EHSDUWLDOO\UHLPEXUVHG E\WKH8QLWHG6WDWHV*RYHUQPHQWXQGHUDIRUPXODHVWDEOLVKHGE\WKH7HUURULVP5LVN,QVXUDQFH $FWDVDPHQGHG+RZHYHU\RXUSROLF\PD\FRQWDLQRWKHUH[FOXVLRQVZKLFKPLJKWDIIHFW\RXU FRYHUDJHVXFKDVDQH[FOXVLRQIRUQXFOHDUHYHQWV8QGHUWKHIRUPXODWKH8QLWHG6WDWHV *RYHUQPHQWJHQHUDOO\UHLPEXUVHVEHJLQQLQJRQ-DQXDU\RIFRYHUHGWHUURULVP ORVVHVH[FHHGLQJWKHVWDWXWRULO\HVWDEOLVKHGGHGXFWLEOHSDLGE\WKHLQVXUDQFHFRPSDQ\ SURYLGLQJWKHFRYHUDJH7KH7HUURULVP5LVN,QVXUDQFH$FWDVDPHQGHGFRQWDLQVDELOOLRQ FDSWKDWOLPLWV86*RYHUQPHQWUHLPEXUVHPHQWDVZHOODVLQVXUHUV¶OLDELOLW\IRUORVVHVUHVXOWLQJ IURPFHUWLILHGDFWVRIWHUURULVPZKHQWKHDPRXQWRIVXFKORVVHVH[FHHGVELOOLRQLQDQ\RQH FDOHQGDU\HDU,IWKHDJJUHJDWHLQVXUHGORVVHVIRUDOOLQVXUHUVH[FHHGELOOLRQ\RXU FRYHUDJHPD\EHUHGXFHG 7KHSRUWLRQRI\RXUDQQXDOSUHPLXPWKDWLVDWWULEXWDEOHWRFRYHUDJHIRUDFWVRIWHUURULVP LVBBBBBBBBBDQGGRHVQRWLQFOXGHDQ\FKDUJHVIRUWKHSRUWLRQRIORVVHVFRYHUHGE\ WKH8QLWHG6WDWHVJRYHUQPHQWXQGHUWKH$FW 3ROLF\1R ,QVXUDQFH&RPSDQ\ 22.00 N9WC485649 Berkshire Hathaway Direct Insurance Company Policyholder: Policy #: Dear Policyholder: Thank you for selecting us as your Workers’ Compensation insurer. In addition to secure coverage, we provide extensive services as part of our effort to achieve complete customer satisfaction. If a claim should happen to occur, our medical management activities are handled through another Berkshire Hathaway partner selected for this program. To better acquaint you with the information and procedures you need to know, we provide the following important Workers’ Compensation and Medical Provider Network (MPN) materials: x Notice to Employees - Injuries Caused By Work (DWC 7) x English and Spanish Time-of-Hire Pamphlet x Workers' Compensation Claim Form and Notice of Potential Eligibility (DWC 1 and NOPE) x English and Spanish MPN Employee Notification x (The MPN ID# is 2397, and the Medical Access Assistant Phone Number is: 1-844-752-1144.) x On-line Directory of Managed Care Providers Each of these resources can be found on-line at: {HeaderAddress_WebsiteClaimsCA} (Hard copies are available upon request.) PROVIDING IMPORTANT WORKERS’ COMPENSATION INFORMATION Be sure to complete the Notice to Employees (DWC-7) and post in a conspicuous location frequented by employees during the hours of the workday. USING THE MPN MATERIALS An English and a Spanish version of the MPN Employee Notification have been supplied for you to download so you can post in proximity to the DWC-7 and distribute to each person enrolled. If you have any questions, do not hesitate to contact our office at 1-800-673-2465 or csr@GUARD.com Thank you, Customer Service Department biBERK PO Box 113247 Stamford, CT 06911-3247 FAX 203-361-3846 www.biBERK.com Toll-Free 844-472-0967 Aviatrix Communications N9WC485649 https://www.biBERK.com/#/california-mpn 844-472-0967 CustomerService@biberk.com Aviatrix Communications 11162 Caminito Vista Pacifica San Diego, CA 92131 ! """# !#$ %&' ()* %$+,-. / ! %0120$*$3 ! " # $# ! " % & # ' ' # ( ( ) * % + # , - ,.+/ # 0 # * # # # . # * # ) # 1 ! 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