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HomeMy WebLinkAboutA8448 - NANCY K. BOHL INC., DBA COUNSELING TEAM INTERNATIONAL - FOR EMPLOYEE SUPPORT SERVICES�^7 A�C,O�RO TRUEREC-01 CERTIFICATE OF LIABILITY INSURANCE DAM(MMIDD/YYYY) 8/2912024 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. N 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 riahts to the certificate holder in lieu of such endorsement(s1. PRODUCER —wma n v, m „v HUB International Insurance Services Inc. C 1525 Faraday Avenue E� Suite 150 Carlsbad. CA 92008 INSURED Nancy K. Bohl, Inc. D.B.A. The Counseling Team International 1881 Business Center Drive, Suite 11 San Bernardino, CA 92408 COVERAGES CERTIFICATE NUMBER- REVISION NUMBER. 2 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. NSR TYPE OF INSURANCE ADDL SUER PoLICY NUMBER PoUCYEFF MMND PODCYEXP LeRTB A X COMMERCWLGENERALLUUr1LITY cMMS-MADE �X OCCUR X X 5088-1981-01 8I31/2024 8/3112025 EACH OCCURRENCE s 1,000,000 DAMMSDEORENTID 0 X MED EXP An ore 5,000 SEE REMARKS FOR PROF PERSONAL & ADV NAM 1,000,000 ENIAGGREGATE LIMIT APPLES PER: PWcy jP& �X LOC GENERAL AGGREGATE 3,000,000 PRODUCTS-COMP/OP AGO S 3,000,000 OTHER B AUTONOBILE UABRITY COMBNED SINGLE LIMB 1,000,000 X ANY Auro 15091.0457-01 8/31/2024 0131/2025 BODILY INJURY IF. BODILY INJURY Per accidwA OWNED SCHEDULED AUTOS ONLY AUTyOSS{n Pa Pa E AUTOS ONLY A�UFOS SJNLB A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE s 2,0001000 AGGREGATE $ 2,000,000 EXCESS UAB CL ws mr 1 8/3112024 8131/2025 DED X I RETENTIONS 10,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YINTLrrET ANY PROPRIETORIPARTNERIEXECUTIVE ❑ ppF�EICERIMEMBEr EXCLUDED'! NIA PER ROTH­ E.L. EACH ACCIDENT (raandnory in NH) U.. Oesc under DESCRIPTION OF OPERATIONS E E.L. DISEASE EA EMPLOYE S E.L. DISEASE - POLICY LIMIT A A Professional Llab Abuse Liability 5088-1981-01 5098-1981-01 8/3112024 8/3112024 8131/2025 8/3112025 OCC IM/AGGREGATE IOCC 1 M I AGGREGATE RECEIVIEb 3,000,000 3,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD tet, Additlonal Remarks Schedule, mey M aNachad X more span Is requbed) Business Office Policy Property Locations: 1881 Business Center Dr. Suite 11, 12 A & 12 B, San Bernardino, CA 92408 S EP 0 3 2024 1545 Anacapa Rd Suite 7C, Victorville, CA 92392 444 Camino Del Rio South, Suite 215 & #208, San Diego CA 92108 74075 El Passe Suite A9 & At 6, Palm Desert, CA 92260 4160 Temescal Canyon Rd Ste 309, Corona, CA 92883 OFFICE OF THE CITY CLERK 41750 Rancho Los Palmas Dr ST #D-2, Rancho Mirage, CA 92270 SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof S Palm Springs s 9 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. its officials, employees & agents 3200 E. Tahquitz Canyon Way AUR10RN10/RR����EEIP'R7ESENTATIVE IAL_ Palm Springs, CA 92262-6959 ACORD 25 (2016/03) (D1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD � 1 ACORO" AGENCY CUSTOMER ID:TRUEREC-01 VSUNGA LOCM 1 ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY License # 0757776 NAMED INSURED HUB International Insurance Services Inc. Nancy K. Bohl, Inc. D.B.A. The Counseling Team International 1881 Business Center Drive, Suite 11 San Bernardino, CA 92408 POUCYNUMBER EE PAGE 1 CARRIER NAIL CODE EE PAGE 1 SEEP 1 EPPECWE DAM: SEE PAGE 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/LocationslVehicles: 39755 Murrieta Hot Springs Rd, Suite D160, Murrieta, CA 92563 135 S State College Blvd Ste 200, Brea, CA 92821 701 Palomar Airport Rd, #300, Carlsbad, CA 92011 232 Harrison Ave Ste D, Claremont, CA 91711 City of Palm Springs, its officials, employees 8: agents are Additional Insured(s) with regard to the General Liability policy when required by a written contract per the attached endorsement form NPSSGLOOD0400 04/18, Primary & Non -Contributory wording included. Waiver of Subrogation applies with regard to the General Liability policy when required by a written contract. © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Insured Name: True Behavioral Health, LP DBA: FR Health COMMERCIAL GENERAL LIABILITY Policy Number: 5088-1981-01 Policy Term: 8/31/2024 to 8/31/2025 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NON-PROFIT AND SOCIAL SERVICES GENERAL LIABILITY ENHANCEMENT ENDORSEMENT It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposures are provided under this policy. If such specific coverage applies, the terms, conditions, and limits of that coverage are the sole and exclusive coverage applicable under this policy. Throughout this endorsement the words "you" and "your" refer to the "Named Insured" shown in the Declarations. The words "we", "us", and "our" refer to the "Company" providing this insurance. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The following is a summary of the Limits of Insurance and Additional Coverage provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. A) Medical Payment —Limit increased to $20,000 B) Supplementary Payments — Bail bonds increased to $3,0001 Loss of Earnings increased to $1,000 each day C) Legal Liability Extension — For fire, lightning, explosion, smoke, and leaks from sprinklers limit increased to $1,000,000 D) Broadened definition of Who is an Insured E) Knowledge or Notice of Occurrence F) Broadened definition of Advertising Injury includes televised or videotaped publication G) Amended definition of Bodily Injury to include mental anguish H) Amended Unintentional Failure to Disclose Hazards 1) Amended Liberalization Clause J) Property Damage — Removal of exclusion for "Property Damage" resulting from the use of reasonable force to protect persons or property K) Premises Sold or Abandoned by You L) Added Blanket Additional Insured - Funding sources M) Added Blanket Additional Insured - Managers or lessors of premises N) Additional Insured — By Contract, Agreement or Permit O) General Aggregate Limit Per Location P) Blanket Special Events Coverage Q) Non -Owned Watercraft Coverage - Length is increased to 65 feet R) Blanket Waiver of Subrogation S) Violation of Rights of Residents Coverage (Patient's Rights) T) Liquor Liability Exception to Exclusion U) Employee Criminal Defense Costs Only Coverage - $25,000 limit of insurance — each"criminal proceeding" A) MEDICAL PAYMENTS If Medical Payments Coverage (Coverage C) is not otherwise excluded from this coverage part: NPSS GL 00004 00 (04118) Includes material copyrighted by ISO Properties, Inc., with its permission Page 1 of 9 I ) The Medical Expense Limit is increased, subject to all the terms of Limits of Insurance (Section III) to $20,000. 2) The requirement in the Insuring Agreement of Coverage C, that expenses must be incurred and reported to us within 'one year" of the accident date is changed to "three years." 3) Exclusion of Coverage, at your option, does not apply to your "volunteer workers" or any person or organization under your direct supervision and control. B) SUPPLEMENTARY PAYMENTS -COVERAGES A AND B: 1) The limit for the cost of bail bonds is changed from $250 to $3,000. 2) The limit for loss of earnings is changed from $250 per day to $1,000 per day. C) LEGAL LIABILITY EXTENSION — FIRE, LIGHTNING, EXPLOSION, SMOKE, AND LEAKS FROM SPRINKLERS 1. The last paragraph of Section I — Coverage A — 2. Exclusions, is deleted and replaced by the following: Exclusions c. through In. does not apply to: a. damage by fire, lightning, explosion, smoke or leaks from automatic fire protective systems; to premises rented to you or temporarily occupied by you with the permission of the owner. A separate limit of insurance applies to this coverage as described in Section III — Limits of Insurance. 2. Paragraph 6. of Section III — Limits of Insurance is deleted and replaced by the following: 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under COVERAGE A for damages because of "property damage": a. resulting from fire, lightning, explosion, smoke or leaks from automatic fire protective systems, or any combination thereof; and b. caused by a resident; to premises, rented to you or temporarily occupied by you with the permission of the owner. Damage To Premises Rented To You Limit is the greater of. a. $1,000,000 for damages due to fire, lightning, explosion, smoke or leaks from automatic fire protective systems, or any combination there of. D) WHO IS AN INSURED Paragraph 2. of Section II — Who Is An Insured is deleted and replaced by the following: 2. Each of the following is also an insured, but only while working within the scope of their duties related to the conduct of your business; a. "Employees", but only for acts within the scope of their employment by you; b. "Volunteer Workers"; c. Independent Contractors However, no "employees", "volunteer workers" or independent contractors are insureds for: (1) 'Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are al limited liability company), to a co=omployee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" or independent contractors while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co -"employee", "volunteer worker" or independent contractors as a consequence of Paragraph (1)(a) above; NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 2 of 9 (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. (2) "Property damage" to property: (a) Owned, occupied or used by, (b) Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by you, any of your "employees', "volunteer workers", independent contractors, any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). d. Medical directors and administrators, including professional persons; e. If you are an organization other than a partnership orjoint venture, your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors; f. If you are a limited liability company, your members are insureds, but only with respect to their duties related to the conduct of your business; g. Any organization and subsidiary thereof which you control and actively manage on the effective date of this endorsement; h. Any person or organization that has financial control of you or owns, maintains or controls premises occupied by you and requires you to name them as an additional insured but only with respect to their liability arising out of: (1) Their financial control of you; or (2) Premises they own maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. I. Any State or Political Subdivision subject to the following provision: This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with premises you own, rent, or control and to which this insurance applies: (1) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar exposures; or (2) The construction, erection, or removal of elevators; or (3) The ownership, maintenance, or use of any elevators covered by this insurance. However, the insurance afforded for any organization and subsidiary thereof not named in the Declarations as a Named Insured, does not apply to injury or damage with respect to which an insured under this endorsement is also an insured under another policy, or would be an insured under such policy but for its termination or the exhaustion of its limits of insurance. j. Students in training, but not for "bodily injury" or "property damage" arising out of his or her rendering or failure to render professional services to patients; k. Your members but only with respect to their liability for your activities or activities they perform on your behalf; I. Your trustees or members of the board of governors while acting within the scope of their duties as such on your behalf; m. Any entity you are required in a written contract (hereinafter called Additional Insured) to name as an insured is an insured but only with respect to liability arising out of your premises, NPSS GL 00004 00 (04118) Includes material copyrighted by ISO Properties, Inc., with its permission Page 3 of 9 .your work" for the Additional Insured, or acts or omissions of the Additional Insured in connection with the general supervision of "your work" to the extent set forth below: Insurance does not apply to "bodily injury," "property damage" or "personal and advertising injury" arising out of the rendering or failure to render any professional services by or for you, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and (2) Supervisors, inspection, or engineering services. Any coverage provided under this provision shall be excess over any other valid and collectible insurance available to the Additional Insured(s) whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary or you request that it apply on a primary basis. Paragraph 3.a. of Section II — Who Is An Insured is deleted and replaced by the following: a. Coverage under this provision is, subject to (1) and (2) below: (1) Effective on the acquisition or formation date; and (2) Afforded only until the end of the policy period of this Coverage Part or the next anniversary of its inception date, whichever is earlier. E) KNOWLEDGE OR NOTICE OF OCCURRENCE 1) As respects any loss reporting requirements under this policy, it is understood and agreed that knowledge of an accident or incident by an agent, servant or "employee" of yours or any other person shall not in itself constitute knowledge by you, unless a corporate officer of yours shall have received notice from said agent, servant, "employee" or any other person. 2) Your failure to give first report of a claim to us shall not invalidate coverage under this policy if the loss was inadvertently reported to another insurer. However, you shall report any such "Occurrence" to us within a reasonable time once you become aware of such error. F) ADVERTISING INJURY —TELEVISED OR VIDEOTAPED PUBLICATION 1) The definition of "Personal and Advertising Injury" items 14. d., e., f. and g. are changed to read: "Personal and Advertising Injury" means injury, including consequential "bodily injury", arising out of one or more of the following offenses: d. Oral, written, televised, or videotaped publication of material that slanders or libels a person or organization or disparages a person's or organization's goods, products, or services; e. Oral, written, televised, or videotaped publication of material that violates a person's right of privacy; f. Misappropriation of advertising ideas or style of doing business; or g. Infringement of copyright, title, or slogan. 2) Exclusions b. and c. of Coverage B., Personal and Advertising Injury Liability, are changed to read: b. "Personal and advertising injury" arising out of oral, written, televised, or videotaped publication of material, if done by or at the direction of the insured with knowledge of its falsity; c. "Personal and advertising injury" arising out of oral, written, televised, or videotaped publication of material whose first publication took place before the beginning of the policy period. G) BODILY INJURY —MENTAL ANGUISH The definition of "bodily injury" is changed to read: NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 4 of 9 "Bodily Injury" means: a. Bodily injury, sickness, or disease sustained by a person, and includes mental anguish resulting from any of these; and b. Except for mental anguish, includes death resulting from the foregoing (item above) at any time. H) UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS It is agreed that, based on our reliance on your representations as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure. 1) LIBERALIZATION If we adopt a change in our forms or rules which would broaden your coverage without an additional premium charge, your policy will automatically provide the additional coverages as of the date the revision is effective in your state. J) EXTENDED "PROPERTY DAMAGE" SECTION I — Coverages, Coverage A, 2. Exclusions, a. is deleted and replaced by the following: a. Expected or Intended Injury "Bodily Injury" or "Property Damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. K) PREMISES SOLD OR ABANDONED BY YOU SECTION I — Coverages, Coverage A., 2. Exclusions, j. (2) is deleted and replaced by the following: (2) Premises you sell, give away, or abandon, if the "property damage" arises out of any part of those premises, and occurred from hazards that were known by you or should have reasonably been known by you, at the time the property was transferred or abandoned. L) ADDITIONAL INSURED — FUNDING SOURCE Under SECTION II — Who is an Insured, the following is added: Any person or organization with respect to their liability arising out of: a. Their financial control of you; or b. Premises they own, maintain, or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction, and demolition operations performed by or for that person or organization. M) ADDITIONAL INSURED — MANAGERS OR LESSORS OF PREMISES Under SECTION II — Who is an Insured, the following is added: Any person or organization with respect to their liability arising out of the ownership, maintenance, or use of that part of the premises leased to you in writing, subject to the following additional exclusions: This insurance does not apply to: a. Any "occurrence" which takes place after you cease to be a tenant in that premises. b. Structural alteration, new construction, or demolition operations performed by or on behalf of that person or organization. N) ADDITIONAL INSURED - BY CONTRACT, AGREEMENT OR PERMIT 1) Any person or organization is an insured with whom you are required to add as an additional insured to this policy by a written contract or written agreement, or permit that is: a) currently in effect or becoming effective during the term of this policy; and NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 5 of 9 b) executed prior to the "bodily injury," "property damage," "personal and advertising injury'. 2) This insurance provided to the additional insured by this endorsement applies as follows: a) That person or organization is only an additional insured with respect to liability caused by your negligent acts or omissions at or from: (1) Premises you own, rent, lease, or occupy, or (2) Your ongoing operations performed for the additional insured at the job indicated by written contract or written agreement. b) The limits of insurance applicable to the additional insured are those specified in the written contract or written agreement or in the Declarations of this policy, whichever is less. These limits of insurance are inclusive of and not in addition to the limits of insurance shown in the Declarations. 3) With respect to the insurance afforded these additional insureds, the following additional exclusions apply: a) 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 site 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 on or at the same project. b) This insurance does not apply to "bodily injury," "property damage," "personal and advertising injury" caused by the rendering of or failure to render any professional services. 4) Regardless of whether other insurance is available to an additional insured on a primary basis, this insurance will be primary and noncontributory if a written contract between you and the additional insured specifically requires that this insurance be primary. O) GENERAL AGGREGATE LIMIT PER LOCATION SECTION III — Limits of Insurance, paragraph 2. is deleted and replaced by the following: 2. The General Aggregate Limit is the most we will pay for the sum of: a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard, and c. Damages under Coverage B. A separate Location General Aggregate Limit applies to each location" and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. SECTION V — DEFINITIONS, is amended by adding the following: "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or (ght-of-way of a railroad. P) BLANKET SPECIAL EVENTS This insurance applies to "Bodily Injury," "Property Damage," and "Personal and Advertising Injury" arising out of all your special events. However, this insurance does not apply to the following EXCLUDED EVENTS: a) Parades b) Aircraft NPSS GL'00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 6 of 9 c) Motorcycle runs and automobile rallies d) Fireworks e) Firearms f) Animals g) Carnivals and fairs with mechanical rides h) Concerts i) Events including contact sports j) Rodeos k) Political rallies 1) Any event lasting more than three (3) days (including otherwise acceptable events) m) Any event with greater than 1,000 people in attendance (including otherwise acceptable events) Separate coverage may be available at the company's discretion for the events excluded above. Possible additional charges may apply if coverage is provided. Q) NON -OWNED WATERCRAFT SECTION I —Coverages. 2. Exclusions, paragraph g.(2) is deleted and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 65 feet long, and (b) Not being used to carry persons or property for a charge; This provision applies to any person, who with your consent, either uses or is responsible for the. use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess, or contingent. R) WAIVER OF SUBROGATION We will waive our right of subrogation in the event of a loss. We must be advised, prior to the loss, of your intention to waive subrogation: We also must know whom subrogation will be waived against. If your request meets the underwriting criteria if will be done at no additional charge. S) VIOLATION OF RIGHTS OF RESIDENTS (PATIENT'S RIGHTS) 1) The following is added to Section 1 — Coverages — Coverage A, paragraph 1. Insuring Agreement: "Bodily Injury" damages arising out of the violation of "Rights of Residents," shall be deemed an "occurrence." 2) As respects the coverage provided in paragraph A. I. of this endorsement, the following exclusions are added to Section I — Coverages — Coverage A-2. Exclusions: This insurance does not apply to: a) Liability arising out of the willful or intentional violation of "Rights of Residents." b) Fines or penalties assessed by a court or regulatory authority. c) Liability arising out of any act or omission in the furnishing, or failure to furnish, professional services in the medical treatment of "residents." 3) As respects the violation of "Rights of Residents" Coverage, the following definition is added to Section V — Definitions: "Rights of residents" means: a. Any right granted to a resident under any state law regulating your business as a health care facility. NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with itsperrnission Page 7 of 9 b. The "Rights of Residents" as included in the United States Department of Health and Welfare regulations governing participation of Intermediate Care Facilities and Skilled Nursing Facilities, regardless of whether your facility is subject to those regulations. T. LIQUOR LIABILITY EXCLUSION —EXCEPTION FOR FUNDRAISING EVENTS SECTION I — Coverages, Coverage A., 2. Exclusions, c. is amended by adding the following subparagraph: This exclusion does not apply to "bodily injury" or "property damage" arising out of the selling, serving or furnishing of alcoholic beverages at any fundraising events. U. EMPLOYEE CRIMINAL DEFENSE COSTS ONLY COVERAGE 1. The following provision is added to the Policy: Employee Criminal Defense Costs Only Coverage We will pay, on your behalf, for "defense costs" incurred by your "employee" in a `criminal proceeding". We will have the right, but not the duty to defend your "employee' in such "criminal proceeding". 2. The most we will pay for any one "criminal proceeding" is $25,000, regardless of the number of "employees" involved in such 'criminal proceeding". The payment of "defense costs" under this Employee Criminal Defense Costs Only Coverage is in addition to and does not reduce the Limits of Insurance shown on the Declarations. However, the payment of "defense costs" under this Employee Criminal Defense Costs Only Coverage is included within and shall reduce the $25,000 each "criminal proceeding" Limit shown in Item V) of the Schedule above and we will not pay for any further "defense costs" for a "criminal proceeding" after the $25,000 limit has been exhausted. 3. The following additional Exclusions apply to this Employee Criminal Defense Costs Only Coverage: This insurance does not apply to: a. Coverage Provided Under Coverages A or B Any "defense costs" for which coverage is provided under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY AND COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY of this policy. b. Damages, Fines or Penalties Any damages, fines or penalties. 4. The following additional Definitions apply to this Employee Criminal Defense Costs Only Coverage: a. "Criminal proceeding" means: The prosecution of any of your "employees" commenced by the filing, with a court, or other regulatory enforcement agency, of an information, a complaint, or an indictment, and any NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 8 of 9 amendments thereto, alleging that your "employee" had, during the policy period, committed one or more crimes involving one or more incidents, acts, or events. Such incidents, acts or events must arise within the scope of your "employee's" employment by you or occur while your "employee" is performing duties related to the conduct of your business. Any "criminal proceeding" shall be considered a single "criminal proceeding", notwithstanding the fact that the prosecution or investigation may involve multiple incidents, multiple counts or charges, and/or multiple trial and/or appellate proceedings. A subsequent or different prosecution or investigation based on the same incidents, acts, or events that provided the basis for the original prosecution or investigation shall not constitute a separate "criminal proceeding". b. "Defense costs" means (1) Reasonable attorney fees (including fees for the services of paralegals, law clerks and/or investigators working under the direction of said attorney); and (2) Reasonable and necessary costs, excluding loss of income. 5. Under no circumstances will "defense costs" payable under this Employee Criminal Defense Costs Only Coverage be payable as Supplementary Payments under Coverages A or B. All other terms and conditions of the policy remain the same. AUTHORIZED REPRESENTATIVE NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 9 of 9 CONTRACT SERVICES AGREEMENT (Employee support services provided by The Counseling Team International) THIS AGREEMENT FOR CONTRACT SERVICES ("Agreement") is made and entered into on January 1, 2020, by and between the City of Palm Springs, a Calif mia c1 hazier city and municipal corporation ("City"), and Nancy K. Bohl Inc., dba The' Counseling Team International, an employee support services agency, ("Contractor"). City and Contractor are individually referred to as "Party" and are collectively referred to as the "Parties". RECITALS A. City requires the services of an employee support services agency, for short-term counseling,training, critical incident intervention and support, ("Project"). B. Contractor has submitted to City a proposal to provide short-term counseling, training, critical incident intervention and support, to City under the terms of this Agreement. C. Based on its experience, education, training, and re {{tb$,-Contractor is qualified and desires to provide the necessary services to City for the Project. D. City desires to retain the services of Contractor for the Project. In consideration of these promises and mutual agreements, City agrees as follows: AGREEMENT 1. CONTRACTOR SERVICES 1.1 Scone of Services. In compliance with all terms_,�and2-cgnd}jons of this Agreement, Contractor shall provide short-term counseling, trauui� {i�s�eritical incident intervention and support services to City as described in the Scope of Services/Work attached to this Agreement as Exhibit"A"and incorporated by reference (the"services"or"work"). Exhibit "A" includes the agreed upon schedule of performance and the schedule of fees. Contractor warrants that all services and work shall be performed in a competent, professional, and satisfactory manner consistent with prevailing industry standards. In the event of any inconsistency between the terms contained in the Scope of Services/Work and the terms set forth in this Agreement, the terms set forth in this Agreement shall govern. 1.2 Comoliance with Law. Contractor services rendered under this Agreement shall comply with all applicable federal, state, and local laws, statutes and ordinances and all lawful orders, rules, and regulations. 1.3 Licenses and Permits. Contractor shall obtain at its sole cost and expense such licenses, permits, and approvals as may be required by law for the performance of the services required by this Agreement. Revised:1/31/18 720599.1 ¢.1"!tj(1=•-f1114+L1:1r 1.4 Familiarity with Work. By executing this Agreement, Contractor warrants that it has carefully considered how the work should be performed and fully understands the facilities, difficulties, and restrictions attending performance of the work under this Agreement. 2. TIME FOR COMPLETION The time for completion of the services to be performed by Contractor is an essential condition of this Agreement. Contractor shall prosecute regularly and diligently the work of this Agreement according to the agreed upon schedule of performance set forth in Exhibit "A." Contractor shall not be accountable for delays in the progress of its work caused by any condition beyond its control and without the fault or negligence of Contractor vslDelays shall not entitle Contractor to any additional compensation regardless of the paftyl1resp6nsible for the delay. 3. COMPENSATION OF CONTRACTOR 3.1 Compensation of Contractor. 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 be $18,000 annually for the monthly services identified as A through F in Exhibit "A'; and up to an additional $4,000 annually for other services identified in Exhibit"A". 3.2 Method of Payment. In any month in which Contractonrwisshes• to receive payment, Contractor shall submit to City an invoice for services rendered''priokca the date of the invoice, no later than the first working day of such month; in the form approved by City's finance director. Payments shall be based on the rates set forth in Exhibit "A" for authorized services performed. City shall pay Contractor for all expenses stated in the invoice that are approved by City and consistent with this Agreement, within thirty (30) days of receipt of Contractor's invoice. 3.3 Changes. In the event any change or changes in the Scope of Services/Work is requested by City, Parties shall execute a written amendment to this Agreement, specifying all proposed amendments, including, but not limited to, any additional fees. An amendment may be entered into: 7tiiaoMoCwIA511, A. To provide for revisions or modifications to docimi rit Cork product, or work, when required by the enactment or revision of any subsequent law; or B. To provide for additional services not included in this Agreement or not customarily furnished in accordance with generally accepted practice in Contractor's profession. 3.4 Appropriations. This Agreement is subject to, and contingent upon, funds being appropriated by the City Council of City for each fiscal year. If such appropriations are not made, this Agreement shall automatically terminate without penalty to City. 4. PERFORMANCE SCHEDULE •,nuauat„•ivzstaru7• 4.1 Time of Essence. Time is of the essence in the performaric&ofgthjs'Agreement. 2 Revised:1131/18 720599.1 4.2 Schedule of Performance. All services rendered under this Agreement shall be performed under the agreed upon schedule of performance set forth in Exhibit "A." Any time period extension must be approved in writing by the Contract Officer. 4.3 Force Maleure. The time for performance of servicestto1l��e;xeL.Nnder ed under this Agreement may be extended because of any delays due to unforeseeabl3e }> es beyond the control and without the fault or negligence of Contractor, if Contractor notifies the Contract Officer within ten (10) days of the commencement of such condition. Unforeseeable causes include, but are not limited to, acts of God or of a public enemy, acts of the government, fires, earthquakes, floods, epidemic, quarantine restrictions, riots, strikes, freight embargoes, and unusually severe weather. After Contractor notification, the Contract Officer shall investigate the facts and the extent of any necessary delay and extend the time for performing the services for the period of the enforced delay when and if, in the Contract Officer's judgment, such delay is justified. The Contract Officer's determination shall be final and conclusive upon the parties to this Agreement. 4.4 Term. Unless earlier terminated in accordance witli gSeetion ,,4.5 of this Agreement, this Agreement shall continue in full force and effect for h4eA6Af 12 months, commencing on January 1, 2020, and ending on December 31, 2020. Thereafter, this Agreement shall automatically renew for successive twelve (12)month terms. 4.5 Termination Prior to Expiration of Term. City may terminate this Agreement at any time, with or without cause, upon thirty (30) days written notice to Contractor. Where termination is due to the fault of Contractor and constitutes an immediate danger to health, safety, and general welfare, the period of notice shall be such shorter time as may be determined by the City. Upon receipt of the notice of termination, Contractor shall immediately cease all services except such as,may be specifically approved by the Contract Officer. Contractor shall be entitled to compensation for all services rendered prior to receipt of the notice of termination and for any services authorized by the Contract Officer after sucKY-`no.f,1�r,c,6,.1M 4 Mtractor may terminate this Agreement, with or without cause, upon thirty (30) days wnifen�lt�i e.to City. 5. COORDINATION OF WORK 5.1 Representative of Contractor. The following principal of Contractor is designated as being the principal and representative of Contractor authorized to act and make all decisions in its behalf with respect to the specified services and work: Nancy K. Bohl-Penrod, Ph.D., Director. It is expressly understood that the experience, knowledge, education, capability, and reputation of the foregoing principal is a substantial inducement for City to enter into this Agreement. Therefore, the foregoing principal shall be responsible during the term of this Agreement for directing all activities of Contractor and devoting sufficient time to personally supervise the services under this Agreement. The foregoing princip �? '' ilvchanged by Contractor without prior written approval of the Contract Officer. 5.2 Contract Officer. The Contract Officer shall be the City Manager, the Director of Human Resources, or designee ("Contract Officer'). Contractor shall be responsible for keeping the Contract Officer fully informed of the progress of the performance of the services. 3 Revised:1131118 720599.1 Contractor shall refer any decisions that must be made by City to the Contract"Officer. Unless otherwise specified, any approval of City shall mean the approval of the Contract Officer. 5.3 Prohibition Against Subcontracting or Assignment. The experience, knowledge, education, capability; and reputation of Contractor, its principals and employees, were,a substantial inducement for City to enter into this Agreement. Therefore, Contractor shall not contract with any other individual or entity to perform any services required under this Agreement without the City's express written approval. In addition, neither this Agreement nor any interest may be assigned or transferred, voluntarily or by operation of law, without the prior written approval of City. 5.4 Independent Contractor. Neither City nor any of its`emp19yees slall have any control over the manner, mode, or means by which Contractor, its agents or efployees, perform the services required, except as otherwise specified. Contractor shall perform all required services as an independent contractor of City and shall not be an employee of City and shall remain at all times as to City a wholly independent contractor with only such obligations as are consistent with that role; however, City shall have the right to review Contractor's work product, result, and advice. Contractor shall not at any time or in any manner represent that it or any of its agents or employees are agents or employees of City. 5.5 Personnel. Contractor agrees to assign the following individuals to perform the services in this Agreement. Contractor shall not alter the assignment of the following personnel without the prior written approval of the Contract Officer. Acting through the,C,ity_Manager, the City shall have the unrestricted right to order the removal of any ll'assigned by Contractor by providing written notice to Contractor. Name: Title: Nancy K. Bohl-Penrod, Ph.D., Director Various Administrative Contractor assigned Administrative Staff to assist as necessary 6. INSURANCE Contractor shall procure and maintain, at its sole cost and expense, policies of insurance as set forth in the attached Exhibit "B", incorporated herein by reference-__.__,_ Ai-, .inbrir�t�l�e}�• 7. INDEMNIFICATION. 7.1 Indemnification. To the fullest extent permitted by law, Contractor shall defend (at Contractor's sole cost and expense), indemnify, protect, and hold harmless City, its elected officials, officers, employees, agents, and volunteers (collectively the "Indemnified Parties"), from and against any and all liabilities, actions, suits, claims, demands, losses, costs, judgments, arbitration awards, settlements, damages, demands, orders, penalties, and expenses including legal costs and attorney fees (collectively "Claims"), including but not limited to Claims arising from injuries to or death of persons (Contractor's employees included), for damage to property, including property owned by City, from any violation,of any;federal, state, or local law or ordinance, and from errors and omissions committed biffbntr WY, its officers, 4 Revised:1/31/1 B 720599.1 employees, representatives, and agents, that arise out of or relate to Contractor's performance under this Agreement. This indemnification clause excludes Claims arising from the sole negligence or willful misconduct of the City, its elected officials, officers, employees, agents, and volunteers. Under no circumstances shall the insurance requirements and limits set forth in this Agreement be construed to limit Contractor's indemnification obligation or other liability under this Agreement. Contractor's indemnification obligation shal'IatirVive ;the;•expiration or earlier termination of this Agreement until all actions against the Inden'i0Nni Parties for such matters indemnified are fully and finally barred by the applicable statute of limitations or, if an action is timely filed, until such action is final. This provision is intended for the benefit of third party Indemnified Parties not otherwise a parry to this Agreement. 7.2 Design Professional Services Indemnification and Reimbursement. If the Agreement is determined to be a "design professional services agreement" and Contractor is a "design professional" under California Civil Code Section 2782.8, then: A. To the fullest extent permitted by law, Contractor shall indemnify, defend (at Contractor's sole cost and expense), protect and hold harmless City and its elected officials, officers, employees, agents and volunteers and all other public agen6ie9ft*fi9sV 4pftoval of the project is required, (individually "Indemnified Party'; collectively "IndemA%169Aa ies") against any and all liabilities, claims,judgments, arbitration awards, settlements, costs, demands, orders and penalties (collectively"Claims"), including but not limited to Claims arising from injuries or death of persons (Contractor's employees included) and damage to property, which Claims arise out of, pertain to, or are related to the negligence, recklessness or willful misconduct of Contractor, its agents, employees, or subcontractors, or arise from Contractor's negligent, reckless or willful performance of or failure to perform any term, provision, covenant or condition of this Agreement ("Indemnified Claims"), but Contractor's liability for Indemnified Claims shall be reduced to the extent such Claims arise from the negligence, recklessness or willful misconduct of the City and its elected officials, officers, employees, agents and volunteers. B. The Contractor shall require all non-design-professional 'sub-contractors, used or sub-contracted by Contractor to perform the Services or Work required under this Agreement, to execute an Indemnification Agreement adopting the indemnity provisions in sub- section 7.1 in favor of the Indemnified Parties. In addition, Contractor shall require all non- design-professional sub-contractors, used or sub-contracted by Contractor to perform the Services or Work required under this Agreement, to obtain insurance that is consistent with the Insurance provisions as set forth in this Agreement, as well as any other insurance that may be required by Contract Officer. 8. RECORDS AND REPORTS 8.1 Reports. Contractor shall periodically prepare and submit to�the Contract Officer reports concerning the performance of the services required by this Agreement, or as the Contract Officer shall require. 8.2 Records. Contractor shall keep complete, accurate, and detailed accounts of all time, costs, expenses, and expenditures pertaining in any way to this Agreement. Contractor 5 Revised:1/31118 720599.1 shall keep such books and records as shall be necessary to properly perf6'k q,Jhe s rvices required by this Agreement and enable the Contract Officer to evaluate the performance'of such services. The Contract Officer shall have full and free access to such books and records at all reasonable times, including the right to inspect, copy, audit, and make records and transcripts from such records. 8.3 Ownership of Documents. All drawings, specifications, reports, records, documents, and other materials prepared by Contractor in the performance of this Agreement shall be the property of City. Contractor shall deliver all above-referenced documents to City upon request of the Contract Officer or upon the termination of this Agreement. Contractor shall have no claim for further employment or additional compensation as a result of the exercise by City of its full rights or ownership of the documents and materials. Contractor mayrretain copies of such documents for Contractor's own use. Contractor shall have anTnrsrte`d right to use the concepts embodied in such documents. 8.4 Release of Documents. All drawings, specifications, reports, records, documents, and other materials prepared by Contractor in the performance of services under this Agreement shall not be released publicly without the prior written approval of the Contract Officer. 8.5 Cost Records. Contractor shall maintain all books, documents, papers, employee time sheets, accounting records, and other evidence pertaining to costs incurred while performing under this Agreement. Contractor shall make such materials available at its offices at all reasonable times during the term of this Agreement and for three (3) years�from?the�date of final payment for inspection by City and copies shall be promptly furnished to'Citljibn request. 9. ENFORCEMENT OF AGREEMENT 9.1 California Law.. This Agreement shall be construed and interpreted both as to validity and to performance of the parties in accordance with the laws of the State of California. Legal actions concerning any dispute, claim, or matter arising out of or in relation to this Agreement shall be instituted in the Superior Court of the County of Riverside, State of California, or any other appropriate court in such county, and Contractor covenants and agrees to submit to the personal jurisdiction of such court in the event of such action. 9.2 Interpretation. This Agreement shall be construed as;a wholetaccording to its fair language and common meaning to achieve the objectives and purpoii's".,rtl e'Parties. The terms of this Agreement are contractual and the result of negotiation between the Parties. Accordingly, any rule of construction of contracts (including, without limitation, California Civil Code Section 1654) that ambiguities are to be construed against the drafting party, shall not be employed in the interpretation of this Agreement. The caption heading's of the various sections and paragraphs of this Agreement are for convenience and identification purposes only and shall not be deemed to limit, expand, or define the contents of the respective sections or paragraphs. 9.3 Waiver. No delay or omission in the exercise of any right or remedy of a non- defaulting party on any default shall impair such right or remedy or be construed as a waiver. No consent or approval of City shall be deemed to waive or render unnecessary City's consent to ss;;xw�rn;.ogp ctl;;rr 6 Revised:1131118 720599.1 . -vtV;GJ.rc.• or approval of any subsequent act of Contractor. Any waiver by either party of any default must be in writing. No such waiver shall be a waiver of any other default concerning the same or any other provision of this Agreement. 9.4 Rights and Remedies are Cumulative. Except with respect to rights and remedies expressly declared to be exclusive in this Agreement, the rights and remedies of the parties are cumulative. The exercise by either party of one or more"of such,YikH s`or remedies shall not preclude the exercise by it, at the same or different times, or* other rights or remedies for the same default or any other default by the other party. 9.5 Legal Action. In addition to any other rights or remedies, either party may take legal action, in law or in equity, to cure, correct, or remedy any default, to recover damages for any default, to compel ,specific performance of this Agreement, to obtain injunctive relief, a declaratory judgment, or any other remedy consistent with the purposes of this Agreement. 10. CITY OFFICERS AND EMPLOYEES: NON-DISCRIMINATION 10.1 Non-Liability of City Officers and Employees. No officer or employee of City M"p'�R flit + '3'il` shall be personally liable to the Contractor, or any successor-in-interest;HrrllN&event of any default or breach by City or for any amount which may become due to 11W Contractor or its successor, or for breach of any obligation of the terms of this Agreement. 10.2 Conflict of Interest. Contractor acknowledges that no officer or employee of the City has or shall have any direct or indirect financial interest in this Agreement nor shall Contractor enter into any agreement of any kind with any such officer or employee during the term of this Agreement and for one year thereafter. Contractor warrants that Contractor has,not paid or given, and will not pay or give, any third party any money or other consideration in exchange for obtaining this Agreement. 10.3 Covenant Against Discrimination. In connection with its performance under this Agreement, Contractor shall not discriminate against any employee or'apphcauftfdriyemployment because of actual or perceived race, religion, color, sex, age, marital status, ancestry, national origin( L e.,place of origin, immigration status, cultural or linguistic characteristics, or ethnicity), sexual orientation, gender identity, gender expression, physical or mental disability, or medical condition (each a "prohibited basis"). Contractor shall ensure that applicants are employed, and that employees are treated during their employment, without regard to any prohibited basis. As a condition precedent to City's lawful capacity to enter this Agreement, and in executing this Agreement, Contractor certifies that its actions and omissions hereunder shall not incorporate any discrimination arising from or related to any prohibited basis in any Contractor activity, including but not limited to the following: employment, upgrading, demotion or transfer; recruitment or recruitment advertising; layoff or termination; rates of pay or other forms of compensation; and selection for training, including apprenticeship; andyfu;ther,;that Contractor is in full compliance with the provisions of Palm Springs Municipal" 7.09.040, including without limitation the provision of benefits, relating to non-discrimination in city contracting. 11. MISCELLANEOUS PROVISIONS 7 Revised:1131/18 720599.1 11.1 Notice. Any notice, demand, request, consent, approval o co unication that either party desires, or is required to give to the other party or any`ofheLvRI Ori shall be in writing and either served personally or sent by pre-paid, first-class mail to the address set forth below. Notice shall be deemed communicated seventy-two.(72) hours from the time of mailing if mailed as provided in this Section. Either party may change its address by notifying the other party of the change of address in writing. To City: City of Palm Springs Attention: City Manager/City Clerk 3200 E. Tahquitz Canyon Way Palm Springs, California 92262 �r'•���,4 yig�:�Fiu�x To Contractor: "hEt� rc�e. Nancy K.Bohl Inc.,dba The Counseling Team International Attention: Nancy K.Bohl-Penrod, Ph.D., 193 S. Civic Dr., Suite 6 Palm Springs,CA 92262 11.2 Integrated Agreement. This Agreement contains all of the agreements of the parties and supersedes all other written agreements. 11.3 Amendment. No amendments or other modifications of this Agreement shall be binding unless through written agreement by all Parties. ya; ifs}r;,. 11.4 Severability. Whenever possible, each provision of this Agreement shall be interpreted in such a manner as to be effective and valid under applicable law. In the event that any one or more of the phrases, sentences, clauses, paragraphs, or sections contained in this Agreement shall be declared invalid or unenforceable by valid judgment or decree of a court of competent jurisdiction, such invalidity or unenforceability shall not affect any of the remaining phrases, sentences, clauses,paragraphs, or sections of this Agreement, which shall be interpreted to carry out the intent of the parties. 11.5 Successors in Interest. This Agreement shall be binding upon and inure to the benefit of the Parties' successors and assignees. qq 'd.it#C15a�;i y;+t 11.6 Third Party Beneficiary. Except as may be expressly provided for in this Agreement, nothing contained in this Agreement is intended to confer, nor shall this Agreement be construed as conferring, any rights, including, without limitation, any rights as a third-party beneficiary or otherwise, upon any entity or person not a party to this Agreement. 11.7 Recitals. The above-referenced Recitals are hereby incorporated into the Agreement as though fully set forth in this Agreement and each Party acknowledges and agrees that such Party is bound, for purposes of this Agreement, by the same. 8 Revised:1/31/18 720599.1 11.8 Authority. The persons executing this Agreement on behalf of the Parties warrant that they are duly authorized to execute this Agreement on behalf of Parties and that by so executing this Agreement the Parties are formally bound to the provisions of this Agreement. IN WITNESS WHEREOF, the Parties have executed this Agreement as of the dates stated below. «CITY" City of Palm Springs Date: /G' By: ' David H. Ready,PhD City Manager APPROVED AS TO FORM: ATTEST i By: �DwBy Jeffrey allinger thony City Attorney City Clerk "CONTRACTOR" Nancy K. Bohl Inc., dba The Counseling Team International Date: /'� /G 12ol9 jByoh prod, Ph.D., N K. Bohl Inc., dba TheTe am Interpational APPROVED BY CITY MANAGER l{�G C �3 . ,C�1�I� A17d AM4 9 Revised:1/31/18 720599.1 CALIFORNIAALL•PURPOSEACIWOWLEDGINfli r CIVILCODE§nee A ratar11 pubre a otma officer corroaft dim celdte va m Wy the idmdly of ft iwlvidird Who signed the dmnnadtawhidmdoeerufiom®mmebed.mdrott BMditdm .emracyervalftddotdoamaL State of Ca5lwuie ) counly D 2- 0= aii `� ' before..�t um l 1a/Qtct��,tJ01 P cil� _ PmussW appeared f�1/ILtn Ct• IL L oh Nams(b) who Proved to me on the basis of saWactury evider ce to 6e the nanmi =a�uplboaedt1 to the win-thin,eo ru mmad erd acknmAmW to me ffudJwI1h90hwAAm9cutedl the same in hziAmrkhakAruwr®dcapacdy(mea),aWthstby tw-aigudure4mthe-ozbmentthapermr{*; orthe entity upon behstf of which the pasm(a)�vcled executed the matrument 1 caddy under PENALTY OF PERJURY under the tm '. LESLIE C. AGUIRRI! of the Sty of CaGfama.dud the forego-igpargtaph COMM.#2232474 islrue and wrta.'L .. NOTARY PUBLIC CALIFORNIA w FNEW u harKI and awl. SAN BERNARDINO COUNTY COMM.EXPIRES MARCH 7,2022" t fury -..�TWO of the Office, Pisoa Notary SasfAbuve OPDOJW 7hauWfms bori In apfimoL oampletbg Bra milhematon ran deterafferdion offhe documador Mu ddadrestfarl meat of Un forth to an ardn6aded document Descriptlnrm of AUadmed Document Title or Type of Document: Dmmmad Dsfa Number of Peg= Si ner(s)Other Than Named Above_ Ce -*Ktrea)Clamed by 5gner(a) signers Nema Sigrwra Name: ❑Cwpords Officer—Tdla(a)c ❑COM-810 Officer—Tdta(a): ❑Partner— ❑Lvdded ❑General ❑Padnr— O Lbwted ❑Genemt ❑IndaidLad ❑Aftomoy to Fad ❑hxfeidual ❑Atomay bm Fed ❑Trustee ❑Gmmrdim or Conservator ❑Tnrdee -zi�Om_ar�,aP,or�Cansaystor []Other ❑Other. signer In Reprimanding: Signer la Represen&g:.-_ - - &M4 NahorLd NatoyAaaaei d m-woveXaSma otmymg•1A00-US WFARY(1-80"78-t827) r-n#5997 � 4jG 10 trClan�gr�ai-oa.^. Revised:1/31/18 720599.1 _ EXHIBIT "A" CONTRACTOR'S SCOPE OF SERVICES/WORK Including, Schedule of Fees And Schedule of Performance 11 Revised:1131/18 720599.1 PROGRAM OPERATIONS COST Upon signing this contract between the City of Palm Springs Police Department and The Counseling Team International (TCTI),TCTI shall provide the following services: A. Professional Short-term Confidential Counseling- for approximately 150 Police Personnel (Sworn and Non-Sworn) and their eligible dependents living within the home. B. Supervisor Referrals—provide consultations with supervisors regarding problem employees and/or any aspect of the Employee Support Services (ESS). C. Follow-up Sessions- for employees involved in Critical Incidents. D. TCTI will conduct an initial orientation for all levels, including management concerning services provided by the Employee Support Services (ESS) for no charge. TCTI will provide all literature for management, employees and their eligible dependents, i.e., brochures, flyers, supervisor handbooks, business cards, etc... E. TCTI will attend one health fair a year at no charge. F. Consultation services. This service is included in the professional counseling portion of this contract. All services above will not exceed the annual amount of$18,000.00. This will be'atthe rate of $1,500.00 per month. Additional Services not included in the amount above: Training—provide a wide variety of training classes at the reduced rate of$125.00 per hour. There will be an additional $50.00 fee per hour for travel. All ICISF certified classes will be billed at the set rate for the requested subject. Critical Incident Intervention -provide 24-hour on-call Critical Incident Debriefing services at the reduced rate of$200.00 per hour. 3-Day Basic Peer Support (Post Certified) M9; 29930Q,pe1r student 2-Day Basic Critical Incident Stress Management (CISM) (Post Certified) $199:00 per student 2-Day Advanced Peer Support(Post Certified) $199.00 per student Peer Support Consultation: $75.00 per hour Peer Support Meetings(Quarterly): $110.00 per hour Pre-Employment Psychological Evaluation: TCTI will provide the written test, oral interview and written report to the department at the reduced rate of$300.00 per applicant. By: By: ncy K. Be 1-Pe od,Ph.D., i for The Counseling Team International Date: Date: EXHIBIT `B" INSURANCE PROVISIONS Including Verification of Coverage, Sufficiency of Insurers, Errors and Omissions Coverage, Minimum Scope of Insurance, Deductibles and Self-Insured Retentions, and Severability of Interests (Separation of Insureds) 12 Revised:1/31118 720599.1 INSURANCE 1. Procurement and Maintenance of Insurance. Contractor shall procure and maintain public liability and property damage insurance against all claims for injuries against persons or damages to property resulting from Contractor's performance under this Agreement. Contractor shall procure and maintain all insurance at its sole cost and expense, in a form and content satisfactory to the City, and submit concurrently with its execution of this Agreement. Contractor shall also carry workers' compensation insurance in accordance with California workers' compensation laws. Such insurance shall be kept in full force and effect during the term of this Agreement, including any extensions. Such insurance shall not be cancelable without thirty (30) days advance written notice to City of any proposed cancellation. Certificates of insurance evidencing the foregoing and designating the City, its elected officials, officers, employees, agents, and volunteers as additional named insureds by original endorsement shall be delivered to and approved by City prior to commencement of services. The procuring of such insurance and the delivery of policies, certificates, and endorsements evidencing the same shall not be construed as a limitation of Contractor's obligation to indemnify City, its elected officials, officers, agents, employees, and volunteers. 2. Minimum Scope of Insurance. The minimum amount of insurance required under this Agreement shall be as follows: 101ce uuu eucu 1. Comprehensive general liability and personal injury4ithclimits of at least one million dollars ($1,000,000.00) combined single limit coverage per occurrence and two million dollars ($2,000,000) general aggregate; 2. Automobile liability insurance with limits of at least one million dollars ($1,000,000.00)per occurrence; 3. Professional liability (errors and omissions) insurance with limits of at least one million dollars ($1,000,000.00) per occurrence and two million dollars ($2,000,000) annual aggregate is: required •crcc HIM --duct is not required; 4. Workers' Compensation insurance in the statutory amount as required by the State of California and Employer's Liability Insurance with limits of at least one million dollars $1 million per occurrence. If Contractor has no employees, Contractor shall complete the City's Request for Waiver of Workers' Compensation Insurance Requirement form. 3. Primary Insurance. For any claims related to this Agreement, Contractor's. insurance coverage shall be primary with respect to the City and its respective elected officials, officers, employees, agents, and volunteers. Any insurance or self-insurance maintained by City and its respective elected officials, officers, employees, agents, and volunteers shall.be in excess of Contractor's insurance and shall not contribute with it. For Workersvi Compensation and Employer's Liability Insurance only, the insurer shall waive all rights of subrogation and 13 Revised:1131118 720599.1 contribution it may have against City, its elected officials, officers, employees, agents, and volunteers. 4. Errors and Omissions Coverage. If Errors & Omisiibi §rlffg� dfi&is required, and if Contractor provides claims made professional liability insurance, �osltractor shall also agree in writing either (1) to purchase tail insurance in the amount required by this Agreement to cover claims made within three years of the completion of Contractor's services under this Agreement, or (2) to maintain professional liability insurance coverage with the same carrier in the amount required by this Agreement for at least three years after completion of Contractor's services under this Agreement. Contractor shall also be required to provide evidence to City of the purchase of the required tail insurance or continuation of the professional liability policy. 5. Sufficiency of Insurers. Insurance required in this Agreement shall be provided by authorized insurers in good standing with the State of California. Coverage shall be provided by insurers admitted in the State of California with an A.M. Best's.Key Ratin of B++, Class VII, or better, unless otherwise acceptable to the City. nXs"li $ > ri�� 6. Verification of Coverage. Contractor shall furnish City with both certificates of insurance and endorsements, including additional insured endorsements, effecting all of the coverages required by this Agreement. The certificates and endorsements are to be signed by a person authorized by that insurer to bind coverage on its behalf. All proof of insurance is to be received and approved by the City before work commences. City reserves the right to require Contractor's insurers to provide complete, certified copies of all required insurance policies at any time. Additional insured endorsements are not required for Errors and Omissions and Workers' Compensation policies. Verification of Insurance coverage may be provided by: (1) an.approved T eneral and/or Auto Liability Endorsement Form for the City of Palm Springs or(2) an af�')'e Certificate of Liability Insurance Coverage with an approved Additional Insured Endorsement with the following endorsements stated on the certificate: 1. "The City of Palm Springs, its officials, employees, and agents are named as an additional insured... " ("as respects City of Palm Springs Contract No. or 'for any and all work performed with the City"may be included in this statement). 2. "This insurance is primary and non-contributory over any insurance or self- insurance the City may have..." ("as respects City of Palm Springs Contract No._" or 'for any and all work performed with the City" may be included in this statement). ;fir 1-,<r" 3. "Should any of the above described policies be cancer Offine expiration date thereof, the issuing company will mail 30 days written notice to the Certificate Holder named." Language such as, "endeavor to" mail and "but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representative" is not acceptable and must be crossed out. 14 Revised:1131118 720599.1 4tts�p '�ii. t '^�- �A1A���.4t}i E�W 4. Both the Workers' Compensation and Employers' Liability policies shall contain the insurer's waiver of subrogation in favor of City, its elected officials, officers, employees, agents, and volunteers. In addition to the endorsements listed above, the City of Palm Springs shall be named the certificate holder on the policies. All certificates of insurance and endorsements are to be received and approved by the City, before work commences. All certificates of insurance must be authorized by a person with authority to bind coverage, whether that is the authorized agent/brokef o (insurance;underwriter. Failure to obtain the required documents prior to the commencement of work`shMl not waive the Contractor's obligation to provide them. 7. Deductibles and Self-Insured Retentions. Any deductibles or self-insured retentions must be declared to and approved by the City prior to commencing any work or services under this Agreement. At the option of the City, either (1) the insurer shall reduce or eliminate such deductibles or self-insured retentions with respect to the City, its elected officials, officers, employees, agents, and volunteers; or (2) Contractor shall procure a bond guaranteeing payment of losses and related investigations, claim administration, and defense expenses. Certificates of Insurance must include evidence of the amount of any deductible or self-insured retention under the policy. Contractor guarantees payment of all deductibles and self-insured r ori,nsrift retentions. :e,r 8. Severability of Interests (Separation of Insureds). This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the limits of the insurer's liability. 15 Revised:1131118 720599.1 AkOteharm- Dear Certificate Holder, We are pleased to attach a standard ACORD certificate of insurance issued to you on behalf of the captioned client. For the reasons stated within this informational letter,State Farm is unable to comply with your request for one or more of the following changes: 1 Modify the current ACORD form including specific requests on notice of cancellation or statements that purport to modify policy provisions • Issue a prior edition of the ACORD form w Complete a proprietary certificate of insurance w Complete a proprietary coverage form,coverage questionnaire or coverage statement Upon request and if authorized by our insured,we will be happy to provide you with certified copies of all property and/or liability insurance policies in force for our insured that are relevant to you. • Notice of cancellation is a policy provision.A certificate that purports to provide a policy provision different from that provided by the policy itself cannot amend the Insurance policy.Adding or modifying language to the certificate regarding coverages or rights may be in violation of laws concerning certificates of Insurance in the given state. • State Farm is unable to provide the cancellation notice you request by endorsement. The policyholder can cancel immediately and state laws grant the insurer the right to cancel for reasons such as nonpayment with less notice than you may require. • ACORD forms carry a copyright and their use is licensed. Use of an older edition of any ACORD form,without ACORD's permission would violate ACORD's licensing agreement and federal copyright law. • We do not issue certificates of insurance that are not on our forms or on an ACORD form we have licensed for use. Many proprietary certificates include language that may or may not comply with state laws, regulations,and insurance department directives. They may include wording implying coverages or rights violating the law concerning certificates of Insurance in the given state. • Coverage surveys,questionnaires or statements are often presented as"affidavits" or warranties that the coverages afforded the insured comply with the contract the policyholder has signed with the certificate holder.We can only certify the coverage State Farm offers,but cannot provide you with assurances regarding other coverages mentioned in your surveys,questionnaires or coverage statements. We appreciate your understanding of why we are not able to comply with your request. COI Response Lever v.10,f9,13 US Providing 1r renae and Finamal Smkw,Homo Ofia,e,abaNrgtorx X StaifeftM State Farm General Insurance Company PO Box 853925 Richardson, TX 75085-3925 ACKNOWLEDGMENT OF CANCELLATION REQUEST AT1 M-23- 7501 -FA48 U WW8 0 5 THE CITY OF PALM SPRINGS, ITS OFFICIALS, EMPLOYEES AND INAGENTS 3200 E TAHGUITZ CANYON WAY PALM SPRINGS CA 92262-6959 11111111111111 111111P1111111111Sol I1111111 RECEIVED F JUL 0 7 2022 Office of the City Clerk IPOLICY NUMBER: 92-J1-H860-4 DATE CANCELED: JUL 12 2022 RETURN PREMIUM: None To:[ -]INSURED []MORTGAGEE [-]OTHER Dear Policyholder, As requested, this policy has been canceled effective 12:01 a.m. (or the time which is required by state law) as of the Date Canceled shown above. We thank you for giving us the opportunity to provide this insurance. 'This policy is being replaced by policy #92-KA-T364-7. Any return premium will be handled through the State Farm Payment Plan. Insured: Location: NANCY K BOHL INC MULTIPLE LOCATIONS DBA THE COUNSELING TEAM INTERNATIONAL AND DBA THE ORGANIZATIONAL NETWORK Agent: SKALA INSURANCE AGENCY INC SFPP No: Telephone: (909) BM-8861 of GQ) 5428 AIN Y (n�f1' g 1 �/ 537-147.12 09-11-2013 (01131229) 001 0190992412 DATE PROCESSED JUN 24 2022 • ......1 ACORO" TRUEREC-01 M CERTIFICATE OF LIABILITY INSURANCE Qg 4yR DATE B(lg/2n23MIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. H SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on PRODUCER HUB Intel 1525 Fare Suite 150 Carlsbad, INSURED Insurance Services Inc. CA 92008 Nancy K. Bohl, Inc. D.B.A. The Counseling Team International 20351 SW Acacia Street Floor 2 Newport Beach, CA 92660 CONTACT NAME.- 231-2572 eedda e o -Travelers Prooertr Casualtv Comoanv of America 125974 1 (1nVFRAG1:R rFRTIFIrATF NIIMRFR• RFVISIr1N NIIMRFR- 2 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 AL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. MSR TWE�INBURANDE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LYRE A X commeacuu. DeNeaAL LIABILITY EACH OCCURRENCE 1,000.000 CLAIMSMADE �X OCCUR X X ACP302979500 8/3112022 8/3112023 DAMAGE TO RENTED 1,000,000 MED EXP [My one 20,000 PERSONAL A ADV INJURY s 1.000•000 GEN'L AGGREGATELIIMIIT APPLIES PER: POLICY JpECT Fx-1 LOC GENERAL AGGREGATE 3,000,000 PRODUCTS -COMPAOP AGO 3,000,000 OTHER: A AUTOMOBILELIABILITY COMBINED SINGLEUMR 11000,000 EOGLYINJURv X ANY AUTO CP BA 3029795490 8/31/2022 8/311"23 BODILY INJURY OWNED SCHEDULED AUTOS ONLY AAUpTNO,pSyylypp PEA AMAC>E PT 1as _ A�RTOS ONLY AUTOS ONCV B X UNBRELLALIAB X OCCUR EACH OCCURRENCE 5,000,000 EXCESS LIAa I CLVMSMADE ACP CAA 3029795490 8131/2022 8/3112023 AGGREGATE 51000,000 DED X RETENTIONS 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORMARTNERIEXECU Mit YIN OOF tided En W, EXCLUDED? ❑Y (Mentlalory In NH) NIA X U87T831211 8111/2023 8/11@024 X PER OTH- STATUTE E.L. EACH ACCIDENT 1,0001000 E.L. DISEASE- EA EMPLOYEE 1.000,000 E.L. DISEASE - POLICY LIMR 1 000 000 Oyes describe under DESCRIPTION OF OPERATIONS Oebw A -Professlonal Liab CP30297SS490 8131/2022 8/3112023 See below for limits A `Abuse Liability CP3029795490 8131/2022 813112023 See below for limits DESCRIPTON OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101. Addllional Remarks Schedule, may be attached I more space Is required) Professional Liability I Occurrence Form 1 $1,000,000 Per Claimi$3,000,000 Aggregate Abuse Liabilityl Occurrence Form 1 $1,000,000 Per Claim/$3,000,000 Aggregate *Umbrella Underlying Policies: General Liability I Professional Liability I Abuse Liability I Auto Liability I Workers Compensation Business Office Policy Property Locations: SEE ATTACHED ACORD 101 rP0T1FIr ATF MrH nFR . .)VF(1 rANCFI 1 ATM1N ' UU 1 2023 OF C ELLED BEFORE City of Palm Springs Its officials, employees & agents 3200 E. Tahquitz Canyon Way Palm Springs, CA 92262-6959 • City Hall Reception Desk THEDLD EXANY IRATIONH DATTEy THEREOFF,,E NOTICES WILL BEC DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORLDED S REPRESENTATIVE -4 o -- ACORD 25 (2016103) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: TRUEREC-01 RDEANDA 1 ACORO" 66� LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 Of 1 AGENCY License # 0757776 NAMED INSURED UB International Insurance Services Inc. Nancy K. Bohl, Inc. D.B.A. The Counseling Team International 20351 SW Acacia Street Floor 2 Newport Beach, CA 92660 POLICY NUMBER EE PAGE 1 CARRIER NAIL CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE: SEEPAGE1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/LocationsNehicles: 1881 Business Center Dr. Suite 11, 12 A & 12 B, San Bernardino, CA 92408 1645 Anacapa Rd Suite 7C, Victorville, CA 92392 444 Camino Del Rio South, Suite 215 & #208, San Diego CA 92108 74075 El Paseo Suite A9 & A16, Palm Desert, CA 92260 4160 Temescal Canyon Rd Ste 309, Corona, CA 92883 41750 Rancho Los Palmas Or ST #D-2, Rancho Mirage, CA 92270 39755 Murrieta Hot Springs Rd, Suite D160, Murrieta, CA 92563 135 S State College Blvd Ste 200, Brea, CA 92821 701 Palomar Airport Rd, #300, Carlsbad, CA 92011 232 Harrison Ave Ste D, Claremont, CA 91711 City of Palm Springs, its officials, employees & agents are named as Additional Insureds with respects to General Liability per form CG8128 01/18. Insurance is Primary and Non -Contributory. Waiver of subrogation applies for General Liability and Workers Compensation. All forms valid where required by written contract. ACORD 101 (2008/01 ) © 2008 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD P91icy Number: ACP 3029795490 COMMERCIAL GENERAL LIABILITY CG 81 28 01 18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL LIABILITY ENHANCEMENT: HUMAN SERVICES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposure is provided under this policy. If such other more specific coverage applies, the terms, conditions, and limits of that coverage are the sole and exclusive coverage applicable under this policy, unless otherwise noted on this endorsement. The following is a summary of the Limits of Insurance and additional coverages provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. Coverage Applicable Limit of Insurance Page # Additionallnsured — As Required bContract Included 7 Additionallnsured — Broad Form Vendors Included 5 Additionallnsured—Fundin Source Included 4 Additionallnsured —Grantor of Franchise Included 6 Additionallnsured — Grantor of Permits Included 4 Additionallnsured — Home Care Providers Included 4 Additional Insured — Lessors Of Leased Equipment — Automatic Status When Required In Lease Agreement With You Included 4 Additional Insured — Managers, Landlords, Or Lessors Of Premises Included 4 Additional Insured —Medical Directors And Administrators Included 4 Additional Insured — State Or Political Subdivision Included 5 Broadened Definition Of Bodily Injury Includes Mental Anguish 9 Damage To Premises Rented To You $1,000,000 Includes Expanded Perils 8 Damage To Property You Own, Rent, Or Occupy $50 000 2 Duties In The Event Of Occurrence, Claim Or Suit Included 8 Employee Indemnification Defense Coverage For Employee $25 000 3 Extended Property Damage Included 3 Key And Lock Replacement Janitorial Services Client Coverage $15,000 2 Liberalization Included 8 Limited Rental Lease Agreement Contractual Liability $100,000 3 Medical Payments $20,000 3 Medical Payments — Athletic Activities Amended 3 Medical Payments — Extended Reporting Period 3 Years 3 Named Insured— Broadened Named Insured Included 3 Named Insured — Newt Acqwired Included 3 Non -Owned Watercraft Less than 58 feet 2 Personal And Advertising Injury — Includes Abuse Of Process And Discrimination Included 9 SuDolementary Pa ments — Bail Bonds $7 500 3 Supplementary Payments — Loss Of Earnings $1 500 r da 3 Transfer Of Rights Of RecoveryAgainst Other To Us Clarification 8 Unintentional Failure To Disclose A Hazard Included 8 CG 81 28 01 18 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 9 with its permission. CG 8128 01 18 A. Key and Lock Replacement — Janitorial Services Client Coverage 1. We will pay for the cost to replace keys and locks at the "client's" premises due to theft or other loss to keys entrusted to you by your "client", up to a $15,000 limit per occurrence/$15,000 policy aggregate. 2. We will not pay for loss or damage resulting from theft or any other dishonest or criminal act that you or any of your partners, members, officers, "employees", "managers", directors, trustees, authorized representatives or any one to whom you entrust the keys of a "client" for any purpose commit, whether acting alone or in collusion with other persons. 3. The following, when used in this coverage only, are defined as follows: a. "Employee" means: (1) Any natural person: (a) While in your services or for 30 days after termination of service; (b) Who you compensate directly by salary, wages or commissions; and (c) Who you have the right to direct and control while performing services for you; or (2) Any natural person who is furnished temporarily to you: (a) To substitute for a permanent "employee" as defined in Paragraph (1) above, who is on leave; or (b) To meet seasonal or short-term workload conditions; while that person is subject to your direction and control and performing services for you. (3) "Employee" does not mean: (a) Any agent, broker, person leased to you by a labor leasing firm, factor, commission merchant, consignee, independent contractor or representative of the same general character; or (b) Any "manager", director or trustee except while performing acts coming within the scope of the usual duties of an "employee". b. "Manager" means a person serving in a directorial capacity for a limited liability company. B. SECTION 1 — COVERAGES, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. Exclusions is amended as follows: 1. Exclusion a. Expected or Intended Injury is deleted and replaced with: a. "Bodily injury" or "property damage" expected or intended from the stand point of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. 2. Exclusion g. Aircraft, Auto or Watercraft Paragraph (2) is deleted and replaced with: (2) A watercraft you do not own that is: (a) Less than 58 feet long; and (b) Not being used to carry persons or property for a charge; This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess, or contingent. 3. Exclusion j. is amended as follows: (a) Exclusion j.(1) is deleted and replaced with: (1) Property you own, rent , or occupy, including any costs or expenses incurred by you, or any other person, organization or entity, for repair, replacement, enhancement, restoration or maintenance of such property for any reason, including prevention of injury to a person or damage to another's' property, unless the damage to property is caused by your "client", in such case we will provide coverage for such "property damage" for which you are legally obligated to pay up to a $50,000 limit per "occurrence". This limit is the only limit of insurance for such "property damage" and will not be combined with the Each Occurrence Limit set for this in Section III — Limits of Insurance and will be included within and not in addition to the Each Occurrence Limit. Any and all damages paid under the terms and condition of this provision will further be applied against and will reduce the Aggregate Limit of Insurance shown on the Declarations page, and as provided in the Commercial General Liability Coverage Form in the same manner and in addition to all other coverages of the Commercial General Liability Coverage Form that are also subject to the Aggregate Limit. 4. The following is added to Paragraph (2) of Exclusion b. Contractual Liability of SECTION I — COVERAGES, COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY, under Subsection 2. Exclusions: We agree to indemnity the Named Insured for their liability assumed in a contract or agreement Page 2 of 9 Includes copyrighted material of Insurance Services Office, Inc., CG 81 28 01 18 with its permission. regarding the rental or lease of a premises on behalf of their "client", up to $100,000 per "occurrence". This limit of insurance is the only limit of insurance for your liability assumed in a contract or agreement regarding the rental or lease of a premises on behalf of your "client" whether or not such contract qualifies as an "insured contract". This limit will not be combined with the Each Occurrence Limit set forth in Section III — Limits of Insurance and is included within and not in addition to the Each Occurrence Limit. This coverage extension only applies to rental lease agreements. This coverage is excess over any renter's liability insurance of the "client". Any and all damages paid under the terms and conditions of this provision will further be applied against and will reduce the Aggregate Limit of Insurance shown on the Declarations page, as provided in the Commercial General Liability Coverage Form in the same manner and in addition to all other coverages of the Commercial General Liability Coverage Form that are also subject to the Aggregate Limit. 5. The last Paragraph of Subsection 2. Exclusions is replaced by the following: If damage by fire to premises rented to you is not otherwise excluded, exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner. A separate limit of insurance applies to this coverage as described in Section III — Limits of Insurance. C. SECTION I — COVERAGES, COVERAGE C — MEDICAL PAYMENTS 1. If COVERAGE C— MEDICAL PAYMENTS is not otherwise excluded from this Coverage Part: a. The Medical Expense Limit shown on the Declarations is deleted and replaced by $20,000. $20,000 is the only limit of insurance for Medical Expenses and this limit will not be combined with any other limit of insurance. b. Subsection 1. Insuring Agreement, Paragraph a.(3)(b) is replaced by: (b) The expenses are incurred and reported to us within three years of the date of the accident; and CG 81 28 01 18 b. Exclusion e. Athletics Activities is deleted and replaced with: e. Athletics Activities To a person injured while practicing or participating in any physical exercises or games, sports or athletic contests. This exclusion shall not apply to an insured while providing instruction with respect to any of the activities otherwise excluded by this provision. D. SECTION I — COVERAGES, SUPPLEMENTARY PAYMENTS — COVERAGES A AND B is amended as follows: 1. 1. b. is replaced with: b. Up to $7,500 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. 2. 1. d. is replaced with: d. All reasonable expenses incurred by the insured at our request to assist us in the "suit", including actual loss of earnings up to $1,500 a day because of time off from work. 3. The following provision is added: We will reimburse you for defense costs that you incur in the defense of an "employee" who is directly involved in a criminal proceeding that arises out of such "employee's" acts or omissions within the scope of their employment by you or while performing duties related to the conduct of your business and which would otherwise be covered by this insurance. The most we will reimburse you for defense costs that you incur in the defense of an "employee" who is alleged to be directly involved in a criminal proceeding is $25,000, subject to an aggregate limit of $25,000 for all reimbursements that we make during the policy period on behalf of all "employees", regardless of the numbers of "employees", claims or "suits" brought or persons or organizations making claims or bringing "suits". E. SECTION II WHO IS AN INSURED is amended as follows: 1. If coverage for a newly acquired or formed organization is not otherwise excluded from this Coverage Part, Paragraph 3.a. is replaced with: 2. Subsection 2. Exclusions, is amended as a. Coverage under this provision is until the follows: end of the policy period during which you a. Exclusion a. Any Insured is deleted and acquired or formed the organization; replaced with: 2. The following is also an insured: a. Any Insured Broadened Named Insured — Any organization To any insured, except "volunteer and subsidiary thereof which you control and workers" or an insured as provided in e. actively manage (whether through ownership of Athletic Activities below. voting securities, by contract, or otherwise) on the effective date of this policy. However, coverage does not apply to any organization or CG 81 28 01 18 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 9 with its permission. CG 81 28 01 18 subsidiary not named in the Declarations as a agreed in writing in a contract or agreement Named Insured, if they are also insured under that such person(s) or organization(s) be another similar policy, or would have been added as an additional insured on your insured but for such policy's termination or the policy. Such person(s) or organization(s) is exhaustion of its limits of insurance. an insured only with respect to liability for 3. Each of the following is also an additional "bodily injury', "property damage" or insured: "personal and advertising injury" caused, in whole or in part, by your maintenance, a. Medical Directors and Administrators — Your operation or use of equipment leased to you medical directors and administrators but by such person(s) or organization(s). only while acting within the scope of and However, the insurance afforded to such during the course of their duties as such. additional insured: Such duties do not include the furnishing or (1) Only applies to the extent permitted by failure to furnish professional services as a physician or psychiatrist in the treatment of law; and a patient. (2) Will not be broader than that which you b. Funding Source — Any person or are required by the contract or organization with respect to their liability agreement to provide for such additional arising out of: insured. (1) Their financial control of you; or A person's or organization's status as an additional insured under this endorsement (2) Premises they own, maintain or control ends when their contract or agreement with while you lease or occupy these you for such leased equipment ends. premises. With respect to the insurance afforded to This insurance does not apply to: these additional insureds, this insurance (a) Any "occurrence" or offense which does not apply to any "occurrence" which takes place after you cease to takes place after the equipment lease lease or occupy that premises; or expires. (b) Structural alterations, new f. Grantors of Permits — Any state or construction or demolition governmental agency or subdivision or operations performed by or on political subdivision granting you a permit in behalf of that person or connection with your premises subject to the organization. following additional provision: c. Home Care Providers — At the first Named This insurance applies only with respect to Insured's option, any person or organization the following hazards for which the state or under your direct supervision and control governmental agency or subdivision or while providing on your behalf private home political subdivision has issued a permit or respite or foster home care for the authorization in connection with premises developmentally disabled. you own, rent or control and to which this d. Managers, Landlords, or Lessors of insurance applies: Premises — Any person or organization with (1) The existence, maintenance, repair, respect to liability arising out of the construction, erection or removal of ownership, maintenance or use of that part advertising signs, awnings, canopies, of the premises leased or rented to you cellar entrances, coal holes, driveways, subject to the following additional manholes, marquees, hoist away exclusions: openings, sidewalk vaults, street This insurance does not apply to: banners or decorations and similar (1) Any "occurrence" which takes place exposures; or after you cease to be a tenant in that (2) The construction, erection or removal of premises. elevators; or (2) Structural alterations, new construction (3) The ownership, maintenance or use of or demolition operations performed by any elevators covered by this insurance. or on behalf of the person or However: organization. (1) The insurance afforded to such e. Lessor of Leased Equipment — Automatic additional insured only applies to the Status When Required in Lease Agreement extent permitted by law; and With You - Any person(s) or organization(s) from whom you lease equipment when you and such person(s) or organization(s) have Page 4 of 9 Includes copyrighted material of Insurance Services Office, Inc., CG 81 28 01 18 with its permission. (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. g. State or Political Subdivision — Any state or political subdivision with whom you agreed under a written contract or agreement to add as an additional insured to your policy but only with respect to their liability with respect to on -going operations performed by you or on your behalf for which the state or political subdivision has issued a permit or license. This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury' arising out of operations performed for the state or political subdivision; or 2. "Bodily injury" or "property damage" included within the "products -completed operations hazard". The insurance provided to such additional insured state or political subdivision by this endorsement is further limited as follows: 1. The additional insured is covered only for such sums that such additional insured is legally obligated to pay as damages under tort law principles to the injured party because of "bodily injury", "property damage" or "personal and advertising injury" to which this insurance applies, and in accordance with the stated policy limits, exclusions, limitations and conditions except as expressly modified by this endorsement. 2. The limits of insurance are those set forth in the policy Declarations or those specified in the written contract or agreement referenced above, whichever is less. Otherinsurance 1. If specifically required by the written contract or agreement referenced above, any coverage provided by this Subsection g. to an additional insured shall be primary and any other valid and collectible insurance available to the additional insured shall be non- contributory with this insurance. If the written contract does not require this coverage to be primary and the additional insured's coverage to be non- contributory, then this insurance will be excess over any other valid and collectible insurance available to the additional insured. CG 8128 01 18 2. Even if the requirements of Paragraph 1. immediately above are met establishing this coverage as primary and the additional insured's coverage as being non-contributory, this coverage will be excess over any other insurance available to the additional insured which is conferred onto said person or organization by a separate additional insured endorsement. h. Broad Form Vendors — Any person(s) or organization(s) which or who is or are a vendor of 'your products" with whom you agreed under a written contract or agreement to add as an additional insured to your policy, but only with respect to "bodily injury' or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: The insurance afforded the vendor does not apply to: 1. "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; 2. Any express warranty unauthorized by you; 3. Any physical or chemical change the vendor intentionally made to the product; 4. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; 5. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. 6. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; 7. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or CG 81 28 01 18 Includes copyrighted material of Insurance Services Office, Inc., Page 5 of 9 with its permission. CG 81 28 01 18 8. 'Bodily injury" or "property damage" excess over any other valid and arising out of the negligence of the collectible insurance available to the vendor for its own acts or omissions or additional insured. those of its employees or anyone else 2. Even if the requirements of Paragraph acting on its behalf and which was not 1. immediately above are met caused in whole or in part by you or any establishing this coverage as primary person or organization acting on your and the additional insured's coverage behalf. However, this exclusion does not as being non-contributory, this coverage apply to: will be excess over any other insurance (a) The exceptions contained in available to the additional insured which Subparagraphs 4. or 6.; or is conferred onto said person or (b) Such inspections, adjustments, organization by a separate additional tests or servicing as the vendor insured endorsement. has agreed to make or normally f. Grantor of Franchise — Any person(s) or undertakes to make in the usual organization(s) with whom you agreed under course of business, in connection a written contract or agreement to add as an with the distribution or sale of the additional insured to your policy but only with products. respect to their liability as grantor of a The insurance provided to such additional franchise to you. insured vendor by this endorsement is The insurance provided to such additional further limited as follows: insured franchisor by this endorsement is 1. The additional insured is covered only further limited as follows: for such sums that such additional 1. The additional insured is covered only insured is legally obligated to pay as for such sums that such additional damages under tort law principles to the insured is legally obligated to pay as injured party because of "bodily injury", damages under tort law principles to the "property damage" or "personal and injured party because of "bodily injury", advertising injury" to which this "property damage" or "personal and insurance applies, and in accordance advertising injury" to which this with the stated policy limits, exclusions, insurance applies, and in accordance limitations and conditions except as with the stated policy limits, exclusions, expressly modified by this endorsement. limitations and conditions except as 2. The limits of insurance are those set expressly modified by this endorsement. forth in the policy Declarations or those 2. The limits of insurance are those set specified in the written contract or forth in the policy Declarations or those agreement referenced above in the first specified in the written contract or paragraph of this Subsection h., agreement referenced above, whichever whichever is less. is less. This insurance does not apply to any Other Insurance insured person or organization, from whom 1. If specifically required by the written you have acquired such products, or any contract or agreement referenced above ingredient, part or container, entering into, in the first paragraph of this Subsection accompanying or containing such products. I., any coverage provided by this Other Insurance endorsement to an additional insured 1. If specifically required by the written shall be primary and any other valid and contract or agreement referenced above collectible insurance available to the in the first paragraph of this Subsection additional insured shall be non- h., any coverage provided by this contributory with this insurance. If the endorsement to an additional insured written contract does not require this shall be primary and any other valid and coverage to be primary and the collectible insurance available to the additional insured's coverage to be non - additional insured shall be non- contributory, then this insurance will be contributory with this insurance. If the excess over any other valid and written contract does not require this collectible insurance available to the coverage to be primary and the additional insured. additional insured's coverage to be non- 2. Even if the requirements of Paragraph contributory, then this insurance will be 1. immediately above are met establishing this coverage as primary and the additional insured's coverage as being non-contributory, this coverage Page 6 of 9 Includes copyrighted material of Insurance Services Office, Inc., CG 81 28 01 18 with its permission. CG 8128 0118 will be excess over any other insurance 2. The limits of insurance are those set available to the additional insured which forth in the policy and Declarations or is conferred onto said person or those specified in the written contract, organization by a separate additional lease, sublease or agreement insured endorsement. referenced in the first Paragraph of this j. As Required by Contract — Any person or Subsection j., whichever is less. organization for whom 'you" are performing With respect to the insurance afforded to an operations, or to whom you are leasing, additional insured under this Subsection J., subleasing or otherwise entrusting the use the following exclusions are added: or occupancy of premises owned by or 1. This insurance does not apply if the rented to 'you", only as specified under a written contract, lease, sublease or written contract, lease, sublease or agreement referenced in the first agreement that requires that such person or Paragraph of this Subsection j. above organization be added as an additional was not executed by the "Named insured on "your" policy. Such person or Insured" prior to the "occurrence" giving organization is an additional insured only rise to the additional insured's potential with respect to liability caused, in whole or in liability. part, by the acts or omissions of the "Named Insured" or the acts the acts or omissions of 2. This insurance does not apply to the those acting on your behalf in the additional insured's liability to indemnify, performance of the "Named Insured's" defend or hold harmless a third party. ongoing operations for the additional insured 3. This insurance does not apply to "bodily or in connection with such premises owned injury", "property damage" or "personal by or rented to a "Named Insured", but in and advertising injury" for which the both instances only as specified under the additional insured is obligated to pay written contract, lease, sublease or damages by reason of the assumption agreement. A person's or organization's of liability in a contract or agreement. status as an additional insured under this This exclusion does not apply to liability endorsement ends the earlier of when "your" for damages that the additional insured on -going operations for that additional would have in the absence of the insured are completed or when "you" no contract or agreement. longer are contractually required to include 4. "Bodily injury", "property damage" or such person or organization as an additional "personal and advertising injuryarising insured under'your" policy. out of the rendering of, or the failure to The insurance provided to an additional render, any professional architectural, insured by this endorsement is limited as engineering or, surveying services, follows: including: 1. The additional insured is covered only (a) The preparing, approving, or failing for such damages which are caused, in to prepare or approve, maps, shop whole or in part, by the acts or drawings, opinions, reports, omissions of the "Named Insured" to surveys, field orders, change orders which the additional insured is entitled or drawings and specifications; and to be indemnified by the "Named (b) Supervisory, inspection, archi- Insured" pursuant to the written tectural or engineering activities. contract, lease, sublease or agreement referenced in the first paragraph of this S. "Bodily injury" or "property damage" subsection I. above and only for those occurring after: sums that the additional insured is (a) All work, including materials, parts legally obligated to pay as damages or equipment furnished in under tort law principles to the injured connection with such work, on the party because of "bodily injury", project (other than service "property damage" or "personal and maintenance or repairs) to be advertising injury" to which this performed by or on behalf of the insurance applies, and in accordance additional insured(s) at the site of with the stated policy limits and policy the covered operations has been conditions. This coverage does not completed; or apply for defense or indemnity of the (b) That portion of 'your work" out of additional insured if state or federal law which the injury or damage arises does not permit indemnification of the has been put tor its intended use by additional insured by the "Named any person or organization other Insured" for the claim of the third party. than another contractor or CG 81 28 01 18 Includes copyrighted material of Insurance Services Office, Inc., Page 7 of 9 with its permission. CG 81 28 01 18 subcontractor engaged in performing operations for a principal as a part of the same project. Other Insurance 1. It specifically required by the written contract, lease, sublease or agreement referenced in the first Paragraph of this Subsection h above, any coverage provided by this endorsement to an additional insured shall be primary and any other valid and collectible insurance available to the additional insured shall be non-contributory with this insurance. If the written contract, lease or sublease does not require this coverage to be primary and the additional insured's coverage to be non-contributory, then this insurance will be excess over any other valid and collectible insurance available to the additional insured. 2. Even if the requirements of Paragraph 1. immediately above are met establishing this coverage as primary and the additional insured's coverage as being non-contributory, this coverage will be excess over other insurance available to the additional insured which is conferred onto said person or organization by a separate additional insured endorsement. Definitions Solely for purposes of the insurance afforded to an additional insured by this endorsement: "Named Insured" is defined as the entity to whom the insurance policy is issued as shown on the Declarations. "You" or "your" means a "Named Insured" as defined above. F. SECTION III — LIMITS OF INSURANCE is amended as follows: 1. Paragraph 6 is replaced with: 6. Subject to 5. above, the Damage To Premises Rented to You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you or in the case of damage by fire while rented to or temporarily occupied by you with permission of the owner. The limit is increased to $1,000,000. However, if damage by fire to premises rented to you is not otherwise excluded, the word fire in the above paragraph is replaced with fire, lightning, explosion, smoke or sprinkler leakage. G. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is amended as follows: 1. Duties In The Event Of Occurrence, Offense, Claim Or Suit is amended as follows: a. The following is added to Paragraph a.: However, this condition only applies when the "occurrence" or offense is known to: f. You, if you are an individual; if. A partner, if you are a partnership; or fit. An executive officer or insurance manager, if you are a corporation. b. The following is added to Paragraph b.: However, this condition will not be considered breached unless the breach occurs after such claim or "suit" is known to: I. You, if you are an individual; if. A partner, if you are a partnership; or III. An executive officer or insurance manager, if you are a corporation. 2. Subsection 4. Other Insurance, Paragraph b. Excess Insurance, Item (1)(a)(11) is replaced by the following if damage to premises rented to you is not otherwise excluded: (if) That is fire, lightning, explosion, smoke or sprinkler leakage insurance for premises rented to you or temporarily occupied by you with permission of the owner. 3. Subsection 6. Representations is amended to include: d. Your failure to disclose all hazards or prior "occurrences" or offenses existing as of the inception dale of the policy shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or prior "occurrences" or offenses is not intentional. This provision does not affect our right to collect additional premium or exercise our right of cancellation or nonrenewal. 4. Subsection 8. Transfer of Rights of Recovery Against Others to Us is amended to include: Therefore, the insured can waive the insurer's Rights of Recovery prior to the occurrence of a loss, provided the waiver is made in a written contract. S. The following condition is added 10. Liberalization If we revise this coverage form to provide more coverage without additional premium charge, your policy will automatically provide the additional coverage as of the day the revision is effective in your state, provided that this implementation date falls within 45 days prior to or during the policy period stated in the Declarations. Page 8 of 9 Includes copyrighted material of Insurance Services Office, Inc., CG 81 28 01 18 with its permission. H. SECTION V — DEFINITIONS is amended as follows: 1. Paragraph 3. "Bodily Injury" is deleted and replaced with the following: "Bodily Injury": a. Means bodily injury, sickness, or disease sustained by a person and includes mental anguish resulting from any of these; and b. Except for mental anguish, includes death resulting from the foregoing (Item a. above) at any time. 2. If damage by fire to premises rented to you is not otherwise excluded, Paragraph 9. "Insured Contract', Item a. is replaced by the following: a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that indemnifies any person or organization for damage by fire, lightning, explosion, smoke or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owners is not an "insured contract"; 3. Paragraph 14. "Personal and Advertising Injury" is amended as follows: a. Item b. is deleted and replaced with the following: b. Malicious prosecution or abuse of process; b. Item h. is added: h. "Personal and advertising injury" also means injury, including consequential "bodily injury", arising out of discrimination based on race, color, religion, sex, age or national origin, except when: (1) Done intentionally by or at the direction of, or with the knowledge or consent of: (a) Any insured; or CG 8128 0118 b. Any executive officer, director, stockholder, partner or member of the insured; or (2) Directly or indirectly related to the employment, former or prospective employment, termination of employment, demotion, failure to promote or application for employment of any person or persons by an insured; or (3) Directly or indirectly related to the sale, rental, lease or sublease or prospective sales, rental, lease or sub -lease of any room, dwelling or premises by or at the direction of any insured; or (4) Insurance for such discrimination is prohibited by or held in violation of law, public policy, legislation, court decision or administrative ruling This coverage does not apply to fines or penalties imposed because of discrimination. 4. "Client" as used in this endorsement means: a. An individual, company or organization with whom you have a written contract or work order for your services for a described premises and have billed for your services; or b. A person under your direct care and supervision for whom you are providing goods and/or services. All terms and conditions of this policy apply unless modified by this endorsement. CG 81 2801 18 Includes copyrighted material of Insurance Services Office, Inc., Page 9 of 9 with its permission. TRAVELERS J� WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 00 03 13 (00) - 001 POLICY NUMBER: UB-7T831211-23-42-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE: 06-27-23 STASSIGN: PAGE 1 OF TRUEREC-01 .4C`�Rv ASUGAHA CERTIFICATE OF LIABILITY INSURANCE A�` DA8131120223 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 terns 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 endorsements . PRODUCER License 1110757776 j32WAcT Dani Pless INSURED Insurance Services Inc. CA 92008 Nancy K. Bohl, Inc. D.B.A. The Counseling Team International 20351 SW Acacia Street Floor 2 Newport Beach, CA 92660 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 2 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. WSR TYPE OF INSURANCE ADDL SURR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X X 5088.1981-00 8131/2023 8/3112024 EACH OCCURRENCE 1,000,000 DAraAGETORENTEO 1,000,000 MEDEXP(Anyenepsi $ 20,000 PERSONAL a ADV INJURY 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: POLICY I--] j O LOC TIMER: GENERAL AGGREGATE 31000,000 PRODUCTS -COMPXOP AM3,000,000 A N,,GLEBILIABILITY ANY AUTO OYINEDU� AUTOS ONLY AUTOS r OONLY Uµ 91-0457-00 8/31/2023 8/3112024 COMBINED SINGLE LIMIT 11000,000 BODILY INJURY Pe s BODILYINJURY Paaosdxe mDaILmY AMAGE A X OCCUR CLAIMSMADE 90-0559-00 8/3112023 8131/2024 EACH OCCURRENCE 2,000,000UXCJ6L AGGREGATE 21000,000 DED I X RETENTIONS 10,000 IS B WORKERS COMPENSATION AND EMPLOYERS' UA&LRV A�NVF �PROPREIETORNARTNEfLEXECUTIVE YIN (rasadarory in BER EXCLUDED? (Irarld NN) yea describe under DESCRIPTION OF OPERATIONS eski NIA X UB7TS31211 8/1112023 8111/2024 Tµ E.L. DENT 11000,000 rACCIDENT A EMPLOIf 1,�B,6BB OLICY LIMITA 1,000,000 Professional Liab •Abuse Liability 88-1981-00 88-1981-00 8131/2023 8/31/2023 8131/2024 or LimitsA 8/31/2024 or limits DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Senaduk, may be attached N more space Is required) Professional Liability I Occurrence Form 1$1,000,000 Per Claiml$3,000,000 Aggregate Abuse Liability) Occurrence Form 1 $1,000,000 Per Claim/E3,000,000 Aggregate Cybed Cyber/PrivacylNetwork I Ret: $5,0001 Limit 2,000,000 'Umbrella Underlying Policies: General Liability I Professional Liability I Abuse Liability I Auto Liability I Workers Compensation SEE ATTACHED ACORD 101 CFRTIFICATF HOi nFR CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Palm Springs THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Its officials, employees 8 agents 3200 E. Tahquitz Canyon Way Palm Springs, CA 92262-6959 AUTHORREEDD REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: TRUEREC-01 ASUGAHARA / 7 ACRO " LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY License # 07577761 NAMED INSURED UB International Insurance Services Inc. Nancy K. Bohl, Inc. D.B.A. The Counseling Team International 20351 SW Acacia Street Floor 2 POLICY NUMBER Newport Beach, CA 92660 EE PAGE 1 CARRIER MAX CODE EE PAGE 1[SEE P 1 EFFECTIVE DATE: SFF PAr7F 1 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORO 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/Locations/Vehicles: Business Office Policy Property Locations: 1881 Business Center Dr. Suite 11, 12 A & 12 B, San Bernardino, CA 92408 1545 Anacapa Rd Suite 7C, Victorville, CA 92392 444 Camino Del Rio South, Suite 215 & #208, San Diego CA 92108 74075 El Paseo Suite A9 & A16, Palm Desert, CA 92260 4160 Temescal Canyon Rd Ste 309, Corona, CA 92883 41750 Rancho Los Palmas Dr ST #13-2, Rancho Mirage, CA 92270 39755 Murrieta Hot Springs Rd, Suite D160, Murrieta, CA 92563 135 S State College Blvd Ste 200, Brea, CA 92821 701 Palomar Airport Rd, #300, Carlsbad, CA 92011 232 Harrison Ave Ste D, Claremont, CA 91711 City of Palm Springs, its officials, employees & agents are named as Additional Insureds with respects to General Liability perform CG8128 01/18. Insurance is Primary and Non -Contributory. Waiver of subrogation applies for General Liability and Workers Compensation. All forms valid where required by written contract. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER:5088-1981-00 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NON-PROFIT AND SOCIAL SERVICES GENERAL LIABILITY ENHANCEMENTENDORSEMENT It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposures are provided under this policy. If such specific coverage applies, the terms, conditions, and limits of that coverage are the sole and exclusive coverage applicable under this policy. Throughout this endorsement the words "you" and "your" refer to the "Named Insured" shown in the Declarations. The words "we", "us", and "our" refer to the "Company" providing this insurance. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The following is a summary of the Limits of Insurance and Additional Coverage provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. A) Medical Payment— Limit increased to $20,000 B) Supplementary Payments — Bail bonds increased to $3,000 / Loss of Earnings increased to $1,000 each day C) Legal Liability Extension — For fire, lightning, explosion, smoke, and leaks from sprinklers limit increased to $1,000,000 D) Broadened definition of Who is an Insured E) Knowledge or Notice of Occurrence F) Broadened definition of Advertising Injury includes televised or videotaped publication G) Amended definition of Bodily Injury to include mental anguish H) Amended Unintentional Failure to Disclose Hazards 1) Amended Liberalization Clause J) Property Damage — Removal of exclusion for "Property Damage" resulting from the use of reasonable force to protect persons or property K) Premises Sold or Abandoned by You L) Added Blanket Additional Insured - Funding sources M) Added Blanket Additional Insured - Managers or lessors of premises N) Additional Insured — By Contract, Agreement or Permit O) General Aggregate Limit Per Location P) Blanket Special Events Coverage Q) Non -Owned Watercraft Coverage - Length is increased to 65 feet R) Blanket Waiver of Subrogation S) Violation of Rights of Residents Coverage (Patient's Rights) T) Liquor Liability Exception to Exclusion U) Employee Criminal Defense Costs Only Coverage - $25,000 limit of insurance — each "criminal proceeding" A) MEDICAL PAYMENTS If Medical Payments Coverage (Coverage C) is not otherwise excluded from this coverage part: NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 1 of 9 I ) The Medical Expense Limit is increased, subject to all the terms of Limits of Insurance (Section III) to $20,000. 2) The requirement in the Insuring Agreement of Coverage C, that expenses must be incurred and reported to us within "one year" of the accident date is changed to "three years." 3) Exclusion of Coverage, at your option, does not apply to your "volunteer workers" or any person or organization under your direct supervision and control. B) SUPPLEMENTARY PAYMENTS - COVERAGES A AND B: 1) The limit for the cost of bail bonds is changed from $250 to $3,000. 2) The limit for loss of earnings is changed from $250 per day to $1,000 per day. C) LEGAL LIABILITY EXTENSION - FIRE, LIGHTNING, EXPLOSION, SMOKE, AND LEAKS FROM SPRINKLERS 1. The last paragraph of Section I - Coverage A - 2. Exclusions, is deleted and replaced by the following: Exclusions c. through n. does not apply to: a. damage by fire, lightning, explosion, smoke or leaks from automatic fire protective systems; to premises rented to you or temporarily occupied by you with the permission of the owner. A separate limit of insurance applies to this coverage as described in Section III - Limits of Insurance. 2. Paragraph 6. of Section III - Limits of Insurance is deleted and replaced by the following: 6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under COVERAGE A for damages because of "property damage": a. resulting from fire, lightning, explosion, smoke or leaks from automatic fire protective systems, or any combination thereof; and b. caused by a resident; to premises, rented to you or temporarily occupied by you with the permission of the owner. Damage To Premises Rented To You Limit is the greater of: a. $1,000,000 for damages due to fire, lightning, explosion, smoke or leaks from automatic fire protective systems, or any combination there of. D) WHO IS AN INSURED Paragraph 2. of Section II - Who Is An Insured is deleted and replaced by the following: 2. Each of the following is also an insured, but only while working within the scope of their duties related to the conduct of your business; a. "Employees", but only for acts within the scope of their employment by you; b. "Volunteer Workers"; c. Independent Contractors However, no "employees", "volunteer workers" or independent contractors are insureds for. (1) "Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are at limited liability company), to a co -"employee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" or independent contractors while performing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co -"employee", "volunteer worker" or independent contractors as a consequence of Paragraph (1)(a) above; NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 2 of 9 (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. (2) "Property damage" to property: (a) Owned, occupied or used by, (b) Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by you, any of your "employees", 'volunteer workers", independent contractors, any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). d. Medical directors and administrators, including professional persons; e. If you are an organization other than a partnership or joint venture, your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors; f. If you are a limited liability company, your members are insureds, but only with respect to their duties related to the conduct of your business; g. Any organization and subsidiary thereof which you control and actively manage on the effective date of this endorsement; h. Any person or organization that has financial control of you or owns, maintains or controls premises occupied by you and requires you to name them as an additional insured but only with respect to their liability arising out of: (1) Their financial control of you; or (2) Premises they own maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. I. Any State or Political Subdivision subject to the following provision: This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with premises you own, rent, or control and to which this insurance applies: (1) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar exposures; or (2) The construction, erection, or removal of elevators; or (3) The ownership, maintenance, or use of any elevators covered by this insurance. However, the insurance afforded for any organization and subsidiary thereof not named in the Declarations as a Named Insured, does not apply to injury or damage with respect to which an insured under this endorsement is also an insured under another policy, or would be an insured under such policy but for its termination or the exhaustion of its limits of insurance. j. Students in training, but not for 'bodily injury" or "property damage" arising out of his or her rendering or failure to render professional services to patients; k. Your members but only with respect to their liability for your activities or activities they perform on your behalf; I. Your trustees or members of the board of governors while acting within the scope of their duties as such on your behalf; m. Any entity you are required in a written contract (hereinafter called Additional Insured) to name as an insured is an insured but only with respect to liability arising out of your premises, NPSS GL 00004 00 (04118) Includes material copyrighted by ISO Properties, Inc., with its perrnission Page 3 of 9 .your work" for the Additional Insured, or acts or omissions of the Additional Insured in connection with the general supervision of "your work" to the extent set forth below: Insurance does not apply to "bodily injury," "property damage" or "personal and advertising injury" arising out of the rendering or failure to render any professional services by or for you, including: (1) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and (2) Supervisors, inspection, or engineering services. Any coverage provided under this provision shall be excess over any other valid and collectible insurance available to the Additional Insured(s) whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary or you request that it apply on a primary basis. Paragraph 3.a. of Section II — Who Is An Insured is deleted and replaced by the following: a. Coverage under this provision is, subject to (1) and (2) below: (1) Effective on the acquisition or formation date; and (2) Afforded only until the end of the policy period of this Coverage Part or the next anniversary of its inception date, whichever is earlier. E) KNOWLEDGE OR NOTICE OF OCCURRENCE 1) As respects any loss reporting requirements under this policy, it is understood and agreed that knowledge of an accident or incident by an agent, servant or "employee" of yours or any other person shall not in itself constitute knowledge by you, unless a corporate officer of yours shall have received notice from said agent, servant, "employee" or any other person. 2) Your failure to give first report of a claim to us shall not invalidate coverage under this policy if the loss was inadvertently reported to another insurer. However, you shall report any such "Occurrence" to us within a reasonable time once you become aware of such error. F) ADVERTISING INJURY —TELEVISED OR VIDEOTAPED PUBLICATION 1) The definition of "Personal and Advertising Injury' items 14. d., e., f. and g. are changed to read: "Personal and Advertising Injury" means injury, including consequential "bodily injurj%, arising out of one or more of the following offenses: d. Oral, written, televised, or videotaped publication of material that slanders or libels a person or organization or disparages a person's or organization's goods, products, or services; e. Oral, written, televised, or videotaped publication of material that violates a person's right of privacy; f. Misappropriation of advertising ideas or style of doing business; or g. Infringement of copyright, title, or slogan. 2) Exclusions b. and c. of Coverage B., Personal and Advertising Injury Liability, are changed to read: b. "Personal and advertising injury" arising out of oral, written, televised, or videotaped publication of material, if done by or at the direction of the insured with knowledge of its falsity; c. "Personal and advertising injury" arising out of oral, written, televised, or videotaped publication of material whose first publication took place before the beginning of the policy period. G) BODILY INJURY— MENTAL ANGUISH The definition of "bodily injury" is changed to read: NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., vnth its permission Page 4 of 9 "Bodily Injury" means: a. Bodily injury, sickness, or disease sustained by a person, and includes mental anguish resulting from any of these; and b. Except for mental anguish, includes death resulting from the foregoing (item above) at any time. H) UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS It is agreed that, based on our reliance on your representations as to existing hazards, if you should unintentionally fail to disclose all such hazards prior to the beginning of the policy period of this Coverage Part, we shall not deny coverage under this Coverage Part because of such failure. LIBERALIZATION If we adopt a change in our forms or rules which would broaden your coverage without an additional premium charge, your policy will automatically provide the additional coverages as of the date the revision is effective in your state. J) EXTENDED "PROPERTY DAMAGE" SECTION I — Coverages, Coverage A, 2. Exclusions, a. is deleted and replaced by the following: a. Expected or Intended Injury "Bodily Injury" or "Property Damage" expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury' or "property damage" resulting from the use of reasonable force to protect persons or property. K) PREMISES SOLD OR ABANDONED BY YOU SECTION I — Coverages, Coverage A., 2. Exclusions, j. (2) is deleted and replaced by the following: (2) Premises you sell, give away, or abandon, if the "property damage" arises out of any part of those premises, and occurred from hazards that were known by you or should have reasonably been known by you, at the time the property was transferred or abandoned. L) ADDITIONAL INSURED— FUNDING SOURCE Under SECTION II — Who is an Insured, the following is added: Any person or organization with respect to their liability arising out of: a. Their financial control of you; or b. Premises they own, maintain, or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction, and demolition operations performed by or for that person or organization. M) ADDITIONAL INSURED — MANAGERS OR LESSORS OF PREMISES Under SECTION II — Who is an Insured, the following is added: Any person or organization with respect to their liability arising out of the ownership, maintenance, or use of that part of the premises leased to you in writing, subject to the following additional exclusions: This insurance does not apply to: a. Any "occurrence" which takes place after you cease to be a tenant in that premises. b. Structural alteration, new construction, or demolition operations performed by or on behalf of that person or organization. N) ADDITIONAL INSURED - BY CONTRACT, AGREEMENT OR PERMIT 1) Any person or organization is an insured with whom you are required to add as an additional insured to this policy by a written contract or written agreement, or permit that is: a) currently in effect or becoming effective during the term of this policy; and NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 5 of 9 b) executed prior to the "bodily injury," "property damage," "personal and advertising injury". 2) This insurance provided to the additional insured by this endorsement applies as follows: a) That person or organization is only an additional insured with respect to liability caused by your negligent acts or omissions at or from: (1) Premises you own, rent, lease, or occupy, or (2) Your ongoing operations performed for the additional insured at the job indicated by written contract or written agreement. b) The limits of insurance applicable to the additional insured are those specified in the written contract or written agreement or in the Declarations of this policy, whichever is less. These limits of insurance are inclusive of and not in addition to the limits of insurance shown in the Declarations. 3) With respect to the insurance afforded these additional insureds, the following additional exclusions apply: a) This insurance does not apply to "bodily injury" or "property damage" occurring after: (1) all work, including materials, parts or equipment fumished 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 site 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 on or at the same project. b) This insurance does not apply to "bodily injury," "property damage," "personal and advertising injury' caused by the rendering of or failure to render any professional services. 4) Regardless of whether other insurance is available to an additional insured on a primary basis, this insurance will be primary and noncontributory if a written contract between you and the additional insured specifically requires that this insurance be primary. O) GENERAL AGGREGATE LIMIT PER LOCATION SECTION III — Limits of Insurance, paragraph 2. is deleted and replaced by the following: 2. The General Aggregate Limit is the most we will pay for the sum of: a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard, and c. Damages under Coverage B. A separate Location General Aggregate Limit applies to each 'location" and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. SECTION V — DEFINITIONS, is amended by adding the following: "Location" means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. P) BLANKET SPECIAL EVENTS This insurance applies to "Bodily Injury," "Property Damage," and "Personal and Advertising Injury" arising out of all your special events. However, this insurance does not apply to the following EXCLUDED EVENTS: a) Parades b) Aircraft NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 6 of 9 c) Motorcycle runs and automobile rallies d) Fireworks e) Firearms f) Animals g) Carnivals and fairs with mechanical rides h) Concerts i) Events including contact sports j) Rodeos k) Political rallies 1) Any event lasting more than three (3) days (including otherwise acceptable events) m) Any event with greater than 1,000 people in attendance (including otherwise acceptable events) Separate coverage may be available at the company's discretion for the events excluded above. Possible additional charges may apply if coverage is provided. Q) NON -OWNED WATERCRAFT SECTION I — Coverages. 2. Exclusions, paragraph g.(2) is deleted and replaced by the following: (2) A watercraft you do not own that is: (a) Less than 65 feet long, and (b) Not being used to carry persons or property for a charge; This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess, or contingent. R) WAIVER OF SUBROGATION We will waive our right of subrogation in the event of a loss. We must be advised, prior to the loss, of your intention to waive subrogation. We also must know whom subrogation will be waived against. If your request meets the underwriting criteria it will be done at no additional charge. S) VIOLATION OF RIGHTS OF RESIDENTS (PATIENT'S RIGHTS) 1) The following is added to Section 1 —Coverages —Coverage A, paragraph 1. Insuring Agreement: "Bodily Injury" damages arising out of the violation of "Rights of Residents," shall be deemed an "occurrence." 2) As respects the coverage provided in paragraph A.1. of this endorsement, the following exclusions are added to Section I — Coverages — Coverage A-2. Exclusions: This insurance does not apply to: a) Liability arising out of the willful or intentional violation of "Rights of Residents." b) Fines or penalties assessed by a court or regulatory authority. c) Liability arising out of any actor omission in the furnishing, or failure to furnish, professional services in the medical treatment of "residents." 3) As respects the violation of "Rights of Residents" Coverage, the following definition is added to Section V — Definitions: "Rights of residents" means: a. Any right granted to a resident under any state law regulating your business as a health care facility. NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 7 of 9 b. The "Rights of Residents" as included in the United States Department of Health and Welfare regulations governing participation of Intermediate Care Facilities and Skilled Nursing Facilities, regardless of whether your facility is subject to those regulations. T. LIQUOR LIABILITY EXCLUSION — EXCEPTION FOR FUNDRAISING EVENTS SECTION 1— Coverages, Coverage A., 2. Exclusions, c. is amended by adding the following subparagraph: This exclusion does not apply to 'bodily injury" or "property damage" arising out of the selling, serving or furnishing of alcoholic beverages at any fundraising events. U. EMPLOYEE CRIMINAL DEFENSE COSTS ONLY COVERAGE 1. The following provision is added to the Policy: Employee Criminal Defense Costs Only Coverage We will pay, on your behalf, for "defense costs" incurred by your "employee" in a "Criminal proceeding". We will have the right, but not the duty to defend your "employee" in such "criminal proceeding". 2. The most we will pay for any one "criminal proceeding" is $25,000, regardless of the number of "employees" involved in such "criminal proceeding". The payment of "defense costs" under this Employee Criminal Defense Costs Only Coverage is in addition to and does not reduce the Limits of Insurance shown on the Declarations. However, the payment of "defense costs" under this Employee Criminal Defense Costs Only Coverage is included within and shall reduce the $25,000 each "criminal proceeding" Limit shown in Item V) of the Schedule above and we will not pay for any further "defense costs" for a "criminal proceeding" after the $25,000 limit has been exhausted. 3. The following additional Exclusions apply to this Employee Criminal Defense Costs Only Coverage: This insurance does not apply to: a. Coverage Provided Under Coverages A or B Any "defense costs" for which coverage is provided under COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY AND COVERAGE B PERSONAL AND ADVERTISING INJURY LIABILITY of this policy. b. Damages, Fines or Penalties Any damages, fines or penalties. 4. The following additional Definitions apply to this Employee Criminal Defense Costs Only Coverage: a. "Criminal proceeding" means: The prosecution of any of your "employees" commenced by the filing, with a court, or other regulatory enforcement agency, of an information, a complaint, or an indictment, and any NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 8 of 9 amendments thereto, alleging that your "employee" had, during the policy period, committed one or more crimes involving one or more incidents, acts, or events. Such incidents, acts or events must arise within the scope of your "employee's" employment by you or occur while your "employee" is performing duties related to the conduct of your business. Any "criminal proceeding" shall be considered a single "criminal proceeding", notwithstanding the fact that the prosecution or investigation may involve multiple incidents, multiple counts or charges, and/or multiple trial and/or appellate proceedings. A subsequent or different prosecution or investigation based on the same incidents, acts, or events that provided the basis for the original prosecution or investigation shall not constitute a separate "criminal proceeding". b. "Defense costs" means (1) Reasonable attorney fees (including fees for the services of paralegals, law clerks and/or investigators working under the direction of said attorney); and (2) Reasonable and necessary costs, excluding loss of income. 5. Under no circumstances will "defense costs" payable under this Employee Criminal Defense Costs Only Coverage be payable as Supplementary Payments under Coverages A or B. All other terms and conditions of the policy remain the same. 7611/.=5�1 AUTHORIZED REPRESENTATIVE NPSS GL 00004 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 9 of 9 6. SUPPLEMENTARY PAYMENTS Paragraphs a.(2) and a.(4) of Supplementary Payments in Paragraph A.2. Coverage Extensions of Section II — Covered Autos Liability Coverage are deleted and replaced by the following: (2) Up to $5,000 for cost of bail bonds (including bonds for related traffic law violations) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day because of time off from work. 7. FELLOW EMPLOYEE Paragraph B.5. Exclusions of Section II — Covered Autos Liability Coverage is deleted. 8. TOWING AND GLASS BREAKAGE Paragraph A.2. Towing of Section III — Physical Damage Coverage is deleted and replaced by the following: 2. Towing We will pay up to $250 per disablement for towing and labor costs incurred each time a covered "auto" is disabled. However, the labor must be performed at the place of disablement. Paragraph A.3. Glass Breakage of Section III — Physical Damage Coverage is deleted and replaced by the following: 3. Glass Breakage —Hitting A Bird Or Animal —Failing Objects Or Missiles If you carry Comprehensive Coverage for the damaged covered "auto", we will pay for the following under Comprehensive Coverage, without application of a deductible: a. Glass breakage; or b. "Loss" caused by hitting a bird or animal; and c. "Loss" caused by falling objects or missiles. However, you have the option of having glass breakage caused by a covered "auto's" collision or overturn considered a "loss" under Collision Coverage. 9. PHYSICAL DAMAGE —TRANSPORTATION EXPENSE COVERAGE Paragraph A.4.a. Transportation Expenses of Section III — Physical Damage Coverage is deleted and replaced by the following: a. Transportation Expenses We will pay up to $100 per day/$3,000 maximum per policy period for temporary transportation expense incurred by you because of the total theft of a covered "auto". We will pay only for those covered "autos" for which you carry either Comprehensive or Specified Causes Of Loss Coverage. We will pay for temporary transportation expenses incurred during the period beginning 24 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss". NPSS CA 00001 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 3 of 7 10. PHYSICAL DAMAGE — LOSS OF USE EXPENSES Paragraph A.4.b. Loss Of Use Expenses of Section III — Physical Damage Coverage is deleted and replaced by the following: b. Loss Of Use Expenses For Hired Auto Physical Damage, we will pay expenses for which an "insured" becomes legally responsible to pay for loss of use of a vehicle rented or hired without a driver, under a written rental contract or agreement. We will pay for loss of use expenses if caused by: (1) Other than collision only if the Declarations indicate that Comprehensive Coverage is provided for any covered "auto; (2) Specified Causes Of Loss only if the Declarations indicates that Specified Causes Of Loss Coverage is provided for any covered "auto"; or (3) Collision only if the Declarations indicate that Collision Coverage is provided for any covered "auto". However, the most we will pay for any expenses for loss of use is $50 per day, subject to a maximum of $1,500 per policy period. 11. COVERAGE EXTENSIONS —PHYSICAL DAMAGE The following are added to Paragraph AA. Coverage Extensions of Section III — Physical Damage Coverage: c. Rental Reimbursement We will pay for rental reimbursement expenses incurred by you for the rental of an "auto' because of 'loss" to a covered "auto". We will pay a maximum of $100 per day for a maximum period of 30 days for each covered auto. The most we will pay for rental reimbursement expenses because of "loss" to any one covered "auto' during the policy term is $3,000. No deductible applies to this coverage. d. Personal Effects If Comprehensive Coverage is provided on this coverage form for a covered "auto" you own and that covered "auto" is stolen, we will pay, without application of a deductible, up to $1,000 for personal effects stolen with that covered "auto". This coverage is excess over any other collectible insurance. Personal effects do not include tools, jewelry, money or securities. e. Hired Auto Physical Damage Physical Damage Coverage is provided for covered "autos" you hire without drivers to the same extent as Physical Damage Coverage for covered "autos" you own, except: (1) The most we will pay for "loss" in any one "accident" is (a) The actual cash value of the damaged or stolen property as of the time of the 'loss"; or (b) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, whichever is smallest, minus a deductible. The deductible will be equal to the largest deductible applicable to any owned "auto" for Physical Damage Coverage shown on the Declarations page of the policy. This deductible is applicable to any "loss" except "loss" caused by fire or lightning. NPSS CA 0000100 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 4 of 7 (2) Subject to Paragraph e.(1) of this endorsement, we will provide coverage equal to the broadest Physical Damage coverage applicable to any covered "auto". f. Limited Physical Damage Deductible Coverage For Employees Or Volunteer Workers At your request, we will pay up to $1,000 as reimbursement of deductible payments made by your "employee" or "volunteer worker" under the Physical Damage Coverage of the "employee's" or "volunteer worker's" policy of automobile insurance but only if: (1) The "loss" is to an "auto" owned by the "employee" or "volunteer worker" but not hired or borrowed by you; and (2) The "auto" was being used at the time of the "loss" in the course and scope of the "employee's" employment by you or while the "volunteer worker" was performing duties related to the conduct of your business. With regards to this endorsement, travel to and from a normal place of employment is not within the course and scope of employment by you unless such travel is in response to an emergency summons of that "employee" or "volunteer worker". 12. LOAN/LEASE GAP Paragraph A.5. Loan/Lease Gap is added to Section III - Physical Damage Coverage. 5. In the event of a total "loss" to a covered "auto" shown in the Schedule or Declarations for which a specific premium charge indicates that Auto Loan/Lease Gap Coverage applies, we will pay any unpaid amount due on the lease or loan for a covered "auto", less: a. The amount paid under the Physical Damage Coverage Section of the policy; and b. Any: (1) Overdue lease/loan payments at the time of the "loss"; (2) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage. (3) Security deposits not refunded by the lessor; (4) Costs for extended warranties and additional protections such as, but not limited to, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; (5) Carry-over, transfer or rollover balances from previous loans or leases; (6) Any amount representing taxes; (7) Loan or Lease Termination Fees; (8) The dollar amount of any unrepaired damage that occurred prior to the "total loss" of a covered "auto"; (9) All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement of a covered "auto"; and (10) Final payment under a "balloon loan". c. For the purposes of this Loan/Lease Gap Coverage provision, SECTION v - DEFINTIONS is amended by adding the following definitions: "Total Loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value at the time of "loss". A "balloon loan" is a load with periodic payments that are insufficient to repay the balance over the term of the loan, thereby requiring a large final payment. NPSS CA 00001 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 5 of 7 13. AIRBAG COVERAGE AND FREEZING OF PERMANENTLY ATTACHED EQUIPMENT The following is added to Paragraph B.3.a. of Section III - Physical Damage Coverage: The exclusion relating to mechanical breakdown does not apply to the accidental discharge of an airbag. The exclusion relating to freezing does not apply to any "loss" caused by freezing to permanently attached special equipment common to a fire or rescue emergency vehicle, unless the "loss" is caused by your failure to properly maintain such equipment. Such equipment includes, but is not limited to, pumps, gauges, valves, fill lines, drains and tanks. In no event will any "loss" caused by freezing to an automobile engine be covered by this policy. 14. ELECTRONIC EQUIPMENT- BROADENED COVERAGE Paragraph BA.c. of Section III - Physical Damage Coverage is deleted and replaced by the following: c. Any electronic equipment that receives or transmits audio, visual or data signals, and that is not designed solely for the reproduction of sound unless permanently installed in the covered "auto" or unless the housing unit for removable equipment is permanently installed in the covered "auto". 15. PHYSICAL DAMAGE - COMPREHENSIVE COVERAGE - DEDUCTIBLE The following is added to Paragraph D. Deductible of Section III - Physical Damage Coverage: Regardless of the number of covered "autos" damaged or stolen, the maximum deductible that will be applied to Comprehensive Coverage for all "loss" from any one cause is $5,000. 16. KNOWLEDGE AND NOTICE OF ACCIDENT The following is added to Paragraph A.2. Duties In The Event Of Accident, Claim, Suit Or Loss of Section IV. Business Auto Conditions: d. The failure of any agent, servant, "volunteer worker" or "employee" of the "insured", other than an "employee" authorized by you to give or receive notice of an "accident", claim, "suit" or "loss", to notify us of any "accident" of which he or she has knowledge, shall not invalidate insurance afforded by this policy. 17. EMPLOYEE HIRED AUTOS - PHYSICAL DAMAGE Paragraph B.5. Other Insurance, subparagraph b. of Section IV - Business Auto Conditions, is deleted and replaced by the following: b. For Hired Auto Physical Damage Coverage, the following are deemed to be covered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any "auto" hired or rented under a written contract or agreement entered into by an "employee" or elected or appointed official with your permission while being operated within the course and scope of that "employee's" or elected or appointed official's employment by you. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". NPSS CA 0000100 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 6 of 7 18. VOLUNTEER WORKER The following is added to Section V — Definitions: "Volunteer worker"means a person who is not your "employee", and who donates his or her work and acts at the direction of and within the scope of duties determined by you, and is not paid a fee, salary or other compensation by you or anyone else for their work performed for you. All other terms and conditions of the policy remain the same. NPSS CA 00001 00 (04/18) Includes material copyrighted by ISO Properties, Inc., with its permission Page 7 of 7 TRAVELERS, WORKERS COMPENSATION AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 00 03 13 (00) - 001 POLICY NUMBER: UB-7T833211-23-42-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE: 06-27-23 ST ASSIGN: PAGE 1 OF