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HomeMy WebLinkAboutA8312 - DENIZA HRISTOVA - PARKS AND REC- RECREATION INSTRUCTOR AGREEMENT NOV 2018-OCT 2019 City of Palm Springs Parks & Recreation Department Recreational Instructor Agreement NAME: Deniza Hristova ADDRESS: 36950 Ferber Drive Rancho Mirage, CA 92270 PHONE: (760)880-1354 INSTRUCTION TYPE: Gymnastics This PAecreational Instructor Agreement ("Agreement") is made and entered into this ' day 20j6L by and between the CITY of Palm Springs, a California charter city and municipal corporation, ("CITY") and Deniza Hristova, Palm Springs Gymnastics, an individual or entity and his/her employees, agents, or officers (collectively referred to as "INSTRUCTOR"). I. SCOPE OF WORK A. CITY seeks to provide Gymnastic instruction. INSTRUCTOR shall perform all necessary and appropriate services consistent with that purpose ("Services"). These Services shall be non-exclusive. Services are detailed in Exhibit "A," attached hereto and incorporated herein by reference. B. Services shall be performed at Demuth Community Center("Facilities"). C. INSTRUCTOR warrants that he/she is qualified to provide CITY with Services, and holds all necessary certifications and licenses. D. INSTRUCTOR warrants that lie/she will provide all necessary supplies, equipment, personnel, and other such necessities that enable him/her to perform all services in a safe, competent, and professional manner. E. INSTRUCTOR shall perform Services in a manner consistent with industry -standards and the expectations of a reasonable person. II. DURATION A. Services shall begin on November 1, 2018 and end on October 31, 2019. B. This Agreement may be extended by written agreement between CITY and INSTRUCTOR. C. CITY may terminate this Agreement at any time, with or without cause, by giving written notice to INSTRUCTOR. Upon receipt of notice of termination, INSTRUCTOR shall cease perfonnance of all Services on the date set forth on the notice of termination, or immediately if no date is provided. INSTRUCTOR shall be entitled only to compensation for services rendered prior to the termination date. 1 1159537.1 III. COMPENSATION A. CITY agrees to pay INSTRUCTOR for the performance of Services on the following terms: 1. Flat fee $ 2. Hourly fee $ 3. Contingent fee $ per 4. Other 75% of total class receipts received by the City. B. City shall provide payment to INSTRUCTOR on a monthly basis following the final class/es of the month in accordance with the City's accounts payable schedule. C. INSTRUCTOR shall not be entitled to any additional compensation of any kind, including but not limited to, payment to INSTRUCTOR'S own employees, reimbursement of expenses, and benefits. IV. USE OF FACILITIES A. INSTRUCTOR shall only use the Facilities for the Services described in this Agreement. B. INSTRUCTOR shall be responsible for any damage caused to the Facilities arising out of his/her rendering of the Services. C. INSTRUCTOR shall ensure that the Facilities are clean following each use. D. INSTRUCTOR shall ensure that the Facilities are secured following each use. V. INSURANCE INSTRUCTOR shall procure and maintain, at its sole cost and expense, policies of insurance as set forth in Exhibit "B," attached hereto and incorporated herein by reference. VI. INDEMNITY To the fullest extent permitted by law, INSTRUCTOR shall defend (at INSTRUCTOR'S sole cost and expense), indemnify, protect, and hold harmless CITY, its 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 (INSTRUCTOR'S employees included), for damage to property, including property owned by CITY, or from any violation of any federal, state, or local law or ordinance, which Claims arise out of, pertain to, or are related to INSTRUCTOR'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 INSTRUCTOR'S indemnification obligation or other liability hereunder. INSTRUCTOR'S indemnification obligation shall survive the expiration or earlier termination of this Agreement until all actions against the Indemnified 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 party to this Agreement. 2 1159537.1 VII. INDEPENDENT INSTRUCTOR The legal relationship between the Parties is that of an independent contractor, and nothing herein shall be deemed to make INSTRUCTOR a CITY employee. During the perforinance of this Agreement, INSTRUCTOR and its officers, employees, and agents shall act in an independent capacity and shall not act as CITY officers or employees. INSTRUCTOR will determine the means, methods and details of performing the Services subject to the requirements of this Agreement. The personnel performing the Services under this Agreement on behalf of INSTRUCTOR shall at all tunes be under INSTRUCTOR'S exclusive direction and control. Neither CITY nor any of its officials, officers, employees, agents or volunteers shall have control over the conduct of INSTRUCTOR or any of its officers, employees, or agents, except as set forth in this Agreement. INSTRUCTOR, its officers, employees or agents, shall not maintain a permanent office or fixed business location at CITY'S offices. CITY shall have no voice in the selection, discharge, supervision, or control of INSTRUCTOR'S officers, employees, representatives or agents or in fixing their number, compensation, or hours of service. INSTRUCTOR shall pay all wages, salaries, and other amounts due its employees in connection with the perforinance of Services under this Agreement and shall be responsible for all reports and obligations respecting them, including but not limited to social security income tax withholding, unemployment compensation, workers' compensation, and other similar matters. CITY shall not in any way or for any purpose be deemed to be a partner of INSTRUCTOR in its business or otherwise a joint venture or a member of any joint enterprise with INSTRUCTOR. VIII. SUBCONTRACTING OR ASSIGNMENT PROHIBITED INSTRUCTOR'S expertise, capability, and reputation were a substantial inducement for CITY to enter into this Agreement. A. Only those authorized in writing by the CITY may render Services or perform any tern of this Agreement. B. INSTRUCTOR shall not agree with any other party to perforn the Services without the CITY'S express prior written approval. C. This Agreement shall not be assigned in whole or in part to another party without CITY'S express prior written approval. IX. INTEGRATED AGREEMENT This Agreement contains all terms and conditions between INSTRUCTOR and CITY and cannot be supplemented or modified without mutual written agreement. X. COMPLIANCE WITH THE LAW A. INSTRUCTOR shall perform all Services in accordance with all applicable federal, state, and local laws. B. INSTRUCTOR shall obtain and keep current any necessary licenses or permits necessary for the lawful performance of Services. C. In the performance of Services, INSTRUCTOR shall not discriminate against any person or group of persons on account of race, color, creed, religion, sex, marital status, disability, sexual orientation, national origin, or ancestry. 3 1159537.1 XI. CRIMINAL BACKGROUND CHECK CITY may require INSTRUCTOR to submit to, and pass, a criminal background investigation prior to the conunencement of Services. XII. 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 declaratory or injunctive relief, or to obtain any other remedy consistent with the purposes of this Agreement. XIII. ATTORNEY FEES In the event any dispute between the Parties with respect to this Agreement results in litigation or any non judicial proceeding, the prevailing Party shall be entitled, in addition to such other relief as may be granted, to recover from the non-prevailing Party all reasonable costs and expenses, including but not limited to, reasonable attorneys' fees, expert INSTRUCTOR fees, court costs and all fees, costs, and expenses incurred in any appeal or in collection of any judgment entered in such proceeding. To the extent authorized by law, in the event of a dismissal by the plaintiff or petitioner of the litigation or non judicial proceeding within thirty (30) days of the date set for trial or hearing, the other Party shall be deemed to be the prevailing Party in such litigation or proceeding. INSTRUCTOR hereby warrants that he/she has fully read this Agreement, understands and agrees to each and every tern, and is authorized to sign on behalf of any authorized persons performing the Services. 12 - 1l - 1g Instru ignature Date Printed Name/Title � 4 avid H. Ready, City Manager Date ity of Palm Springs 3200 E. Tahquitz Canyon Way APPROVED PY rMt KANACER A ST: Palm Springs, CA 92262 Y�O�IG ( 760.323.8201 Clerk APPROVED AS TO FORM: Q,451 ,73 , (_, (6, 2-c)19 Teg 11;1ST— Date City Attorney 4 1159537.1 EXHIBIT A 1. Describe activity/instruction and services to be rendered: Gymnastic classes for youth. TLAIKafSP 5V-�(IS 2. Frequency of meetings: Wednesdays, 3:00 p.m. —6:00 p.m.; Thursdays &Fridays, 4:00 p.m. —6:00 p.m.; and Saturdays, 9:00 a.m.— 12:00 p.m. 3. List all instructors, employees, assistants, helpers, volunteers: NAME ROLE 4. List materials and supplies to be used: -k5#-v e 2 7 -fu 1) c'N Q1l2Q Le."_ 5. Estimated class size: 6. Fee schedule: $65/month—2 hour class $85/month—3 hour class $100/month—4 hour class 6 1159537.1 EXHIBIT B INSURANCE 1. Types of Insurance. INSTRUCTOR shall procure and maintain, at its sole cost and expense, the insurance described below. The insurance shall be for the duration of this Agreement and includes any extensions, unless otherwise specified in this Agreement. The insurance shall be procured in a form and content satisfactory to CITY. The insurance shall apply against claims which may arise from the INSTRUCTOR'S performance of Services under this Agreement, including INSTRUCTOR'S agents, representatives, or employees. In the event the City Manager determines that the Services to be performed under this Agreement creates an increased or decreased risk of loss to the CITY, the INSTRUCTOR agrees that the minimum limits of the insurance policies may be changed accordingly upon receipt of written notice from the City Manager or his designee. INSTRUCTOR shall immediately substitute any insurer whose A.M. Best rating drops below the levels specified in this Agreement. All insurance provided under this Agreement shall be on an occurrence basis. The minimum amount of insurance required shall be as follows: A. Workers' Compensation Insurance. INSTRUCTOR shall obtain and maintain, in full force and effect throughout the term of this Agreement, workers' compensation insurance in at least the miniinum statutory amounts, and in compliance with all other statutory requirements, as required by the State of California. INSTRUCTOR agrees to waive and obtain endorsements from its workers' compensation insurer waiving subrogation rights under its workers' compensation insurance policy against the CITY and to require each of its subcontractors, if any, to do likewise under their workers' compensation insurance policies. If INSTRUCTOR has no employees, INSTRUCTOR shall complete the CITY'S Request for Waiver of Workers' Compensation Insurance Requirement form. B. Commercial General Liability Insurance. INSTRUCTOR shall obtain and maintain, in full force and effect throughout the tenn of this Agreement, a policy of commercial general liability insurance written on a per occurrence basis with a combined single limit of at least one million dollars ($1,000,000.00) and two million dollars ($2,000,000.00) general aggregate for bodily injury and property damage including coverages for contractual liability, personal injury, independent contractors, broad form property damage, products and completed operations. 2. Deductibles and Self-Insured Retentions. Any deductibles or self-insured retentions must be declared to and approved by the City Manager or his/her designee prior to commencing any Services under this Agreement. INSTRUCTOR guarantees payment of all deductibles and self-insured retentions. CITY reserves the right to reject deductibles or self-insured retentions in excess of$10,000, and the City Manager or his/her designee may require evidence of pending claims and claims history as well as evidence of INSTRUCTOR'S ability to pay claims for all deductible amounts and self-insured retentions proposed in excess of$10,000. 3. Other Insurance Requirements. The following provisions shall apply to the insurance policies required of INSTRUCTOR under this Agreement: 7 1159537.1 A. For any claims related to this Agreement, INSTRUCTOR'S coverage shall be primary insurance with respect to the CITY and its officers, council members, officials, employees, agents, and volunteers. Any insurance or self-insurance maintained by the CITY and its officers, council members, officials, employees, agents, and volunteers shall be in excess of INSTRUCTOR'S insurance and shall not contribute with it. B. Any failure to comply with reporting or other provisions of the policies, including breaches of warranties, shall not affect coverage provided to CITY and its officers, council members, officials, employees, agents, and volunteers. C. All insurance coverage and limits provided by INSTRUCTOR and available or applicable to this Agreement are intended to apply to each insured, including additional insureds, against whom a claim is made or suit is brought to the full extent of the policies. Nothing contained in this Agreement or any other agreement relating to the CITY or its operations shall limit the application of such insurance coverage. D. No required insurance coverages may include any limiting endorsement which substantially impairs the coverages set forth in this Agreement (e.g., elimination of contractual liability or reduction of discovery period), unless the endorsement has first been submitted to the City Manager and approved in writing. E. INSTRUCTOR agrees to require its insurer to modify insurance endorsements to delete any exculpatory wording stating that failure of the insurer to mail written notice of cancellation imposes no obligation, or that any party will "endeavor" (as opposed to being required) to comply with the requirements of the endorsements. Certificates of insurance will not be accepted in lieu of required endorsements, and submittal of certificates without required endorsements may delay commencement of the Project. It is INSTRUCTOR'S obligation to ensure timely compliance with all insurance submittal requirements as provided in this Agreement. F. INSTRUCTOR acknowledges and agrees that any actual or alleged failure on the part of the CITY to inform INSTRUCTOR of non-compliance with any insurance requirement in no way imposes any additional obligations on the CITY nor does it waive any rights in this or any other regard. G. INSTRUCTOR shall provide proof that policies of insurance required in this Agreement, expiring during the terin of this Agreement, have been renewed or replaced with other policies providing at least the same coverage. Proof that such coverage has been ordered shall be submitted prior to expiration. Endorsements as required in this Agreement applicable to the renewing or new coverage shall be provided to CITY no later than ten (10) days prior to expiration of the lapsing coverage. 8 1159537.1 H. Requirements of specific insurance coverage features or limits contained in this section are not intended as limitations on coverage, limits, or other requirements, or as a waiver of any coverage normally provided by any given policy. Specific reference to a given coverage feature is for purposes of clarification only as it pertains to a given issue, and is not intended by any party or insured to be limiting or all-inclusive. I. The requirements in this section supersede all other sections and provisions of this Agreement to the extent that any other section or provision conflicts with or impair the provisions of this section. J. INSTRUCTOR agrees to provide immediate notice to CITY of any claim or loss against INSTRUCTOR arising out of the Services performed under this Agreement and for any other claim or loss which may reduce the insurance available to pay claims arising out of this Agreement. CITY assumes no obligation or liability by such notice, but has the right (but not the duty) to monitor the handling of any such claim or claims if they are likely to involve CITY, or to reduce or dilute insurance available for payment of potential claims. K. INSTRUCTOR agrees that the provisions of this section shall not be construed as limiting in any way the extent to which the INSTRUCTOR may be held responsible for the payment of damages resulting from the INSTRUCTOR'S activities or the activities of any person or person for which the INSTRUCTOR is otherwise responsible. 4. 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 Rating of B++, Class VII, or better, unless such requirements are waived in writing by the City Manager or his designee due to unique circumstances. 5. Verification of Coverage. INSTRUCTOR shall furnish CITY with both certificates of insurance and endorsements, including additional insured endorsements, affecting 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 INSTRUCTOR'S insurers to provide complete, certified copies of all required insurance policies at any time. Additional insured endorsements are not required for Workers' Compensation policies. Verification of Insurance coverage may be provided by: (1) an approved General and/or Auto Liability Endorsement Form for the City of Palm Springs or (2) an acceptable Certificate of Liability Insurance Coverage with an approved Additional Insured Endorsement with the following endorsements stated on the certificate: 9 1159537.1 A. "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). B. "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 workperformed with the City" may be included in this statement). C. "Should any of the above described policies be canceled before the 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. D. The Workers' Compensation policy 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 Services commence. All certificates of insurance must be authorized by a person with authority to bind coverage, whether that is the authorized agent/broker or insurance underwriter. Failure to obtain the required documents prior to the commencement of Services shall not waive the INSTRUCTOR'S obligation to provide them. 10 1159537.1 #2154 P. 001,'O01 02/'211/2019 16:40 DATE(MWDD/YYM CERTIFICATE OF LIABILITY INSURANCE RAW019 ON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATI 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement- A statement on this certificate does not confer rights to the certificate holder-in lieu of such endorsement(s)- CONTACT PRODUCER - NAME:. Francis-L.Dean . PHONE FAY No): _ 6900 Daniels Parkway E�i E� Suite 29-303 ADDRESS: clink(�fdean-corn Fort Myers,FL 33912 INSURER(S)AFFORDING COVERAGE it fdean.Com INSURERA: U.S.Fire Insurance Company21113 INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION(PURCHASING GROUP)ANO INSURER B: - - ITS PARTICIPATING MEMBERS: INSURER C: PALM RECREATION TUMBLING&DANCE-DENICE HRISTOVA INSURERD: 3601 EAST MESQUITE AVENUE INSURERS: PALM SPRING,CA 92264 INSURERFI ------------ COVERAGES CERTIFICATE NUMBER: USP283664, , REVISION NUMBER: THIS is TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH_POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED_BY-PAID CLAIMS. INSR ADDL sUSR POLICY EFR POUCY EXP LIf�O'f$ LTR . TYPEOFINSURANCE wSR yJyp POUCTNUMBER MMIDOrYYYY MMIODfrYYY GENERAL AGGREGA75 $ 1 000,000 GENERAL LIABILITY PP.GDUCTS-C��MP/OP AG S 1,000,000 X COMMERCIAL GENERAL WBILrTY - CLAIMS•MPDE D OCCUR PERSONAL✓;ADV INJURY _$ 1 A00,900 12/1/2018 12/1/2019 F�L H OCCURRENCE $ 1,000,000 q x SRPGAPMC-101-0718 12-01 AM 12:01 AM FIRE DAMAGE(Any one fim) $ :00,000 x INCLUDES ATHLETIC PARTICIPAtJT$ MED EXP(Any one person) $ 4000 GEN'L AGGREGATE LIMIT APPLIES CER• x POUCY _ PECT.. lO� -- - COMBINEDSINGLEIJMR E.—d, AUTOMOBILE LIABILITY BODILY INJURY(POT ITJT50D) $ ANY AJTO ALL OW4AE1 uLE0 BODILY INJURY(PaT saitlent) $ �. PROPERTY DAMAGE II-OWNED (Orr-mdvTO: EACH OCCURRENCEUMBROCCUR AGGREGATE $EXCESCLAIMP—MADE pEDo _ __ ___ _ -- - - OTH WORKERS COMPENSATION TORY LIMITZ AND EMPLOYERS'I IABIUN YIN ANY VROPk1t-TOR1PARTNERJEXrCLRIVE . E.L.E4C:HACGIDENT $ OFFICERIMEMBER CXUUJ LLY? NIA - E.L.DISEASE-E4 EMPLOYEE $ (Mandatory in NH) - E.L.DISEASE-POLICY LIMIT S If y ,dwribe under _ _ DESCRIPTION OF OPERATIONS Wow_ AD&D $500 000 1211/2018 12/1/2019 MAXIMUM MEDICAL $100,000 A Accident/Medical Coverage US10245VO 12:01 AM 12:01 AM DEDUCTIBLE $100 TERMS OF PAYMENT EXCESS, DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101.Additional Remark.Schedule,IT More space is required) Covered activities:Dance Activities.Locations:3601 East Mesquite Avenue,Paim Spring CA 92264.Certificate Holder is named as additional insured with respect to the operations of the Named Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED CITY OF PALM SPRINGS BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE 3601 EAST MESQUITE AVENUE PALM HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE SPRING,CA 92264 COMPANY,ITS AGENTS OR REPRESENTATIVES _ AMORIZEb REPRESENTATIVE �I�avu1c.Y L. D ea.K� (d 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Certificate of • • - Compensation TO: City of Palm Springs ATTN: City Clerk and Risk Manager SUBJECT: Sole Proprietor/Partnership/Closely Held Corporation-with No Employees Please let this memorandum notify the City of Palm Springs that I am a sole proprietor ❑ partnership ❑ closely held corporation and do not have any employees whose employment requires me to carry workers' compensation insurance. Therefore, I do not carry workers' compensation insurance coverage. I further.warrant that I understand the requirements of Section 3700, et seq., of the California Labor Code with respect to providing Workers' Compensation coverage for any employees. I agree to comply with the code requirements and all other applicable laws and regulations regarding workers' compensation, payroll taxes, FICA and tax withholding and similar employment issues. I further agree to hold the City of Palm Springs harmless from loss or liability which may arise from the failure to comply with any such laws or regulations. -- - Risk Management Approval: Contrac or Signature Printed Name of Contractor Date Date AC© DATE(MMIDDNYYY) - �.... CERTIFICATE OF LIABILITY INSURANCE 6/18/2019 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT FL DEAN CHUCK LINK NAME` FAX 12800 UNIVERSITY DR STE 125 a"c°No Ext; (800)745-2409 ac No): FORT MYERS,FL 33907-5336 EMAIL _ ADDRESS: (800)745-2409 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: United States Fire Insurance 21113 INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION(PURCHASING GROUP)AND INSURERB: ITS PARTICIPATING MEMBERS: INSURER C: Palm Recreation Tumbling&Dance INSURERD: 3601 East Mesquite Avenue Palm Spring,CA 92264 INsuRERE: INSURERF: COVERAGES CERTIFICATE NUMBER: USP283684 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE,.-AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSIR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFP POLICY EXP LIMITS LTR INSR WVD MMIDDIYYYY MMIDD/YYYY GENERAL LIABILITY GENERAL AGGREGATE $1,000,000.00 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMPIOPAGG $1,000,000.00 CLAIMS-MADE Fx]oCCUR PERSONAL&ADV INJURY $1.000,000.00 A X SRPGAPML-101-0718 12/01/2018 12/01l2019 12:01 AM 12:01 AM EACH OCCURRENCE $1,000,000.00 FIRE DAMAGE(Any one fire) $300,000.00 GEN•L AGGREGATE LIMIT APPLIES PER: MED EXP(Any one person) $5,000.00 �( POLICY PE 0 LOC AUTOMOBILE LIABILITY Ea a_d_COMBINED SINGLE uMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTO NON-OWNED' - PROPERTY DAMAGE $ AUTOS f Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB I CLAIMS-MADE AGGREGATE $ DED RETENTION S EACH OCCURRENCE $0.00 GENERAL AGGREGATE $0.00 EACH OCCURENCE $ GENERAL AGGREGATE $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Dance Studio The Certificate Holder is added as an additional insured but only with respect to liability arising out of the named insured during the policy period. CERTIFICATE HOLDER CANCELLATION City Of Palm Springs Recreation SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 3601 East Mesquite Avenue BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE Palm Spring,CA 92264 HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Francis L. Dean ACORD 25(2010/05)v141120.001 ©198872010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION Policy Number: SRPGAPML-1 01-0718/USP283684 Insured: Palm Recreation Tumbling 8, Dance This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organization(s) City of Palm Springs 3200 E.Tahquintz Canyon Way Palm Springs, CA 92262 Information required to complete this Schedule, if not shown above will be shown in the Declarations. To the extent that any of the additional insureds Section II - WHO IS AN INSURED is amended to named herein are liable for occurrences arising out include as an insured the person(s) or organization(s) of the named insured's negligent acts or omissions, shown in the Schedule, but only with respect to liability the insurance afforded to the additional insureds for"bodily injury", "property damage" or "personal and under this endorsement is primary insurance over advertising injury" caused, in whole or in part, by your any other valid or collectible insurance which the acts or omissions of the acts or omissions of those additional insureds may have with respect to loss acting on your behalf: under any of the listed policies. Other insurance of any additional insured applicable to loss is non- A. In the performance of your ongoing operations; or contributory and excess over the coverage provided by this endorsement, and the amount of the B. In connection with your premises owned by or company's liability under this policy shall not be rented to you. reduced by the existence of such other insurance. CG 20 26 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 ❑ A�Q DATE(MMIDDIYYYY) �... CERTIFICATE OF LIABILITY INSURANCE 6/18/2019 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT FL DEAN CHUCK LINK NAME: 12800 UNIVERSITY DR STE 125 AICNNo Ext: (800)745-2409 plc No FORT MYERS, FL 33967-5335 E-MAIL ADDRESS: (800)745-2409 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: United States Fire Insurance 21113 INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION(PURCHASING GROUP)AND INSURER B: ITS PARTICIPATING MEMBERS: INSURER C: Palm Recreation Tumbling&Dance INSURERD: 3601 East Mesquite Avenue Palm Spring,CA 92264 INSURERE:' INSURER F: COVERAGES CERTIFICATE NUMBER: USP283684 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MMIDDNYYY MMIDDIYYYY GENERAL LIABILITY GENERAL AGGREGATE $1,000,000.00 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $1,000,000.00 CLAIMS-MADE OCCUR PERSONAL&ADV INJURY $1,000,000.00 A X SRPGAPML-101-0718 12/01/2018 12101/2019 12:01 AM 12:01 AM EACH OCCURRENCE $1,000,000.00 FIRE DAMAGE(Any one fire) $300,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: MED EXP(Any One person) $5,000.00 P - X POLICY JECROT LOC AUTOMOBILE LIABILITY Ea_CideDt51NGLELIhi1T $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTO S AUTOS BODILY INJURY(Per accident) $ HIRED AUTO NON-OWNED PROPERTY DAMAGE AUTOS (per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HXCESS LIAB CLAIMS-MADE _ AGGREGATE $ ED RETENTION S EACH OCCURRENCE $0.00 GENERAL AGGREGATE $0.00 EACH OCCURENCE $ GENERAL AGGREGATE $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Dance Studio The Certificate Holder is added as an additional insured but only with respect to liability arising out of the named insured during the policy period. CERTIFICATE HOLDER CANCELLATION City of Palm Springs SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 3200 E.Tahquintz Canyon Way BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Palm Springs,CA 92262 AUTHORIZED REPRESENTATIVE Francis L. Dean ACORD 25(2010/05)v141120.001 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD A� CERTIFICATE OF LIABILITY INSURANCE DAT6/18/2D19 - 6/18/2019 " 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT FL DEAN CHUCK LINK NAME: 12800 UNIVERSITY DR STE 125 PHONE N Ext, (800)745-2409 FAX No): FORT MYERS,FL 33907-5335 E-MAIL (800)745-2409 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: United States Fire Insurance 21113 INSURED. SPORTS AND RECREATION PROVIDERS ASSOCIATION(PURCHASING GROUP)AND INSURER B: ITS PARTICIPATING MEMBERS: INSURER C: Palm Recreation Tumbling&Dance INSURERD: 3601 East Mesquite Avenue Palm Spring,CA 92264 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: USP283684 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM/DDNYW MM/DD/YYYY GENERAL LIABILITY' GENERAL AGGREGATE $1,000,000.00 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OPAGG $1,000,000.00 CLAIMS-MADE OCCUR PERSONAL&ADV INJURY $1,000,000.00 A X SRPGAPML-101-0718 - 12/01/2018 12/01/2019 12:01 AM 12:01 AM EACH OCCURRENCE $1,000,000.00 FIRE DAMAGE(Any one fire) $300,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: MED EXP(Any One person) $5,000.00 - ( POLICY JPROECT LOC A COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident $ ANY AUTO BODILY INJURY(Per person) S ALL Or SCHEDULED AUTOS Auios BODILY INJURY(Per accident) $ HIREDAUTO NON-OWNED PROPERTY DAMAGE AUTOS fPer accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS4.1ADE AGGREGATE $ DED RETENTION s EACH OCCURRENCE $0.00 GENERAL AGGREGATE $0.00 EACH OCCURENCE, $ GENERAL AGGREGATE $ _ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Dance Studio CERTIFICATE HOLDER CANCELLATION Palm Recreation Tumbling&Dance SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 3601 East Mesquite Avenue BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Palm Spring,CA 92264 AUTHORIZED REPRESENTATIVE Francis L. Dean ACORD 25(2010/05)041120.001 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACVRV DATE(MM(DD/YYY1) �..�- ADDITIONAL INTEREST SCHEDULE 6/18/2019 AGENCY CARRIER NAIC CODE FL Dean Chuck Link United States Fire-insurance Company 21113 POLICY NUMBER [EFFECTIVE DATE NAMED INSUREDS) SRPGAPML-101-0718/USP283684 1/2018 Palm Recreation Tumbling&Dance 01 AM ADDITIONAL.INTEREST(Not all fields apply to all scenarios—provide only the necessary data) INTEREST NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN REM NUMBER ADDITIONAL LOSS PAYEE LOCATION: BUILDING: x INSURED BEACH OF MORTGAGEE City of Palm Springs VEHICLE: BOAT: WARRANTY CO-OWNER OWNER 3200 E.Tahquintz Canyon Way AIRPORT: AIRCRAFT: EMPLOYEE REGISTRANT Palm Springs, CA 92262 ITEM ITEM: AS LESSOR CLASS: LEASEBACK TRUSTEE REM DESCRIPTION OWNER LIENHOLDER REFERENCE I LOAN#: INTEREST ENO DATE: UEN AMOUNT: PHONE(A/C,No,Ex): FAX(A/C,No): REASON FOR INTEREST: E-MAIL ADDRESS: INTEREST - NAME AND ADDRESS RANK: EVIDENCE: CERTIFICATE POLICY SEND BILL INTEREST IN ITEM NUMBER ADDITIONAL LOSS PAYEE LOCATION: BUILDING: X INSURED BEACH OF MORTGAGEE City Of Palm Springs Recreation - VEHICLE: BOAT: WARRANTY CO-OWNER OWNER 3601 East Mesquite Avenue AIRPORT: AIRCRAFT: EMPLOYEE REGISTRANT Palm Spring, CA 92264 REM ITEM: AS LESSOR CLASS: LEASEBACK OWNER' TRUSTEE REM DESCRIPTION LIENHOLDER REFERENCE I LOAN#: INTEREST END DATE: UEN AMOUNT: PHONE(A/C,No,Ex): FAX(A/C,No): REASON FOR INTEREST: E-MAIL ADDRESS: The above are added as additional insured but only with respect to liability arising out of operations of the named insured during the policy period. ACORD 45(2009/04) ©1993-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ' CERTIFICATE OF INSURANCE PRINT DATE: 6/17/2019 CERTIFICATE NUMBER: 20190617703942 AGENCY: Integro USA Inc. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND d/b/a Integro Insurance Brokers CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES 2727 Paces Ferry Road,Building TWO,Suite 1500 NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Atlanta,GA 30339 678-324-3300(Phone),678-324-3303(Fax) NAMED INSURED: INSURERS AFFORDING COVERAGE: United States Masters Swimming,Inc. Elite Otters Swim Team(33-OTTR) INSURER A:Everest National Ins.Co.NAIC#:10120 1751 Mound Street Suite 201 INSURER B:Everest National Ins.Co.NAIC#:10120 Sarasota FL 34236 EVENT INFORMATION: i USMS Registered Club Workouts(6/17/2019-9/30/2019) j POLICY/COVERAGE INFORMATION: 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INS TYPE OF INSURANCE: POLICY NUMBER(S): EFFECTIVE: 1 EXPIRES: LIMITS: E A GENERAL LIABILITY S 18 M L00043-181 1011/2018 110/1/2019 X Occurrence GENERAL AGGREGATE(Applies Per Event) $5,000,000 — ---- --— 12:01 AM 12:01 AM --..._.........._........_.. ----- - ----................-- X Participant Legal Liability EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES(Each Occ.) $1,000,000 i j ! MEDICAL EXPENSE(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 PRODUCTS-COMP/OP AGG $2,000,000 j B UMBRELLA/EXCESS LIABILITY X Occurrence S18EX00028-18110/1/2018 10/1/2019 EACH OCCURRENCE $10,000,000 — 12:01 AM :12:01 AM i AGGREGATE $20,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS: The certificate holder is an Additional Insured with respect to liability arising out of the negligence of the Named Insured, but only where required by written contract and as per the following endorsement:Additional Insured-Automatic Status When Required in a Written Agreement With You(Form ECG 20 600 05 09). Coverage applies only to the United States Masters Swimming(USMS)sanctioned or approved events or activities specified on this certificate,and only if the club or workout group shown as a Named Insured on this certificate is a member in good standing with USMS at the time of the event or activity. The General Liability policy includes$1,000,000 Each Occurrence/$5,000,000 Aggregate Abuse&Molestation coverage. Coverage available under policy 9906-7881 is on file with the policyholder-Accident Medical coverage$25,000 per person per accident with no deductible,excess of any other valid and collectible insurance-Accidental Death&Dismemberment$5,000 per person per accident.Policy effective date:October 1,2018/Policy expiration date:October 1,2019. {f f 3 i CERTIFICATE HOLDER: NOTICE OF CANCELLATION: Palm Springs Swim Center Should any of the above described policies be cancelled before the expiration date thereof, 405 S Pavilion Way notice will be delivered in accordance with the policy provisions. Palm Springs CA 92262 AUTHORIZED REPRESENTATIVE: f1-1 t-:7 ® DATE(MM/DD/YYYY) '4 CERTIFICATE OF LIABILITY INSURANCE 11/28/2018 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate'does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Francis L.Dean NAME: 6900 Daniels Parkway PHONE FAX. A/C No EM: A/0 No Suite.29-303 EMAIL ADDRESS: clink@fdean.com Fort Myers,FL 33912 INSURER(S)AFFORDING COVERAGE NAIL# fdean.com INSURERA: U.S.Fire Insurance Company 21113 INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION(PURCHASING GROUP)AND INSURERB: ITS PARTICIPATING MEMBERS: INSURERC: PALM.RECREATION TUMBLING&DANCE INSURERD: 3601 EAST MESQUITE AVENUE INSURERE: PALM SPRING,CA 92264 INSURER F: COVERAGES CERTIFICATE NUMBER: USP283684 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR-CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO.WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MWDDIYYYY MMIDDIYYYY GENERAL LIABILITY GENERAL AGGREGATE $ 1.000,000 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMPIOPAGG $ 1,000,000- CLAIMS-MADE �OCCUR PERSONAL&ACV INJURY $ 1.000.000 A X SRPGAPML-101-0718 12:01 A 8 12M 12::01 A01 A M 9 12:01 A EACH OCCURRENCE $ 1,000,000 X INCLUDES ATHLETIC PARTICIPANTS FIRE DAMAGE(Any one fire) $ 300,000 GEN'LAGGREGATE UMIT APPLIES.PER: MED EXP(Any One person) $ 5,000 PRO- ( POLICY JECT LOC COM AUTOMOBILE LIABILITY Ea aBc aED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS HIRED AUTO NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION WC 5TA7U- OTH AND EMPLOYERS'LIABILITY YIN 70RY LIMITS ER S ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? ❑N/A $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ It yes,describe under E.L.DISEASE-POLICY LIMIT g DESCRIPTION OF OPERATIONS below AD&D $500,000 A Accident/Medical Coverage US1024586 12/1/2018 12/1/2019 MAXIMUM MEDICAL $100,000 12:01 AM 12:01 AM DEDUCTIBLE $100 TERMS OF PAYMENT EXCESS DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Covered activities:Dance Activities.Locations:3601 East Mesquite Avenue, Palm Spring CA 92264.Certificate Holder is named as additional insured with respect to the operations of the Named Insured. CERTIFICATE HOLDER CANCELLATION CITY OF PALM SPRINGS RECREATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN- 3601 EAST'MESQUITE AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. PALM SPRING, CA 92264 AUTHORIZED REPRESENTATIVE 00 :9 Hd 01 ItIJ, Fra.LiyL. Deav, ( ° 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo"are registered marks of ACORD { DATE(MM/DD/ Y) '41�® YYYCERTIFICATE OF LIABILITY INSURANCE 11/28/2018 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 pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Francis L.Dean NAME: ONE FAX 6900 Daniels Parkway A/CC,N Ext: A/C No): Suite 29-303 E-MAIL ADDRESS: clink@fdean.com Fort_Myers,FL 33912 INSURER(S)AFFORDING COVERAGE NAIC# fdean.com INSURERA: U.S.Fire Insurance Company 21113 INSURED SPORTS AND RECREATION PROVIDERS ASSOCIATION(PURCHASING GROUP)AND INSURERB: ITS PARTICIPATING MEMBERS: INSURERC: PALM RECREATION TUMBLING&DANCE INSURERD: 3601 EAST MESQUITE AVENUE INSURERE: PALM SPRING,CA 92264 INSURER F: COVERAGES CERTIFICATE NUMBER: USP283684 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ., INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD MM/DDIYYYY YYY MMIDDIY GENERAL LIABILITY GENERAL AGGREGATE $ 1,000.000 X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ 1.000,000 CLAIMS-MADE a OCCUR PERSONAL&ADV INJURY $ 1,000,000 12:01 A SRPGAPML-101-0718 12: 12: A 9 01 A s AM 12:01 01 AM EACH OCCURRENCE $ 1,000,000 X INCLUDES ATHLETIC PARTICIPANTS FIRE DAMAGE(Any one fire) $ 300.000 GEN'LAGGREGATE LIMITAPPLIES PER: MED E:XP(Any One person) $ 5.000 PRO- LOC X POLICY JECT AUTOMOBILE LIABILITY EOMeBIc aED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIREDAUTO NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER $ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? ❑NIA $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE S It yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below AD&D $500,000 A Accident/Medical Coverage US1024586 12/1/2018 12/1/2019 MAXIMUM MEDICAL $100,000 12:01 AM 12:01 AM DEDUCTIBLE $100 TERMS OF PAYMENT EXCESS DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Covered activities:Dance Activities.Locations:3601 East Mesquite Avenue,Palm Spring CA 92264. CERTIFICATE HOLDER CANCELLATION PALM RECREATION TUMBLING &DANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 3601 EAST MESQUITE AVENUE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PALM SPRING,CA 92264 AUTHORIZED REPRESENTATIVE Fra.c,. L. D eaav ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Dance Policy Application for: Palm Recreation Tumbling &Dance Date Purchased: 11/28/2018 Policy Information Policy Number:SRPGAPML-101-0718 Accident Policy Number: US1024586 Liability Certificate Number: USP283684 Contact Information Applicant Name: Palm Recreation Tumbling& Dance Contact Name: Deniza Hristova Phone Number 1:760-449-7878 Phone Number 2: Fax Number: E-mail Address:clink@fdean.com Mailing Address 1:3601 East Mesquite Avenue Mailing Address 2: Mailing City: Palm Spring Mailing State: CA Mailing Zip Code: 92264 Is Mailing Address also a School or Studio Address?:Yes Dates First Date of Coverage: 12/1/2018 Last Date of Coverage: 11/30/2019 Date Purchased: 11/28/2018 Number of Students:30 Dance Style: Dance&Tumbling General Aggregate:$1,000,000 Optional Coverages Medical Expense Benefit Coverage:Yes Sexual Abuse and Molestation Coverage: No Past Coverage Cancellation: No Has Risk Management Plan:Yes Non-Owned Hired Auto Coverage:$0 Additional Insureds Additional Insured#1 Full Name:City Of Palm Springs Recreation Address 1:3601 East Mesquite Avenue Address 2: City: Palm Spring State:CA Zip Code:92264 Email: Relationship:Venue Primary and Non-Contributory Endorsement: No Waiver of Subrogation Endorsement: No CG 20 26 Endorsement: No Submission Details Date and Time Application Submitted: 11/28/2018 2:29:16 PM Producer: FL Dean CL Digital Signature: Palm Recreation Tumbling& Dance