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Home My WebLink AboutA7050 - RIVERSIDE COUNTY SUPERINTENDENT OF SCHOOLS - LAND LEASE AGMT -DESERT HIGHLAND PARKKeenan & Associates 4204 Riverwalk Parkway Suite 400 Riverside, CA 92505 CITY MANAGER JUL_ 3 2024 CITY OF PALM SPM, Attn: City Manager City of Palm Springs 3200 East Tahquitz Canyon Way Palm Springs CA 92262 This document was created by eCertsONLINE. MAIL DOCUMENT Certificate of Insurance DOCUMENT ecertsonlineTM Sender: Halliona Bacon Phone: 951-715-0190 Subject: Cert No. 80945934 - Certificate of Coverage: Riverside County Office of Education - City of Palm Sppringgs Date: 7/15/2024 No, of Pages: 5 URL: www.keenan.com The attached document(s) contain certification of insurance coverage for the insured named in the subject above.Your company is listed as the organization requesting receipt of these documents. If this document is sent via e-mail, you must click on the attached PDF document. The document is in a pdf format, and you must have Adobe Acrobat Reader installed on your system. To download the Adobe Reader for free, visit www.Adobe.com. If you have any questions regarding the content of this message, you should contact the Producer/ Agency listed on the attached/linked documents. Please contact me for any certificate modifications. Thank you, Halliona Bacon Jr. Account Manager CA License No. 4249881 951-715-0190 ext.1116 hbacon@keenan.com RECEIVED JUL 2 5 2024 CFP,rE, OF THE CITY CLERK THIS MESSAGE IS INTENDED FOR THE USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRNILEGEO, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. IF THE READER OF THE MESSAGE IS NOT THE INTENDED RECIPIENT, OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY US IMEDIATELY BY TELEPHONE. AND RETURN THE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE. Certificate of Insurance Delivered by ecertsonline- Insurance Visions, Inc. All rights reserved. Southern California RegCERTIFICATE OF COVERAGE Issue Date 7115/2024 Protected Insurance Program for Schools ADMINISTRATOR: LICENSE # 0451271 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Keenan & Associates AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 4204 Riverwalk Parkway Suite 400 CERTIFICATE OES NOT AMEND, EXTEND ALTER THE COVERAGE Riverside, CA 92505 AFFORDED BY COVERAGE DOCUMENTS BELOW ENTITIES AFFORDING COVERAGE: Halliona Bacon License No. 4249881 310-212-0363 x1116 hbacon(W_Keenan.com ENTITYA: Southern California RELIEF ENTITYB: Protected Insurance Program for Schools COVERED PARTY: Riverside County Office of Education Riverside Schools' Insurance Authority ENTITYC: P.O. Box 868 ENTITY D: Riverside CA 92502 ENTITY E'. THIS IS TO CERTIFY THAT THE COVERAGES LISTED BELOW HAVE BEEN ISSUED TO THE COVERED PARTY NAMED ABOVE FOR THE 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. THECOVERAGE AFFORDED HEREIN IS SUBJECT TO ALL THE TERMS AND CONDITIONS OF SUCH COVERAGE DOCUMENTS. MEMBER ENT LTR TYPE OF COVERAGE COVERAGE DOCUMENTS EFFECTIVE/ EXPIRATION DATE RETAINED LIMIT / DEDUCTIBLE LIMITS A GENERAL LIABILITY COMBINED SINGLE LIMIT EACH OCCURRENCE [,�JGENERN- LIABILITY Cl-AiMSMADE SCR 00101-38 7/1/2024 $ 50,000 $ 1,000,000 [ j [yforcURRENCE GOVERNMENT CODES I ,-r/,I{rj 7/1/2025 [ ERRORS & OMISSIONS [ SEXUALABUSE AND MOLESTATION A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT EACH OCCURRENCE [ ANY AUTO SCROO101.38 7/1/2024 It 50,000 $ 1,000,000 I AUTO 7/1/2OZS [ NON -OWNED AUTO ✓}HIRED I GARAGE LIABILITY I AUTO PHYSICAL DAMAGE A PROPERTY SCR00101-38 7/1/2024 $ 25,000 $ 500,250,000 I ALL RISK 7/1/2025 EACH OCCURRENCE I EXCLUDES EARTHQUAKE & FLOOD I I BUILDER'S RISK A STUDENT PROFESSIONAL LIABILITY SCR00101-38 7/1/2024 $ 50,000 $ Included 7/1/2025 EACH OCCURRENCE B WORKERS COMPENSATION I IWC STATUTORY LIMITS [Aj OTHER [� EMPLOYERSLIABILITY PIPS129-21 7/1/2024 $ 7/1/2025 $ 1,000,000 E.L. EACH ACCIDENT $ 1,000,000 EXCESS WORKERS COMPENSATION $ I ]EMPLOYERS' LIABILITY E.L. DISEASE - EACH EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMITS OTHER $ DESCRIPTION OF OPERATIONSILOCATIONS EHICLESIRESTRICTMNVSPECIAL PROVISIONS: Pursuant to Use of Facilities Agreement Number C1006389 between Riverside County Superintendent of Schools and The City of Palm Springs for RCOE to lease property located at Desert Highland Park from the City of Palm Springs in order to place a portable building to house a Head Start program. CERTIFICATE HOLDER: Agreement Number C1006389 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Ci%ty of Palm Springs THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 320 East Tatitz Canyon Way ACCORDANCE WITH THE POLICY PROVISIONS Palm Springs CA 92262 John Stephens AUTHORIZED REPRESENTATIVE 80995939 1 RIVERIVER6CH2 1 24/23 Super Pool PIL w/endeawr I Nalliona Bacon 1 7/1$/2029 1:47:41 PM (PDT) I Page 1 OL 4 DISCLAIMER The Certificate of Coverage on the reverse side of this form does not constitute a contract between the issuing entily(ies), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the coverage documents listed thereon. xenwanmemm 80945934 I €JV CH2 1 24/25 Super Pool P6L v/Eadeavoa I Nalliona Bacon 1 7/15/2024 1:47:41 PM (POT) I Page 2 of 4 ENDORSEMENT ADDITIONAL COVERED PARTY COVERED PARTY I COVERAGE DOCUMENT Riverside County Office of Education SCR 00101-38 Riverside Schools' Insurance Authority ADMINISTRATOR Keenan & Associates Subject to all its terms, conditions, exclusions, and endorsements, such additional covered party as is afforded by the coverage document shall also apply to the following entity but only as respects to liability arising directly from the actions and activities of the covered party described under "as respects" below. Addditional Covered Party- 320of Eat Tahqu tz Canvvon way Palm Springs A 92262 Pursuant to Use of Facilities Agreement Number C1006389 between Riverside County Superintendent of Schools and The City of Palm Springs for RCOE to lease property located at Desert Highland Park from the City of Palm Springs in order to place a portable building to house a Head Start program. This coverage shall be primary to the certificate holders coverage, but only as respects to liability arising directly from the actlons'and activities of the Covered'Party. The insurance of the Additional Covered Party shall not'be called upon to contribute to a loss covered by the Covered Party's coverage. The Covered Party waives their right of subrogation, only as it pertains to general liability coverage, per the terms and conditions set forth by the Memorandum of Coverage. This waiver applies only with respect to the operations described and required by a written contract to obtain this waiver from the Covered Party. " Authorized Representative Issue Date: 7/15/2024 80945934 1 RIVER5CR2 1 24125 Super Pool PSL v/Endeavor I Ralliona Bacon 1 7/15/2024 1:47:41 PM (PDT) I Page 3 of 4 PIPS Waiver of Our Right to Recover From Others Endorsement ;Coveted Patty' Endorsement Number j Riverside Schools Risk Management Autho/Riverside County Office of Education 92 'Memorandum of Coverage Memorandum of Coverage Period Effective bate of Endorsement PIPS0012921 1 7/1/2024-7/1/2025 7/1/2024 1 12:01 AM !Issued By (Name of Entity) j Protected Insurance Proeram for Schools Workers' Compensation and Employers' Liability Policy This endorsement applies only to the coverage provided by the Memorandum of Coverage. We have the right to recover our payments from anyone liable for an injury covered by this Memorandum of Coverage. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. Schedule Specific Waiver - Name of Person or Organization: City of Palm Springs 3200 East Tahquitz Canyon Way Palm Springs CA 92262 Operations: Pursuant to Use of Facilities Agreement Number C1006389 between Riverside County Superintendent of Schools and The City of Palm Springs for RCOE to lease property located at Desert Highland Park from the City of Palm Springs in order to place a portable building to house a Head Start program. Contribution: There is no contribution charged for this endorsement. Authorized Agent NO 0 J CA License #0451271 Confidential Client Use Only 60945934 1 RIVERSCH2 124/25 Super Pool PAL v/Endeavor I Hallicna Bacon 1 7/15/2024 1:47:41 Pe (POT) I Page 4 of 4 RCOE Agreement Number C 1006389 AGREEMENT TO USE FACILITIES This Agreement to Use Facilities ("Agreement") is made this 1st day of October, 2017, by and between the City of Palm Springs ("City") and the Riverside County Superintendent of Schools ("SUPERINTENDENT"). The parties enter into this Agreement on the basis of the following facts and intentions: RECITALS WHEREAS, the City and SUPERINTENDENT are mutually interested in and concerned with providing quality recreational facilities and educational programs for the citizens of Palm Springs; and WHEREAS, it is recognized that through a cooperative Agreement between the City and SUPERINTENDENT, the community will be afforded the fulfillment of one of its educational and recreational goals for citizens. NOW THEREFORE,the City and SUPERINTENDENT do hereby mutually agree as follows: 1. INTENT OF AGREEMENT 1.1 It is the intent of this Agreement, based upon the true and correct recitals above which are incorporated by this reference herein as material terms of this Agreement, to describe the responsibilities of the City and SUPERINTENDENT in their cooperative effort to effectively promote and provide early childhood education through a Head Start program. 1.2 The parties agree that the SUPERINTENDENT may utilize certain property located at Desert Highland Park, consisting primarily of modular buildings joined together and operating as a single facility, for location of the Head Start facility in the southwest comer of the park during the term of this Agreement. 1.3 It is the intent of this Agreement to solidify a supportive and working relationship between SUPERINTENDENT and the City. 1.4 It is the intent of this Agreement that both the City and SUPERINTENDENT acknowledge and direct their efforts toward the development of Head Start programs at Desert Highland Park. 1.5 The parties understand and agree that although Palm Springs Unified School District ("PSUSD") is not a party to this Agreement, PSUSD shall be the entity operating the Head Start program based upon a separate agreement with the SUPERINTENDENT. ORIGINAL BID 23324v2 AND/OR AGREEMENT AGREEMENT TO USE FACILITIES Page 2 2. AREAS OF RESPONSIBILITY 2.1 Fees and Charges 2.1.1 SUPERINTENDENT agrees to pay the City for its use of the property at Desert Highland Park on an annual basis. The payments shall be one dollar($1.00)per year. 2.1.2 SUPERINTENDENT will take all necessary steps to ensure that all electrical service necessary to support the Head Start program at Desert Highland Park are billed to and payable by the SUPERINTENDENT, and not part of this Agreement. 2.1.3 The City will continue to pay for water service in support of the Head Start program at Desert Highland Park, and shall invoice the SUPERINTENDENT with respect to the SUPERINTENDENT's duty to reimburse City for said water service. 2.1.4 SUPERINTENDENT will take all steps necessary to ensure that the following costs of operating the Head Start program at Desert Highland Park are billed to and payable, in advance of January 1 of each year, by the SUPERINTENDENT: Landscape Maintenance — six thousand four hundred twenty dollars ($6,420.00); Integrated Pest Management (IPM) — four hundred thirty two dollars ($432.00). 2.1.5 City and SUPERINTENDENT understand and agree that (i) landscape maintenance and pest control charges will increase annually, (ii) electrical and water charges in accordance with the lawful discretion and authority of utility service providers, and the provisions of this Section 2.1 shall remain applicable through the term of this Agreement regardless of said increases. 2.2 Facility Use and Scheduling 2.2.1 The City shall make the parking lot at Desert Highland Park available on a shared, nonexclusive basis,which does not interfere with the City's other recreation programs. Notwithstanding the foregoing, it is understood that SUPERINTENDENT shall be permitted to utilize the parking lot at its discretion during normal business hours. The City has sole discretion and shall act in a timely manner to resolve all scheduling conflicts. AGREEMENT TO USE FACILITIES Page 3 2.3 Staff 2.3.1 SUPERINTENDENT shall have complete responsibility for procuring from PSUSD adequately and reasonably controlled and supervised staff to operate the Head Start program at Desert Highland Park. 2.3.2 SUPERINTENDENT shall take all steps necessary to ensure that the separate agreement referenced above in Section 1.5 provides for PSUSD's control and safety of staff, students and Head Start program participants at Desert Highland Park. 2.3.3 SUPERINTENDENT shall take all steps necessary to ensure that the separate agreement referenced above in Section 1.5 provides that all teaching and administrative staff are appropriately credentialed according to the laws and regulations of the State of California. 2.3.4 SUPERINTENDENT shall take all steps necessary to ensure that the separate agreement referenced above in Section 1.5 provides that (i) any person having supervisory or disciplinary authority over any minor participating in the Head Start program at Desert Highland Park is subject to a criminal background screening as specified in California Public Resources Code Section 5164, (ii) each SUPERINTENDENT or Palm Springs Unified School District employee or volunteer having supervisory or disciplinary authority over any minor enrolled in the Head Start program at Desert Highland Park must complete the supplemental questions attached as Exhibit"A"and must concurrently submit to being fingerprinted. SUPERINTENDENT shall submit a completed copy of Exhibit"A" and arrange for the fingerprinting of each employee and/or volunteer working at the Head Start program facility at Desert Highland Park before this Agreement may be executed by the City. Background checks and fingerprinting will be done at the sole cost of SUPERINTENDENT. The first year that SUPERINTENDENT performs the background screening for any particular individual,the screening shall include screening by the federal government with respect to the individual in question. All subsequent years that the SUPERINTENDENT is required to perform a background check on that same individual, the screening need only be performed by the state government. 2.3.5 SUPERINTENDENT shall take all steps necessary to ensure that the separate agreement referenced above in Section 1.5 provides for the City's receipt of a complete list of all SUPERINTENDENT-and Palm Springs Unified School District employees and/or volunteers who will have supervisory or disciplinary authority over any minors while at the Head Start facility. A true and correct list of such employees as of the date of execution of this Agreement is attached hereto as Exhibit `B." Should SUPERINTENDENT and/or Palm AGREEMENT TO USE FACILITIES Page 4 Springs Unified School District hire a new employee or volunteer who should be listed on Exhibit `B," SUPERINTENDENT must notify City of this fact within one week and SUPERINTENDENT must concurrently submit a completed copy of the questionnaire, attached as Exhibit"A," for the new person. 3. INSURANCE AND INDEMNIFICATION 3.1 SUPERINTENDENT shall procure and maintain, at its sole cost and expense, in a form and content satisfactory to City, during the entire term of this Agreement, including any extension thereof, the following policies of insurance: a. Comprehensive General Liability Insurance. A policy of comprehensive general liability insurance written on a per- occurrence basis with a combined single limit of one million dollars ($1,000,000.00). b. Worker's Compensation Insurance. A policy of worker's compensation insurance in such amount as will fully comply with the laws of the State of California and shall indemnify, insure and provide legal defense for both SUPERINTENDENT and the City against any loss, claim or damage arising from any injuries or occupational diseases occurring to any worker employed by or any person retained by SUPERINTENDENT in the course of carrying out the work or services contemplated in this Agreement. C. Automotive Insurance. A policy of comprehensive automobile liability insurance written on a per-occurrence basis in an amount not less than either (i) bodily injury liability limit of two hundred fifty thousand dollars ($250,000.00) per person and five hundred thousand dollars($500,000.00)per occurrence and property damage liability limits of one hundred thousand dollars ($100,000.00) per occurrence and of two hundred fifty thousand dollars ($250,000.00) in the aggregate, or (ii) combined single limit liability of five hundred thousand dollars ($500,000.00). Said policy shall include coverage for owned, non-owned, leased and hired vehicles. All of the above policies of insurance shall be primary and shall name the City, its officers, employees and agents as additional insureds. The insurer shall waive all rights of its subrogation and contribution it may have against the City,its officers, employees and agents and their respective insurers. All of said policies of insurance shall provide that said insurance may not be amended or canceled without providing thirty(30)days' prior written notice by registered mail to the City. In the event any of said policies of insurance are canceled, SUPERINTENDENT shall, prior to the cancellation date, submit new evidence of insurance in conformance with this Section 3.1 to the Contract Officer. No work or services under this Agreement shall commence until SUPERINTENDENT has provided the City with AGREEMENT TO USE FACILITIES Page 5 certificates of insurance or appropriate insurance binders evidencing the above insurance coverage and said certificates of insurance or binders are approved by the City. SUPERINTENDENT agrees that the provisions of this Section 3.1 shall not be construed as limiting in any way the extent to which SUPERINTENDENT may be held responsible for the payment of damages to any persons or property resulting from SUPERINTENDENT's activities or the activities of any person or persons for which SUPERINTENDENT is otherwise responsible. Since SUPERINTENDENT will subcontract with PSUSD to provide for PSUSD's operation of the Head Start program at Desert Highland Park, SUPERINTENDENT shall take all steps necessary to ensure that the separate agreement referenced above in Section 1.5 provides that PSUSD shall have and maintain the same policies of insurance that SUPERINTENDENT is required to maintain pursuant to all terms and conditions provided by this Section 3.1 and Section 3.3. 3.2 Indemnification. SUPERINTENDENT agrees to indemnify and defend the City, its officers, agents and employees against and will hold and save them and each of them harmless from, any and all actions, suits, claims, damages to persons or property,losses,costs,penalties,obligations,errors, omissions or liabilities (herein"claims or liabilities") that may be asserted or claimed by any persons, firm or entity arising out of or in connection with the negligent, wrongful, or allegedly negligent or wrongful performance of the work, operations or activities of SUPERINTENDENT, its agents, employees, subcontractors or invitees, provided for herein, or arising from the negligent performance of or failure to perform any term, provision, covenant or condition of this Agreement, whether or not there is concurrent passive or active negligence on the part of the City, its officers, agents or employees, but excluding such claims or liabilities arising from the sole negligence or willful misconduct of the City, its officers, agents or employees who are directly responsible to the City and, in connection therewith: a. SUPERINTENDENT will defend any action or actions filed in connection with any of said claims or liabilities and will pay all costs and expenses, including legal costs and attorneys' fees, incurred in connection therewith; b. SUPERINTENDENT will promptly pay any judgment rendered against the City, its officers, agents or employees for any claim or liabilities arising out of or in connection with negligent performance of or failure to perform such work, operations or activities of SUPERINTENDENT hereunder; and SUPERINTENDENT agrees to save and hold the City, its officers, agents and employees harmless therefrom; AGREEMENT TO USE FACILITIES Page 6 C. In the event the City, its officers, agents or employees, is made a party to any action or proceeding filed or prosecuted against SUPERINTENDENT for such damages or other claims arising out of or in connection with the negligent performance of or failure to perform the work, operation or activities of SUPERINTENDENT hereunder, SUPERINTENDENT agrees to pay the City, its officers, agents or employees, any and all costs and expenses incurred by the City, its officers, agents or employees, in such action or proceeding, including, but not limited to, legal costs and attorneys' fees. Since SUPERINTENDENT will subcontract with PSUSD to provide for PSUSD's operation of the Head Start program at Desert Highland Park, SUPERINTENDENT shall take all steps necessary to ensure that the separate agreement referenced above in Section 1.5 provides that PSUSD shall provide the City with the same indemnification that SUPERINTENDENT has provided pursuant to all terms and conditions provided by this Section 3.2 and Section 3.3. 3.3 Sufficiency of Insurer or Surety. Insurance or bonds required by the Agreement shall be satisfactory only if issued by companies qualified to do business in California rated"A" or better in the most recent edition of Best Rating Guide, The Key Rating Guide or in the Federal Register, and only if they are of a financial category Class VII or better, unless such requirements are waived by the Risk Manager of the City("Risk Manager")due to unique circumstances. In the event the Risk Manager of the City determines that the work or services to be performed under this Agreement creates an increased or decreased risk of loss to the City, SUPERINTENDENT agrees that the minimum limits of the insurance policies and the performance bond required by this Section 3 may be changed accordingly upon receipt of written notice from the Risk Manager; provided that SUPERINTENDENT shall have the right to appeal a determination of increased coverage by the Risk Manager to the City Council of City within ten(10) days of receipt of notice from the Risk Manager. 4. WAIVER OF UTILITY FAILURE 4.1 SUPERINTENDENT expressly waives any and all claims to the City for compensation for any and all losses or damages sustained for any reason or any defect, deficiency or impairment of any utility system, water supply system, drainage system, electrical apparatus or wires serving the Head Start facility at Desert Highland Park, and shall procure a coextensive waiver to that provided in this Section 4.1 from Palm Springs Unified School District in the agreement referenced above in Section 1.5. AGREEMENT TO USE FACILITIES Page 7 5. ENFORCEMENT OF AGREEMENT 5.1 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 SUPERINTENDENT covenants and agrees to submit to the personal jurisdiction of such court in the event of such action. 5.2 Disputes. In the event of any dispute arising under this Agreement, the injured party shall notify the injuring party in writing of its contentions by submitting a claim therefor. The injured party shall continue performing its obligations hereunder so long as the injuring party commences to cure such default within ten(10)days of service of such notice and completes the cure of such default within forty-five (45) days after service of the injured party; provided that if the default is an immediate danger to the health, safety and general welfare, such immediate action may be necessary. Compliance with the provisions of this section shall be a condition precedent to termination of this Agreement for cause and to any legal action, and such compliance shall not be a waiver of any party's right to take legal action in the event that the dispute is not cured, provided that nothing herein shall limit City's or SUPERINTENDENT's right to terminate this Agreement without cause pursuant to Section 5.6. 5.3 Waiver. No delay or omission in the exercise of any right or remedy by a non-defaulting party on any default shall impair such right or remedy or be construed as a waiver. A party's consent to or approval of any act by the other party requiring the party's consent or approval shall not be deemed to waive or render unnecessary the other party's consent to or approval of any subsequent act. Any waiver by either party of any default must be in writing and shall not be a waiver of any other default concerning the same or any other provision of this Agreement. 5.4 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 and the exercise by either party of one or more of such rights or remedies shall not preclude the exercise by it, at the same or different time, of any other rights or remedies for the same default or any other default by the other party. 5.5 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 declaratory or injunctive relief, or to obtain any other remedy consistent with the purpose of this Agreement. AGREEMENT TO USE FACILITIES Page 8 5.6 Termination Prior to Expiration of Term. This section shall govern any termination of this Agreement. The City reserves the right to terminate this Agreement at any time,with or without cause,upon thirty(30)days' written notice to SUPERINTENDENT, except that where termination is due to the fault of SUPERINTENDENT,the period of notice may be such shorter time as may be determined by the Contract Officer. In addition, SUPERINTENDENT reserves the right to terminate this Agreement at any time, with or without cause, upon sixty (60) days' written notice to City, except that where termination is due to the fault of the City, the period of notice may be such shorter time as SUPERINTENDENT may determine. 5.7 Attorneys' Fees. If either party to this Agreement is required to initiate or defend or made a party to any action or proceeding in any way connected with this Agreement, the prevailing party in such action or proceeding, in addition to any other relief which may be granted, whether legal or equitable, shall be entitled to reasonable attorneys' fees. Attorneys' fees shall include attorneys' fees on any appeal. In addition, a party entitled to attorneys' fees shall be entitled to all other reasonable costs for investigating such action, taking depositions and discovery, and all other necessary costs the court allows that are incurred in such litigation. All such fees shall be deemed to have accrued on commencement of such action and shall be enforceable whether or not such action is prosecuted to judgment. 6. CITY OFFICERS AND EMPLOYEES: NON-DISCRIMINATION 6.1 Non-liability of City Officers and Employees. No officer or employees of the City shall be personally liable to SUPERINTENDENT or any successor in interest in the event of any default or breach by the City or for any amount that may become due to SUPERINTENDENT or to its successor or for breach of any obligation of the terms of this Agreement. 6.2 Conflict of Interest. No officer or employee of the City shall have any financial interest, direct or indirect, in this Agreement nor shall any such officer or employee participate in any decision relating to the Agreement that affects his financial interest or the financial interest of any corporation, partnership or association in which he is directly or indirectly interested, in violation of any state statute or regulation. SUPERINTENDENT warrants that it has not paid or given and will not pay or give any third party any money or other consideration for obtaining this Agreement. 6.3 Covenant against Discrimination. SUPERINTENDENT covenants that, by and for itself, its heirs, executors, assigns and all persons claiming under or through them,there shall be no discrimination against or segregation of any person or group of persons on account of race, color, creed, religion, sex, marital status, sexual preference, domestic partnership status, national origin or ancestry in the performance of this Agreement. AGREEMENT TO USE FACILITIES Page 9 7. MISCELLANEOUS PROVISIONS 7.1 Notice. Any notice, demand, request, document, consent, approval or communication either party desires or is required to give to the other party or any other person shall be in writing and either served personally or sent by pre-paid, first-class mail, in the case of the City, to the City Manager of the, CITY OF PALM SPRINGS, P.O. Box 2743, Palm Springs, California 92263,and,in the case of SUPERINTENDENT,to the person at the address designated on the execution page of this Agreement. Either party may change its address by notifying the other party of the change of address in writing. Notice shall be deemed communicated at the time personally delivered or in seventy-two(72)hours from the time of mailing if mailed as provided in this section. 7.2 Interpretation. The terms of this Agreement shall be construed in accordance with the meaning of the language used and shall not be construed for or against either party by reason of the authorship of this Agreement or any other rule of construction that might otherwise apply. 7.3 Integration; Amendment. It is understood that there are no oral agreements between the parties hereto affecting this Agreement and this Agreement supersedes and cancels any and all previous negotiations, arrangements, agreements and understandings, if any, between the parties and none shall be used to interpret this Agreement. This Agreement may be amended at any time by the mutual consent of the parties by an instrument in writing. 7.4 Severability. 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 a valid judgment or decree of court of competent jurisdiction, such invalidity or unenforceability shall not affect any of the remaining phrases, sentences, clauses, paragraphs or sections of this Agreement that are hereby declared as severable and shall be interpreted to carry out the intent of the parties hereunder unless the invalid provision is so material that its invalidity deprives either party of the basis benefit of their bargain or renders this Agreement meaningless. 7.5 Corporate Authority. The persons executing this Agreement on behalf of the parties hereto warrant that (i) such party is duly organized and existing, (ii)they are duly authorized to execute and deliver this Agreement on behalf of said party, (iii) by so executing this Agreement, such party is formally bound to the provisions of this Agreement, and (iv) the entering into this Agreement does not violate any provision of any other agreement to which said party is bound. 7.6 Notices. Any correspondence and notice required, contemplated or transmitted pursuant to this Agreement shall be delivered to the respective parties at the addresses set forth below and are deemed submitted one (1) day after their deposit in the United States Mail, postage prepaid. AGREEMENT TO USE FACILITIES Page 10 SUPERINTENDENT CITY SUPERINTENDENT CITY MANAGER Riverside County Office of Education City of Palm Springs Contracts and Purchasing Services 3200 E. Tahquitz Canyon Way 3939 13th Street Palm Springs, CA 92262 Riverside, CA 92502 760-323-8200 951-826-6546 8. EARLY TERMINATION, MODULAR UNIT DISPOSITION 8.1 In the event that the Head Start program ceases to operate for a period of one (1) year or more for any reason prior to the expiration of the term provided below in Section 10 of this Agreement, SUPERINTENDENT shall transfer, in accordance with the Notice of Federal Interest filed by SUPERINTENDENT,its entire ownership interest in the modular buildings utilized for the Head Start program at Desert Highland Park to the City, or alternatively remove said modular buildings from Desert Highland Park at SUPERINTENDENT's sole cost. 9. COORDINATION OF WORK 9.1 Representative of SUPERINTENDENT. The following principal of SUPERINTENDENT are hereby designated as being the principals and representatives of SUPERINTENDENT, authorized to act in its behalf with respect to the work specified herein and make all decision in connection therewith: SUPERINTENDENT Riverside County Office of Education Contracts and Purchasing Services 3939 13th Street Riverside, CA 92502 951-826-6546 It is expressly understood that the experience, knowledge, capability and reputation of the foregoing principals were a substantial inducement for City to enter into this Agreement. Therefore, the foregoing principals shall be responsible during the term of this Agreement for directing all activities of SUPERINTENDENT and devoting sufficient time to personally supervise the uses hereunder. However, if, through the course of this contract,the representatives of SUPERINTENDENT change,written notice of such change shall be submitted to the City. A change in representatives shall not represent a change in the intent or direction of the contractual agreement between the City and SUPERINTENDENT. AGREEMENT TO USE FACILITIES Page 11 9.2 Contract Officer. The Contract Officer shall be such person as may be designated by the City Manager of City. It shall be SUPERINTENDENT's responsibility to assure that the Contract Officer is kept informed of SUPERINTENDENT's use of the Even Start facility and shall refer any decisions that must be made by the City to the Contract Officer. Unless otherwise specified herein, any approval of the City required hereunder shall need the approval of the Contract Officer. The Contract Officer shall have authority to sign all documents on behalf of City required hereunder to carry out the terms of this Agreement. 10. TERM 10.1 Unless earlier terminated in accordance with Section 5.6 of this Agreement, this Agreement shall continue in full force and effect for a period of fifteen (15) years beginning on the date first written above, and ending on the fifteenth (15") anniversary of said date. THIS SPACE INTENTIONALLY BLANK AGREEMENT TO USE FACILITIES Page 12 This Agreement is executed by the duly authorized representatives of the City and SUPERINTENDENT as of the date first written above. "CITY" AP TO FORM CITY OF PALM SPRINGS «. GTY ATFORNEY By: Y 4E21 City Manager AMR=BYCff UVOM Attest: 1 City Clerk r►1A�inu(�G✓�U.w�,-�'- t1F U'ISCS "SUPERINTENDENT" RIVERSIDE COUNTY SUPERINTENDENT OF SCHOOLS B Its Ssistant Superintendent, ELS By: vV�i,Ir r `,yfi Its: AGREEMENT TO USE FACILITIES Page 13 "EXI I1BIT A" Page I of 10 SUPPLEMENTAL QUESTIONAIRE Pumsurrt to California Public Resources Code§5164.this form must be completed by all applicants for positions involving supervisory of disciplinary authority over any minor. YES NO 1. Have you evv been convicted of saual assault or ossmrh with intenl 10 commit mayhem? - 6/ 2. }lave you ever been convicted of uNawful secaai auercoune with a pavan urakr age I a? f 3. Hmm yoo ever been canvicidid of rape? 4. ttmc you eve been convicted ofthc rape of a spouse? 5. Haw you ever been convicted of willfid tmrm of injury to a child? 6. Have you"a been convicted of child ea}ongero nt? v 7, Have you ever been convicted orco poral punishment or iryury to a chikt? fY 8, Have you ever bern convicted of willful infliction of corporal injury to a sporac,fomrer sanest,cobabiumL Or mother or father of yvur child? 9. Have you"a been convicted of my sexual crime or offense? 10. Have you ever been convicted of any of The following vimes or of an Attempt o certmla any of the r0110ein9 crimes? -. 10.1 Kidnapping? C/4 tfyes,west youconricteJ of lishoppbtgaattempted kirktoppittg veldt de(Meat tocanma rape,sodomy,lewd - ' a lacivious acts,and copulation,or forcible acts of smaal pmaralinn? 10.2 Kidnappingfarmasom? v5/ If yes,were you convicted of kidnapping for ransom or allempicd kidnapping for rmtsorn with the intent to commit rape, sodomy,lewd a lascivious sea,ant eapulalkn,or forcible actsofsestml penctrmion? 10.3 Sexual battery? 104 Aiding,abating or soliciting de rare,rope of a spouu,or forcible sets of saved Pcneuatim? !l 1o.5 cnttcemem elan ounitried minor remote fa purposes ofprostimlion? 10.6 Aiding,abaft the enticement of an unmarried Braver kmak for Purposes of pmstu-stun? 101 inducing weal iMvcowtt with mother when the other's consent is procured by fabe pretenses tvah the intent to ... Crew:fear? 10.8 Pimping of doff ` 10.4 Paadctingofamimtr? 10,10 IYneurrmcnt of a child under 16 years of age for kwd or Imcivi"acts? - 10.t 1 Abduction(taking away)of a person antler age I fa purposes of pnstatdion? 10,12 Agravaled usual wok of a Wild? 10.13 loom? 10.14 Sodomy? 10,15 Lewd or iascivtau ow or the soliehmion of Use same? J 10.16 pal copufmion? 10.17 Coakmininstatusabase Ora Child? :/ AGREEMENT TO USE FACILITIES Page 14 "EXIIIHIT A" Page 2 of 10 SUPPLEMENTAL QUESTIONAIRE VFS Yn/ 10,18 Forcible acts of sexual penetration or the solicitation of the same7 10,19 Selling,distributing,priming or exhibaing of child paaognphy7 10.20 Sexual exploitation of a child? 10,21 Employment or roc of a minor to perform protabitcd am? { 1022 Advertising clwW pomogmphy? t/ 1013 Possession of child pamogrWhy? 10.24 Annoying a moksting a child under 19? 1015 Solldatien of rape by force of violcrscc,sodomy by force or violence,or Mal copulation by force a violnue, 10.26 indecent cxposae7 � 1011 Procuring,counseling,of assisting my person to cannot Indecent exposure? 10 25 Contributirtg to the delinquawy of a nowrt 1019 Sending harmful material to a minor with the intent so seduce said minor? 11. Htnc sou ever been convicted of mood robbery? 12 hove you ever been convicted of amid eagacking? 11, }lave you ever been convicted of assauk a attempted murder of a publ&officiat7 14. Have you ever been convicted of use imprisonment? IS, Have you ever been convicicdofassmlt? t� IS, Have you"a been convicted ofba1Wy? f 17. Have you met been Convicted ofmrtdW. (� It. IInc you ever been Convicted a f mayhem? 19. Have you ever been convicted of a crime that rcqui cs you to register as a sex ofTcnder in the State of Califtmna? M1� CERTIFICATION OF APPLICANT I hereby cenify that all responses herein ure true and correct,and I understand nod agree that any misstatement or omission of'trmterial fact Tray cause forfeiture on my part of all rights to employment with the Palm Springs Unified School District andfur Riverside County 0111kc o'Ed/oc�aa ion. signature: •rWrr/1J AGREEMENT TO USE FACILITIES Page 15 "EXHIBIT A" Page 3 of 1 o SUPPLEMENTAL QUESTIONAIRE Pursuant to California Public Resources Code§5164.this form must be compleW by all applicants for positimis involving supm'isory o disciplinary authority over any minor. YES AO 1. Hrwe you ever been convicted of sexual annuli or assoult with intent to commit mayhtan? }� 2. tlavc you nor been convicted of uniawful sexual intercourse with a pawn under age Ill? ... 3. lion you Cato ban convicted of rape? y�� 4. Have you ever been co victed of the rape ore spouse7 -. x 5. Bove you ever been convicted of willful harm of injury to a child? X 6. liavc you nTr been Convicted of child crxteaCcnncra7 x 7. Rave you ever been convicted of corpora punishment or injury to a child? S. Have you ever been convicted of willful infliction of corporal injury to a spouse,former spouse,cohnbiu nt,or moiler or father of your chid? \y� 9. Have yat ever been convicted of any soxuel Crime or offenseW, r in, Have you nor been convicted of my of the following o k or of an attempt to commit my of the fuilowi ng Crime a ... 104 Kidnappi+g7 if yes,wart you convicted of kidnapping or attempted kidnapping with the intent to comma rope,sodomy,lewd x or lascivious acts,oral copulation,a furcibde acts of w=1 penetntion7 101 Kimeapping fur ransom? If yes.were you convicted of kidnapping for roman or attempted kidnaptimi;foe ransom with the imem to commit nape. sodomy,icwd or Imcivimrs acts,oral copulmim Or forcible nets of sexual pcnnrotion? 10.3 Sexual banery7 ' t0.4 Aiding obening or soliciting the rope,rape ore vouse,or forcible ads of sexual peaetr2eion7 . 10.5 Enticement of an unmarried minor female for purposes of prostitution? - \` 10.6 Aiding,abetting the enticement of an unmarried minor female for purposes of prostitution? 10.7 lndai%steal ire"course with another when the other's consent is procured by false preltmses with the i imt to overdo kart 10.9 Pimping of a minor? X 10.9 Pandering of amintor? 10.10 Pmcuremcm urn child under 16 years of age for lewd or lascivious acts? - x 10.11 Abduction(taking away)of a pun under age 1 g for purposes of prosliunion7 X 10.12 Agrovtucd sexual nssmdl of a child? x 10.13 1ncesR 'v 10.14 Sodomy? 10.15 Lewd or lascivious acts or the solicitation of 11k s401e7 10,16 Oral copulation? 10.17 Cotlitmaus sexad abate of a child? r AGREEMENT TO USE FACILITIES Page 16 "EXHIBIT A" Page 4 of 10 SUPPLEMENTAL QUESTIONAIRE 1 kS NO 10-I9 Futabic acu aCscxaal penMtianwthe solicantson oftivc surtu7 tt, 10,19 Sell 4 distributing,printing or exhibiting of chili pornography? I0.2o Savaj exploitation of n child? �f 10.21 Empdoytnci t ar use of a minor m Perform prubibiled acts? 10.22 Advertising child pornography'! y 10 23 Pos=sax,of child pornography? 10.24 Amsrying or[molesting a child under 197 10.25 Solicitation ofmpe by force or violence,sodomy by force or victories,or oral copulation by force or vioiencv? 10.26 Indemm exposure? 10,27 Procuring,counseling,or assisting my person to comma indecent exposure" 1028 Contributing to the delinquency of a minor? 10-29 Seocing harmful trtmerial to a minor with the intent to seduce said tramie Yv [I. Have you act been convicted of armed robbery? 12. Have you ever kern convicted of armed carjackiti 13. Htvc you ever been convicted of assault or attenfried murder ora public ofGcid' 14. Have yxm ever been conv toed of fake imprisonment? ,7 13. Have you cm been convicted of ussuuh? /V`J ly Have you ever been convicted of banery? 17. I love you ever been convicicd of murdW, 18 Hove yw ever been convicted of maybcm? 19 Bove you eve bcm cervlead or a crime that requites you to register as a sex dtrnuier in the S late of CodifwrW CERTIFICATION OF APPLICANT I hereby certify that all responses herein an true and correct,and I understand and agree that any misstatement or Omission of material fact may cause farrciture on my part oral[rights to employment with the Palm Spring Unified School District ardor Riverside County Office of Education. thttr.jb 7 Signature: , ---. _ ___.---- AGREEMENT TO USE FACILITIES Page 17 "EXHIBIT A" Page 5 of 10 SUPPLEMENTAL QUESTIONAIRE Pursurmt to California Public Resources Code§5164,this form muss be completed by all applicants for positions involving supervisoy or d6ciplinary authority over any minor. YES M1M1tO++ I. Hnve you ever bean convicted of sexual usmlt a assauh with intent to canms mayhem? 2. have you ever been eatvietd of unlawlut Scowl inincourso with a persnn under agc 181 3. Have you cm been convicted of rapt? 4. Have yet ever been convictd of the tape of a spoon? 5- have you eves been convicted of willful harm of injury be a child? / 6. I Iave yea eve been convicted of child awtmugennam7 Y"` 7. Have you ever been convicted of corporal punishment or ir§try to a chiW? S, Have you ever been convicted of willful infliction of corporal injury to a spouse,lamer spouse,cohablarv,Of mother a fotber of year child? 9. Have you ever been convicted of my saved crime w offenx? 'J� 10. Hove you ever been convicted of nay of the following crimes or of an attempt to commit any of the following crimes? -- 7C 10 1 KiMopping? If yes,were you convicted of kidnapping or uncmptd kidnapping with the intent to corm h rapt,sodomy,lewd ' v or losciviom acts,and copulalim,of forcible am orsexad pcneVatitvtt 10.2 Kidnapping for ruuom? y\ If yes.were you convicted of kidmpsping for ransom or i ucmpled kdnapping for ruisom with the intent to co n imi rape, - '( sodomy,lewd or ha iviom acts,oral copulation,a forcible acts of sexual perlaratian? 10.3 Se"A bavery? 10,4 Aiding.aborting Or soliciting the repo,repo of a apwure,or faelble new of sexual penetmrinn7 'ytn 10.5 Eraiceeaat of N unmaried mirror female for purposes of prostitution? 10.6 Aiding,obcaing cite rntiecrncnt or an unmarried minor km ale for poposcs Ofprouitutian? y 10.7 Inducing sad imercoume wits hunt er when file other's consent is procured by Use prncnses with the intent to .ram acmes tear? as Pinpktg of a awuor 10.9 Pondering of a minor? V 10.10 Procurement of a child under 16 yeah of age for lewd a lascivious acls7 10.11 Abduction(taking away)of a pawn akler age 19 for purposes of prostitution? 10.12 Agmvated eecudd msauh of a chi Id? 10.13 Incest? .- x 10.14 Sodomy? - x 10.15 Lewd a lascivious acts or the soliciluhn of the same? 10.16 Oral copulafion? 'v 10.17 Continous scud abuse of a child? JC AGREEMENT TO USE FACILITIES Page 18 "EXIIIBIT A" Page 6 of 10 5'I.S Nt) 10.18 Forcible 10J9 Sclling,distribuling,printing or exhibiting of child pornography! - ' K 10.20 Sexual explanation of a child? X 10,21 Employmem Or use Ora rnirwr to perform prohN:ed acts? �y 10.22 AdvmJsingchildpamograpby! f\.� 10,23 Possession of child pomogniphy? /DK 10,24 Armoying or molesting a chdd under 187 to 25 Sdisilali rot olrope by force a violence,Wormy by force a violence,or oral copulmion by force or violence? y� 10,26 Indecent exposure'? /r ` 10.27 Procuring,counuling,or assisting any person to commit indecent cxposurO x 1029 Comriboting to the delinquency Ora minor? ,^ 10 29 Srndirng hamrfui material to a mirror with UK inteal to 5cvtuce said rninot! :. 11. Have you ever been convicted of aired rob6cry? 12 1-lave you ever been convicted of armed eerjad:ing? :: B !lave you ever been convicted Of assault or ellempled murder of a public olrKial? 14 Have you ever been convicted of false Imprisonment? 15. Have you ever been covvicted of usAult? x 16 Have you"a been convicted of batlay? 17 Have you ever been emnvicted of murder? 18 Hove you cmi been convicted of mayhem? 19 Hoye you ever ban cons icled of a trine[hot rcqu ins you ki register as a sex olirnder in the State of Caiifomia? CERTIFICATION OFAPPLICANT I hereby certify that all responses hondn we true and correct,and I understand and agree that any misstatement or omission of material fact may cause forfeiture on my part of all rights to employment with the Palm Springs Unified School District and/or Riverside County Office of Education. Uate: 7 Signature: AGREEMENT TO USE FACILITIES Page 19 "EXHIBIT A" Page 7 of 10 SUPPLEMENTAL QUESTIONAIRE Pursuant to California Public Resources Code§5164,this form must be completed by all applicants for positions involving supervisory or disciplinary authority over any minor. YES piD 1, Have you eve been Convicted of mum assarsh or assault with intent to commit mgbria? 2. Have)on ever been convicted of tadawful sexual imacourse wills It person under MCC 197 3. Have you ever been convkledofrape? 4. have you ever been convicted of the rape of a spouse? We 3. Have you ever been amicled of willful harm or injury to a chiWT 6. Have you ever been convicted of child er6lartgvaamR ✓ 7. I cove yuu over been convicted of corporal punishment or injury In a child? ✓ 8. Have you ever been convicted of willful infliction of corporal injury to a spouse,farm spouse,cobabiumt.Of rmrther ./ m father of)mr child? 9. Haveyou over been convielal of any sexual Crime or oltetsso7 10. Have)w ever been convicted of any of the following crime or of in ommp In cwmh MY of VIC f[1110%rtg cruses? ✓ 10.1 KidnuppinO. If ycs,wat you convicted of kidnapping or aucarptcd kidnapping with the intent to commit rape,sodomy,lewd or lascivious acts,oral copula ion,or forcible acts of sexual pctrctnation? 10.2 Kidnapping far ransom? - If Yes.were you convicted of kidnapping for tarnom or sucmpted kidnapping for rmtsem with the intent to Commit rape, -: sodomy,lewd or lascivious acts,oral e01pulalk n,or finebk acts of sexual pettesr itiCn? 10,3 Sexual balter)<.t `. 10.4 Aiding,abotlitic or soliciting dot rap%rape of a spouse,or finxible acts of wvM11 rn mtinn? - a� 10.3 Fnticeinenl of an unmarried minor female far purposes of prostitution? 10.6 Aiding,obetting the enticement arm unmarried minor femak for purposes orprouitutian7 = 10.7 Inducing sexal knercoum.svkh ams0ner when the others cement is procured by false pretense with the intent to " create feed. to.8 Pimpingofaminofl 'r 10.9 Pandering of a minor? 9;- 10.10 Procurement of a child under 16 years of age far kwd or lascivious acts' - ♦✓ 10.11 Abduction(taking away)of a person under age 19 for purposes or prostitution? 10.12 Agmvwcd sexual assault of a child? 40.13 tritest? v 10.14 Sodony? 10.15 lewd or lascivious acts or the solicitation of the same? 10.16 Oral Copulation? 10,17 Continuous sexual abuse of a child? AGREEMENT TO USE FACILITIES Page 20 `EXIII13IT A" Page 8 of 10 YES RU I of g forcible nos of sexed penetnsion or Use solicitation of tht smne7 ✓ 10.19 Selling.distributing,printing or exhibiling of child psxswgraphy? C✓ 10.20 Sexudewoitatim ofa child? ✓ 10.21 C•mployrssem or use of a minor to perform prohibited nets? ✓ 10.22 Advertising child pernoF phyf 10.23 Possession ofchild pornography? M24 Annoying or motcsiing a child under t8? [ 10.25 Solictation of rope by force or violence,sodomy by force or violence,uraral es"Inuco by force or violence+ 10.26 bWocent exposure? 10.27 Procuring,counseling,a assisting my ps:son to camerii indccenl exposure'? see- 10.28 Contributing to the delinquency of a m srar? c/ 10.20 Sending homtful material to a minor with the invent to seduce said minor? IL Have you ever been convicted of armed mbbtr}? IZ Han you over been convicted of armed cwjmking? 13 Han you ever been convicted of assault or attempted murder era ptblie MGciafl 14. Hare you ever been convicted of false imprisonment? 15 Have you ever tram wmicted of assault? 16, Have you ever been comicted of baosxp? ry 17, have you ow beets camicted of mnrda? ✓ 18, Have you nxr been convicted of ineyhcm7 M Have you ever been convicted ore crime that requires you he re`Wer as a sex aiknder in the Siren of Co:ifomio? CERTIFICATION OF APPLICANT I hereby certify that alt responses herein are true and eoatxt,said I understand and agree that any misstatement or omission of material fact may cause farfciture on my par oral[rights to employment with the Palm Sprints Uniftcd School District and/or Riverside County Officc of Education. Dale:,10-ales Signature: AGREEMENT TO USE FACILITIES Page 21 "EXHIBIT A" Page 9 of 10 SUPPLEMENTAL QUESTIONAIRE Pursuant to California public Resources Code§5164,this form muss be completed by all applicants for positions involving supervisory or disciplinary authority over may minor. ves No/ I Have yttu ever been convicted of sexual assault or assault with intent to commN mayfiem? / 2 Have you ever been convicted of unlawful sesual intercourse with a person under age 194 J 3. Have you ever been convected of rape? { 4 }lave you ever been convicted of tho rape of a spouse? 5. Have you ever been cmvicttd of willful boom or injury to n chifd? !+ 6 Have you ever been convicted of child etWanilcmao'' /•• 7 I lave you ever been convicted of corporal prmishoent or injury,to a child? 8. Ilove you ever been convicted awdliul ion'wtion of corporal injury in aspouse,farms spouse,cohabitant,or mother _. or father of your child? 9. Have yvu ever been convicted army y sexual crime or offense? - 10 Have you ever been convicted of any of the following crime ar of an mormin to commit any of the following crimct? - 101 Kidnappinir if yes.,were you convkied of kidnapping or attempted bidnapli ft with the intent to commit rape,sodomy,lewd or lascivious gets,Oral population,Or forcible acts of sexual penarateon? 102 Kidnaping for poisorn? N If yes,were you convicted of►idnapping for namorn or attempted hidaapping for nafsom with the intent to commit rope, salamy,lewd or lascivious=is,and copulation,or file acts of sexual peactrmiwr? 10.3 Sexual battery' / 10.4 Aiding,alycning or soliciting the tape,rape of spouse.or forcible gas ofsexnal frmetratlon? /G 10.5 Enticement ofan unmarried mina kmale for purposes of prostitution' 10.6 Aiding,abetting the co6cemrntofan unmarried minor female for purposes of prostitution? 10.7 Inducing sexd innxeorrse with another when the other's consent is procured by false pretenses with the tr><ent IQ create rear? 10.8 t'inping of a minor' l 10.9 Pandering of a minor' 10.10 Procurement of a child under 16 years of ogc rot kwd or tateivious ocu? JC7 10.11 Abduction(inking away)aIn person tntder age 18 for purposes of prostitution? 10,12 Agrovated sexual assault of child? - 10.13 Incest? / 10.14 Sodomy? 10.15 Lewd or 1 aseivlais acts or 0tc solicitation of the sane' {- 10.16 Oral population? 10A7 Contimops sexual abuse of a child? AGREEMENT TO USE FACILITIES Page 22 "EXHIBTT A" Page 9 of 10 YES No 10.11 Feecible acts ofsexuel peretrmion athr solicnWitm ufam same! 10.19 Selling,dlstribmlag,priming or esh ibbng of eltad pomagmphy! 1020 Sezml exploitation of a child? 1071 Employment or use of a minor to per"pahtbacd acts? .. 10,22 Adveniting child pumography? 1022 Posussion of child porsragruphy! 10.24 Annoying or molesting achild umkr 18! 10.25 Solicitation of rope by fora or violence,sodomy by force or violence,or and copulation by force or viokna? Y 10.26 indecent evposar? 10,27 Procuring,counsel ing,or assisting any person m commit indocem caposum? 1028 Contributing to the delinquency of a mmcn7 ��1 W29 Scndul haofut material to a motor with are nlcm to seduce said minor? I 11, Have you ever been convicted of armed robbery^ / 12. Have you ever been convicted of armed cmjacicirug7 11 Hint you over barn tonvicicd of assault or allcmpnc it murder of a public official?. 14. Have ym ever been convicted of fdse imprisonment? 15, Have you ever bmn convicted of assault? 16. Have you ever been convicted ofhWtery? .: 17. Have you ever been convicted of mi rdeR Jf 18. Have you ever been convicted ormayheni? 19. Hare you ever been coat ictcd of a crime the requires you to rc&hkr as a sex offender in the State of Culifomin? / CERTIFICATION OF APPLICANT I hereby certify that all responses herein are true and coa�Yl,and 1 unckrstmid and agree that any misstatement or emission of material fact may muse forfeiture an my put of all rights to employment with am Palm Sprin},n Unified School District and/or Riverside:County Office orEduccation[. / Dale: 1 t I I�// Signature: AGREEMENT TO USE FACILITIES Page 23 EXHIBIT"B" Page 1 of 8 LIST OF FACILITY USER'S EMPLOYEES AND VOLUNTEERS WHO HAVE SUPERVISORY OR DISCIPLINARY AUTHORITY PALM SPRINGS UNIFIED SCHOOL DISTRICT Early Childhood Education MEMORANDUM Jan PtModa.ECE Pdneipai Sch*W Rwdnm Carter 1000 E.TdwquSz Canyon Way,Sulb C R E C E I V E Q Paton Springs,CA 02202 HUMAN RESOURCES (r00)41a-00a0 FAX(7Q0)4161413 JON 2 9 2015 Ipmhcda®psusd.us Date: June 22, 2016 PALM SPRINGS UNIFIED SCHOOL DISTRICT To: La Sonya Brummell Pats Director, Classified Human Resources From: Joan Prehoda Principal, Eady hildhood Education Subject: Human Resource Requirements Head Start Performance Standards(1304.52(3)(j-kl)states that Grantee and delegate agencies must assure that each staff member has had an initial health examination(that includes screening for tuberculosis)and a periodic re- examination(as reoonrmended by their health care provider). In order to comply with this please review the following information and make necessary changes. Please return to me. Thank you for your assistance. Employee Name: Diana Romo Job Title: Paraprofessional Bilingual ECE Category Current Information Update information(as needed Date of Hire 11/27/06 ^ Date of Criminal 3/22/05 IVIA Background Clearance Date of Physical 10/23106 P/1A Date of TB Clearance 3/12113 Z6 1/3 Und alty of perjury,the above information is correct. He roes Signature Date AGREEMENT TO USE FACILITIES Page 24 EXHIBIT'B" Page 2 of 8 Document r/ Page I of 1 Note:If you have questions about the information displayed below,please click bmfor a listing o Last Name ROMO Last Known County of Employment First Name DIANA Adverse and Commission Actions Indicator. Middle Name Term Document Number Document Tide } 1 71101 341 6 Child Development Site Supervisor Permit Ex P t1PrTE:w > Authorization/Subjects Authorization Description Authorization Code Subject Code > 12E NONE C > Renewal Requirements Please disregard any#signs you may see below and refer to the'Additional Description"column tj Renewal Description > To renew this permit for an additional five-year period,the holder must complete a minimum of hours of planned and approved professional growth activities as described in'The California Profe Growth Manual for Child Development Permits'. C � Employment Restrictions Organization Type Organization County AGREEMENT TO USE FACILITIES Page 25 EXHIBI'l "B" Page 3 of 8 fI 6, PALM SPRINGS UNIFIED SCHOOL DISTRICT Early Childhood Education MEMORANDUM Jam PrWwt*ECE Prkkiwl SePoW Ro"nns CerAw 1000 E.Tahquft Canyon Way,Suits C PWm 3Wb*VG,CA 2ZM t760)41I"= FAX(740)4144413 jpr*hoda@pausd.us Date; June 21,2016 To: Rosario Maloney Senior Credential Specialist From: Joan Prehoda'. Principal,Early hik1hood Education Ste4e& Human Resource Requirements Head Start Performance Standards(1304.52(3)(j Ikl)states that Grantee and delegate agencies must assure that each staff member has had an initial health examination(ftl includes screening for tuberculosis)and a periodic re- examination(as recommended by their health care provider). In order to comply with this please review the following information and make necessary changes. Please return to me. Thank you for your assistance. Employee Name: Made Hamrick Job Title: ECE Tea Ili I Update information(as Category Current Information needed) Di-4 of—Hire 9/112005 Date of Criminal 8/3112005 Background Clearance Date of Physical I Date of TB Clearance 12f6/2012 bW f i('P Under penalty of perjury,the above information is correct. 0 Human Resources Signs hke Date AGREEMENT TO USE FACILITIES Page 26 FXHIBIT"B" Page 4 of 8 CTC Online 0 Page I of 1 ftL 04 commmsm ON Hems FAQ I GIGMrvv)- TEACHER CREDENnALM I >�bdlea07f Doaraaia n ®pale:XYw Ieie giaetlae abed the Mabraatlm daplalad bdon,pNra dkk here 1b a 41ka d CwmaaYm meacb taatpaaefNAflM Laetrimmocofadllaf6aabFr®b Ndcpb %mwfcomtvd3apb►nrdloco 1aatNawafllaRE Ada*raaadCearmNraaAttlmaLrdleabe DaadekyW,ddca.Aereaeawda�wWadaa NldiafiwfafAtRX AgW1a rnargrarbwlaatraddundwarAa oomwb dr to vkr wq aMww seem bbm. awed Doammut I MDK=mb A*mw and CMW Wm AM" 1-3d3 Daorrwt6 Domammta d 1s >saawC Oa4 8 .A tp�t peaaba 0 Tala 1w Tana w abbaQ Dab • aeta S9 Dab 0 'v each C ' Chid D 1301d1m � wed 713 anr7oia ate 5 sum m D YM 71uAe aluio>3 wmet ate D 0soolm %Wm ille/mol Iul m 11/ m tmm Fwat (Araee+ Z. tarwa�bl 1-idi p AaiiatraiMn DawbtlmvON"afted 17 � PlIder�v Added Ndhabldwn- Dab lb pewee m*atm the hatdarb sVwA a a dpd an and derd*Twt Paganoparav atarolearmdlpa s%%pvAk sente k the are, tv deedopma1 And**uW=ddddrm NONE FtU N a ddld sae and drelumme p epvw, aidservebaaoofdmWdaw' ' and ddf daAWnud in a ddd are and derdopmad PmgaR � Ranaaaal Ro*dfw mmft Rom disregard ell 1 f a you mW eft blow and mkrb the aAdOWW Deo"W cok mn to ere rlpht for Wodh nsneerd two pareawat p Reefnl Deward AddMwW ,ah Coda v tr DaanlpltNf -47 Taw wthbpw*tomadmbmlfNafeart '49ehollermmtaortgaeeamHnaan 12 d t05 dads howedplwp oral Roofed g 'I il, 1 g vAh aWvbw as deaDbed h Oise CeIMb*kdomm"GmwM NwA ter Chid DerdopeeMPmrdl�. Empioyaaeplt Raed'rictioaaa No*acmes V 0. P .1 Vs� yea a r � AGREEMENT TO USE FACILITIES Page 27 FXHIBIT"B" Page 5 of 8 PALM SPRINGS UNIFIED SCHOOL DISTRICT Early Childhood Education MEMORANDUM Joan P"haft,EcrE Pflnelpd School Readimms C~ 1000E Tahquitz Canyon Way,Sull*C Palm SprkViN CA 12M RECEIVED (?N)4104M HUMAN RESOURCES FAX(T40)4115-W3 JUN 2 9 2016 Jpr*hodsQpsusd.us Date: June 21,2016 PAI V-SPRINGS LONIFILI) ECHOOLDISTRIC7 To: La Sonya Brummell Pitts Director. Classified Human Resources From: Joan Prehoda\ Principal, Earty Childhood Education Subject Human Resource Requirements Head Start Performance Standards(1304.52(3)(Fkl)states that Grantee and delegate agencies must assure that each staff member has had an Initial health examination(Mat includes screening for tuberculosis)and a periodic re- examination(as recommended by their health care provider). In order to comply with this please review the following information and make necessary changes. Please return to me, Thank you for your assistance. Employee Name: Judith Gonzalez Job Title: Paraprofessional Bilinoual ECE Category Current Information Update information(as needed Date of Hire 1 0/1 711 994 Date of Cdrninal 2110/1995 Background Clearance Date of Physical 7/111M002 C1ate of TB Clearance 1/14/2014 ,;� d! alty perjury, tlre above information is correct. — /C2;31'(V, "0 cWrcesSignatuaDate AGREEMENT TO USE FACILITIES Page 28 EXHIBIT"B" Page 6 of 8 taps:/;edW2tDr.CtC.CLSOV/Ogles tUWSIAMSWC?SWER*Wld^I-26,. 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EsPbYnamt no PAWN$ AGREEMENT TO USE FACILITIES Page 29 EXHIBIT"Q" Page 7 of 8 PALM SPRINGS UNIFIED SCHOOL DISTRICT Early Childhood Education MEMORANDUM Joni Pr haft ECE PdwJpel school Raadlam camw 1000 E Tdrpdt Canyon wry,SLdle C l? C E!V=D Para Springs.CA 122112 H UVAN FESoLi R^E3 (Me)4164an FAX(711111)416-s417 JUN 2 9 2916 1p►eWdnQpsusd.us Date: June 21,2016 PALM;SPRINGS UN FIED SCFOC}L GISTF?!CT To: La Sonya Brummell Pitts Director,Classified Human Resources From: Joan Prehoda Principal, Early hildhood Education Subject: Human Resource Requirements Head Start Performance Standards(1304.52(3)G*I)states that Grantee and delegate agencies must assure that each staff member has had an initial health examination(that includes screening for tuberculosis)and a periodic re- examination(as raoommended by their health care provider). In order to comply with this please review the following information and make necessary changes. Please return to me. Thank you for your assistance. Employee dame: Manuala Hinojcea Job Title: Paraprofessional Bilingual ECE Category Current information Update Information(as needed Date of Hire 8/23/1993 /^ Date of Criminal 4/4/1994 ,� Baftround Clearance Date of Physical fxo .r ti / Date of TB Clearance 12/8/2012 Und F e ' y of ry,the above information is correct. _ 6-Z5- «v Huma urces Signature Date AGREEMENT TO USE FACILITIES Page 30 EXHIBIT"B" Page 8 of 8 CoWumRnt Mtpsl'educatar co.gov;mtta enulmmswe?SWERavld-1-2.. McO)M wrttd a omnat rwrsdd"::j ede if la IrtrtgaUt6r rdd va YbmWn d~tety,Olrr titll tWe Iar a►1►gdlaWvlee mMa[It NR Nurrl®1UMA laR RmOe 4rteTd tll►IOtRMtt NIhI RR�rOOT/TaebCd �erlue FIR leuwHWL9LA hhwRynsGan.rd.iAtllaa�tnOmn 7tM+M+�+dexs.a+n�rd �Nrs v4 irrrp¢rrr Need Middle ednn dW vlwds Nam.wR aem rll�an�tl rtm ataYn vie. �C1eHld P.."At tm0NICOM Mrllr Add SA#peVM Atlas 0earrRe :> „part .�. 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Employment Resbicdcas d No Records ► Southern California ReLiEF CERTIFICATE OF COVERAGE Issue Date Protected Insurance Program for Schools 11/2/2017 ADMINISTRATOR: LICENSE# 0451271 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Keenan &Associates AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 4204 Riverwalk Parkway Suite 400 CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE Riverside, CA 92505 AFFORDED BY THE COVERAGE DOCUMENTS BELOW. ENTITIES AFFORDING COVERAGE: 951-715-0190 www.keenan.com ENTITY A: Southern California ReLiEF COVERED PARTY: ENTITY B: Protected Insurance Program for Schools Riverside County Office of Education Riverside Schools' Insurance Authority ENTITY P.O. BOX 868 ENTITY D. Riverside CA 92502 ENTITY E: THIS IS TO CERTIFY THAT THE COVERAGES LISTED BELOW HAVE BEEN ISSUED TO THE COVERED PARTY NAMED ABOVE FOR THE 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 COVERAGE AFFORDED HEREIN IS SUBJECT TO ALL THE TERMS AND CONDITIONS OF SUCH COVERAGE DOCUMENTS. MEMBER ENT TYPE OF COVERAGE COVERAGE EFFECTIVE/ RETAINED LIMIT LIMITS LTR DOCUMENTS EXPIRATION DATE I DEDUCTIBLE A GENERAL LIABILITY COMBINED SINGLE LIMIT EACH OCCURRENCE [y GENERAL LIABILITY SCR00101-31 7/1/2017 $ 50,000 s 1,000,000 [ lCLAIMS MADE t/OCCURRENCE [1YI GOVERNMENT CODES 7/1/2018 [ ERRORS&OMISSIONS [ I A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT EACH OCCURRENCE [ ANY AUTO SCR 00101-31 7/1/2017 s 50,000 s 1,000,000 [ HIREDAUTO 7/1/2018 [ NON-OWNEDAUTO [ GARAGE LIABILITY [ AUTO PHYSICAL DAMAGE A PROPERTY SCR 00101-31 7/1/2017 $ 25,000 s 250,250,000 [ ALL RISK 7/1/2018 EACH OCCURRENCE [ EXCLUDES EARTHQUAKE&FLOOD [ I BUILDER'S RISK A STUDENT PROFESSIONAL LIABILITY SCR 00101-31 7/1/2017 $ 50,000 s Included 7/1/2018 EACH OCCURRENCE B WORKERS COMPENSATION [ I WC STATUTORY LIMITS [,A OTHER [EMPLOYERS LIABILITY PIPS129-14 7/1/2017 S 7/1/2018 $ 1,000,000 E.L.EACH ACCIDENT EXCESS WORKERS COMPENSATION $ 1,000,000 [ ]EMPLOYERS LIABILITY $ E.L.DISEASE-EACH EMPLOYEE S 1,000,000 E.L.DISEASE-POLICY LIMITS OTHER $ S DESCRIPTION OF OPERATIONSfLOCATIONSNEHICLESIRESTRICTIONS/SPECIAL PROVISIONS: Pursuant to Use of Facilities Agreement Number C1006389 between Riverside County Superintendent of Schools and The City of Palm Springs for RCOE to lease property located at Desert Highland Park from the City of Palm Springs in order to place a portable building to house a Head Start program.Coverage shall be primary to certificate holder's coverage as respects to the actions and activities of the Covered Party due to their negligence.Covered Party waives their rights to subrogation,as specified in the agreement between Covered Party and Certificate Holder,subject to the terms and conditions of the MCC. CERTFICATE HOLDER: Agreement Number C1006389 CANCELLATION......SHOULD ANY OF THE ABOVE DESCRIBED COVERAGES BE CANCELED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING ENTITY/JPA Cltyy of Palm Springs WILL� MAIL 30 DAY RITT TI T CATE 3200 East Tahuitz Canyon Way "oL�DERNAMEroTHEheFr � ��LX Palm Springs CA 9226214Ncffii� PtFl�4�t?CdS. John Stephens AUTHORIZED REPRESENTATIVE 38674944 RIV.RSC112 117/10 Super Pool PEL w/Endeavor Susan Bissoone[te 11/2/2017 B:46:37 A /PDT) Page 1 0_` 4 DISCLAIMER The Certificate of Coverage on the reverse side of this form does not constitute a contract between the issuing entily(ies),authorized representative or producer, and the certificate holder,nor does it affirmatively or negatively amend,extend or alter the coverage afforded by the coverage documents listed thereon. icna(hiloic can 38674944 1 R-VERSCH2 17/18 Super Pool P&L w/Endeavor i Susan 2issorneLts 11!2/2017 8:48-37 A (POT) Page 2 of 4 ENDORSEMENT ADDITIONAL COVERED PARTY COVERED PARTY COVERAGE DOCUMENT ADMINISTRATOR Riverside County Office of Education SCR 00101-31 Keenan &Associates Riverside Schools' Insurance Authority Subject to all its terms, conditions, exclusions, and endorsements, such additional covered party as is afforded by the coverage document shall also apply to the following entity but only as respects to liability arising directly from the actions and activities of the covered party described under"as respects" below. Additional Covered Party- Cityy of Palm Springs 3200 East Tahquitz Canyon Way Palm Springs CA 92262 As RPs P�_rts: Pursuant to Use of Facilities Agreement Number C1006389 between Riverside County Superintendent of Schools and The City of Palm Springs for RCOE to lease property located at Desert Highland Park from the City of Palm Springs in order to place a portable building to house a Head Start program. Coverage shall be primary to certificate holder's coverage as respects to the actions and activities of the Covered Party due to their negligence. Covered Party waives their rights to subrogation, as specified in the agreement between Covered Party and Certificate Holder, subject to the terms and conditions of the MOC. Authorized Representative Issue Date: 11/2/2017 JBG74944 I arveasce2 117/16 suoer Pool Psi w/endeavor I Susan Eissonnette 1/2/2017 8:43.37 AM (PDT) I Page 3 Of 4 PI �S t PIPS Waiver of Our Right to Recover From Others Endorsement Riverside Schools Risk Management Autho/Riverside Countv Office of Education 129 PIPS0012914 7/1/2017- 7/l/2018 7/1/2017 12:01 AM Protected Insurance Program for Schools Workers' Compensation and Employers' Liability Policy This endorsement applies only to the coverage provided by the Memorandum of Coverage. We have the right to recover our payments from anyone liable for an injury covered by this Memorandum of Coverage. We will not enforce our right against the person or organization name in the Schedule,but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule,where you are required by a written contract to obtain this waiver from US. Schedule Specific Waiver-Name of Person or Organization: City of Palm Springs 3200 East Tahquitz Canyon Way Palm Springs,CA 92262 Operations: Pursuant to Use of Facilities Agreement Number C1006389 between Riverside County Superintendent of Schools and The City of Palm Springs for RCOE to lease property located at Desert Highland Park from the City of Palm Springs in order to place a portable building to house a Head Start program. Contribution: There is no contribution charged for this endorsement. Authorized Agent Keenan License#0451271 Confidential Client Use Only 38674944 1 RI^.ERSCH2 17/18 Super Poo_ P" w/Endeavor Susan 3issonnette 1111/2/2017 8:48:37 AM ;PDT! Page 4 of 4 fi a-iJ Southern California ReLiEF CERTIFICATE OF COVERAGE Issue Date 6/24/2022 Protected Insurance Program for Schools ADMINISTRATOR: LICENSE # 0451271 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY Keenan & Associates AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 4204 Riverwalk Parkway Suite 400 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE Riverside, CA 92505 AFFORDED BY THE COVERAGE DOCUMENTS BELOW. ENTITIES AFFORDING COVERAGE: RECEIVED 951-715-0190 ENTRYA Southern California ReLiEF entry a Protected Insurance Program for Schools COVERED PARTY: JUL U b ZUZZ Riverside Coun Office of Education nD. Riverside Schools' Insurance AuthQfi�ice of the ClerkENTITr hCity P.O. Box 868 ENT D: Riverside CA 92502 ENTITY E. THIS ISTO CERTIFY THAT THE COVERAGES LISTED BELOW HAVE BEEN ISSUED TO THE COVERED PARTYNAMED ABOVE FOR THE PERIOD INDICATED. NOTWITHSTMDNGANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MY BE ISSUED OR MAY PERTAIN. THECOVERAGE AFFORDED HEREIN IS SUBJECT TO ALL THE TERMS AND CONDITIONS OF SUCH COVERAGE DOCUMENTS. MEMBER ENT TYPE OF COVERAGE COVERAGE EFFECTIVE/ RETAINED LIMIT LIMITS LTR DOCUMENTS EXPIRATION DATE /DEDUCTIBLE A GENERAL LIABILITY COMBINED SINGLE LIMIT EACH OCCURRENCE I ✓IGENEHAL LIABIUT"Y�!( MADE OCCURRENCE SCR 00101-36 7/1/2022 $ 50,000 s 1,000,000 ( }1CIAIMS ♦I I aTIGOVERNMENT CODES 7/1 /2D23 t a�Y�l ERRORS & OMISSIONS 11 A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT EACH OCCURRENCE I ANY ALTO SCR 00101-36 7/1/2022 g 50,000 s 1,000,000 I HIRED AUTO ( NON-0O"ED AUTO 7/1/2023 ( GARAGE UASIUTY I AUTO PHYSICAL DAMAGE A PROPERTY SCR 00101-36 7/1/2022 s 25,000 s 500,250.000 I ALL RISK 7/1 /2023 EACH OCCURRENCE I EXCLUDES EARTHQUAKE B FLOOD I I BUILDER'S RISK A STUDENT PROFESSIONAL LIABILITY SCR 00101-36 7/1/2022 a 50,000 s Included 711 /2023 EACH OCCURRENCE B WORKERS COMPENSATION 1 ]VVCSTATUTORYUMRS IA OTHER I� EMPLOYERSLIABILITY PIPS129-19 7/1/2022 a 7/1/2023 a 1,000,000 El EACH ACCIDENT $ 1,000,000 EXCESS WORKERS COMPENSATION I I EMPLOYERS' LABILITY $ E.L. DISEASE - EACH EMPLOYEE s 1,000,000 El, DISEASE - POLICY LIMITS OTHER a a DESCRIPTION OF OPER nONSILOCATIONSIVEHICLESIRESTMCTIONS/SPECIAL PROVISIONS: Pursuant to Use of Facilities Agreement Number C1006389 between Riverside County Superintendent of Schools and The City of Palm Springs for RCOE to lease property located at Desert Highland Park from the City of Palm Springs in order to place a portable building to house a Head Start program. Coverage shall be primary to certificate holder's coverage as respects to the actions and activities of the Covered Party due to their negligence. Covered Parry waives their Fights to subrogation, as specified in the agreement between Covered Party and Certificate Holder. subject to the terms and Conditions of the MOC. CERTIFICATE HOLDER: Agreement Number C1006389 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cittyy of Palm Springs THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 3200 East Tahquitz Canyon Way Palm Springs CA 92262 ACCORDANCE WITH THE POLICY PROVISIONS John Stephens AUTHORIZED REPRESENTATIVE 69904o.Y RIVERSCH2 1 S2/23 S:rr Pool 11L v/Endeavor I aalliona Bacon 1 6/24/2022 1:30:58 M IPBf1 I Page I of 3 DISCLAIMER The Certificate of Coverage on the reverse side of this form does not constitute a contract between the issuing entity(ies), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the coverage documents listed thereon. 68909069 1 RIVP.RBCH2 1 22/23 Super Pool PiL v/Endeavor I Halliona Bacon 1 6/24/2022 1:38:58 N tPM) I Page 2 of 3 ENDORSEMENT ADDITIONAL COVERED PARTY COVERED PARTY COVERAGE DOCUMENT ADMINISTRATOR Riverside County Office of Education SCR 00101-36 Keenan & Associates Riverside Schools' Insurance Authority Subject to all its terms, conditions, exclusions, and endorsements, such additional covered party as is afforded by the coverage document shall also apply to the following entity but only as respects to liability arising directly from the actions and activities of the covered party described under "as respects" below. AydditionaCCl Covypred Party- of Palm Springs Palm SpringshCA 9 262on Way Pursuant to Use of Facilities Agreement Number C1006389 between Riverside County Superintendent of Schools and The City of Palm Springs for RCOE to lease property located at Desert Highland Park from the City of Palm Springs in order to place a portable building to house Mead Start program. Coverage shall be primary to certificate holder's coverage as respects to the actions and activities of the Covered Party due to their negligence. Covered Party waives their rights to subrogation, as specified in the agreement between Covered Party and Certificate Holder, subject to the terms and conditions of the MOC. Authorized Representative Issue Date: 6/24/2022 68909088 1 RIVER W 1 22/23 Super Pool PiL v/Endeavor I Nalliona Bacon 1 6/24/2022 1:36:58 ea (PM) I Page 3 of 3