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HomeMy WebLinkAbout04984 - PALM SPRINGS AQUATICS PSA COMPETITIVE SWIMMING CITY'S SWIM CENTER POOL DOCUMENT TRACKING Page: 1 Report: Detailed Transactions Detail December 5, 2005 Condition: Document Number a4984, Document# Description Approval Date Expiration Date Closed Date A4984 Swim Center 11/01/2004 10/31/2005 10/31/2005 Company Name: Aquatics Address: , , Group: PARKS & RECREATION Service: In File xRef: PARKS & RECREATION Ins. Status: No Certificate on file. Document Tracking Items: Due Completed Tracking Amount Amount Code Item Description Date Date Date Added Paid to CM for sigs 10/29/2004 ENDOFREPORT * * * * * * v calm aprings Aquauw (PQA) Competitive Swimming AGREEMENT #4984 AGREEMENT TO USE FACILITIES CM signed on 10-29-04_ (/'A This Agreement to Use Facilities ("Agreement") is made this Z&*- day of c, ,4 ,-- 200 �by and between the City of Palm Springs ("City") and Palm Springs Aquatics ("PSA"). The parties enter into this Agreement on the basis of the following facts and intentions: RECITALS WHEREAS,the City of Palm Springs("City")and Palm Springs Aquatics("PSA") are mutually interested in and concerned with providing quality recreational facilities for the citizens of Palm Springs; and WHEREAS,it is recognized that through a cooperative agreement between the City and PSA the community will be afforded the fulfillment of one of its recreational goals for citizens. NOW THEREFORE, the City and PSA do hereby mutually agree as follows: 1. INTENT OF AGREEMENT 1.1 It is the intent of this Agreement to describe the responsibilities of the City and PSA in their cooperative effort to effectively promote and provide competitive swimming for an average of twenty-five (25) youth and adults. 1.2 The parties agree that PSA may identify the City's Swim Center Pool as its "home"pool for all swim meets held for or on behalf of PSA during the term of this Agreement. 1.3 It is the intent of this Agreement to solidify a supportive and working relationship between PSA and the City. 1.4 It is the intent of this Agreement that both the City and PSA acknowledge and direct their efforts toward the development of quality swim programs at the City's Swim Center. 2. AREAS OF RESPONSIBILITY 2.1 Fees and Charges 2.1.1 PSA agrees to pay the City for its use of the Swim Center Pool on a monthly basis. The payments shall be a minimum of $150 per month, payable in advance on the first of each month and may be increased pursuant to the rates identified inthe City's Comprehensive Fee Schedule. (If the number of swimmers exceeds what is stated in Section 1.1 above at any time during the term of this Agreement, PSA shall notify City so that an adjustment to the monthly fee can be made.) 23324v2 AGREEMENT TO USE FACILITIES Page 2 2.2 Pool Use and Scheduling 2.2.1 The City shall make the Swim Center available on a shared, non- exclusive basis, which does not interfere with the City's other recreation programs. Notwithstanding the foregoing,it is understood that PSA shall be permitted to utilize the Swim Center in accordance with the schedule below. This schedule is subject to change with the approval of the Contract Officer and in accordance with Section 2.2.2. The City has sole discretion to resolve all scheduling conflicts. The City shall act in a timely mamzer to resolve all scheduling conflicts. During high school water sports season, Palm Springs Unified School District's ("District") schools shall have priority use of the Swim Center. PSA TYPICAL PRACTICE SCHEDULE 5:00 A.M. to 7:00 a.m. Monday— Wednesday—Friday 3:00 p.m. to 6:30 p.m. Monday through Friday 7:00 a.m. to 9:00 a.m. Saturday The District's schedule is subject to changes which may affect PSA's use of the Swim Center Pool. During the Monday, Wednesday and Friday morning sessions,and the Monday through Friday after school sessions, identified above, PSA may use three (3) lanes at the Swim Center Pool. At the discretion of City, PSA may be given access to four (4) additional lanes if they are available. The lanes will be assigned by the City. On Saturday mornings when the Piranha Swim Team has dual meets scheduled, PSA will not be allowed to use the Swim Center Pool. The above-listed times apply only to"short course"training. Priority will be given to the Piranhas Swim Team("PST") for"long course" training. PSA will have to adjust its times around the PST if it chooses to train"long course." 2.2.2 PSA must submit its seasonal practice schedule in writing at least thirty (30) days in advance of the beginning date of the schedule. 2.2.3 PSA members shall not enter the Swim Center facility for meets or practices until a coach or designated PSA adult representative is on deck to supervise unless that PSA member has paid the public fee to use the pool. 2.2.4 When the Swim Center is closed for maintenance,the monthly rental rate will be prorated and adjusted accordingly. 23324v2 AGREEMENT TO USE FACILITIES Page 3 2.3 Coaching Staff 2.3.1 PSA shall have complete responsibility for the control and supervision of its coaching staff. 2.3.2 PSA shall be responsible for the control and safety of its members and guests within the Swim Center. 2.3.3 It is the responsibility of PSA to insure that all coaching staff is currently certified in C.P.R., First Aid and lifeguard training. The United States Swimming Coach's Certification in First Aid can apply to this qualification. Proof of such certification must be presented by PSA to the City on a yearly basis. City will not provide lifeguard services for practice or swim meets. 2.3.4 Any person having supervisory or disciplinary authority over any minor member of PSA is subject to a criminal background screening as specified in California Public Resources Code Section 5164. Each PSA employee or volunteer having supervisory or disciplinary authority over any minor must complete the supplemental questions attached as Exhibit "A" and must concti rently submit to being fingerprinted by the City. PSA must submit a completed copy of Exhibit"A" and arrange for the fingerprinting of each employee and volunteer before this Agreement may be executed by the City. The first year that the City performs the background screening for a particular individual, the screening shall include screening by the federal government. All subsequent years that the City is required to perform a background check on that same individual, the screening need only be performed by the state govenmient. 2.3.5 PSA must provide the City with a list of its employees and/or volunteers who will have supervisory or disciplinary authority over any minors while at the Swim Center. A true and correct list of such employees as of the date of execution of this Agreement is attached hereto as Exhibit"B". Should PSA hire anew employee or volmiteer who should be listed on Exhibit "B", PSA must notify City of this fact within one week and PSA must concurrently submit a completed copy of the questionnaire, attached as Exhibit "A" for the new person. 2.4 Equipment and Storage 2.4.1 PSA shall install equipment necessary to conduct practice and swim meets, with the exception of starting blocks. In a like manner, PSA shall remove, in a timely fashion, all equipment that it installs to 233242 AGREEMENT TO USE FACILTIES Page 4 conduct practice and swim meets (with the exception of starting blocks). 2.4.2 PSA shall repair or replace, at its expense, damaged equipment if damage occurred as a result of negligence by PSA or its officers, employees, members or invitees. 2.4.3 The City shall repair or replace damaged equipment, if damaged other than by PSA, at City's expense. 2.4.4 PSA shall notify the City of any damaged equipment in need of repair. Should the City fail to make the requested repairs,PSA shall be held harmless from any claim filed against PSA for injury resulting from said damaged equipment. 2.4.5 If the rental of joint-use equipment is deemed appropriate, a charge of$40/day will be imposed. All proceeds will be donated back to the City for purchase of more joint-use equipment. 2.5 PSA Bylaws 2.5.1 PSA must maintain on file two (2) copies of its Articles of Incorporation, Bylaws, and Rules and Regulations with the City Clerk's office. Any revisions must be submitted to the Parks and Recreation Manager prior to action by PSA's Board. 3. INSURANCE AND INDEMNIFICATION 3.1 PSA 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$1,000,000. 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 that shall indermiify, insure and provide legal defense for both PSA 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 PSA 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 233242 AGREEMENT TO USE FACILITIES Page 5 less than either(i)bodily injury liability limit of$250,000 per person and$500,000 per occurrence and property damage liability limits of $100,000 per occurrence and $250,000 in the aggregate, or (ii) combined single limit liability of$500,000. 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,PSA 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 PSA has provided the city with Certificates of Insurance or appropriate insurance binders evidencing the above insurance coverage and said Certificates of Insurance or binders are approved by the City. PSA agrees that the provisions of this Section 3.1 shall not be construed as limiting in any way the extent to which PSA may be held responsible for the payment of damages to any persons or property resulting from PSA's activities or the activities of any person or persons for which PSA is otherwise responsible. In the event PSA subcontracts any portion of the work or services, the contract between PSA and such subcontractor shall require the subcontractor to maintain the same policies of insurance that PSA is required to maintain pursuant to this Section 3.1. 3.2 Indemnification. PSA agrees to indemnify the City, its officers, agents and employees against and will hold quid 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 performance of the work, operations or activities of PSA, 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 23324v2 AGREEMENT TO USE FACILITIES Page 6 the City, its officers,agents or employees who are directly responsible to the City and, in cormection therewith: a. PSA 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. PSA 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 PSA hereunder; and PSA agrees to save and hold the City, its officers, agents and employees harmless therefrom; C. In the event the City, its officers, agents or employees, is made a party to any action or proceeding filed or prosecuted against PSA for such darnages or other claims arising out of or in comiection with the negligent performance of or failure to perform the work,operation or activities of PSA hereunder, PSA 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. 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, PSA 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 PSA 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. 23324v2 AGREEMENT TO USE FACILITIES Page 7 3.4 PSA shall provide the City with a properly executed copy of the "Medical Release and Liability and Waiver and Release" form attached hereto as Exhibit "C" for each swim team member, swim program participant, swim competition participant, swim coach, swim official and/or anyone else associated with PSA in any way prior to said person using the City's Swim Center pool and/or facilities.The"Medical Release and Liability and Waiver and Release"form shall be executed by the coach,official,participant if over eighteen(18) years of age, and the participant's parent, natural and/or legal guardian if the participant is under eighteen (18) years of age. 4. WAIVER OF UTILITY FAILURE 4.1 PSA 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 Swim Center. 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 PSA 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 PSA's right to terminate this Agreement without cause pursuant to Section 5.6. 23324v2 AGREEMENT TO USE FACILITIES Page 8 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. hi 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. 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 sixty(60) days' written notice to PSA, except that where termination is due to the fault of PSA, the period of notice may be such shorter time as may be determined by the Contract Officer. In addition, PSA 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 PSA 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. 23324v2 AGREEMENT TO USE FACILITIES Page 9 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 PSA 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 PSA or to its successor or for breach of any obligation of the terms of this Agreement. 62 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. PSA 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. PSA 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. 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 Director of Parks and Recreation, CITY OF PALM SPRINGS, P.O. Box 2743, Palm Springs, California 92263, and, in the case of PSA, 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. 23324v2 AGREEMENT TO USE FACILITIES Page 10 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 mienforceable 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. 8. COORDINATION OF WORK 8.1 Representatives of PSA. The following principals of PSA are hereby designated as being the principals and representatives of PSA, authorized to act in its behalf with respect to the work specified herein and make all decision in connection therewith: President or Board of Directors' Designee I I I I Tahquitz Carryon Way, Suite 103 Palm Springs, CA 92262 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 PSA and devoting sufficient time to personally supervise the uses hereu ider. However, if, through the course of this contract, the representatives of PSA 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 PSA. 233242 AGREEMENT TO USE FACILITIES Page 11 8.2 Contract Officer. The Contract Officer shall be such person as may be designated by the City Manager of City. It shall he PSA's responsibility to assure that the Contract Officer is kept informed of PSA's use of the Swim Center 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. 9. TERM 9.1 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 one year beginning November 1, 2004 and ending October 31, 2005. This Agreement is executed by the duly authorized representative of the City of Palm Springs and Palm Springs Aquatics as of the date first written above. "CITY" CITY OF PALM SPRINGS -/' BY By/rec4��� l City Manager ofParlcs and Recreation Att st � ity Clerk Tf Tvflc�".' C,/R lAnu�l.��"J�*aOL�R, "PSA" 'a i � -""�"` "`6"'" PALM SPRINGS AQUATICS y I15: Its: / — Approved as to Form: By: Legal Counsel for Palm Springs Aquatics 23324v2 "EXHIBIT A" Page 1 of 2 SUPPLEMENTAL QUESTIONNAIRE 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 NO 1. Have you ever been convicted of sexual assault or assault with intent to commit mayhem? ❑ C3 2. Have you ever been convicted or unlawful sexual intercourse with a person under age 18? ❑ la 3. Have you ever been convicted of rape? ❑ LEI 4. Have you ever been convicted of the rape of a spouse? ❑ C� 5. Have you ever been convicted of willful harm or injury to a child? ❑ Ell 6. Have you ever been convicted of child endangerment? ❑ B 7. Have you ever been convicted of corporal punishment or injury to a child? ❑ R� 8. Have you ever been convicted or willful infliction of corporal injury to a spouse,former ❑ CH' spouse,cohabitant,or mother or father of your child? 9. Have you ever been convicted of any sexual crime or offense? ❑ 2' 10. Have you ever been convicted of any of the following crimes or of an attempt to commit any of the following crimes? 10.1. Kidnapping? ❑ Ky If yes,were you convicted of kidnapping or attempted kidnapping with the intent to ❑ a commit rape,sodomy, lewd or lascivious acts, oral copulation, or forcible acts of sexual penetration? 10.2. Kidnapping for ransom? ❑ CAI If yes,were you convicted of kidnapping for ransom or attempted kidnapping for ransom ❑ la' with the intent to commit rape, sodomy, lewd or lascivious acts,oral copulation,or forcible acts of sexual penetration? 10.3. Sexual battery? ❑ C� 10.4. Aiding,abetting or soliciting the rape,rape of a spouse, or forcible acts of sexual ❑ CN penetration? 10.5. Enticement of an unmarried minor female for purposes of prostitution? ❑ C3 10.6. Aiding and abetting the enticement of an unmarried minor female for proposes of ❑ Pf prostitution? 10.7. Inducing sexual intercourse with another when the other's consent is procured by false ❑ 2-� pretenses with the intent to create fear? 10.8. Pimping of a minor? ❑ R11 10.9. Pandering of a minor? ❑ C( 10.10. Procurement of a child under 16 years of age for lewd or lascivious acts? ❑ D" 10.11. Abduction(taking away)of a person under age 18 for purposes of prostitution? ❑ EEl 10.12. Aggravated sexual assault of a child? ❑ P/ 10.13. Incest? ❑ [oll YES NO 10.14. Sodomy? ❑ 10.15. Lewd or lascivious acts or the solicitation of the same? ❑ d 10.16. Oral copulation? ❑ 10.17. Continuous sexual abuse of a child? ❑ 10.18. Forcible acts of sexual penetration or the solicitation of the same? ❑ C✓1 10.19. Selling,distributing,printing or exhibiting of child pornography? ❑ CAI 10.20. Sexual exploitation of a child? ❑ CAI 10.21. Employment or use of a minor to perform prohibited acts? ❑ rd 10.22. Advertising child pornography? ❑ LY 10.23. Possession of child pornography? ❑ Cf 10.24. Annoying or molesting a child under 18? ❑ L� 10.25. Solicitation of rape by force or violence,sodomy by force or violence, or oral ❑ I� copulation by force or violence? 10.26. Indecent exposure? ❑ Ll 10.27. Procuring, counseling, or assisting any person to commit indecent exposure? ❑ C� 10.28. Contributing to the delinquency of a minor? ❑ L( 10.29. Sending harmful material to a minor with the intent to seduce said minor? ❑ 11. Have you ever been convicted of armed robbery? ❑ C� 12. Have you ever been convicted of armed carjacking? ❑ LY 13. Have you ever been convicted of assault or attempted murder of a public official? ❑ Ll� 14. Have you ever been convicted of false imprisonment? ❑ G� 15. Have you ever been convicted of assault? ❑ Ei 16. Have you ever been convicted of battery? ❑ L( 17. Have you ever been convicted of murder? ❑ LY 18. Have you ever been convicted of mayhem? ❑ 19. Have you ever been convicted of a crime that requires you to register as a sex offender in the ❑ G3� State of California? CERTIFICATION OF APPLICANT I hereby certify that all responses herein are true and correct, and I understand and agree that any misstatement or omission of material fact may cause forfeiture n my part of all rights to employment by t is City. Date: Signature: a "EXHIBIT A" Page 2 of 2 "EXHIBIT B" LIST OF FACILITY USER'S EMPLOYEES AND VOLUNTEERS WHO HAVE SUPERVISORY OR DISCIPLINARY AUTHORITY "EXHIBIT B" Page 1 of 1 233242 "EXHIBIT U - Page 1 of 2 CITY OF PALM SPRINGS RECREATION DIVISION SWIM CENTER EMERGENCY CARD/MEDICAL RELEASE/WAIVER AND RELEASE FORM Participant Name: Last First MI Parent/Guardian Name: Last First MI Home Address: City/State/Zip Code: Phone(day): Phone(evening): If under 18,the following information is required. Age Date of Birth: Medical/Health Insurance: Physician's Name/Phone: EMERGENCY CONTACTS First and Last Names Relationship to Phone(Day) Phone(Evening) Phone Participant (Pager/Cellular) MEDICAL RELEASE I hereby represent that I am/the participant is physically able to participate in the swim program,event,practice and/or other related activity and that I have/the participant has no medical condition that may cause any health problem related to my/the participant's involvement in the swim program, event, practice and/or other related activity at the Palm Springs Swim Center. WAIVER AND RELEASE FORM I acknowledge,understand and agree that swimming and/or diving and participation in a swimming program,event,practice and/or other related activity are extreme tests of a person's physical and mental limits and that my/my child's and/or minor's,for whom I am the natural and/or legal guardian, (hereinafter the term"child"shall refer to the parent's child and/or a minor under the care of a natural and/or legal guardian) participation in a swimming program, event, practice and/or other related activity can cause potential death, minor to serious injuries,disability,property damage and/or loss. I also acknowledge,understand and agree that being in the proximity of swimming pools creates a danger given wet, slippery and/or other conditions which may result in my/my child's slipping and/or falling. With a full understanding of the potential risks, I HEREBY ASSUME ALL RISKS associated with my/my child's participation in any and all swim programs, events, practices,team sports, and other related activities at the Palm Springs Swim Center, including, but not limited to, any injury, disability, damage, and/or loss related in any way to: swimming; diving; coaching, officiating; strenuous physical activity and/or exertion;striking and/or being struck by objects and/or persons;slipping and/or falling off/from any and all surfaces and/or all appurtenances located at the Palm Springs Swim Center;and/or exposure to chemicals,heat,cold and/or humidity.I acknowledge,understand and agree that said risks may result in injuries that include,but are not limited to:sprain;strain and/or tear of muscles and/or ligaments;fracture and/or dislocation of joints and/or bones; head and/or facial injuries; spinal cord and/or internal injuries; and/or other injuries and/or disabilities. I acknowledge,understand and agree that the usual risks, hazards and dangers of incurring damages and/or injuries increase when any structure and/or device is used in conjunction with swimming,diving,coaching,and/or officiating.I understand that these risk,hazards and dangers are further increased when other persons,whether or not of the same level of experience of swimming, are present at the same time and using the same facilities.ALL SUCH RISKS ARE KNOWN AND APPRECIATED BY ME. I hereby take the following action for myself,my child and my child's executors,administrators, heirs,next of kin,successors and assigns, and/or anyone else who might claim on my and/or my child's behalf:a)I WAIVE, RELEASE AND DISCHARGE the City of Palm Springs, its officers,agents,and employees,from any and all duty to me and/or my child from any and all actions,suits,claims,damages to person orproperty,losses,costs,penalties,obligations or liabilities(hereinafter"claims or liabilities")which are related in anywayto my/my child's use of the Palm Springs Swim Center for any purpose,including,but not limited to,participating in a swim program,practice,events,and/or other related activity, including all liability for any active or passive negligence by the City of Palm Springs, its officers, agents, or employees, but excluding such claims or liabilities arising from the sole negligence or willful misconduct of the City of Palm Springs, its officers,agents, or employees.This release and waiver extends to all claims and liabilities of every kind or nature whatsoever,foreseen or unforeseen,known or unknown;b)I AGREE NOT TO SUE the City,its employees,agents,and officers forany ofthe claims or liabilities that I have waived,released or discharged herein; and c)I AGREE TO INDEMNIFY, DEFEND AND HOLD HARMLESS the City of Palm Springs, its employees, agents, and officers from claims or liabilities that may be asserted or claimed by any person, firm, and/or entity arising out of or in connection with my/my child's actions during my/my child's use of the Palm Springs Swim Center,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. I further agree to grant to the City of Palm Springs the right to take my photograph and/or video of myself/my child,to use my/my child's name, likeness,and image, in print,video,and/or electronic medial form, in promotional materials and/or any account or record of my/my child's participation in any activities at the Palm Springs Swim Center without compensation to me/my child. I understand and agree that if I/my child vandalize and/or destroy City property,fees and/or damages will be assessed for which I will be billed and which I agree to pay forthwith. I/my child understand and agree that I/my child may be denied further admission to the Palm Springs Swim Center if I/my child vandalize and/or destroy any City property. SIGNATURE(S) REQUIRED As evidenced by my signature,I certify that I have read and I understand the foregoing Medical Release and Waiver and Release of Liability form; and understand and agree that I have given up substantial rights, and affirm that I am eighteen (18)years of age or older. Printed Name Participant's Signature Date Signed I AM UNDER THE AGE OF EIGHTEEN (18)YEARS OF AGE, MY PARENT/GUARDIAN HAS READ AND COMPLETED THE SECTION BELOW. (If applicant is under 18 years of age, a parent or guardian must execute, in addition to the foregoing Waiver and Release,the following,for and or behalf of the minor.) The undersigned (parent or guardian name), the parent or natural guardian or legal guardian of (minor's name) executes the foregoing Medical Release and Waiver and Release of Liability form for and on behalf of the minor named herein. I hereby bind myself,the minor and all other assigns to the terms of the Medical Release and Waiver and Release of Liability. I represent that I have legal capacity and authority to act for and on behalf of the minor named herein, and I agree to indemnify, defend, and hold harmless the City, its employees, agents, and officers from any claims or liabilities assessed against them as a result of any insufficiency of my legal capacity or authority to act for and on behalf of the minor in the execution of the Medical Release and Waiver and Release of Liability form 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. Printed Name Parent's/Guardian's Signature Date Signed "EXHIBIT C"- Page 2 of 2 DATE(MWDDNY) CERTIFICATE OF LIABILITY INSURANCE I 02/02/04 r. )DUCER 1-800-777-4930 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Risk Management Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P.O. Box 32712 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phoenix, AZ 85064-2712 INSURERS AFFORDING COVERAGE INSURED INSURERA.Lexington Insurance Company PALM SPRINGS AQUATIC USA Swimming etal Incl Local Swimming Committees INSURERS Mutual of Omaha Insurance Company JOHN CYGANIEWICZ INSURER C 1111 E TAHQUITZ CANYON WAY, SUITE 103 PALM SPRINGS, CA 92262-6789 INSURER D: INSURER E COVERAGES 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. INSR POLICYEFFECTIVE POLICY EXPIRATION LTR TYPEOFINSURANCE POLICY NUMBER DATE fMMIDU/YYI DATE fMM/DD/YYI LIMITS A GENERAL LIABILITY 0379401 12/31/03 12/31/04 EACH OCCURRENCE 1$2,000,000 X COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Anyone fire) §1001000 CLAIMS MADE lxl OCCUR MED EXP(Any one person) ($EXCLUDE➢ X Participant Legal PERSONAL&ADV INJURY $1,000,000 X Liability Included GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $2,000,000 IPRO- POLICY 71 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON,OWNED AUTOS (Peraccldenl) § PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY EAACCIDENT $ ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGO $ A EXCESS LIABILITY 6500411 12/31/03 12/31/04 EACH OCCURRENCE $3,000,000 y1 J OCCUR CLAIMS MADE AGGREGATE $8,000,000 $ DEDUCTIBLE $ RETENTION $ § WORKENS COMPENSATION AND TNCSLAMIT OTH- EMPLOYERS'LIABILITY E L.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT $ OTHER R XS ACC MED/DENTAL AD & D TSMPSP35054 01/01/04 01/01/05 Maximum 25,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 7erification of General/Excess Liability for INSURED ACTIVITIES per attached. The Certificate Holder is included is Additional Insured per attached ADDITIONAL INSURED ENDORSEMENT EFFECTIVE CERTIFICATE ISSUE DATE. JERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER:. CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ity of Palm Springs DATE THEREOF,THE ISSUING INSURER WILL d7WQ4W MAIL 30 DAYS WRITTEN ept of Fac/Rec Division NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,IKJrAU NKX7=I3O SHALL TTN: Vicki Oltean 01 S Pavilion Way R Awph)wfaxmKxx=xxmmxxoMDLUX=XXXXXXXXXXXXXKEMxnxxx alto Sprin I gs, CA 92262 USA 'A �'L*AUTHORIZED REPRESENTATIVE A � lz- CORD 25-S(7197) CA—PSA O ACORD CORPORATION 1988 1643619 Powered ByCertfficatesNDwTM '