HomeMy WebLinkAbout04164 - ROBERT TETTE POLICE PERSONNEL RECRUIT MO 6523 pA�M s City of Palm Springs
Office of the City Clerk
(760) 323-8204
V U+
MEMORANDUM
i 0��011A1t�`
r
roc,FORN\
Date: April 23, 2003
To: Police Department
From: City Clerk
AGREEMENT #4164— Robert L. Tette, Background Investigation
Please let us know the status of the above agreement, and if it may be closed.
Termination Date of Agreement: 7-1-01
STATUS:
COMPLETED:
REMAIN OPEN UNTIL:
Date & Initials
c�
CLOSE AGR �
Sighat��
PLEASE RETURN TO THE OFFICE OF THE CITY CLERK
c-clk\forms.std\agr-clse.mem
F • O Robert Tette
Personnel Recruitment
AGREEMENT #4164 Amend #1
M06791, 2-23-01
AMENDMENT TO CONTRACT SERVICES AGRL�,,.-- -- - - _
FOR PERSONNEL RECRUITMENT, TESTING,
AND INVESTIGATION SERVICES
This AMENDMENT TO CONTRACT SERVICES AGREEMENT FOR PERSONNEL
RECRPITMENT, TESTING, AND INVESTIGATION SERVICES ("Amendment") is entered
this° day of--U� 2001, by and between the CITY OF PALM SPRINGS, a California
municipal corporation ("City"), and ROBERT L. TETTE ("Contractor").
RECITALS
WHEREAS, on November 3, 1999, City entered into that certain Contract Services
Agreement for Personnel Recruitment, Testing, and Investigation Services ("Agreement") with
Contractor concerning personnel services provided by Contractor to City, as outlined in Exhibit
"A" therein.
WHEREAS, .City is desirous of retaining Contractor to be available additional services
and for longer time periods per week than those required under the Agreement to address the
City's needs in providing recruitment, testing and background investigation services.
WHEREAS, Contractor is desirous of providing the additional personnel services to the
City to meet the City's needs, in consideration for an adjustment of the compensation and
contract sum, as set forth in this Amendment.
NOW THEREFORE, in consideration of the mutual covenants hereinafter contained, the parties
mutually agree as follows:
1. Exhibit "A" of the Agreement, at the introductory paragraph immediately before
Paragraph "A" therein shall be amended in its entirety to read as follows:
Contractor shall provide personnel recruitment, testing, background investigation
and training services to City in accordance with this agreement and the terms and
conditions below:
2. Exhibit "A" of the Agreement, at Paragraph "B" therein shall be amended to add the
following new paragraphs 7 through 9, with the existing paragraphs to remain unchanged and in
full force and effect:
7. Maintain and update police department employee training records.
8. Ensure compliance with P.O.S.T. standards for continued professional training for
police department employees.
9. Schedule and coordinate approved training and training requests for police
department employees.
3. Exhibit "A" of the Agreement, at Paragraph "C" therein shall be amended in its entirety
to read as follows:
627/014084-0001
145848 01 aI2/27/00 '
f
• o
C. Hours of Work. Contractor shall generally be available to perform the services
required by this Agreement approximately forty (40) hours per week on a schedule
approved by the Police Chief.
4. Exhibit "B" of the Agreement, at Paragraph "1 " therein shall be amended in its entirety to
read as follows:
1. Compensation. Contractor shall be compensated at a rate of Twenty Dollars
($20.00) per hour for services performed pursuant to this Agreement.
5. Exhibit "B" of the Agreement, at Paragraph "3" therein shall be amended in its entirety to
read as follows:
3. Contract Sum. The total amount authorized by this Agreement shall not exceed
Fifty Thousand Dollars ($50,000.00).
6. Full Force and Effect. Except as expressly amended herein, all terms of the Agreement
shall remain unchanged and in full force and effect.
IN WITNESS WHEREOF, theparties have executed and entered into this Amendment as
of the date first written above.
CITY OF PALM SPRINGS,
City Manager
T-T- T:
City Clerk
APPROVED AS TO FORM:
((X7W COUNCIL
City A It or ey ✓9 1j`!
CONTRACTOR
ROBERT L. TETTE
By.
Robert L. Tette
Address: 44-930 Mailia Circle
La Quinta, CA 92253
(END OF SIGNATURES)
627/014094 OW
145848 01 e 12/27/00 -2-
Robert L. Tette
Police Dept. Personnel Recruitment
Services
AGREEMENT#4164
CITY OF PALM SPRINGS M06523, 11-3-99
CONTRACT SERVICES AGREEMENT FOR
PERSONNEL RECRUITMENT, TESTING,
AND INVESTIGATION SERVICES
THIS CONTRACT SERVICES AGREEMENT (herein "Agreement") is made and
entered into this 3rd day of November, 1999, by and between the CITY OF PALM SPRINGS,
a municipal corporation, (herein "City") and ROBERT L. TETTE (herein "Contractor") (The
term Contractor includes professionals performing in a consulting capacity.).
NOW, THEREFORE, the parties hereto agree as follows:
1.0 SERVICES OF CONTRACTOR
1.1 Scope of Services. In compliance with all of the terms and conditions of
this Agreement, the Contractor shall perform the work or services set forth in the "Scope of
Services" attached hereto as Exhibit "A" and incorporated herein by reference. Contractor
warrants that all work and services set forth in the Scope of Services will be performed in a
competent, professional and satisfactory manner.
1.2 Compliance With Law. All work and services rendered hereunder shall
be provided in accordance with all ordinances, resolutions, statutes, rules, and regulations of the
City and any Federal, State or local governmental agency of competent jurisdiction.
1.3 Licenses, Permits, Fees and Assessments. Contractor shall obtain at its
sole cost and expense such licenses, permits and approvals as may be required by law for the
performance of the services required by this Agreement.
2.0 COMPENSATION
2.1 Contract Sum. For the services rendered pursuant to this Agreement,
Contractor shall be compensated in accordance with the "Schedule of Compensation" attached
hereto as Exhibit "B" and incorporated herein by this reference.
2.2 Method of Pam. Provided that Contractor is not in default under the
terms of this Agreement, Contractor shall be paid upon submitting an invoice to the City, in
accordance with the City's regular accounts payable cycle, for services rendered prior to the date
of the invoice.
-1 of 8- ROBERT L.TETTE/PERSONNEL RECRUITMENT,
276/01,1084-0004/3301337.1 m10/28/99 TESTING,AND INVESTIGATION SERVICES AGR
• O
3.0 COORDINATION OF WORK
3.1 Representative of Contractor. Robert L. Terre is hereby designated as
being the principal and representative of Contractor authorized to act in its behalf with respect
to the work and services specified herein and make all decisions in connection therewith. It is
expressly understood that the experience, knowledge, capability and reputation of the foregoing
principal were a substantial inducement for City to enter into this Agreement. Therefore, the
foregoing principal shall be responsible during the term of this Agreement for directing all
activities of Contractor and devoting sufficient time to personally supervise the services
hereunder. For purposes of this Agreement, the foregoing principal may not be replaced nor
may his responsibilities be substantially reduced by Contractor without the express written
approval of City.
3.2 Contract Officer. The Police Chief is hereby designated as being the
representative the City authorized to act in its behalf with respect to the work and services
specified herein and make all decisions in connection therewith ("Contract Officer").
3.3 Prohibition Against Subcontracting or Assi> nment. Contractor shall not
contract with any entity to perform in whole or in part the work or services required hereunder
without the express written approval of the City. Neither this Agreement nor any interest herein
may be assigned or transferred, voluntarily or by operation of law, without the prior written
approval of City. Any such prohibited assignment or transfer shall be void.
3.4 Independent Contractor. Neither the City nor any of its employees shall
have any control over the manner, mode or means by which Contractor, its agents or employees,
perform the services required herein, except as otherwise set forth. Contractor shall perform
all services required herein as an independent contractor of City and shall remain under only
such obligations as are consistent with that role. Contractor shall not at any time or in any
manner represent that it or any of its agents or employees are agents or employees of City.
4.0 INSURANCE, INDEMNIFICATION, AND BOND
4.1 Insurance. The Contractor 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) 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 limits of$100,000.00 per person and $300,000.00 per occurrence
and property damage liability lirnits of $100,000.00 per occurrence and $300,000.00 in
the aggregate. Said policy shall include coverage for owned, non-owned, leased and
hired cars.
All of the above policies of insurance shall be primary insurance. The insurer shall
waive all rights of subrogation and contribution it may have against the City, its officers,
-2 Of g- ROBERT L.TETTE/PERSONNEL RECRUITMENT,
276/014084-0004/3301337.1 m10/28/99 TESTING,AND INVESTIGATION SERVICES AGR
• o
employees and agents and their respective insurers. 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, the Contractor shall, prior to the
cancellation date, submit new evidence of insurance in conformance with this Section 4.1 to the
Contract Officer.
The Contractor agrees that the provisions of this Section 4.1 shall not be construed as
limiting in any way the extent to which the Contractor may be held responsible for the payment
of damages to any persons or property resulting from the Contractor's activities or the activities
of any person or persons for which the Contractor is otherwise responsible.
The insurance required by this 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 due to unique circumstances.
4.2 Indemnification. City shall defend, hold harmless and indemnify
Contractor against any tort, professional liability claim, demand or other legal action, arising
out of an alleged act or omission occurring in the performance of Contractor's services pursuant
to this Agreement, except that this provision shall not apply with respect to any intentional tort
or crime committed by the Contractor.
4.3 Bond. City shall bear the full cost of any fidelity or other bonds required
of the Contractor under any law or Ordinance.
5.0 TERM
5.1 Term. Unless earlier terminated in accordance with Section 5.2 below,
this Agreement shall continue in full force and effect until June 30, 2001.
5.2 Termination Prior to Expiration of Term. Either party may terminate this
Agreement at any tirne, with or without cause, upon fourteen (14) days' written notice to the
other party. Upon receipt of the notice of termination, the Contractor shall immediately cease
all work or services hereunder except as may be specifically approved by the Contract Officer.
In the event of termination by the City, Contractor shall be entitled to compensation for all
services rendered prior to the effectiveness of the notice of termination and for such additional
services specifically authorized by the Contract Officer and City shall be entitled to
reimbursement for any compensation paid in excess of the services rendered.
6.0 MISCELLANEOUS
6.1 Covenant Against Discrimination. Contractor covenants that, by and for
himself, his heirs, executors, assigns and all persons claiming under or through them, that there
-3 Of g- ROBERT L TETTE/PERSONNEL RECRUITMENT,
276/014084-0004/3301337.1 m10/28/99 TESTING,AND INVESTIGATION SERVICES AGR
0
shall be no discrimination against or segregation of, any person or group of persons on account
of race, color, creed, religion, sex, marital status, national origin, or ancestry in the
performance of this Agreement. Contractor shall take affirmative action to ensure that applicants
are employed and that employees are treated during employment without regard to their race,
color, creed, religion, sex, marital status, national origin or ancestry.
6.2 Non-liability of City Officers and Employees. No officer or employee of
the City shall be personally liable to the Contractor, or any successor in interest, in the event
of any default or breach by the City or for any amount which may become due to the Contractor
or to his successor, or for breach of any obligation of the terms of this Agreement.
6.3 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 which effects 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. The Contractor warrants
that he has not paid or given and will not pay or give any third party any money or other
consideration for obtaining this Agreement.
6.4 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 prepaid, first-class mail, in the case
of the City, to the Police Chief and to the attention of the Contract Officer, CITY OF PALM
SPRINGS, 200 S. Civic, P.O. Box 1830, Palm Springs, CA 92263, and in the case of the
Contractor, to the person at the address designated on the execution page of this Agreement.
6.5 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
which might otherwise apply.
6.6 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.
6.7 Severability. In the event that part of this Agreement shall be declared
invalid or unenforceable by a valid judgment or decree of a court of competent jurisdiction, such
invalidity or unenforceability shall not affect any of the remaining portions of this Agreement
which 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 basic benefit of their bargain or renders this Agreement meaningless.
6.8 Waiver. No delay or omission in the exercise of any right or remedy by
a nondefaulting party on any default shall impair such right or remedy or be construed as a
-4 of 8- ROBERT L TETTE/PERSONNEL RECRUITMENT,
276/014084-0004/3301337.1 m10/28/99 TESTING,AND INVESTIGATION SERVICES AGR
• o
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.
6.9 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.
[SIGNATURES FOLLOW ON NEXT PAGE]
-5 of 8- ROSERT L.TETTE/PERSONNEL RECRUITMENT,
276/014084-0004/3301337.1 m1028/99 TESTING,AND INVESTIGATION SERVICES AGR
• o
IN WITNESS WHEREOF, the parties have executed and entered into this Agreement
as of the date first written above.
CITY:
CITY OF PALM SPRINGS,
a municipal corporation
Polic�,Chief
A T=F- T:
Ity Clerk City Manager
PPI�OVFD BY`N CITYCOUiNCIL
APPROVED AS TO FORM: Iyy- S�Nt0 523 3_fc f7
RUTAN & TUCKER, LLP 1117V
111
David leshire
City Attorney
CONTRACTOR:
ROBERT L. TETTE
Robert L. Tette
Address: 44-930 Malia Circle
La Quinta, CA 92253
[END OF SIGNATURES]
-6 of 8- ROEERT L.TETTE/PERSONNEL RECRUITMENT,
276/014084-0004/3301337.1 m10/28/99 TESTING,AND INVESTIGATION SERVICES AGR
• o
EXHIBIT "A"
SCOPE OF SERVICES
Contractor shall provide personmel recruitment, testing, and background investigation
services to City in accordance with this Agreement and the terms and conditions below:
A. General. Contractor shall generally assist and consult with the Police Chief or his
designee(s) (Special Services Commander, Personnel and Training Sergeant), in matters
related to personnel services as outlined below.
B. Duties. Contractor's duties shall include, but are not limited to, the following:
1. Assist in the recruitment of prospective Police Department employees.
2. Assist in all phases the testing process of prospective Police Department
employees.
3. Conduct background investigations of prospective Police Department employees
in accordance with P.O.S.T. standards.
4. Schedule and coordinate related personnel functions including polygraph
examinations and medical testing (psychological and physical examinations).
5. Assist new employees in agency orientation, and provide liaison with P.O.S.T.
approved police academics.
6. Other projects and tasks as directed by the Police Chief or his designee(s),
(Special Services Commander, Personnel and Training Sergeant).
C. Hours of Work. Contractor shall generally be available to perform the services required
by this Agreement approximately twenty-four (24) hours per week on a schedule
approved by the Police Chief.
-7 of 8- EXHIBIT "A" (i pg)
276/014084-0004/3301337.1 m10/28/99 TO ROBERT L.TETTE AGR
EXHIBIT "B"
SCHEDULE OF COMPENSATION
1. Compensation. Contractor shall be compensated at a rate of Seventeen Dollars
($17.00) per hour for services performed pursuant to this Agreement.
2. Expenses. City shall reimburse Contractor for out of pocket expenses for
copying, telephone, or other similar expenses; mileage at the rate of Thirty-One Cents ($0.31)
per mile; and for any travel involving charges for air fare, meals, or for overnight lodging.
3. Contract Sum. The total amount authorized by this Agreement shall not exceed
Thirty Thousand Dollars ($30,000.00).
-8 Of 8- EXHIBIT 'B" (1 pg)
276/014084-0004/3301337.1 m1028/99 TO ROBERT L TETTE AGR
*G
INTERINSURANCE EXCHANGE of the Automobile Club
AUTOMOBILE INSURANCE RENEWAL DECLARATTOAS _ _
PLEASE READ: These declarations constitute our offer to renew this insurance for the policy period shown below. Renewal is contingent upon
your payment of at least the Minimum Due before or on the Due Dale shown in the enclosed Insurance Billing.Failure to pay at least the Minimum
Due before or on the Due Date shall mean that you rejected this renewal offer. All coverage afforded by this policy will then terminate at 12:01
a.m., Pacific Standard Time, on the Effective Date shown in these declarations under "Policy Period." These declarations, together with the
contract and the endorsements in effect,complete your policy.
ITEM 1.YOUR NAME AND ADDRESS PROCESS DATE AUTO POLICY NUMBER
TETTE, ROBERT L AND LINDA C 8- 6-99 G 5282260
44930 MALIA CIR
LA QUINTA CA 92253-3959 POLICY PERIOD (PACIFIC STANDARD TIME)
EFFECTIVE DATE 9-1299 12:01 A.M.
EXPIRATION DATE 9-1 2-00 12:01 A.M.
ITEM 2.DESCRIPTION OF VEHICLES
VEH. YEAR MAKE IDENTIFICATION NO. RESIDENCE ANTI-THEFT DEVICE AIR
NO. LEASED FINANCED ZIP CODE ANNUAL MILES ELECTRONIC BAGS
LOCATOR OTHER
1 90 TOYO JT2ST87N9L0024536 NO NO 92253 1 - 5,000 NO NO YES
2 93 TOYO JT2SK12E4P0099538 NO NO 92253 15,001 - 20,000 NO YES YES
VEHICLE SPECIAL EQUIPMENT* SOUND EQUIPMENT* PARKED
NUMBER CAMPER/ OTHER 2-WAY TELE- RADIO OTHER IN UNDER COVERAGE M -EXCESS
VAN CONV. RADIO PHONE GARAGE
MEDICAL PAYMENTS- SEVERE
1 YES COVERAGE RESTRICTIONS
2 YES APPLY IF THERE IS NO
PRIMARY MEDICAL COVERAGE
IN EFFECT AT THE TIME OF
THE ACCIDENT AND DURING
* WARNING: Under Part III of the policy(Physical Damage),special coverage limitations apply unless coverage was THE 30 DAYS BEFORE.
specifically purchased for certain equipment.Coverage is indicated by an"X"in the appropriate equipment column.
ITEM 3.COVERAGES AND ANNUAL PREMIUMS(COVERAGES ARE NOT IN EFFECT UNLESS INDICATED AND A PREMIUM IS SHOWN)
POLICY I-LIABILITY II-MEDICAL III-PHYSICAL DAMAGE IV-UNINSURED MOTORIST
PART
COVER- B-PROPERTY c M NLAR L-UNINSURED F-BODILY INJURY UNNL
AGES A"BODILY INJURY DAMAGE MED.PAY EXCESS D-COMPREHENSIVE RENTAL EXPENSE E-COLLISION MOTORIST SHRED A U NEHICLESED
MED.PAY.
THOUSAND THOUSAND THOUSAND THOUSAND THOUSAND ACTUAL CASH LESS ACTUAL CASH LESS UNINS. THOUSAND THOUSAND
VEH. DOLLARS DOLLARS DOLLARS DOLLARS DOLLARS VALUE OR SPECIFIED DOLLARS VALUE OR SPECIFIED QED. UNINS. DOLLARS DOLLARS
NO. EACH EACH EACH EACH EACH LIMIT OF DEDUCTIBLE PER DAY LIMIT OF DEDUCTIBLE WAIVER COLL. EACH EACH
PERSON OCCUR. OCCUR. PERSON PERSON LIABILITY LIABILITY PERSON ACCIDENT
1 100 1 300 50 25 ACV 100 30 ACV 250 X 30 60
M 2 100 300 50 25 ACV 100 30 ACV 250 X 30 60
T I
S
II
P 1 134 53 41 88 13 152 41
R 2 175 70 48 94 17 184 49
M
I
U
M
S
PREMIUM DISCOUNT (S) APPLIED TO THIS POLICY: GRAND TOTAL $ 1159
GOOD DRIVER AIR BAGS MULTI-VEHICLE GARAGE PARKING LESS POLICYHOLDER'S
ANTI-THEFT DIVIDEND $ 114
NET TOTAL PREMIUM $ 1o45
E9<99ZA THANK YOU FOR BEING OUR INSURED SINCE SEPTEMBER 1993 (SEE REVERSE)
INTERINSURANCE EXCHANGE&he Automobile Club le
AUTOMOBILE INSURANCE RENEWAL DECLARATIONS—CONTINUED AUTO POLICY NUMBER G 5282260
0POLICY EFFECTIVE DATE 9-12-99
ITEM 4.DRIVERS(UNLESS EXCLUDED)
DRIVER NAME GENDER DATE MARITAL DRIVER'S LICENSE YEAR FIRST
NO. OF BIRTH STATUS NUMBER LICENSED
1 TETTE, ROBERT L MALE 12-20-41 MARRIED H 68766 57
2 TETTE, LINDA C FEMALE 11-10-49 MARRIED N 5871968 75
DRIVING RECORD STATUTORY DRIVER RATED GOOD DRIVER IMPROVEMENT CERTIFICATES
DRIVER NUMBER OF No.of TRAFFIC coNmcnaNs GOOD VEHICLE
NO. Pq NUMB ROOF STATUS STUDENT MATURE OFFENSIVE
FAU LT ACCIDENTS MINOR SERIOUS MAJOR SEVERE DRIVER NO. DRIVER OPINING COURSE
1 YES PRIMARY 2
2 YES PRIMARY 1
ITEM 5.ENDORSEMENTS AND CERTIFICATES IN EFFECT AT ISSUANCE
NUMBER TITLE NUMBER TITLE
I
I
II I
I
I
I
I �
I I
I I
I I
I I
I I
ANY LOSS UNDER PART III—PHYSICAL DAMAGE—IS PAYABLE AS INl"EREST MAY APPEAR TO YOU AND
FOR QUESTIONS OR CHANGES
CALL 1-800-924-6141 TOLL FREE
ITS00426
E0499
`4oH.0elff�.
= INTERINSURANCE EXCHANGE of the Automobile Club "
�''xxclv`�p
AUTOMOBILE INSURANCE RENEWAL DECLARATIONS
PLEASE READ: These declarations constitute our offer to renew this insurance for the policy period shown below. Renewal is contingent upon —_
your payment of at least the Minimum Due before or on the Due Date shown in the enclosed Insurance Billing.Failure to pay at least the Minimum
Due before or on the Due Date shall mean that you rejected this renewal offer. All coverage afforded by this policy will then terminate at 12:01
a.m., Pacific Standard Time, on the Effective Date shown In these declarations under "Policy Period." These declarations, together with the
contract and the endorsements in effect,complete your policy.
ITEM 1.YOUR NAME AND ADDRESS PROCESS DATE AUTO POLICY NUMBER
TETTE, ROBERT L AND LINDA C 8- 8-01 G 528226o
44930 MALIA CIR
LA QU I NTA CA 92253-3959 POLICY PERIOD (PACIFIC STANDARD TIME)
EFFECTIVE DATE 9-12-0112:01 A.M.
EXPIRATION DATE 9—1 2-02 12:01 A.M.
ITEM 2.DESCRIPTION OF VEHICLES
VEH. YEAR MAKE IDENTIFICATION NO. GARAGE ANTI-THEFT DEVICE AIR
NO. LEASED FINANCED ZIP CODE ANNUAL MILES ELECTRONIC BAGS
LOCATOR OTHER
1 90 TOYO JT2ST87N9L0024536 NO NO 92253 1 - 5,000 NO NO YES
2 00 TOYO JT2BG22K7Y0531120 NO NO 92253 5,001 - 7,500 NO YES YES
VEHICLE SPECIAL EQUIPMENT• SOUND EQUIPMENT* PARKED
NUMBER CAMPER/ OTHER 2-WAY TELE- IN
VAN CONV RADIO PHONE RADIO OTHER GARAGE
1 YES
2 YES
WARNING: Under Part III of the policy(Physical Damage),special coverage limitations apply Unless coverage was
speclficzlly purchased for certain equipment.Coverage is Indicated by an"X"In the appropriate equipment column.
ITEM 3.COVERAGES AND ANNUAL PREMIUMS(COVERAGES ARE NOT IN EFFECT UNLESS INDICATED AND A PREMIUM IS SHOWN)
POLICY I-LIABILITY II-MEDICAL
PART III-PHYSICAL DAMAGE IV-UNINSURED MOTORIST
COVER- A-BODILY INJURY B-PPOPERTY C M NCAR L-UNINSURED F-BODILY INJURY UNIN-
AGE$ DAMAGE MED PAY. EXCESS D-COMPREHENSIVE RENTAL E-COLLISION MOTORIST SURED d UNDERINSURED
MED PAY EXPENSE COLLISION MOTOR VEHICLES
THOUSAND THOUSAND THOUSAND THOUSAND THOUSAND ACTUAL CASH ACTUAL CASH THOUSAND THOUSAND
VIER DOLLARS DOLLARS DOLLARS DOLLARS DOLLARS VALUE OR LESS DOLLARS VALUE OR LESS UNINS. DNINS. DOLLARS I DOLLARS
NO EACH EACH EACH EACH EACH LIMIT OF SPECIFIED PER DAY LIMIT OF SPECIFIED DED. COLL EACH EACH
L PERSON OCWP OCCUR PERSON PERSON LIABILITY DEDUCTIBLE LIABILITY DEDUCTIBLE WAIVER PERSON ACCIDENT
I 1 100 1 300 50 25 ACV 100 M 30 ACV 250 X 30 60
T 2 100 300 50 25 ACV 100 30 ACV 250 x 30 60
S
1
P 1 138 74 40 82 17 156 48
E 2 150 92 26 42 16 256
M 30
D
M
S
PREMIUM DISCOUNTS: GRAND TOTAL $ 1 167
Please refer to the enclosed "PREMIUM DISCOUNTS APPLIED TO YOUR AUTOMOBILE LESS POLICYHOLDER'S $ 149
POLICY"document. DIVIDEND
NET TOTAL PREMIUM $ 1018
ITSOOA2A
EOBOI
(SEE REVERSE)
oMoeue�
3 a INTERINSURANCE EXCHANG0he Automobile Club
AUTOMOBILE INSURANCE RENEWAL DECLARATIONS—CONTINUED AUTO POLICY NUMBER G 5282260
Fex cAL`�
POLICY EFFECTIVE DATE 9—1 2-01
ITEM 4.DRIVERS(UNLESS EXCLUDED)
DRIVER NAME DATE MARITAL DRIVER'S LICENSE YEAR FIRST
NO. GENDER OF BIRTH STATUS NUMBER LICENSED
1 TETTE, ROBERT L MALE 12-20-41 MARRIED H 68766 57
2 TETTE, LINDA C FEMALE 11-10-49 MARRIED N 5871968 75
DRIVER DRIVING RECORD ISTATUTORY DRIVER RATED GOOD DRIVER IMPROVEMENT CERTIFICATES
NUMBER OF NO OF TRAFFIC CONVICTIONS GOOD
NO. PRINCIPALLY-AT- STATUS VEHICLESTUDENT MATURE DRIVING COURSE
FAULT ACCIDENTS MINOR SERIOUS MAJOR SEVERE DRIVER NO. DRIVER
1 YES PRIMARY 2
2 YES PRIMARY 1
ITEM 5.ENDORSEMENTS AND CERTIFICATES IN EFFECT AT ISSUAe CE
NUMBER
TITLE NUMBER I TITLE
2231 ' GUARANTEED RENEWAL
I
I
I
I
I I
I
I I
I I
I I
I I
ANY LOSS UNDER PART III—PHYSICAL DAMAGE—IS PAYABLE AS INl'REST MAY APPEAR TO YOU AND
FOR QUESTIONS OR CHANGES
CALL 1-800-924-6141 TOLL FREE
TSU0,28
EOeoI