HomeMy WebLinkAboutPageantry Productions - 2018-04-25 PROFESSIONAL SERVICES CONTRACT BETWEEN
THE CITY OF HUNTINGTON BEACH AND
PAGEANTRY PRODUCTIONS
FOR
COORDINATION AND PRODUCTION OF THE 2018 FOURTH OF JULY PARADE
THIS AGREEMENT ("Agreement") is made and entered into by and between the
City of Huntington Beach, a municipal corporation of the State of California, hereinafter
referred to as "CITY, and Pageantry Productions, a sole proprietor, hereinafter referred to
as "CONSULTANT."
WHEREAS, CITY desires to engage the services of a consultant to coordinate and
produce the 2018 Fourth of July Parade; and
Pursuant to documentation on file in the office of the City Clerk, the provisions of
the Huntington Beach Municipal Code, Chapter 3.03, relating to procurement of
professional service contracts have been complied with; and
CONSULTANT has been selected to perform these services,
NOW, THEREFORE, it is agreed by CITY and CONSULTANT as follows:
1. SCOPE OF SERVICES
CONSULTANT shall provide all services as described in Exhibit "A,"
which is attached hereto and incorporated into this Agreement by this reference. These
services shall sometimes hereinafter be referred to as the "PROJECT."
CONSULTANT hereby designates William Lomas, who shall represent it
and be its sole contact and agent in all consultations with CITY during the performance of
this Agreement.
18-6410/177908/mv 1
2. CITY STAFF ASSISTANCE
CITY shall assign a staff coordinator to work directly with CONSULTANT
in the performance of this Agreement.
3. TERM; TIME OF PERFORMANCE
Time is of the essence of this Agreement. The services of CONSULTANT
are to commence on y�o��lo (the "Commencement Date"). This
Agreement shall automatically terminate on September 1, 2018, unless extended or sooner
terminated as provided herein. All tasks specified in Exhibit "A" shall be completed on or
before July 4, 2018. The time for performance of the tasks identified in Exhibit "A" are
generally to be shown in Exhibit "A." This schedule may be amended to benefit the
PROJECT if mutually agreed to in writing by CITY and CONSULTANT.
In the event the Commencement Date precedes the Effective Date,
CONSULTANT shall be bound by all terms and conditions as provided herein.
4. COMPENSATION
In consideration of the performance of the services described herein, CITY
agrees to pay CONSULTANT on a time and materials basis at the rates specified in
Exhibit "B," which is attached hereto and incorporated by reference into this Agreement,
a fee, including all costs and expenses, not to exceed Fifteen Thousand Dollars
($15,000.00.).
5. EXTRA WORK
In the event CITY requires additional services not included in Exhibit "A"
or changes in the scope of services described in Exhibit "A," CONSULTANT will
undertake such work only after receiving written authorization from CITY. Additional
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compensation for such extra work shall be allowed only if the prior written approval of
CITY is obtained.
6. METHOD OF PAYMENT
CONSULTANT shall be paid pursuant to the terms of Exhibit "B."
7. DISPOSITION OF PLANS, ESTIMATES AND OTHER DOCUMENTS
CONSULTANT agrees that title to all materials prepared hereunder,
including, without limitation, all original drawings, designs, reports, both field and office
notices, calculations, computer code, language, data or programs, maps, memoranda,
letters and other documents, shall belong to CITY, and CONSULTANT shall turn these
materials over to CITY upon expiration or termination of this Agreement or upon
PROJECT completion, whichever shall occur first. These materials may be used by CITY
as it sees fit.
8. HOLD HARMLESS
CONSULTANT hereby agrees to protect, defend, indemnify and hold
harmless CITY, its officers, elected or appointed officials, employees, agents and
volunteers from and against any and all claims, damages, losses, expenses, judgments,
demands and defense costs (including, without limitation, costs and fees of litigation of
every nature or liability of any kind or nature) arising out of or in connection with
CONSULTANT's (or CONSULTANT's subcontractors, if any) negligent (or alleged
negligent) performance of this Agreement or its failure to comply with any of its
obligations contained in this Agreement by CONSULTANT, its officers, agents or
employees except such loss or damage which was caused by the sole negligence or willful
misconduct of CITY. CONSULTANT will conduct all defense at its sole cost and expense
18-6410/177908/mv 3
and CITY shall approve selection of CONSULTANT's counsel. This indemnity shall
apply to all claims and liability regardless of whether any insurance policies are applicable.
The policy limits do not act as limitation upon the amount of indemnification to be
provided by CONSULTANT.
9. PROFESSIONAL LIABILITY INSURANCE
CONSULTANT shall obtain and furnish to CITY a professional liability
insurance policy covering the work performed by it hereunder. This policy shall provide
coverage for CONSULTANT's professional liability in an amount not less than One
Million Dollars ($1,000,000.00) per occurrence and in the aggregate. The above-
mentioned insurance shall not contain a self-insured retention, "deductible" or any other
similar form of limitation on the required coverage except with the express written consent
of CITY. A claims-made policy shall be acceptable if the policy further provides that:
A. The policy retroactive date coincides with or precedes the initiation
of the scope of work (including subsequent policies purchased as
renewals or replacements).
B. CONSULTANT shall notify CITY of circumstances or incidents
that might give rise to future claims.
CONSULTANT will make every effort to maintain similar insurance during
the required extended period of coverage following PROJECT completion. If insurance is
terminated for any reason, CONSULTANT agrees to purchase an extended reporting
provision of at least two (2) years to report claims arising from work performed in
connection with this Agreement.
I
18-6410/177908/mv 4
If CONSULTANT fails or refuses to produce or maintain the insurance
required by this section or fails or refuses to furnish the CITY with required proof that
insurance has been procured and is in force and paid for, the CITY shall have the right, at
the CITY's election, to forthwith terminate this Agreement. Such termination shall not
affect CONSULTANT's right to be paid for its time and materials expended prior to
notification of termination. CONSULTANT waives the right to receive compensation and
agrees to indemnify the CITY for any work performed prior to approval of insurance by
the CITY.
10. CERTIFICATE OF INSURANCE
Prior to commencing performance of the work hereunder, CONSULTANT
shall furnish to CITY a certificate of insurance subject to approval of the City Attorney
evidencing the foregoing insurance coverage as required by this Agreement; the certificate
shall:
A. provide the name and policy number of each carrier and policy;
B. state that the policy is currently in force; and
C. promise that such policy shall not be suspended, voided or canceled
by either party, reduced in coverage or in limits except after thirty
(30) days' prior written notice; however, ten (10) days' prior written
notice in the event of cancellation for nonpayment of premium.
CONSULTANT shall maintain the foregoing insurance coverage in force
until the work under this Agreement is fully completed and accepted by CITY.
The requirement for carrying the foregoing insurance coverage shall not
derogate from CONSULTANT's defense, hold harmless and indemnification obligations as
18-6410/177908/mv 5
set forth in this Agreement. CITY or its representative shall at all times have the right to
demand the original or a copy of the policy of insurance. CONSULTANT shall pay, in a
prompt and timely manner, the premiums on the insurance hereinabove required.
11. INDEPENDENT CONTRACTOR
CONSULTANT is, and shall be, acting at all times in the performance of
this Agreement as an independent contractor herein and not as an employee of CITY.
CONSULTANT shall secure at its own cost and expense, and be responsible for any and
all payment of all taxes, social security, state disability insurance compensation,
unemployment compensation and other payroll deductions for CONSULTANT and its
officers, agents and employees and all business licenses, if any, in connection with the
PROJECT and/or the services to be performed hereunder.
12. TERMINATION OF AGREEMENT
All work required hereunder shall be performed in a good and workmanlike
manner. CITY may terminate CONSULTANT's services hereunder at any time with or
without cause, and whether or not the PROJECT is fully complete. Any termination of this
Agreement by CITY shall be made in writing, notice of which shall be delivered to
CONSULTANT as provided herein. In the event of termination, all finished and
unfinished documents, exhibits, report, and evidence shall, at the option of CITY, become
its property and shall be promptly delivered to it by CONSULTANT.
13. ASSIGNMENT AND DELEGATION
This Agreement is a personal service contract and the work hereunder shall
not be assigned, delegated or subcontracted by CONSULTANT to any other person or
entity without the prior express written consent of CITY. If an assignment, delegation or
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subcontract is approved, all approved assignees, delegates and subconsultants must satisfy
the insurance requirements as set forth in Sections 9 and 10 hereinabove.
14. COPYRIGHTS/PATENTS
CITY shall own all rights to any patent or copyright on any work, item or
material produced as a result of this Agreement.
15. CITY EMPLOYEES AND OFFICIALS
CONSULTANT shall employ no CITY official nor any regular CITY
employee in the work performed pursuant to this Agreement. No officer or employee of
CITY shall have any financial interest in this Agreement in violation of the applicable
provisions of the California Government Code.
16. NOTICES
Any notices, certificates, or other communications hereunder shall be given
either by personal delivery to CONSULTANT's agent (as designated in Section 1
hereinabove) or to CITY as the situation shall warrant, or by enclosing the same in a sealed
envelope, postage prepaid, and depositing the same in the United States Postal Service, to
the addresses specified below. CITY and CONSULTANT may designate different
addresses to which subsequent notices, certificates or other communications will be sent by
notifying the other party via personal delivery, a reputable overnight carrier or U. S.
certified mail-return receipt requested:
TO CITY: TO CONSULTANT:
City of Huntington Beach William Lomas
ATTN: Fred Wilson 8057 1st Street
2000 Main Street Paramount, CA 90723
Huntington Beach, CA 92648
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17. CONSENT
When CITY's consent/approval is required under this Agreement, its
consent/approval for one transaction or event shall not be deemed to be a consent/approval
to any subsequent occurrence of the same or any other transaction or event.
18. MODIFICATION
No waiver or modification of any language in this Agreement shall be valid
unless in writing and duly executed by both parties.
19. SECTION HEADINGS
The titles, captions, section, paragraph and subject headings, and descriptive
phrases at the beginning of the various sections in this Agreement are merely descriptive
and are included solely for convenience of reference only and are not representative of
matters included or excluded from such provisions, and do not interpret, define, limit or
describe, or construe the intent of the parties or affect the construction or interpretation of
any provision of this Agreement.
20. INTERPRETATION OF THIS AGREEMENT
The language of all parts of this Agreement shall in all cases be construed
as a whole, according to its fair meaning, and not strictly for or against any of the parties.
If any provision of this Agreement is held by an arbitrator or court of competent
jurisdiction to be unenforceable, void, illegal or invalid, such holding shall not invalidate
or affect the remaining covenants and provisions of this Agreement. No covenant or
provision shall be deemed dependent upon any other unless so expressly provided here.
As used in this Agreement, the masculine or neuter gender and singular or plural number
shall be deemed to include the other whenever the context so indicates or requires.
18-6410/177908/mv 8
Nothing contained herein shall be construed so as to require the commission of any act
contrary to law, and wherever there is any conflict between any provision contained herein
and any present or future statute, law, ordinance or regulation contrary to which the parties
have no right to contract, then the latter shall prevail, and the provision of this Agreement
which is hereby affected shall be curtailed and limited only to the extent necessary to bring
it within the requirements of the law.
21. DUPLICATE ORIGINAL
The original of this Agreement and one or more copies hereto have been
prepared and signed in counterparts as duplicate originals, each of which so executed shall,
irrespective of the date of its execution and delivery, be deemed an original. Each
duplicate original shall be deemed an original instrument as against any party who has
signed it.
22. IMMIGRATION
CONSULTANT shall be responsible for full compliance with the
immigration and naturalization laws of the United States and shall, in particular, comply
with the provisions of the United States Code regarding employment verification.
23. LEGAL SERVICES SUBCONTRACTING PROHIBITED
CONSULTANT and CITY agree that CITY is not liable for payment of any
subcontractor work involving legal services, and that such legal services are expressly
outside the scope of services contemplated hereunder. CONSULTANT understands that
pursuant to Huntington Beach City Charter Section 309, the City Attorney is the exclusive
legal counsel for CITY; and CITY shall not be liable for payment of any legal services
expenses incurred by CONSULTANT.
18-6410/177908/mv 9
24. ATTORNEY'S FEES
In the event suit is brought by either party to construe, interpret and/or
enforce the terms and/or provisions of this Agreement or to secure the performance hereof,
each party shall bear its own attorney's fees, such that the prevailing party shall not be
entitled to recover its attorney's fees from the non-prevailing party.
25. SURVIVAL
Terms and conditions of this Agreement, which by their sense and context
survive the expiration or termination of this Agreement, shall so survive.
26. GOVERNING LAW
This Agreement shall be governed and construed in accordance with the
laws of the State of California.
27. SIGNATORIES
Each undersigned represents and warrants that its signature hereinbelow has
the power, authority and right to bind their respective parties to each of the terms of this
Agreement, and shall indemnify CITY fully for any injuries or damages to CITY in the
event that such authority or power is not, in fact, held by the signatory or is withdrawn.
28. ENTIRETY
The parties acknowledge and agree that they are entering into this
Agreement freely and voluntarily following extensive arm's length negotiation, and that
each has had the opportunity to consult with legal counsel prior to executing this
Agreement. The parties also acknowledge and agree that no representations, inducements,
promises, agreements or warranties, oral or otherwise, have been made by that party or
anyone acting on that party's behalf, which are not embodied in this Agreement, and that
18 6410/177908/mv 10
that party has not executed this Agreement in reliance on any representation, inducement,
promise, agreement, warranty, fact or circumstance not expressly set forth in this
Agreement. This Agreement, and the attached exhibits, contain the entire agreement
between the parties respecting the subject matter of this Agreement, and supersede all prior
understandings and agreements whether oral or in writing between the parties respecting
the subject matter hereof.
29. EFFECTIVE DATE
This Agreement shall be effective on the date of its approval by the City
Attorney. This Agreement shall expire when terminated as provided herein.
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be
executed by and through their authorized officers.
CONSULTANT, CITY OF HUNTINGTON BEACH,
PAGEANTRY PRODUCTIONS, a sole a municipal corporation of the State of California
proprietor
By: Director/Chief
ti _ (Pursuant to HBMC§ 3.03.100)
print name
APPROVED AS
City Attorney .^AA�
Date. � -hel-
RECEIVE ND FIILLE,:
City Clerk
Date
18-6410/177908/mv I I
EXHIBIT A
�
I
t
Pageantry Productions ,o ,s A, (562)618-5558
&Awards (562)421.4411 fax
80571 ST e•�33 www-pageaniryproductions.com
Paramount.CA 90723 '
A Division of Wald N`idc Stxclaculars,Inc.
March 8, 2018
City of Huntington Beach CA
Pageantry Productions will perform the services required for the 2
Parade. q 018 4th of July City
1. Coordinate with the 4" of July Board the activities of the parade including the
parade entries (including rented vehicles and float builders, etc), line up, staging
areas and disbanding area. Provide Board-updated lineups including final line up
7 days prior to parade.
2. Participate in distribution of parade application to potential parade entries. A link
to online parade application to be emailed out to prior years entries with Event
Directors attached.
3. Attend required planning meetings associated with the planning of the parade.
4. Email all parade information (maps, formation route, times of arrival, disbanding
information, etc.) to Parade Entry no later than June 25, 2018.
5. Mail Parade Participant Drop Off Passes to Parade Entry no later than June 8,
2018.
6. Assign a parade coordinator from your staff.
7. Designate an area as the parade check-in office for the day of the parade
8. Formulate the parade line-up from the approved applications.
9. Provide directional signs for parade staging area.
10. Oversee and review disbanding area and provide informational signs for parade
entries.
11. 4t" of July Board and City to approve all expenditures outside of contractor fee.
Proposal amount of f 4_%_ t
Pro
po �3;��p to include: 12,730.50
1. Coordinating service fee 2. Float Float Judge fee - $250
3. VIP area barricade set up and decorations - $600
Separate budget items to be considered outside of proposal price:
1. VIP signs for cars - $650
2. VIP ribbons - $495
'To be paktonorr bdore the 40h offlullyl2018
u4"1z_L "Z ow As 3/20/2018
Pageantry Productions Signature & Date City Signature &Date
EXHIBIT B
EXHIBIT "B"
Payment Schedule (Fixed Fee Payment)
1. CONSULTANT shall be entitled to monthly progress payments toward the fixed fee
set forth herein in accordance with the following progress and payment schedules.
2. Delivery of work product: A copy of every memorandum, letter, report, calculation
and other documentation prepared by CONSULTANT shall be submitted to CITY to demonstrate
progress toward completion of tasks. In the event CITY rejects or has comments on any such
product, CITY shall identify specific requirements for satisfactory completion.
3. CONSULTANT shall submit to CITY an invoice for each monthly progress payment
due. Such invoice shall:
A) Reference this Agreement;
B) Describe the services performed;
C) Show the total amount of the payment due;
D) Include a certification by a principal member of CONSULTANT's firm that
the work has been performed in accordance with the provisions of this
Agreement; and
E) For all payments include an estimate of the percentage of work completed.
Upon submission of any such invoice, if CITY is satisfied that CONSULTANT is making
satisfactory progress toward completion of tasks in accordance with this Agreement, CITY shall
approve the invoice, in which event payment shall be made within thirty (30) days of receipt of the
invoice by CITY. Such approval shall not be unreasonably withheld. If CITY does not approve an
invoice, CITY shall notify CONSULTANT in writing of the reasons for non-approval and the
schedule of performance set forth in Exhibit "A" may at the option of CITY be suspended until the
parties agree that past performance by CONSULTANT is in, or has been brought into compliance, or
until this Agreement has expired or is terminated as provided herein.
4. Any billings for extra work or additional services authorized in advance and in
writing by CITY shall be invoiced separately to CITY. Such invoice shall contain all of the
information required above, and in addition shall list the hours expended and hourly rate charged for
such time. Such invoices shall be approved by CITY if the work performed is in accordance with the
extra work or additional services requested, and if CITY is satisfied that the statement of hours
worked and costs incurred is accurate. Such approval shall not be unreasonably withheld. Any
dispute between the parties concerning payment of such an invoice shall be treated as separate and
apart from the ongoing performance of the remainder of this Agreement.
5. CONSULTANT shall be paid on or before July 4, 2018.
18-6410
WORLWID-04 PEDENN
�co�zory CERTIFICATE OF LIABILITY INSURANCE DATE 3/ 3/20113/201YYY)
8
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER License#OE67768 CONTACT Nikki Peden
NAME:
IOA Insurance Services PHONE FAX
16000 Ventura Blvd. (A/C,No,Ext):(323)951-4208 54208 (A/C,No):
Suite 400 E-MADDAIL SS•Nikki.Peden@ioausa.com
RE
Encino,CA 91436
INSURERS AFFORDING COVERAGE NAIC#
INSURER A:Sentinel Insurance Company, Ltd 11000
INSURED INSURER B:AmGUARD Insurance Company 42390
World Wide Spectaculars dba Pageantry Productions INSURER C:StarStone National Insurance Company 25496
8057 1 st Street INSURER D:
Paramount,CA 90723
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS
LTR INSD WVD MM/D MM/DD
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE IF X OCCUR21SBARS8184 12/01/2017 12/01/2018 DAMAGE TO RENTED 1,000,000X
PREMISES Ea occurrence $
X Promoter/Parade Cons MED EXP An one person) $ 10,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
X POLICY J T LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: Hired/Non Owned $ 1,000,000
B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000
Ea accident $
ANY AUTO X WOAU881383 12/21/2017 12/21/2018 BODILY INJURY Perperson) $
X OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY Per accident $
AUTOS ONLY AUUTOS ONELY PROPERTY
accident)DAMAGE $
C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000
EXCESS LIAR CLAIMS-MADE 89337X170ALI 04/28/2017 04/28/2018 AGGREGATE $
DED I X I RETENTION$ 0 Agg $ 1,000,000
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N STAT TE_ ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? N/A
(Mandatory in NH)
E.L.DISEASE-EA EMPLOYE $
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
City of Huntington Beach,its officers,elected or appointed officials,employees,agents and volunteers are Included as Additional Insured as respects claims
arising out of the negligence of the Named Insured.The insurance captioned above is primary and non-contributory with any insurance held by or to the
benefit of the Additional Insured.30 Days Notice of Cancellation,Except 10 Days Notice for nonpayment of premium.qE_gpecial Event/4th of July Parade
2018 FORTR
LM41CH6. G�ATES
B
P Y
CERTIFICATE HOLDER CANCELLAT lit'(OF TTNGTO
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
City of Huntington Beach
2000 Main Street
lHuntinaton Be ch- A 92648v
ACORD 25(2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
World Wide Spectaculars dba Pageantry Production
8057 1st Street
Paramount, CA 90723
POLICY NUMBER: 21SBARS8184 COMMERCIAL GENERAL LIABILITY
EFFECTIVE:12/01/2017-12/01/2018 CG 20 26 11 85
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY
ADDITIONAL INSURED-DESIGNATED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART;
SCHEDULE: Name of Organization.-
City of Huntington Beach, its officers, elected or appointed officials, employees, agents and volunteers.
City of Huntington Beach
2000 Main Street
Huntington Beach, CA 92648-2702
(If no entry appears above, the information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
WHO IS AN INSURED (Section 11) is amended to include as an insured the person or organization shown in
the Schedule, but only with respect to liability arising out of"your work"for that insured by or for you.
Modification to ISO form CG 20 10 11 85:
1. The insured scheduled above includes the Insured's officers, officials, employees and
volunteers.
2. This insurance shall be primary as respects the insured shown in the schedule
above, or if excess, shall stand in an unbroken chain of coverage excess of the
Named Insured's scheduled underlying primary coverage. In either event, any other
insurance maintained by the Insured scheduled above shall be in excess of this
insurance and shall not be called upon to contribute with it.
3. The insurance afforded by this policy shall not be canceled except after thirty days
prior written notice by certified mail return receipt requested has been given to the
Entity: City of Huntington Beach
2000 Main Street
Huntington Beach,CA 92648-2702
4. Coverage shall not extend to any indemnity coverage for the active negligence of the
additional insured in any case where an agreement to indemnify the additional
insured would be invalid under Subdivision (b) of section 2782 of the Civil Code.
CG 20 26 1185
Page 1 of 1
S i CITY OF �H UNTINGTON BEACH[
ty 2000 Main Street, Huntington Beach, CA 92648-2702
Huntin each DECLARATION OF PERMITTEE
I certify that no vehicle(s) will be used or operated in the performance of the
task(s) or event(s) for which this permit is granted.
I authorize the City of Huntington Beach to immediately and retroactively
revoke the license or permit issued in connection with or in the performance of
said task(s) or events(s) if any vehicle(s) is used.
Signature of Permittee:
Print Name:
Company Name (if applicable): 1 x 6�
Date Signed:
16407 EXHIBIT 1
ATTACHMENT#5
Resolution No. 2008-63
S - lry CCITT OF HUNTINGTON BEACH
2000 Main Street, Huntington Beach, CA 92648-2702
H=tin;_ each
Declaration of Non-Employer Status
The State of California requires every enterprise or business to provide workers
compensation insurance coverage. If you have no employees, you may make a
declaration to that effect by completing and signing this form and returning to:
City of Huntington Beach
2000 Main Street
Huntington Beach, CA 92648-2702
1 certify that in the performance of the activity or work for which this permit is
issued, I shall not employ any person in any manner so as to become subject to
California Workers' Compensation Insurance requirements.
I authorize the City of Huntington Beach to immediately and retroactively
revoke the license or permit issued under this declaration if I hire any
employee(s) or become subject to the provision of the laws requiring Workers'
Compensation Insurance.
Company / Organization: '
Address: � t y i `4av2
Applicant [please print]: >> � L��►, ��
Title, if any:
Applicant's Signature:
Date Signed:
Telephone Number:
ATTACHMENT #7