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HomeMy WebLinkAboutItem No. 11 Agreement Lorena Hancock City of Lake Elsinore 130 South Main Street Lake Elsinore,CA 92530 Cn1r L - LS www.lake-elsinore.org Di.,.. pInt.-I Text File File Number: ID# 17-690 Agenda Date: 6/26/2018 Version: 1 Status: Consent Agenda In Control: City Council/Successor Agency/Public Financing Authority File Type: Report Agenda Number: 11) City of Lake Elsinore Page 1 Printed on 612112018 CITY OF JOWIN-14 - LAKE , L1E DRFAm F Ti Fm Fn REPORT TO CITY COUNCIL To: Honorable Mayor and Members of the City Council From: Grant Yates, City Manager Prepared by: Beau Davis, Recreation Supervisor Date: June 26, 2018 Subject: Lorena Hancock Recommendation: Authorize the City Manager to execute the Independent Contractor Agreement — Lorena Hancock. Background: The City of Lake Elsinore contracts with private instructors to perform recreational instruction at City owned facilities such as the Lake Community Center and Lake Elsinore Senior Center. The City of Lake Elsinore collects all of the registration fees for the classes through Recl, a software program. Upon the City's receipt of invoice, the City then pays each of the contract instructors 75 percent of the participation Registration Fees collected. The City retains 25 percent of the fees for facility maintenance and staffing costs. Discussion: Ms. Hancock is an existing business providing pre-school and ballet folklorico dance instruction at the Lake Community Center. Due to Ms. Hancock's class' popularity, the last two years she has exceeded the City Manager's signing authority threshold of$30,000. We anticipate that she will continue to maintain and potentially grow in popularity. Thus we anticipate this instructor to exceed the City Manager's signing authority threshold this year as well. As you shall find attached in Exhibit A, Independent Contractor Agreement for Instruction — Agreement is not to exceed $70,000. Fiscal Impact: Since the City collects the Registration Fees and then pays the Instructor their 75 percent dues, the expenses are countered with the appropriate revenue stream and therefore, no fiscal impact is anticipated. Exhibits: A—Agreement N7EI AGREEMENT CHECKLISTI� STRUCTOR yi y DREAM EXTREME W ' 1 ` Instructor Name: Legal Business Name: Title/Position: 1, Types of Class(es): Phone#: Email: i c� —6 m El Completed Agreement (2 original copies with wet signatures) Business License (Copy) Liability Insurance (Accord 25 Form) $1 Million Per Occurrence $2 Million General Aggregate List "City of Lake Elsinore" as additionally insured Automobile insurance $100,000 Per Occurrence $300,000 General Aggregate Worker's Compensation Insurance (Accord 25 Form, or if eligible, provide waiver) $1 Million Per Occurrence $2 Million General Aggregate Vendor Form (Only if new instructor with the City or change made to DBA) W-9 Form (Only if new instructor with the City or change made to DBA) Live Scan (Only if new instructor with City) *All documentation must match legal "Doing Business As" name. *All documentation must be valid. Instructor responsible updating documentation upon expiration. *All documentation must be submitted together as one Agreement Package. *Instructors must submit invoices based on rosters. Invoices will be processed within 45 days. C) — ' Z0 �� Instru t Er Signature Date Official Use City Official Name City Official Signature Date CITY OF LAKE ELSINORE INDEPENDENT CONTRACTOR AGREEMENT FOR INSTRUCTION THIS INDEPENDENT CONTRACTOR AGREEMENT FOR INSTRUCTORS ("Agreement") is made and entered into on June 26, 2018 by and between the CITY OF LAKE ELSINORE, hereinafter the"CITY,"and Lorena Hancock ,hereinafter the'CONTRACTOR." 1. Purpose.The CITY hereby engages CONTRACTOR for purposes of providing instruction in skillful and competent manner,and shall abide by all laws in doing so.CONTRACTOR shall perform such other duties as are customarily performed by one holding such position in other same or similar businesses or enterprises as that engaged in by CITY and shall maintain instruction area in a clean, safe and orderly manner. 2. Contractor's Status.CONTRACTOR is an independent contractor and is solely responsible for his or her own actions or omissions.CONTRACTOR is not City's employee for any purpose.Any additional personnel performing the services under this Agreement on behalf of CONTRACTOR shall also not be employees of the CITY and shall at all times be under Contractor's direction and control. CONTRACTOR shall pay all wages, salaries and other amounts due such personnel in connection with their performance of this Agreement and as required by law. 3. Term.The term of this Agreement shall begin July 1,2018 and end June 30,2019. 4. Collection of Fees. Registration fees shall be collected by the CITY through set registration procedures implemented by designated CITY staff.The CONTRACTOR is not authorized to collect registration fees. Following the collection of registration fees,the CITY shall confirm the number of participants enrolled.The CONTRACTOR will be compensated only for participants who have paid. 5. Compensation.In consideration of the performance of the instruction and/or services provided herein,the CONTRACTOR shall receive seventy-five percent(75%)of the participation registration fees collected for instruction and/or services identified in Section 1 above, exclusive of any facility entrance, pool use, field/court night lights,insurance fees and/or publicity fees where charged.Compensation to be paid to the Contractor shall not exceed$70,000 without prior additional written authorization from the City. It is also understood that all taxes and/or other withholdings are the CONTRACTOR'S responsibility. 6. Payment.The compensation provided in Section 5 shall be paid upon satisfactory completion of Instruction and/or services and receipt of an invoice within 45 days by CONTRACTOR submitted to the Community Services Department in the format specified by the Department,net 45 days. 7. Business License, Insurance.and LiveScan.CONTRACTOR and any subcontractor agrees to obtain and follow all business license requirements as required by the Lake Elsinore Municipal Code, Chapter 5.08.All business license requirements must be met prior to contract approval. CONTRACTOR and any subcontractor agrees to obtain all insurance required and present valid insurance certificates in accordance with the attached Terms and Conditions.CONTRACTOR,its employees,agents,consultants,contractors and volunteers agrees to perform and provide proof of LiveScan. 8. Terms and Conditions.This Agreement includes the terms and conditions as printed and set forth on the following page,which terms and conditions are incorporated herein by reference;and the CONTRACTOR, by executing this Agreement,agrees to comply with such terms and conditions. CITY OF LAKE ELSINORE CONTRACTOR By: By 6m-- — Grant Yates,City Manager Prih aaie: ' Dated: 20 Title: Business Name: L yeyi 'I ATTEST: Business License Number: Susan M. Domen,MMC,City Clerk Cless(es): PY ac (l� I Address: mv y Ho Im cit V AA Dated: ,20_ City/State/Zip: fiY ( I C r y 125-10 Email Address:WS I.t)I(fv,irl!{ �2, ` i Phone Number: Is-1 h CA TERMS AND CONDITIONS 1. EQUIPMENT AND LABOR: The Contractor shall goals. Contractor further acknowledges that failure furnish all tools, equipment, apparatus, supplies and to do so will result in immediate termination of this materials unless otherwise mutually agreed by City. Agreement. Contractor assumes all risk of loss, damage or harm to such equipment or materials arising in connection 8. COORDINATION OF WORK: The Contractor with this Agreement.The Contractor shall perform the agrees to coordinate with the City specified time(s) services under this Agreement in a skillful and and date(s) in order to avoid conflict of use. It is competent manner and shall abide by all laws in doing agreed that the resolution of any conflict is at the so. sole discretion of the City Manager or his/her designee. Contractor agrees to work with assigned 2. COMMUNITY HEALTH PROGRAM City staff to maintain accurate enrollment records. PARTICIPATION: The Contractor shall participate in the City's community health program by providing at g. RULES: Contractor agrees to obey all rules and least one hour of scheduled class services at least regulations of the City of Lake Elsinore and any twelve times per year(i.e.once per month or during a directives and memoranda issued by the seasonal series) free of charge to the program Department's Director. participants.The location of the classes shall be at the discretion of the City. 10. LIVESCAN: Contractor, its employees, agents, consultants, contractors and volunteers must 3. SUBCONTRACTORS: In the event a contractor will comply with fingerprinting requirements, Public not be able to teach class due to illness, etc. the Resources Code,Section 5164,by presenting proof Contractor will implement the following procedure: of LiveScan to the City, prior to commencing work with minors. a. Contractor will procure a substitute contractor equally or better qualified and acceptable to 11. HOLD HARMLESS AND INDEMNIFICATION. The the City to instruct class at the prescribed time Contractor shall defend, indemnify, and hold and place. Subcontractors must meet the harmless the City, its officials, officers, agents, criminal background screening and employees and volunteers free and harmless from fingerprinting requirements according to Cal any and all claims, demands, causes of action, Public Resources Code Section 5164. costs, expenses, liability,loss, damage or injury, in law or equity to property or persons, including b. Contractor will notify assigned designated wrongful death, in any manner arising our of our staff regarding the substitute's name, incident to any alleged acts, omissions or willful qualifications, address and phone. Payment misconduct of Contractor, its employees, agents, for subcontractors shall be responsibility of the consultants, contractors and volunteers arising out Contractor. of or in connection with the performance of the services in this Agreement, including without c. If a substitute cannot be procured, the class limitation the payment of all consequential damages will be canceled and a make up class added and attorneys' fees and other related costs and to the end of the session. The contractor will expenses. Contractor shall pay and satisfy any be responsible for notifying the students of the judgment, award or decree that maybe rendered cancellation. against City or its officials, officers, employees, agents, or volunteers, in any such suit, action or d. Contractor is responsible for ensuring other legal proceeding. Contractor shall reimburse subcontractors must meet all of the criteria City and its officials, officers, employees, agents, stipulated in these Terms and Conditions, and/or volunteers for any and all legal expenses and including but not limited to,maintaining a valid costs incurred by each of them in connection City of Lake Elsinore Business License, therewith or in enforcing the indemnity herein providing valid certificates of insurance in provided. Contractor's obligation to indemnify shall accordance with City policies, and providing not be restricted to insurance proceeds, if any, proof of LiveScan. received by the City, its officials, officers, 4. SUPERVISION: Contractor agrees to establish employees, agents or volunteers. Such appropriate rules for conducting the class and to indemnification shall cover death or bodily injury to assume responsibility for student discipline to ensure any person;injury to,loss,or theft of property,injury adequate protection of students and facility. arising from the furnishing or use of any copyrighted or uncopyrighted composition, secret process, or 5. FACILITY.The City shall be responsible for providing patented or unpatented invention,or any other type a suitable facility for the conduct of the class, unless of injury,whether such injury or damage occurs on otherwise noted under "Special Arrangements". or off City property. Contractor shall pay City for any and all costs 12. INSURANCE: Contractor, its employees, agents, associated with using the facility.Contractor agrees to consultants,contractors and volunteers understand assume full responsibility for setting up any facility for that certain types of activities create additional instruction and for cleaning and/or restoring the facility exposure of risk to City.Unless otherwise waived or to its usual condition following each class session. modified by the City's Risk Manager,Contractor and 6. ACCESS TO FACILITY: City representatives shall at any agents, consultants, or subcontractors shall all times have access to facility,whenever class is in similarly maintain the following insurance progress to monitor programs for quality. requirements and present the applicable valid certificates to the City of Lake Elsinore.Commercial 7. CONDUCT: Contractor understands that the City is a General Liability/Umbrella Insurance total limits public entity under the laws of the State of California, shall be no less than $1,000,000 per accident and and that the City's purpose in engaging Contractor is $2,000,000 general aggregate. Contractor shall to provide its residents with recreational activities in a maintain automobile liability insurance covering manner that will foster a sense of community,security, bodily injury and property damage for all activities of fun and fair play. Contractor agrees to conduct the Contractor arising out of or in connection with himself/herself in a manner that will further these the work to be performed under this Agreement, TERMS AND CONDITIONS including coverage for owned, hired and non-owned 19. GENERAL COMPLIANCE WITH LAWS.Contractor vehicles, in an amount of not less than $300,000 shall comply with all federal, state, and local laws, combined single limit for each occurrence.Contractor statutes, rules and regulations in any manner shall maintain Workers'Compensation Insurance and affecting the performance of this Agreement.By law, Employer's Liability Insurance for his/her employees Contractor,Contractor's employees and any agreed in an amount not less than$1,000,000 in accordance upon substitute personnel or subcontractor must with the laws of the State of California.Any notice of comply with the requirements of Cal Pub Resources cancellation or non-renewal of all Workers' Code Section 5164 before engaging in the services Compensation policies must be received by the City under this Agreement. Contractor, Contractor's at least thirty (30) days prior to such change. The employees and any agreed upon substitute insurer shall agree to waive all rights of subrogation personnel or subcontractor hereby agree to a against City, its officers, agents, employees and criminal background check as required under Cal volunteers for losses arising from work performed by Pub Resources Code Section 5164 by the City's Contractor for City.City and its employees and agents Police Department if Contractor or any of Contractor shall be added as additional insureds using ISO 's employees or agreed upon substitute personnel additional insured endorsement form CG 20 10 or CG or subcontractor shall work with persons of eighteen 20 26 (in no event will City accept an endorsement (18)years of age or under.Contractor,Contractor's form with an edition date later than 1990). Coverage employees or any agreed upon substitute personnel shall apply on a primary non-contributing basis in or subcontractor must be cleared by City prior to relation to any other insurance or self-insurance, working with persons of eighteen years of age of primary or excess, available to City or any employee under. If the background check for Contractor, or agent of City. Coverage shall not be limited to the Contractor's employees or agreed upon substitute vicarious liability or supervisory role of any additional personnel or subcontractor reveals illegal or insured. Contractors and subcontractors must objectionable information or activities,the person to maintain this insurance requirement and have the City whom the background check applies shall be listed as additionally insured in accordance with the prohibited from providing the services hereunder above statements. and, in City's sole and absolute discretion, this Agreement may be terminated, in which case 13. CONTRACTOR NOT OFFICER, EMPLOYEE OR Contractor will be entitled to no further AGENT OF CITY.While engaged in carrying out the compensation under this Agreement. Contractor, terms and conditions of the Agreement,the Contractor Contractor's employees, and any agreed upon is an independent contractor and not an officer, substitute personnel or subcontractor shall not be employee or agent of the City.The Contractor has no permitted to provide services hereunder for classes authority, express or implied, to act on behalf of the with attendees who are eighteen years of age or City as an agent or representative of the City under under unless a criminal background check has been this Agreement to bind the City to any obligation.The performed and clearance has been received from Contractor is not eligible for benefits from Social the Department of Justice. Security, State Unemployment Insurance, Disability Insurance or Workman's Compensation Insurance. In 20. MODIFICATION. No waiver, modification or the event of injury, the Contractor is responsible for termination of this Agreement is valid unless made his/her own medical expenses. in writing. 14. PUBLICITY: Contractor shall not advertise, print or 21. NONASSIGNMENT. Contractor shall not have any publish any promotional materials in connection with right to assign and/or transfer his/her rights and/or the instruction or service to be conducted under this obligations under this Agreement without the prior Agreement without the prior written approval of the written consent of the City. Director of Community Services or his/her authorized representative. 22. DEFAULT BY CONTRACTOR: Failure to comply with any of the terms and/or conditions of this 15.ASSUMPTION OF RISK. Contractor works at his/her agreement shall constitute default by the Contractor. own risk. Contractor shall ensure each participant signs the City's "Waiver& Release Agreement" prior 23.TERMINATION: The agreement may be terminated to participation. by the City upon 30 days' notice given in writing. Both parties will perform in accordance with the 16. COLLECTION OF FEES: The Contractor agrees not agreement prior to the effective termination date. to accept any registration fees from students. All Nothing contained herein shall diminish the right of registration fees shall be paid directly to the City and the City to cancel, immediately and without prior the Contractor shall be paid at the conclusion of the notice, the agreement for cause without penalty or course by the City. The Contractor may collect liability on the part of the City. additional fees for materials and supply costs. The Contractor shall appropriately inform the participants 24. ENTIRE AGREEMENT: This contract constitutes of the additional material fees prior to registration. the entire Agreement between the parties Participants may be required to bring certain supplies concerning the subject manner hereof and and materials to class. supercedes all agreements, representations, statements, promises and understandings,whether 17. PAYMENT OF FEES: City agrees to pay Contractor oral or written, with respect to the subject manner according to compensation provision provided on first hereof. page of this Agreement. Contractor is responsible for payment to any subcontractors. 25. SPECIAL ARRANGEMENTS: 18.AMERICANS WITH DISABILITIES ACT. Contractor agrees that he/she shall make every attempt to accommodate people with physical and/or mental disabilities. BUSINESS LICENSE CITY OF LAKE ELSINORE This business license is issued for revenue purposes only and does not grant authorization to operate a business. This business license is issued without verification 130 South Main Street SERVICES-LICENSING C 92530 that the holder is subject to or exempted from licensing by the state,county,federal 130 South Main Street Lake Elsinore,CA 92530 government,or any other governmental agency. 951,674.3124 TO BE POSTED 1N A CONSPICUOUS PLACE Business Name: LORENA HANCOCK Business Location: 27280 HAMMACK AVE PERRIS,CA 92570 BUSINESS LICENSE NO. 01'/343 Owner Name(s): Business Type: CLASS INSTRUCTOR LORENA HANCOCK 27280 HAMMACK AVE PERRIS, CA 92570 Issue Date: 2/1/2018 Expiration Date: 1/31/2019 THIS IS YOUR LICENSE • NOT TRANSFERABLE EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 6365.13667645711661 CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY(ADDITIONAL INSURED) Alliant Insurance Services,Inc.in conjunction with City of Lake Elsinore Apex Insurance Services P.O.Box 6450 Newport Beach,CA 92658 License No:OC 36861 NAMED INSURED(EVENT HOLDER): EVENT INFORMATION: Lorena Hancock TYPE: Dance(Various) 27280 Hammack Ave DATE(S): 01/17/2018-12/20/2018 Perris, CA 92570 LOCATION: Lake Community Center *Liquor Liability Yes C) No "Liquor Liability after 12 am ends before 2 am ❑ This is to certify that the insurance policy listed below has been issued to the above insured named(event holder)for the policy period indicated. The insurance described herein is subject to all the terms,exclusions and conditions of such policy(ies)unless amended as described in Special Conditions. INSURANCE CARRIER:Evanston Insurance Company MASTER POLICY NUMBER: SEP41026 MASTER POLICY DATES: EFFECTIVE: January 01,2018 EXPIRATION: January 01, 2019 COMMERCIAL GENERAL LIABILITY General OCCURRENCE FORM DEDUCTIBLE: NONE Aggregate Limit $2,000,000 Products&Completed Operations 1,000,000 SPECIAL CONDITIONS: Personal&Advertising Injury 1,000,000 The following endorsements attached to Each Occurrence Limit 1,000,000 the Master Policy do not apply to this Damage To Premises Rented To You(Any One Premises) 100,000 Certificate Of Insurance: Medical Payments(Any One Person) 5,000 MEGL1643 Liquor Liability (If purchased) 1,000,000 Optional Limits Purchased ❑ $1,000,00053,000,000 ❑ $2,000,000/$2,000,000 Property Damage(If purchased) No Property Damage Coverage The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event. OTHER ADDITIONAL INSUREDS City of Lake Elsinore CANCELLATION: Should the above described policy be cancelled before the expiration date thereof,notice will be delivered in accordance with the policy provisions. AUTHORIZED REPRESENTATIVE: DATE ISSUED: 01/12/2018 EVANSTON INSURANCE COMPANY CERTIFICATE NO.: 6365-13665105589405 CERTIFICATE OF INSURANCE SPECIAL EVENT LIABILITY PROGRAM PRODUCER PUBLIC ENTITY(ADDITIONAL INSURED) Alliant Insurance Services,Inc.in conjunction with City of Lake Elsinore Apex Insurance Services P.O.Box 6450 Newport Beach,CA 92658 License No:OC 36861 NAMED INSURED(EVENT HOLDER): EVENT INFORMATION: Lorena Hancock TYPE: Preschool/Daycare 27280 Hammack Ave DATE(S): 01/12/2018-12/21/2018 Perris, CA 92570 LOCATION: The Learning Center *Liquor Liability Yes o No "Liquor Liability after 12 am ends before 2 am ❑ This is to certify that the insurance policy listed below has been issued to the above insured named(event holder)for the policy period indicated. The insurance described herein is subject to all the terms,exclusions and conditions of such policy(ies)unless amended as described in Special Conditions. INSURANCE CARRIER:Evanston Insurance Company MASTER POLICY NUMBER: SEP41026 MASTER POLICY DATES: EFFECTIVE: January 01,2018 EXPIRATION: January 01, 2019 COMMERCIAL GENERAL LIABILITY General OCCURRENCE FORM DEDUCTIBLE: NONE Aggregate Limit $2,000,000 Products&Completed Operations 1,000,000 SPECIAL CONDITIONS: Personal&Advertising Injury 1,000,000 The following endorsements attached to Each Occurrence Limit 1,000,000 the Master Policy do not apply to this Damage To Premises Rented To You(Any One Premises) 100,000 Certificate Of Insurance: Medical Payments(Any One Person) 5,000 MEGL1643 Liquor Liability (If purchased) 1,000,000 Optional Limits Purchased ❑ $1,000,000/$3,000,000 ❑ $2,000,000/$2,000,000 Property Damage(If purchased) No Property Damage Coverage The limits of insurance apply separately to each event insured by this policy as if a separate policy of insurance has been issued for that event. OTHER ADDITIONAL INSUREDS City of Lake Elsinore CANCELLATION: Should the above described policy be cancelled before the expiration date thereof,notice will be delivered in accordance with the policy provisions. AUTHORIZED REPRESENTATIVE: DATE ISSUED: 01/12/2018 Evidence of Insurance GEICO California Evidence of Liability Insurance Here are your Evidence of Liability Insurance Cards. geico.com 1-800-841-3000 Two cards have been provided for each vehicle GOVERNMENT EMPLOYEES INSURANCE COMPANY insured. One card must be carried in the proper P.O. Box 509090- San Diego, CA 92150-9090 insured vehicle. Proof of insurance is required to register or renew the registration of your vehicle. A NAIC Code: 22063 law enforcement officer can ask you to prove that Policy Number Effective Date Expiration Date you have liability insurance meeting the basic 4207-99-04-43 03-28-18 09-28-18 requirements of California law. Year Make Model Vehicle ID No. A violation of these requirements can result in a fine Insured: of up to: John L Hancock $1,000 for the first time Lorena G Hancock $2,000 for additional times 27280 Hammack Ave Also, a judge can have your vehicle impounded. Perris CA 92570-8610 False proof of insurance may result in a fine up to $750 and 30 days In prison. The coverage provided by this policy meets the minimum requirements of sections 16056&16500.5 of the California Vehicle Code,minimum liability limits prescribed by law. Due to space limitations on the ID card, only the Named Insured and the Co-insured are listed. For a full list of drivers covered under this policy, please reference the Drivers section of your Declarations Page (Page 9). JOHN L HANCOCK AND LORENA G If you would like additional ID cards you can go HANCOCK online to geico.com or call us at 1-800-841-3000. 27280 HAMMACK AVE PERRIS CA 92570-8610 GEICO California Evidence of Liability Insurance G geico.com 1-800-841-3000 GOVERNMENT EMPLOYEES INSURANCE COMPANY P.O. Box 509090 - San Diego, CA 92150-9090 NAIC Code: 22063 Policy Number Effective Date Expiration Date 4207-99-04-43 03-28-18 09-28-18 Year Make Model Vehicle ID No. Ln Insured: gJohn L Hancock N Lorena G Hancock 0 0 v 27280 Hammack Ave Perris CA 92570-8610 0 V The coverage provided by this policy meets the minimum requirements of sections 16056&16500.5 of the California N Vehicle Code,minimum liability limits prescribed by law. S 0 v 6/12/2018 Coverage Summary 11 Coverage Summary Print Policy Number: 4207990443 Policy Period: 03/28/2018 to 09/28/2018 Your current 6 $815.50 month premium: These coverages apply across all vehicles *For specific details, consult your policy contract. For Others The below coverages pay out to other parties if the accident is your fault. Bodily Injury Liability $402.40 $300,000 per person/$300,000 per occurrence State Minimum: $15,000 per person/$30,000 per occurrence Pays if you are responsible for another person's injury or death in an auto accident. It also pays for your legal defense. Property Damage Liability $251.30 $100,000 per occurrence State Minimum: $5,000 per occurrence Pays if you are responsible for damage to another person's property. For You The below coverages pay out to you and your passengers. Uninsured Motorist & Underinsured Motorist $41.10 $15,000 per person/$30,000 per occurrence Pays for injuries caused by motorists who don't carry sufficient coverage for the extent of your injuries. Vehicle Coverage Vehicle total 6 month premium: $326.00 2008 NISSAN VERSA Comprehensive $20.20 Deductible: $500 Pays for vehicle and glass damage due to, among other causes, theft, vandalism, explosion and fire. Collision $94.10 Deductible: $1,000 Pays for damages to your vehicle caused by a collision or when it overturns. Vehicle total 6 month premium: $251.40 1997 LINC TOWNCAR EX Uninsured Motorist Property Damage $3.10 $3,500 per occurrence Pays for damages to your vehicle caused by a driver without insurance. Vehicle total 6 month premium: $238.10 1999 FORD TAURSSE/SP https://service.geico.com/insite/simplifiedCoverageSummary.xhtml?CW6305D=370075&ts=l 528844753829 1/2 6/12/2018 Coverage Summary Uninsured Motorist Property Damage $3.30 $3,500 per occurrence Pays for damages to your vehicle caused by a driver without insurance. https://service.geico.com/insite/simplifiedCoverageSummary.xhtml?CW6305D=370075&ts=l528844753829 2/2 CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE I hereby certify that in the performance of the work for which this Agreement is entered into, I shall not employ any person in any manner so as to become subject to the Worker's Compensation Laws of the State of California. Executed o his 4 - da of ,�wt 1,�1, 201 at Lake Elsinore, California. LvY� I'1q -- U �LU�j� ontra64 Name . Contractor Signature