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HomeMy WebLinkAboutComplete_with_Docusign_9th_Shield_Short_Form Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B SHORT FORM PURCHASE OF GOODS AND/OR SERVICE CONTRACT The parties to this Short Form Purchase of Goods 5. Compensation: Contractor's total compensation and/or Services Contract (Contract) do mutually for the goods and/or services performed under agree and promise as follows: this Contract is $9,961.75 , to be paid as (check one): (1)✓]lump sum upon completion of all 1. Parties: The parties to this Contract are the Contractor's bligations; (2) lump sum per-task CITY OF LAKE ELSINORE, a municipal in the amounts indicated e ow, payable upon corporation (City) and the following named completion of each task; (3)E]lump sum per-task in Contractor: the amounts indicated below, payable in monthly installments not to exceed the percentage Name: 9th Shield Securitv completion of each task; (4) per attached written Street Address: 27851 BradIey Rd, Suite #120 quote, up to a guaranteed no -to-exceed amount of City/State/Zip: Menifee, CA 92586 Telephone: 951-557-8909 Fax: Task Amount Email: kellyCcD9thshield.com 1' 4th of July Events- B $9,961.75 Taxpayer ID #: 85-3342602 2. City Business License #: 028268 3. 2. Term: The effective date of this contract is 4. 07/03/2024 and it terminates 07/08/2024 unless sooner terminated as provided herein. 6. Signatures: The person executing this 3. Contractor's Obligations: Agreement on behalf of Contractor warrants and represents that he/she has the authority to (a) To the satisfaction of the City's Project execute this Agreement on behalf of Contractor Manager, Contractor shall provide the and to bind Contractor to perform its obligations following goods and/or services: (Attach hereunder. These signatures attest the parties' extra sheet/s if necessary) agreement hereto: Provide security in and around the duck CONTRACTOR: event starting July 3rd and through July 6th. o Justin Metoyer, President (b) Contractor shall perform the above- referenced services or delivery the required Name and Title 51L4itA, goods at or to the following specified DocuSigned by: By: edby: yv location/s: (Attach extra sheet/s if �--Eh135F453FY947h_ necessary) CITY OF LAKE ELSINORE: Diamond Stadium Ls' dby: nStKifS&, By Saeeeeiz 4. Supplemental Conditions: This Contract is City Manager subject to the Supplemental Conditions attached Approved as to content/Insurance: hereto, which are incorporated herein by reference. By:5DocuSigned by: "V, 1Juc�lc 678FB35A1E42495... Assistant City Manager DocuSigned by: Attested by: 111411411 9th Shield Security City Clerk 07/03/2024 Short Form Goods or Services Contract 1 Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B SUPPLEMENTAL CONDITIONS 1. Independent Contractor. It is expressly agreed that Contractor is to perform or deliver the goods and/or services described herein as an independent contractor pursuant to California Labor Code Section 3353, under the control of the City as to the result of Contractor's work only but not as to the means by which such result is accomplished. Nothing contained herein shall in any way be construed to make Contractor or any of its agents or employees, an agent, employee or representative of the City. Contractor shall be entirely responsible for the compensation of any assistants, employees, and subcontractors used by Contractor in providing said goods and/or services. 2. Termination. Either the City or Contractor may terminate this Contract with or without cause at any time upon giving the other party five (5) calendar days' written notice of such termination. In the event of termination, the City shall be liable only to pay to the Contractor compensation for goods delivered or services rendered up to the date of the Contract's termination. Under no circumstances shall City be responsible for payment of lost profits, or damages beyond the total amount of compensation set in this Contract. 3. Assignment. Contractor shall not assign this Contract, or any part thereof, or any right of the Contractor hereunder without the prior written consent of the City. 4. Indemnity. Contractor shall indemnify, defend and hold the City harmless from and against all claims, demands and causes of action for injury, death or damage to any person or property that may arise or result from Contractor's performance of this Contract or from acts or omissions of any person(s) employed by Contractor.This indemnity shall survive expiration or termination of the Purchase Order or final payment thereunder. 5. Anti-Discrimination. Contractor shall not discriminate against any employee or applicant for employment because of race, color, religious creed, age, sex, actual or perceived sexual orientation, national origin, disability as defined by the American with Disabilities Act (42 U.S.C. § 12010, et seq.) or veteran's status. To the extent applicable, Contractor shall comply with all federal, state, and local laws regarding non-discrimination, equal employment opportunity, affirmative action and occupational-safety-health concerns, shall comply with all applicable rules and regulations thereunder, and shall comply with same as each may be amended from time to time. 6. Legal Responsibilities. Contractor shall comply with all local, state and federal laws and regulations applicable to the goods or services required hereunder, including any rule, regulation or bylaw governing the conduct or performance of Contractor and/or its employees, officers, or board members. Contractor represents that it has obtained and will maintain at all times during the term of this Contract all professional and/or business licenses, certifications and/or permits for necessary for delivering the goods or performing the services described in this Contract, including a City business license. 7. Insurance. During the entire term of this Contract and any extension or modification thereof, the Contractor shall keep in effect insurance policies meeting the following insurance requirements: 9th Shield Security 07/03/2024 Short Form Goods or Services Contract 2 Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B 7.1 Commercial General and Automobile Liability Insurance. Contractor, at its own cost and expense, shall maintain commercial general insurance in an amount not less than ONE MILLION DOLLARS ($1,000,000.00) per occurrence, coverage and automobile liability insurance in an amount not less than ONE MILLION DOLLARS ($1,000,000.00) per occurrence for the term of this Contract in an amount not less than ONE MILLION DOLLARS ($1,000,000.00) per occurrence, combined single limit coverage for risks associated with the work contemplated by this Contract. If a Commercial General Liability Insurance or an Automobile Liability form or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to the work to be performed under this Contract or the general aggregate limit shall be at least twice the required occurrence limit. Such coverage shall include but shall not be limited to, protection against claims arising from bodily and personal injury, including death resulting therefore, and damage to property resulting from activities contemplated under this Contract, including the use of owned and non-owned automobiles. The following endorsements shall be attached to the policy: 7.1.1 Policy shall cover on an "occurrence basis." 7.1.2 Policy must cover personal injuries as well as bodily injuries. Exclusion of contractual liability must be eliminated from personal injury endorsement. 7.1.3 Broad form property damage endorsement must be attached. 7.1.4 Policy must cover contractual liability by amending the definition of "incidental contract" to include any written contract. 7.1.5 Notwithstanding any inconsistent statement in any required insurance policies or any subsequent endorsements attached thereto, the protection offered by all policies, except for Worker's Compensation, shall bear an endorsement whereby it is provided that, the City and its officers, employees, servants, volunteers and agents and independent contractors, including without limitation, the City Manager and City Attorney, are named as additional insureds. Additional insureds shall be entitled to the full benefit of all insurance policies in the same manner and to the same extent as any other insureds and there shall be no limitation to the benefits conferred upon them other than policy limits to coverages. 7.2 Worker's Compensation The Contractor, at its own cost and expense shall carry and maintain statutory Worker's Compensation Insurance and Employer's Liability with limits of not less than One Million Dollars ($1,000,000) with an insurance carrier satisfactory to the City. In the event Contractor is self-insured, it shall furnish the City with a Certificate of Permission to Self-Insure signed by the Department of Industrial Relations Administration of Self-Insurance in Sacramento, California. If any injury occurs to any employee of 07/03/2024 Shield Security Contractor for which the employee, or his dependents in the event of his 7/ Short Form Goods or Services Contract 3 Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B death, is entitled to compensation from the City, the City may retain out of sums due the Contractor under this Contract an amount sufficient to cover such compensation as fixed by said Act, until such compensation is paid or until it is determined that no compensation is due and if the City is compelled topay such compensation, it will deduct and retain from the sums due the Contractor the amount so paid. 7.3 Additional Insurance Provisions. Said policies shall constitute primary insurance as to the City, and its officers, agents, and employees, so that other insurance policies held by or for them or the City's self-insurance program shall not be required to contribute to any loss covered under the Contractor's insurance policy or policies. 7.4 Coverage Verification. 7.4.1 Upon notification of receipt by the City of a notice of cancellation, major change in coverage or expiration, Contractor shall file with the City a certified copy of the required new or renewal policy. 7.4.2 If, at any time during the life of the Contract or any extension thereof, Contractor fails to maintain the required insurance in full force and effect, all work under the Contract shall be discontinued immediately and all payments due or that become due to the Contractor will be withheld until notice is received by the City that the required insurance has been restored to full force and effect and that the premiums therefore have been paid for a period satisfactory to the City. Any failure to maintain the required insurance will be sufficient cause for City to immediately terminate the Contract. 8. Payment of Prevailing Wages Contractor is aware of the requirements of California Labor Code Section 1720, et seq., and 1770, et seq., as well as California Code of Regulations, Title 8, Section 1600, et seq., ("Prevailing Wage Laws"), which require the payment of prevailing wage rates and the performance of other requirements on "Public Works" and "Maintenance" projects. If services are being performed as part of an applicable "Public Works" or "Maintenance" project, as defined by the Prevailing Wage Laws, and if the total compensation is $1,000 or more, Contractor agrees to fully comply with such Prevailing Wage Laws. Contractor shall determine the applicable prevailing rates and make copies of the prevailing rates of per diem wages for each craft, classification or type of worker needed to execute the services available to interested parties upon request, and shall post copies at the Contractor's principal place of business and at the project site. Contractor shall defend, indemnify and hold the City, its elected officials, officers, employees and agents free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. The provisions of this Section may be waived in if inapplicable to the services provided hereunder. 9th Shield Security 07/03/2024 Short Form Goods or Services Contract 4 Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B 9. Background Checks At any time during the term of this Contract, the City reserves the right to make an independent investigation into the background of Contractor's personnel who perform work required by this Contract, including but not limited to their references, character, address history, past employment, education, social security number validation, and criminal or police records, for the purpose of confirming that such personnel are lawfully employed, qualified to provide the subject service or pose a risk to the safety of persons or property in and around the vicinity of where the services will be rendered or City Hall. If the City makes a reasonable determination that any of Contractor's prospective or then current personnel is deemed objectionable, then the City may notify Contractor of the same. Contractor shall not use that personnel to perform work required by this Contract, and if necessary, shall replace him or her with a suitable worker. 10. Amendment Any amendments to this Contract must be in writing, signed by both parties and affixed hereto. 11. Entire Agreement This Contract contains the entire understanding between the parties relating to the obligations described herein. All prior or contemporaneous understandings, agreements, representations and statement, oral or written, are superseded in total by this Contract and shall be of no further force or effect. 9th Shield Security 07/03/2024 Short Form Goods or Services Contract 5 Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B QUOTE FOR SERVICES May 28, 2024 City of Lake Elsinore C/O: Beau Davis Re: Uniformed Security Services We are pleased to have the opportunity to work with you. This letter will confirm our understanding of professional services to be provided, and our fee arrangements, including our billing procedures and payment requirements. It will also serve as our standing quote for services. We will provide security protection services, where authorized by law. We are mindful of the cost of professional services and always attempt to use professionals who are best suited to attain the desired results for our clients. We will provide competent professional services and use our best efforts. We appreciate the opportunity to provide you with a proposal for an unarmed/armed uniformed guard contract services for City of Lake Elsinore. Please find enclosed our company information and solicitation bid pertaining to our services. The 9' Shield thanks you for the opportunity to earn your business. We are looking forward to working with you on this project. Regards, 3ustin Metoyer Justin Metoyer President C: 951.557.0303 O: 951.557.8909 Justin e,9thshield.com Note: This quote must be signed prior to commencement of services. Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B The 91h Shield Representative: Justin Metoyer Date:7 . D 77-,, ' City of Lake Elsinore Representative: Jason Simpson Date: SERVICES ARE AS FOLLOWS: • UNIFORMED SECURITY OFFICER/$37.00 PER HOUR PER GUARD • UNIFORMED SECURITY SUPERVISOR/$40.00 PER HOUR PER SUPERVISOR • BILLING TIME AND A HALF AFTER 8 HOURS • BILLING TIME AND A HALF FOR ALL HOLIDAYS(EASTER, INDEPENDENCE DAY, MEMORIAL DAY, LABOR DAY, THANKSGIVING DAY, CHRISTMAS EVE, CHRISTMAS DAY,NEW YEARS EVE,NEW YEARS DAY) $55.50/$60 • BILLING NET 30. Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B July 3: (1 ) Guard 8:OOpm-5:30am $37 x 4 hours = $148 + $55.5 x 5.5 hours = $305.25 = $453.25 July 4: (1 ) Guard 5:30am-3:OOpm $55.50 x 9.5 hours = $527.25 (7) Guards 3:00-10:00pm $55.50 x 49 hours = $2,719.50 (1 ) Supervisor 3:00-10:00pm $60 x 7 hours = $420 (1 ) Guard 10:00pm-6:30am $55.50 x 2 hours = $111 + $37 x 6 hours =$222 + $55.50 x .5 hours overtime = $360.75 Total $4,027.50 July 5: (1 ) Guard 6:30am-3:OOpm $37 x 8 hours + $55.50 x .5 hours = $323.75 (7) Guards 3;00-10:00pm $37 x 49 hours = $1 ,813 (1 ) Supervisor 3:00-10:OOpm $40 x 7 hours = $280 (1 ) Guard 10:OOpm-6:30am $37 x 8 hours + $55.5 x .5 hours = $323.75 Total $2,740.50 July 6: (1 ) Guard 6:30am-3:OOpm $37 x 8 hours + $55.50 x .5 hours = $323.75 (7) Guards 3;00-10:00pm $37 x 49 hours = $1 ,813 (1 ) Supervisor 3-.00-10:OOpm $40 x 7 hours = $280 (1 ) Guard 10:OOpm-6:30am $37 x 8 hours + $55.5 x .5 hours = $323.75 Total $2,740.50 GRAND TOTAL $9,961 .75 Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B CITY OF � l' OFFICE USE ONLY LADE LSII`IOI�E ` DREAM EXTREME City of Lake Elsinore VENDOR NUMBER Attn:Finance Department 130 South Main Street VENDOR APPLICATION INPUT DATE Lake Elsinore,CA 92530 (951)674-3124 (951) 557-8909 E-mail The 9th Shield Incorporated kelly@9thshield.com Individual Name(if sole proprietor): Taxpayer ID#or Social Security# 85-3342602 First MI Last Business Address: Remittance Address(if different) 27851 Bradley Rd., Ste 120 Address Address Menifee CA 92586 City State Zip City State Zip Principal Contact for Firm: Title Phone: Kelly Hammond Controller (951) 557-8909 Type of Entity: ❑ Sole Proprietor ❑✓ Corporation ❑Partnership ❑ Tax Exempt/Non-profit ❑ Government or Trust Is business licensed to do business in the City of Lake Elsinore? ® Yes ❑ No City of Lake Elsinore Business License is required if conducting business within the City of Lake Elsinore(LEMC 5.08.) City Business License# 0_Z S Z&B Expiration Date:3 - 31 • ZozS Check all that apply: ❑Goods only ❑ Goods and Services ❑ Rents/Leases paid to you as agent ❑Legal Services ❑ Medical Services ❑✓ Other: Services Brief description of type of supplies and/or services offered(required): Armed/Unarmed Security Services, Patrol Services, Campus Security, K9 Detection Services Executive Protection, Work Place Violance Protection The undersigend hereby certifies that the above and foregoing information is a full,true,and correct statement of the facts. President/CEO 07/02/2024 Signature Title Date 1. Terms: The City of Lake Elsinore is Net 45 days. 2. The City of Lake Elsinore is not tax exempt. 3. Purchase order required for$2,000.00 or more. 4. W-9 form must be completed to be accepted. Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B 7DATE(MM/DD/YYYY) ACORO° CERTIFICATE OF LIABILITY INSURANCE 7/03/2024 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 CONTACT Countryside Insurance Agency NAME: Neil FedunlW,Broker 29970 TechnologyDrive, Suite 214 a/c°NNv Ext: (951)296-9995 FAX No: (951)719-1071 E-MAIL MURRIETA, CA 92563 ADDRESS: service@countrysideagent.com License#: Ca.OM65618 Az.30008 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Lexington Insurance Company 19437 INSURED INSURERB: National Liability&Fire Insurance Co. 20052 THE 9TH SHIELD INCORPORATED INSURERC: Endurance American Specialty Insurance Company 41718 27851 BRADLEY ROAD INSURER D: STATE COMPENSATION INSUANCE FUND 35076 MENIFEE, CA 92586 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 00003865-0 REVISION NUMBER: 948 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 EFF POLICY EXP LIMITS LTR IN SD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY Y Y 052114875 10/23/2023 10/23/2024 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE DAMAGE TO RENTED X OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 0 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PE� LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY Y Y 73APBOO7991 02/01/2024 02/01/2025 Ea acINED ccdenISINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS HIRED NON-OWNED X AUTOS ONLY X AUUTOS ONLY PerOa cidentPER DAMAGE $ 1,000,000 Comp/Coll Ded $ 1000 `` X UMBRELLA LIAB X OCCUR Y Y ELD30036687901 10/23/2023 10/23/2024 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ $ D WORKERS COMPENSATION PER Y 9361375-24 06/15/2024 06/15/2025 X STATUTE ERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate is subject to policy limits, conditions and exclusions. Certificate Holder is named as Additional Insured as per attached endorsement form(s). CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN The City of Lake Elsinore ACCORDANCE WITH THE POLICY PROVISIONS. 130 S Main Street LAKE ELSINORE, CA 92530 AUTHORIZED REPRESENTATIVE F , , (NPF) ©1988-2 5 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Printed by NPF on 07/03/2024 at 05:43PM Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B M-5887(08/2017) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM TRUCKERS COVERAGE FORM SCHEDULE—ADDITIONAL INSURED: SEE M-2904 (11/80) EDITION N/A, CA 11111 A. In consideration of payment of the additional premium listed below, LIABILITY COVERAGE is extended to include the additional insured named herein, provided that: 1) such insurance applies only to the ownership, maintenance or use of a covered "auto"; and 2) such insurance applies only to acts or omissions by you,your agents or your"employees"while such covered auto is being used in your business; and 3) such insurance does not apply to the acts or omissions of the additional insured or any of the additional insured's agents or"employees"other than you; and 4) such insurance does not apply if the additional insured is subject to motor carrier insurance requirements and is not insured for hired "autos"under an"auto"liability insurance form that insures on a primary basis the owners of the"autos"and their agents and "employees"while the"autos"are being used exclusively in the additional insured's business and pursuant to operating rights granted to the additional insured by a public authority. B. The insurance afforded to such additional insured: 1) Applies only to the extent permitted by law; and 2) Will not be broader than that which you are required by a contract or agreement to provide for such additional insured. C. The most we will pay on behalf of the additional insured is the lesser of the amount of insurance: 1) That you are required by a contract or agreement to provide for such additional insured;or 2) That is available under the applicable Limits of Insurance shown in the Declarations. All other terms, conditions and agreements remain unchanged. Additional Premium: $ 0 Company Name Policy Number 73 APB 007991 National Liability&Fire Insurance Company Endorsement Effective 02/01/2024 12:01 AM Named Insured Countersigned by THE 9TH SHIELD INC (Authorized Representative) (The Attaching Clause need be completed only when this endorsement is issued subsequent to preparation of the policy.) M-5887(08/2017) 02/05/2024 Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B POLICY NUMBER: 73 APB 007991 M-5144a(0612007) WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modi- fied by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: Countersigned By: 02/01/2024 12:01 AM Named Insured: THE 9TH SHIELD INC (Authorized Representative) SCHEDULE Name Of Person(s)Or Organization(s): SEE M-2904 (11/80)EDITION N/A, CA 11111 Additional Premium I $ (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person(s)or organiza- tion(s)shown in the Schedule. We will retain the additional premium shown above, regardless of any early termi- nation of this endorsement or the policy. Includes copyrighted material of Insurance Services Office,Inc.with its permission. M-5144a(06/2007) 02/05/2024 Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B ENDORSEMENT # 014 This endorsement, effective 12:01 AM 10/23/2023 Forms a part of policy no.: 0521 14875 Issued to: 9TH SHIELD INCORPORATED, THE By: LEXINGTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED REQUIRED BY WRITTEN CONTRACT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY POLICY, COVERAGE APPLICABLE TO COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE (SECTION I - COVERAGES) ONLY A. Section II - Who Is An Insured is amended to i. The preparing, approving, or failing to include any person or organization you are prepare or approve maps, shop required to include as an additional insured on drawings, opinions, reports, surveys, this policy by a written contract or written field orders, change orders, or drawings agreement in effect during this policy period and and specifications; and executed prior to the "occurrence" of the "bodily ii. Supervisory, inspection, architectural, or injury" or "property damage." engineering activities. B. The insurance provided to the above described A 5. This insurance does not apply to "bodily additional insured under this endorsement is injury" or "property damage" arising out of limited as follows: "your work" or "your product" included in 1. COVERAGE A BODILY INJURY AND PROP- the "product-completed operations hazard" ERTY DAMAGE (Section I - Coverages) only. unless you are required to provide such 2. The person or organization is only an coverage by written contract or written additional insured with respect to liability agreement and then only for the period of arising out of "your work" or "your product". time required by the written contract or 3. In the event that the Limits of Insurance written agreement and in no event beyond provided by this policy exceed the Limits of the expiration date of the policy. Insurance required by the written contract or 6. Any coverage provided by this endorse- written agreement, the insurance provided by ment to an additional insured shall be this endorsement shall be limited to the Limits excess over any other valid and collectible of Insurance required by the written contract insurance available to the additional insured or written agreement. This endorsement shall whether primary, excess, contingent or on not increase the Limits of Insurance shown in any other basis. the Declarations pertaining to the coverage C. In accordance with the terms and conditions of provided herein. the policy and as more fully explained in the 4. The insurance provided to such an additional policy, as soon as practicable, each additional insured does not apply to "bodily injury" or insured must give us prompt notice of any "property damage" arising out of an archi- "occurrence" which may result in a claim, tect's, engineer's, or surveyor's rendering of forward all legal papers to us, cooperate in the or failure to render any professional services, defense of any actions, and otherwise comply including, but not limited to: with all of the policy's terms and conditions. Failure to comply with this provision may, at our option, result in the claim or "suit" being denied. . Q11- Authorized Representative OR Countersignature (In states where applicable) Includes copyrighted information of the Insurance Services Offices, Inc., with its permission. All rights reserved. LX9776(08/04) Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B ENDORSEMENT # 015 This endorsement, effective 12:01 AM 10/23/2023 Forms a part of policy no.: 0521 14875 Issued to: 9TH SHIELD INCORPORATED, THE By: LEXINGTON INSURANCE COMPANY WAIVER OF SUBROGATION (BLANKET) It is agreed that we, in the event of a payment under this policy, waive our right of subrogation against any person or organization where the insured has waived liability of such person or organization as part of a written contractual agreement between the insured and such person or organization entered into prior to the "occurrence" or offense. All other terms and conditions remain unchanged. Authorized Representative OR Countersignature (In states where applicable) LEXOCC234(11/03) LX0485 Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B _ T E ENDORSEMENT AGREEMENT BROKER COPY COMPENSATION WAIVER OF SUBROGATION REP 02 BLANKET BASIS 9361375-24 FUND NEW NA HOME OFFICE 9-60-80-65 SAN FRANCISCO EFFECTIVE JUNE 15, 2024 AT 12.01 A.M. PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AND EXPIRING JUNE 15, 2025 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME 9TH SHIELD 27851 BRADLEY RD STE 120 MENIFEE, CA 92586 WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR ORGANIZATION NAMED IN THE SCHEDULE. THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM US. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ---------------------- --------------- ANY PERSON OR ORGANIZATION BLANKET WAIVER OF FOR WHOM THE NAMED INSURED SUBROGATION HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: JUNE 14, 2024 2572 AUTHORIZED REPRESENT IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.7-2014) OLD DP 217 Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B BUSINESS LICENSE CITY OF LAKE ELSINORE This business license is issued for revenue purposes only and does not grant authorization Administrative Services-Licensing I to operate a business. This business license is issued without verification that the holder is 130 South Main Street, Lake Elsinore, CA 92530 subject to or exempted from licensing by the state,county,federal government,or any PH (951) 674-3124 other governmental agency. Business Name: THE 9TH SHIELD INCORPORATED BUSINESS LICENSE NO. 028268 Business Location: 27851 BRADLEY RD STE 120 Business Type: SECURITY SERVICE&PATROL MENIFEE,CA 92586-2213 Owner Name(s): THE 9TH SHIELD INCORPORATED Description: SECURITY GUARD SERVICES AT STORM STADIUM FOR GAMES&EVENTS Issue Date: 3/19/2024 Expiration Date: 3/31/2025 THE 9TH SHIELD INCORPORATED 27851 BRADLEY RD STE 120 MENIFEE, CA 92586-2213 Starting January 1,2021,Assembly Bill 1607 requires the prevention of gender-based discrimination of business establishments.A full notice is available in English or other languages by going to:https://www.dca.ca.gov/publications/ TO BE POSTED IN A CONSPICUOUS PLACE THIS IS YOUR LICENSE • NOT TRANSFERABLE Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B The 9th Shield Incorporated 27851 Bradley Rd Ste 120 r Menifee, CA 92586 +1 9515578909 kelly@9thshield.com BILL TO INVOICE 4552 CITY OF LAKE ELSINORE 130 S MAIN STREET DATE 07/10/2024 TERMS Net 30 LAKE ELSINORE, CA DUE DATE 08/09/2024 92530 JY RATE AMOUNT ADMN-001 Administration of Account- DUCK EVENT UNARMED SECURITY SERVICES LOCATION SITE: LAKE ELSINORE STORM STADIUM ADDRESS 500 DIAMOND DRIVE, LAKE ELSINORE, CA 92530 BILLING PERIOD 07/03/2024-07/06/2024 DATE WEDNESDAY 07/03/2024 STORM EVENT GUARD 4 37.00 148.00 GUARD: JOSHUA GASPAR: 2000-0000 HOLIDAY STORM EVENT GUARD 5.50 55.50 305.25 GUARD: JOSHUA GASPAR: 0000-0530 DATE THURSDAY 07/04/2024 HOLIDAY HOLIDAY STORM EVENT GUARD 9.50 55.50 527.25 GUARD: KLOE RICE: 0530-1500 HOLIDAY STORM EVENT GUARD 7 55.50 388.50 GUARD: ANTONIO VALVERDE: 1500-2200 HOLIDAY STORM EVENT GUARD 7 55.50 388.50 GUARD: ISABEL RODRIGUEZ: 1500-2200 Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B mmm QTY RATE AMOUNT HOLIDAY STORM EVENT GUARD 7 55.50 388.50 GUARD: HENRY URIBE: 1500-2200 HOLIDAY STORM EVENT GUARD 7 55.50 388.50 GUARD: DANIELLA GRAVETTE-HUSTON: 1500-2200 HOLIDAY STORM EVENT GUARD 7 55.50 388.50 GUARD: CARLY GARAMONE: 1500-2200 HOLIDAY STORM EVENT GUARD 7 55.50 388.50 GUARD: ANDRE THURMAN: 1500-2200 HOLIDAY STORM EVENT GUARD 7 60.00 420.00 GUARD: SUPERVISOR: CHARLES ANDREWS: 1500-2200 HOLIDAY STORM EVENT GUARD 7 55.50 388.50 GUARD: NICKOLAS YOUNG: 1500-2200 HOLIDAY STORM EVENT GUARD 2 55.50 111.00 GUARD: HERB TREVYLAN: 2200-0000 STORM EVENT GUARD 6 37.00 222.00 GUARD: HERB TREVYLAN: 0000-0600 OVERTIME STORM EVENT GRUARD 0.50 55.50 27.75 GUARD: HERB TREVYLAN: 0600-0630 DATE FRIDAY 07/05/2024 STORM EVENT GUARD 8 37.00 296.00 GUARD: CARLY GARAMORE: 0630-1430 OVERTIME STORM EVENT GRUARD 0.50 55.50 27.75 GUARD: CARLY GARAMORE: 1430-1500 STORM EVENT GUARD 7 37.00 259.00 GUARD: ANTONIO VALVERDE: 1500-2200 STORM EVENT GUARD 7 37.00 259.00 GUARD: PETE YBARRA: 1500-2200 STORM EVENT GUARD 7 37.00 259.00 GUARD: HENRY URIBE: 1500-2200 STORM EVENT GUARD 7 37.00 259.00 GUARD: WILLIAM SMITH: 1500-2200 STORM EVENT GUARD 7 37.00 259.00 GUARD: ANDRE THURMAN: 1500-2200 STORM EVENT GUARD 7 40.00 280.00 GUARD: SUPERVISOR: CHARLES ANDREWS: 1500-2200 STORM EVENT GUARD 7 37.00 259.00 GUARD: ANGEL RICCI: 1500-2200 STORM EVENT GUARD 8 37.00 296.00 GUARD: HERB TREVYLAN: 2200-0600 OVERTIME STORM EVENT GRUARD 0.50 55.50 27.75 GUARD: HERB TREVYLAN: 0600-0630 SATURDAY 07/06/2024 STORM EVENT GUARD 8 37.00 296.00 GUARD: CARLY GARAMORE: 0630-1430 Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B QTY RATE AMOUNT OVERTIME STORM EVENT GRUARD 0.50 55.50 27.75 GUARD: CARLY GARAMORE: 1430-1500 STORM EVENT GUARD 7 37.00 259.00 GUARD: HERB TREVYLAN: 1500-2200 STORM EVENT GUARD 7 40.00 280.00 GUARD: SUPERVISOR: PETE YBARRA: 1500-2200 STORM EVENT GUARD 7 37.00 259.00 GUARD: MARCO CARREON: 1500-2200 STORM EVENT GUARD 7 37.00 259.00 GUARD: WILLIAM SMITH: 1500-2200 STORM EVENT GUARD 7 37.00 259.00 GUARD: ISABEL RODRIGUEZ: 1500-2200 STORM EVENT GUARD 7 37.00 259.00 GUARD: KLOE HICE: 1500-2200 STORM EVENT GUARD 7 37.00 259.00 GUARD: NICKOLAS YOUNG: 1500-2200 STORM EVENT GUARD 7 37.00 259.00 GUARD: WILLIAM SMITH: 1500-2200 STORM EVENT GUARD 7 37.00 259.00 GUARD: HENRY URIBE: 1500-2200 STORM EVENT GUARD 8 37.00 296.00 GUARD: ANA DAGUE: 2200-0600 OVERTIME STORM EVENT GRUARD 0.50 55.50 27.75 GUARD: ANA DAGUE: 0600-0630 Thank you for your business! We look forward to working with you again! • $9,961 .75 Docusign Envelope ID:929D3C6A-15D0-443D-8BB5-5C8F2DF1075B Request for Taxpayer Form �� Give Form to the (Rev.October2018) Identification Number and Certification requester.Do not Department of the Treasury send to the IRS. Internal Revenue Service ►Go to www.irs.gov/FormW9 for instructions and the latest information. 1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank. The 9th Shield Incorporated 2 Business name/disregarded entity name,if different from above 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1.Check only one of the 4 Exemptions(codes apply only to co following seven boxes. certain entities,not individuals;see a instructions on page 3): p ❑ Individual/sole proprietor or ❑✓ C Corporation n S Corporation ❑ Partnership ❑ Trust/estate to single-member LLC 0 o Exempt payee code(if any) ❑ Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=Partnership)► o y Note:Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check Exemption from FATCA reporting N LLC if the LLC is classified as a single-member LLC that lis disregarded from the owner unless the owner of the LLC is code(if any) c another LLC that is not disregarded from the owner for U.S.federal tax purposes.Otherwise,a single-member LLC that a is disregarded from the owner should check the appropriate box for the tax classification of its owner. w U ❑ Other(see instructions)► (Applies to accounts maintained outside the U.S) N N 5 Address(number,street,and apt.or suite no.)See instructions. Requester's name and address(optional) CO) 27851 Bradley Road, Suite 120 6 City,state,and ZIP code Menifee, CA 92586 7 List account number(s)here(optional) IT.ME Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid Social security number backup withholding.For individuals,this is generally your social security number(S .However,for a FM _M _ resident alien,sole proprietor,or disregarded entity,see the instructions for Part I,later.For other entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN, later. or Note:If the account is in more than one name,see the instructions for line 1.Also see What Name and Employer identification number Number To Give the Requester for guidelines on whose number to enter. 8 5 - 3 3 1 4 1 2 1 6 0 2 90 Ma Certification Under penalties of perjury, I certify that: 1.The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and 2.1 am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding;and 3.1 am a U.S.citizen or other U.S.person(defined below);and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct. Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid, acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required t sign the certification but you must provide your correct TIN.See the instructions for Part II,later. Sign Signature of Here U.S.person► Date► General Instructions •Form 1099-DIV(dividends,including those from stocks or mutual funds) Section references are to the Internal Revenue Code unless otherwise .Form 1099-MISC(various types of income,prizes,awards,or gross noted. proceeds) Future developments.For the latest information about developments •Form 1099-B(stock or mutual fund sales and certain other related to Form W-9 and its instructions,such as legislation enacted transactions by brokers) after they were published,go to www.irs.gov/FormW9. •Form 1099-S(proceeds from real estate transactions) Purpose of Form •Form 1099-K(merchant card and third party network transactions) An individual or entity(Form W-9 requester)who is required to file an •Form 1098(home mortgage interest), 1098-E(student loan interest), information return with the IRS must obtain your correct taxpayer 1098-T(tuition) identification number(TIN)which may be your social security number •Form 1099-C(canceled debt) (SSN),individual taxpayer identification number(ITIN),adoption •Form 1099-A(acquisition or abandonment of secured property) taxpayer identification number(ATIN),or employer identification number (EIN),to report on an information return the amount paid to you,or other Use Form W-9 only if you are a U.S.person(including a resident amount reportable on an information return.Examples of information alien),to provide your correct TIN. returns include,but are not limited to,the following. If you do not return Form W-9 to the requester with a TIN,you might •Form 1099-INT(interest earned or paid) be subject to backup withholding.See What is backup withholding, later. Cat.No.,10231 X Form W-9(Rev.10-2018) WcuSign Certificate Of Completion Envelope Id:929D3C6A15D0443D8BB55C8F2DF1075B Status:Completed Subject:Complete with Docusign:9th Shield Short Form Agreement-Security Duck Event-07-08-2024.pdf Source Envelope: Document Pages:20 Signatures:4 Envelope Originator: Certificate Pages:5 Initials:0 Jill Theriot AutoNav: Enabled 130 S. Main Street Envelopeld Stamping: Enabled Lake Elsinore,CA 92530 Time Zone: (UTC-08:00)Pacific Time(US&Canada) jtheriot@lake-elsinore.org IP Address:47.180.22.242 Record Tracking Status:Original Holder:Jill Theriot Location: DocuSign 7/12/2024 4:05:09 PM jtheriot@lake-elsinore.org Signer Events Signature Timestamp Shannon Buckley by: Sent:7/12/20244:07:41 PM sbuckley@Lake-Elsinore.org EDICUSig"Id �.adnlnh" Viewed:7/12/2024 4:17:01 PM Y 9er Assistant City Manager 678FB35A1E42495... Signed:7/12/2024 4:17:13 PM Security Level: Email,Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address:47.180.22.242 Electronic Record and Signature Disclosure: Accepted:7/12/2024 4:17:01 PM ID:bcd10a87-a5ea-478c-afcf-bf69934904d7 Justin Metoyer by: Sent:7/12/2024 4:17:14 PM kelly@9thshield.com ED—Sig"Id tsfin, hdb�w Viewed:7/15/2024 9:02:26 AM Security Level: Email,Account Authentication EA135F453F4947A... Signed:7/15/2024 9:02:40 AM (None) Signature Adoption: Pre-selected Style Using IP Address: 107.115.120.27 Electronic Record and Signature Disclosure: Accepted:7/15/2024 9:02:26 AM ID:ff43452e-7455-42d0-99e8-d7ef5253fc99 Jason Simpson by: Sent:7/15/2024 9:02:42 AM sim son lake-elsinore.or ED—Signed antinj p @ g P Viewed:7/15/2024 9:35:04 AM City Manager 1F551F63E6FE412 Signed:7/15/2024 9:35:09 AM city of Lake Elsinore Signature Adoption: Pre-selected Style Security Level: Email,Account Authentication (None) Using IP Address:47.180.22.242 Electronic Record and Signature Disclosure: Accepted:7/15/2024 9:35:04 AM ID:be630452-68ef-4fbe-b79b-02dd24e880f1 Candice Alvarez CD—Signed by: Sent:7/15/2024 9:35:11 AM calvarez@lake-elsinore.org Viewed:7/15/2024 11:36:45 AM City Clerk 2941B149748c460 Signed:7/15/2024 11:36:50 AM City of Lake Elsiniore Signature Adoption: Uploaded Signature Image Security Level: Email,Account Authentication (None) Using IP Address:47.180.22.242 Electronic Record and Signature Disclosure: Accepted: 10/24/2019 11:01:03 AM ID:0018f862-4e7a-4c04-91a9-67d7112db44f In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Brendan Rafferty COPIED Sent:7/15/2024 11:36:53 AM brafferty@lake-elsinore.org Security Level: Email,Account Authentication (None) Electronic Record and Signature Disclosure: Accepted:6/30/2022 11:05:58 AM ID:706c7293-4fff-4a42-bd8d-a03bc71 bf87d Beau Davis COPIED Sent:7/15/2024 11:36:54 AM bdavis@lake-elsinore.org Viewed:7/15/2024 11:44:51 AM Security Level: Email,Account Authentication (None) Electronic Record and Signature Disclosure: Accepted:6/17/2024 3:20:20 PM ID: 1e66dOf6-d28b-4172-a0e7-48e2fa07d3ee Luz Reyes COPIED Sent:7/15/2024 11:36:55 AM Ireyes@lake-elsinore.org Deputy City Clerk City of Lake Elsinore Security Level: Email,Account Authentication (None) Electronic Record and Signature Disclosure: Not Offered via DocuSign Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 7/12/2024 4:07:41 PM Certified Delivered Security Checked 7/15/2024 11:36:45 AM Signing Complete Security Checked 7/15/2024 11:36:50 AM Completed Security Checked 7/15/2024 11:36:55 AM Payment Events Status Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on:2/5/2018 9:41:59 AM Parties agreed to:Shannon Buckley,Justin Metoyer,Jason Simpson,Candice Alvarez,Brendan Rafferty, Beau Davis CONSUMER DISCLOSURE From time to time, Carahsoft OBO City of Lake Elsinore (we, us or Company) may be required by law to provide to you certain written notices or disclosures. 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