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Home My WebLink AboutWhitley, Peter and Kenney, Nora; 2017-05-03;AMENDMENT NO. 3 TO EXTEND AND AMEND AGREEMENT FOR INDEPENDENT CONTRACTOR RESIDENT CARETAKER SERVICES BETWEEN THE CITY OF CARLSBAD AND PETER WHITLEY AND NORA KENNY FOR LEO CARRILLO RANCH HISTORIC PARK 3 is entered into and effective as of the l,~day of _ _.._,<......::-=.::,,.... _______ , 20).a, extending and amending the agreement dated May 3, greement") by and between the City of Carlsbad, a municipal corporation, ("City"), hitley and Nora Kenny, ("Contractor") (collectively, the "Parties") for independent contractor resident caretaker services. RECITALS A On April 11, 2018, the Parties executed Amendment No. 1 to the Agreement to extend independent contractor resident caretaker services for Leo Carrillo Ranch Historic Park; and;and B. On May 6, 2019, the Parties executed Amendment No. 2 to the Agreement to extend independent contractor resident caretaker services for Leo Carrillo Ranch Historic Park; and C. The Parties desire to extend the Agreement for a period of one year and amend the Agreement to provide a monthly stipend; and NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, City and Contractor agree as follows: 1. That the Agreement, as may have been amended from time to time, is hereby extended for a period of one year ending on May 3, 2021. 2. The first sentence of Section 3 of the Agreement is amended to read as follows, "The City will provide an unfurnished two bedroom/two bathroom (1,752 square foot) manufactured Residence on the Property where the Resident Caretaker(s) may live, and a $5,000 annual stipend payable in equal monthly installments." 3. All other provisions of the Agreement, as may have been amended from time to time, will remain in full force and effect. 4. All requisite insurance policies to be maintained by the Contractor pursuant to the Agreement, as may have been amended from time to time, will include coverage for this Amendment. 5. The individuals executing this Amendment and the instruments referenced in it on behalf of Contractor each represent and warrant that they have the legal power, right and actual authority to bind Contractor to the terms and conditions of this Amendment. City Attorney Approved Version 1/30/13 CONTRACTOR By~ (signhere (print name/title) By: (sign here) {'J , r "" \L. t... vi V\ l ~ (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California By: Assi t nt ity Manager, Deputy City Manag r or Department Director as authorized by the City Manager BARBARA ENGLESON City Clerk I If required by City, proper notarial acknowledgment of execution by Contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Chairman, President, or Vice-President Group B Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CELIA A. BREWER, City Attorney City Attorney Approved Version 1/30/13 2 POLICY NUMBER: AMW0026080 COMMERCIAL GENERAL LIABILITY CG 20 260413 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 Additional Insured Person(s) Or Organization(&): City of Carlsbad 1200 Carlsbad Vilage Drive Carlsbad CA 92008 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as a n additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily inju ry•, "prope rty damage" or "personal and advertising injury" caused, in whole o r in part, by your act s or om issions or the acts or omissions of those acting on your behalf: 1. In the performance of yo ur ongoing operations; or 2. In connection with your premise s owned by or rented to you. However: 1. The insuran ce afforded to such additional insured only applies to th e extent permitted by law; and 2. If coverage provided to the additional insured is required by a contra ct or agree ment, the insurance aff orded to su ch ad ditional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional in sureds, the following is added to Section Ill -Limits Of Insurance: If coverage provide d to the additional insured i s required by a contra ct or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement: or 2. Available un der the ap plicable Limi ts of Insurance shown in the De clarations; whichever is less. This end orsement shall not incre ase the applicable Li mits of lnsuran ce sho wn in the Declaration. CG 2026 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 A~!lD• CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY} 5/15/2020 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 hokier Is an ADDITIONAL INSURED, the polic:y(les) 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 endoraement(s). PRODUCER Cun,ACT David Miller NAME: Dave Miller Insurance ~N,_t "•"· (760) 717-1707 lrffc..,,,, (866) 477-0370 2318 Pio Pico Dr =iH:. d11!in.s1Jran<:~@9m~i1.com INSURER(SI AFFORDING COVERAGE NAIC# Carlsbad CA 92008 INSURER A: Nautilus Insurance Company INSURED .INSURER.B; ,. ~· ~--··----~---·········· Peter Whitley INSURERC: 6200 Flying L C Lane .INSURER.D.: .. -------·----------------~---------- INSURERE: Carlsbad CA 92009 INSURERF: 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. NOlWITHSTANDING 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. I~, TYPE OF INSURANCE = i~ POUCYEFF l'OUCYEXP LIMITS POLICY NUMBER .. IM )~ COIIMERQALGENERALUAIIUTY EACH OCCURRENCE $ 1,000,000 ~ CLAIMS-MADE ~ OCCUR '•OAJAAm:tTCfKt:N I tu s 300,000 PREMISES /Ea occurrencel -MED EXP (MY one person) s 10,000 :----~ 4/17/2020 4/17/2021 A y AMW0026080 PERSONAL & ADV INJURY s 1,000,000 ~-----------·----------------------·----· ----·--··-- . GEN"L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 2,000,000 :&l POLICY □ rt& =:J LOC PRODUCTS· COMP:OP AGG $ 2,000,000 OTHER. s , AUTOMOBILE LIABILITY COMBINEu SINGLE LIMlr s ; (Ea accident) ANY AUTO BOOIL Y INJURY (Per person) $ -OWNED -SCHEDULED BODIL y INJURY (Per accident) s ~ AUTOS ONLY -AUTOS HIRED NON-OWNED PROPERTY DAMAGE s AUTOS ONLY AUTOS ONLY (Per accident} s -UMBRE\.LA UAB l__j OCCUR EACH OCCURRENCE $ EXCESS UAB i CLAIMS-MADE AGGREGATE s . .. I RETENTION~ . ... . . .. """""" --·-·---· DED s 'WORKERS COMPENSATION • ~~:TUTE I I OTH- ; AND EMPLOYERS' UAIIUTY ER YIN • NN PROPRIETOR,PARTNER/EXECUTIVE □ E.L. EACH ACCIDENT _ ····-s ---------' OFFICER!MEMBER EXCLUDED? NIA ----- : (lllandato,y In NH) ... E.L. DISEASE• EA EMPLOYEE $ i ~r~~~~RATIONS below E.L. DISEASE• POLICY LIMIT s . DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Sehedule, may be attached If more apace la ,-quired) Certificate Holder is added as additional insured for designated premises 6200 Flying Leo CarrHlo Lane Carlsbad CA 92009 CERTIACATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WU.L BE DELIVERED IN City of Carlsbad ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1200 Carlsbad Village Drive David Miller Carlsbad CA 92008 I © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF EXEMPTION WORKERS' COMPENSATION/EMPLOYERS' LIABILITY INSURANCE I, Nora Kenney, am an independent contractor/sole proprietor. I hereby certify that I have no employees and am not required by law to maintain workers' compensation or employers' liability insurance. Should I employ any person during the term of the Agreement with the City of Carlsbad for independent contractor resident caretaker services, then workers' compensation and employers' liability insurance will be obtained. ((___~ Nora Kenney Independent Contractor/Sole Proprietor aRTIFICATE OF EXEMPTION WORKERS' COMPENSATION/EMPLOYERS' UABIUTY INSURANCE I, Peter Wlftley, am an independent ,ontractor/sole proprietor. I hereby certify that I h.we no employees and am not required by law to maintain workers' compensation or empl()yers' lfability Insurance. Should l employ any pcr1on duung 1he term of tM Agrte~l"lt wnh the C•tv of Cltfsb~ fof il\dependent contractor resident c:aretal<er $ervke$, then w011cer\' compen\.ittion a!ld employer.$' l1ab1hty ,nsurance w11I b<' obtained. AMENDMENT NO. 2 TO EXTEND THE AGREEMENT FOR INDEPENDENT CONTRACTOR RESIDENT CARETAKER SERVICES BETWEEN THE CITY OF CARLSBAD AND PETER WHITLEY AND NORA KENNY FOR LEO CARRILLO RANCH HISTORIC PARK This Amendment No. 2 is entered into and effective as of the (o~day of vfY\ ~ , 20--1..9i_, extending the agreement dated May 3, 2017 (the "Agreement") bya between the City of Carlsbad, a municipal corporation, ("City"), and Peter Whitley and Nora Kenney (collectively, the "Parties") independent contractor resident caretaker services. RECITALS A. On April 11, 2018, the Parties executed Amendment No. 1 to the Agreement to extend independent contractor resident caretaker services for Leo Carrillo Ranch Historic Park; and B. The Parties desire to extend the Agreement for a period of one year. NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, City and Contractor agree as follows: 1. The Agreement, as may have been amended from time to time, is hereby extended for a period of one year ending on May 3, 2020. 2. All other provisions of the Agreement, as may have been amended from time to time, shall remain in full force and effect. 3. All requisite insurance policies to be maintained by the Contractor pursuant to the Agreement, as may have been amended from time to time, shall include coverage for this Amendment. Ill Ill Ill Ill Ill Ill Ill Ill City Attorney Approved Version 1/30/13 4. The individuals executing this Amendment and the instruments referenced on behalf of Contractor each represent and warrant that they have the legal power, right and actual authority to bind Contractor to the terms and conditions hereof of this Amendment. CONTRACTOR Byj/~\2=: (sign here) t.J~l'1,., \Lt.V\...-l'j_ _____ _ (print name/title) By:,,...., -.'~{✓-~ -' ~ (sign here) Pere: 12 w 1tt T(Ll1 (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California By: ~ -------#--.~-~,__-----·----·-------------- City Manager ATTEST: City Clerk If required by City, proper notarial acknowledgment of execution by Contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Chairman, President, or Vice-President Group B Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CELIAA. BREWER, City Attorney BY: U:1 .; --.As-s-is-ta~□~t~C-it-y~A-tt~o-rn~r-. ---- ~-.vj City Attorney Approved Version 1 /30/13 2 ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 4/18/2019 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIACATE 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 David Miller NAME: Dave Miller Insurance wg_NJo.Ext): (760) 717-1707 I FAX (A/C, No): (866) 477-0370 2318 Pio Pico Dr E.fo!AIL dminsurance@gmail.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Carlsbad CA 92008 INSURER A: Voyager Insurance INSURED INSURER B: Peter Whitley INSURER C: I 6200 Flying L C Lane INSURER D: INSURER E: Carlsbad CA 92009 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 ADDL SUBR I POLICY EFF POLICY EXP LTR TYPE OF INSURANCE ,,~c,n I ••••n POLICY NUMBER I fMM/DD/YYYYl fMM/DD/YYYYl LIMITS X COMMERCIAL GENERAL LIABILITY i EACH OCCURRENCE $ 1,000,000 [X OCCUR DAMAGE TO RENTED 300,000 --~ CLAIMS-MADE PREMISES !Ea occurrence\ $ ~----MED EXP (Any one person) $ 10,000 I AMW0026080 A y I 4/17/2019 4/17/2020 1,000,000 I PERSONAL & ADV INJURY $ ~ GEN'L AGGREGATE LIMIT APPLIES PER I GENERAL AGGREGATE $ 2,000,000 X ~ PRO- ---------, I ----- ~ POLICY _ JECT ~iLOC I PRODUCTS -COMPtOP AGG $ 2,000,000 ' ./ OTHER $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ !Ea accident) ------------ ANY AUTO BODILY INJURY (Per person) $ ---OWNED : SCHEDULED --- BODILY INJURY (Per accident) $ ~ AUTOS ONLY r= AUTOS HIRED NON-OWNED I PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY I !Per accident) -~ I ' $ UMBRELLA LIAB I OCCUR ! : EACH OCCURRENCE $ I ! EXCESS LIAB CLAIMS-MADE ' AGGREGATE $ OED I RETENTION$ ' i $ ' I WORKERS COMPENSATION ' I PER I 10TH- AND EMPLOYERS' LIABILITY STATUTE ER Y/N ANY PROPRIETORtPARTNER/EXECUTIVE □ EL EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ If yes, descnbe under EL DI SEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS below I I I I ' I I ' I I I i ; DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is added as additional insured for designated premises 6200 Flying Leo Carrillo Lane Carlsbad CA 92009 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Carlsbad ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1200 Carlsbad Village Drive David Miller Carlsbad CA 92008 I © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: AMW0026080 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 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 Additional Insured Person(s) Or Organization(s): City of Carlsbad 1200 Carlsbad Village Drive Carlsbad CA 92008 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as a n additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily inju ry", "prope rty damage" or "personal and advertising injury" caused, in whole or in part, by your act s or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of yo ur ongoing operations; or 2. In connection with your premise s owned by or rented to you. However: 1. The insuran ce afforded to such additional insured only applies to th e extent permitted by law; and 2. If coverage provided to the additional insured is required by a contra ct or agree ment, the insurance afforded to su ch ad ditional insureo will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional in sureds, the following is added to Section Ill -Limits Of Insurance: If coverage provide d to the additional insured is required by a contra ct or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available un der the ap plicable Limi ts of Insurance shown in the De clarations; whichever is less. This end orsement shall not incre ase the applicable Li mits of lnsuran ce sho wn in the Declaration. CG 20 26 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 CERTIFICATE OF EXEMPTION WORKERS' COMPENSATION/EMPLOYERS' LIABILITY INSURANCE 1, Nora Kenney, am an independent contractor/sole proprietor. I hereby certify that I have no employees and am not required by law to maintain workers' compensation or employers' liability insurance. Should I employ any person during the term of the Agreement with the City of Carlsbad for independent contractor resident caretaker services, then workers' compensation and employers' liability insurance will be obtained. Nora Kenney Independent Contractor/Sole Proprietor CERTIFICATE OF EXEMPT10N WORKERS' COMPENSAT10N/6MPLOVERS' LIAB,LJTY INSURANCE I, fett?f Whitley1 am an independent contractor/sot~ propnetor. I hereby certify that I have no emp,oyees and am not requ ited by law to ti'Hiin taln w!l rkers' compensattoh or emptoyers1 Uabinty insunmce. Should 1 ernplo\• any p~rson during the lerm of the Agreement w,th the Ctty of Carlsbad fo r indepemient contr~ctor re~lden t cat!?taker s~rvice-, then workers1 comp~nSJttion a,nd t'tr1 ployers' 1iabU.~ insurance will be 9btalned. P ter Whitley I l ; •--REPRINTED FROM THE ARCHIVE THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS •••• A l.i!-.<·ny \1uru,il Compa,w CRIST FRITSCH! & PATERSON INS 101 YGNACIO VALLEY RD STE 200 WALNUT CREEK CA 94596-4087 NORA KENNEY PETER WHITLEY 6200 FL YING LEO CARRILLO LN CARLSBAD CA 92009-3042 August 23, 2018 Policy Number: OA4088476 24-Hour Claims: 1-800-332-3226 Policy Service: (925) 956-7700 Online Account Services: www.safeco.com THIS IS NOT A BILL. Thank you for allowing us to continue serving your home insurance needs. We appreciate your business and the trust that you have placed in us. This renewal reflects adjustments to your personal property limit. This adjustment is based on a Consumer Price Index average. You should review whether your coverage is adequate at least annually, and after each significant personal property purchase. If you would like to change your limits, or schedule any of your high value items, please contact your agent. With this renewal the following changes were made, including those requested by you or your agent or broker: -Personal Property Limits (Coverage C) changed from $29,200 to $30,400. We would also like to draw your attention to the following: • Your new policy period begins October 22, 2018. The 12-month premium for this policy is $367.00 for the October 22, 2018 to October 22, 2019 policy term. • This is not a bill. Your bill will be sent in a separate mailing approximately 25 days before it is due. It will provide an explanation of any money owed, your payment options with applicable fees and your payment due date. If you have any questions or wish to make any changes to your policy, you can do so by calling your agent at (925) 956-7700. We have made changes to our program that impact both coverage and premium. The impact on individual customers will vary. Please review the declarations page, the policy and any enclosed notices carefully to see how these changes affect you. PLEASE SEE REVERSE FIRST NATIONAL INSURANCE COMPANY OF AMERICA (A SAFECO Company) PO BOX 515097, LOS ANGELES, CA 90051 OC-429/EP 10/13 ._. REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS .... We appreciate the opportunity to serve you. Thank you. ~ct-- President, Safeco Insurance OC-430/EP 5/98 G1 •-• REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS ._. A 1.ihenv \luwal Cnmpanv CRIST FRITSCH! & PATERSON INS 101 YGNACIO VALLEY RD STE 200 WALNUT CREEK CA 94596-4087 NORA KENNEY PETER WHITLEY 6200 FLYING LEO CARRILLO LN CARLSBAD CA 92009-3042 AUGUST 23, 2018 POLICY NUMBER: OA4088476 AGENT TELEPHONE: (925) 956-7700 EARTHQUAKE COVERAGE OFFER Your residential property insurance policy does not cover earthquake damage to your rented home or its contents. To cover earthquake damage to your personal property and assist with additional living expenses if your rented home needs repair or rebuilding, you need to purchase a separate earthquake insurance policy. The coverage provided by an earthquake insurance policy is different from, and typically more limited than, the coverage provided by your residential property insurance policy. California law requires insurance companies to offer earthquake insurance in conjunction with a residential property insurance policy. If you do not accept the offer of earthquake insurance below within 30 days of the mailing of this notice, your insurance company shall presume that you have not accepted this offer of earthquake insurance. You may purchase earthquake insurance coverage on the following terms: LIMITS: A. Contents Coverage Limit: $ 5,000 B. Deductible: $ 750 C. Additional Living Expenses Coverage Limit: $ 1,500* NO DEDUCTIBLE D. Estimated Annual Premium: $ 35.00 The deductible represents the amount of damage your covered property must incur before the earthquake insurance coverage begins. If your covered loss is less than the applicable deductible, you may not receive any payment. If you choose not to accept this offer within the 30-day period, you may apply for earthquake coverage at a later date. Your insurance company contracts with the California Earthquake Authority (CEA) to offer earthquake insurance to its customers. For an additional premium, you can choose CEA coverage options such as higher limits for Contents or Additional Living Expenses, increased building code upgrade limits, or a lower deductible. You can also choose to buy certain CEA coverages separately. Contact your insurance agent or your insurance company to obtain details regarding this offer of earthquake insurance and other coverage options. EQ-0201/CAEP 1/16 Page 1 of 1 ._. REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS .... IMPORTANT NOTICE -ADD A PARTY TO RECEIVE NOTICE California law gives you the right to identify an additional person to receive a duplicate copy of any notice of lapse, termination, expiration, nonrenewal or cancellation we send to you due to non-payment of premium. To assign a designee, simply complete the form below and mail the form to: Safeco Insurance Companies Personal Lines Underwriting PO Box 515097 Los Angeles, CA 90051-5097 Email· dac11rneots@safeca cam Fax: 877-344-5107 You may also deliver the form to your independent Safeco agent. Agent contact information is shown on your policy Declarations. Please keep a copy of the completed form for your records. You may also change or terminate the third party designee by sending us written notification or completing the relevant section below. Request to Designate a Third Party to Receive a Copy of Policy Termination Notices for Non-Payment of Premium. Policy Insured Name ---------------------Number(s)* __________ _ Address ____________________ _ *List all applicable policy numbers. I designate the following person to receive a duplicate copy of any notice of lapse, termination, expiration, nonrenewal or cancellation that you send me due to non-payment of premium for the policy number shown above. I understand the third party designee does not have any right, whether as an additional insured or otherwise, to any benefits under the policy other than the right to receive the notice of lapse, termination, expiration, nonrenewal, or cancellation for nonpayment of premium. Designee Name _________________ _ Street ______________ _ City ________ _ State ____ Zip ____ _ Signature of Insured Date P--4537/CAEP 1/16 Page 1 of 2 •••• REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS •••• Request to Change a Third Party to Receive a Copy of Policy Termination Notices for Non-Payment of Premium. Policy Insured Name _____________________ Number(s)* __________ _ Address ____________________ _ *List all applicable policy numbers. I would like to replace my prior third party designee with the following person to receive a duplicate copy of any notice of lapse, termination, expiration, nonrenewal or cancellation that you send me due to non-payment of premium for the policy number shown above. I understand the third party designee does not have any right, whether as an additional insured or otherwise, to any benefits under the policy other than the right to receive the notice of lapse, termination, expiration, nonrenewal, or cancellation for nonpayment of premium. Designee Name _________________ _ Street ______________ _ City ________ _ State ____ Zip ____ _ Signature of Insured Date Request to Delete a Third Party from Receiving a Copy of Policy Termination Notices for Non-Payment of Premium. Policy Insured Name ____________________ Number(s)* __________ _ Address ____________________ _ *List all applicable policy numbers. I would like to delete my previously selected third party designee from receiving a duplicate copy of any notice of lapse, termination, expiration, nonrenewal or cancellation that you send me due to nonpayment of premium for the policy number shown above. Designee Name _________________ _ Street ______________ _ City _______ _ State ___ _ Zip ____ _ Signature of Insured Date P-4537/CAEP 1/16 Page 2 of 2 .-. REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS --• CALIFORNIA RESIDENTIAL PROPERTY INSURANCE BILL OF RIGHTS A consumer is entitled to receive information regarding homeowner's insurance. The following is a limited overview of information that your insurance company can provide: The insurance company's customer service telephone number for underwriting, rating, and claims inquiries. A written explanation for any cancellation or nonrenewal of your policy. A copy of the insurance policy. An explanation of how your policy limits were established. In the event of a claim, an itemized, written scope of loss report prepared by the insurer or its adjuster within a reasonable time period. In the event of a claim, a copy of the Unfair Practices Act and, if requested, a copy of the Fair Claims Practices Regulations. In the event of a claim, notification of a consumer's rights with respect to the appraisal process for resolving claims disputes. An offer of coverage and premium quote for earthquake coverage, if eligible. A consumer is also entitled to select a licensed contractor or vendor to repair, replace, or rebuild damaged property covered by the insurance policy. The information provided herein is not all inclusive and does not negate or preempt existing California law. If you have any concerns or questions, contact your agent, broker, insurance company, or the California Department of Insurance consumer information line (800) 927-HELP (4357) or at www.insurance.ca.gov for free insurance assistance. This insurer reports claim information to one or more claims information databases. The claim information is used to furnish loss history reports to insurers. If you are interested in obtaining a report from a claims information database, you may do so by contacting: Choicepoint (CLUE) 1-800-456-6004 www coos11merdisclasme cam ISO Claimsearch 1-800-888-44 76 CN-2121/CAEP 1/12 •••• REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS .... A 1.ih,·nv \lutual Cnmpanv NOTICE OF PRIVACY PRACTICES-CALIFORNIA We appreciate the trust you place in us when you buy insurance from one of our companies. We want you to know how we gather information about you, how we protect it, and how you can make sure it's correct. WHAT WE COLLECT Most of the information we obtain comes directly from you and your insurance agent. For example, your application gives us your name, address and Social Security number. We may also ask for data from other outside sources, including: Your transactions with our affiliates or other insurance companies (such as your payment history or claims history); or Data we receive from a consumer reporting agency or insurance support organization ("Organization"), such as your credit history, driving record, claims history or value and condition of your property. Organizations from which we obtain information may keep it and disclose it to others as permitted by law. If we obtain medical information about you, it is generally received in connection with the administration or management of your insurance policy or claim or for the detection and prevention of fraud. We will not share your medical information with our affiliates or non-affiliates for marketing purposes. We treat information about our former customers in the same manner that we treat information about current customers. HOW WE USE DATA ABOUT YOU We only disclose personal data about you as permitted by law. Generally, this includes sharing it with third parties to administer your transactions with us, service your insurance policy or claim, detect and prevent fraud, or with your authorization. We require these parties to use your personal data only for the reasons we gave it to them. These third parties may include: Agents and brokers authorized to sell Safeco insurance products; Independent contractors (such as auto repair facilities, towing companies, property inspectors and independent adjusters); Auditors, attorneys, courts and government agencies; Other companies which may reinsure your policy or with which you have other coverage; Group policyholders (for reporting claims data or an audit); and/or, Other companies and Organizations for actuarial or research studies. We may also share data with other companies with which we have joint marketing agreements for products offered by Safeco. We may also share information about our transactions (such as payment history) and experiences (such as claims made) with you within the Safeco family of companies. Finally, we may share data in response to court orders, such as subpoenas. We do not sell your information to others, nor do we provide it to third parties for their own marketing purposes. SECURITY We maintain physical, electronic, and administrative safeguards to protect your data from unauthorized access. Our employees are authorized to access customer files only for legitimate business purposes. YOUR AGENT OR BROKER Your agent or broker is not a Safeco employee and is not subject to our privacy policy. Because your agent or broker has a unique business relationship with you, he or she may have data about you that Safeco does not have. Your agent or broker may use this information differently than Safeco. Contact your agent or broker to learn more about their privacy practices. CN-2/CAEP 11/11 G1 Page 1 of 2 ._. REPRINTEDFROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS .... REVIEWING YOUR FILE You can request a copy of the data about you in our files to review. Your request must be in writing. We will respond within 30 business days of receiving your request. We will advise you of third parties to whom we have given the data during the last two years. We will also give you the name and address of any reporting organization from which we received data about you. There are certain types of information, such as the information collected for a claim or when the possibility of a lawsuit exists, that we are not required to provide you. If the law allows you to review records supplied by a medical provider, you can direct us to send the records to you or to a provider of your choice (as long as the provider is licensed in the area related to the records being provided). We may send mental health records directly to you only with your medical provider's approval. IF YOU DISAGREE WITH OUR RECORDS If you believe information in our files is wrong, you can notify us in writing. We will review your file within 30 business days of receiving your notice. If we agree with you, we will amend our records and notify you about the change. This change will become part of the file. It will be included in any future disclosures to others and will be sent to: Anyone you designate who may have received the data during the previous two years. • Anyone who received the data from us during the previous seven years. Organizations that provided the data that was changed pursuant to your request. If we disagree with you, we will explain why. You can provide us with a written statement explaining why you believe the data is wrong. This statement will become part of the file and will be included in any future disclosures of the disputed subject matter. Your statement will also be sent to the parties listed above. SAFECO'S WEB SITE If you have Internet access and want to learn more about our online security practices, click on the Privacy Policy link on www safeco corn. American Economy Insurance Company American States Insurance Company American States Insurance Company of Texas American States Preferred Insurance Company First National Insurance Company of America General Insurance Company of America Insurance Company of Illinois Safeco Insurance Company of America Safeco Insurance Company of Illinois Safeco Surplus Lines Insurance Company (For mailing address, please contact your agent or nearest local Safeco office.) @ 2011 Safeco Insurance Co!ll'any of Amelica, Member of Liberty Mutual Group. All Rights Reserved CN-2/CAEP 11/11 Page 2 of 2 •••• REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS •••• i-ittl•i insurance." •\ l.ilwnr \lu1ual C,m1pam· FIRST NATIONAL INSURANCE COMPANY OF AMERICA (A SAFECO Company) Home Office: 62 Maple Ave, Keene, NH 03431 (A stock insurance company.) RENTERS POLICY DECLARATIONS INSURED: NORA KENNEY PETER WHITLEY 6200 FLYING LEO CARRILLO LN CARLSBAD CA 92009-3042 RESIDENCE PREMISES: 6200 FLYING LEO CARRILLO LN CARLSBAD CA 92009-3042 I IMPORTANT NOTICES POLICY NUMBER: OA4088476 POLICY PERIOD FROM: OCT. 22 2018 AT: 12:01 A.M. TO: OCT. 22 2019 AGENT: CRIST FRITSCH! & PATERSON INS 101 YGNACIO VALLEY RD STE 200 WALNUT CREEK CA 94596-4087 TELEPHONE: (925) 956-7700 -Your policy has renewed effective October 22, 2018. -THIS POLICY DOES NOT PROVIDE EARTHQUAKE COVERAGE. I COVERAGES SECTION I -PROPERTY COVERAGES C -Personal Property D -Loss of Use SECTION II -LIABILITY COVERAGES E -Personal Liability (each occurrence) F -Medical Payments (each person) INCLUDED COVERAGES Full Value on Personal Property California Workers Compensation I OPTIONS Option E -Scheduled Personal Property Option Q -Valued Jewelry (Category V) Option KK -Special Personal Property Option ID -Identity Recovery -$250 deductible I DEDUCTIBLE (S) PERCENTAGE Section I N/A $ $ $ TOTAL ANNUAL PREMIUM LIMIT PREMIUM 30,400 $ 185.00 24 MONTHS 300,000 32.00 2,000 Included 5.00 LIMIT PREMIUM 6,411 $ 113. 00 Included 25.00 25,000 12.00 AMOUNT 500 i s 367.oo 1 You may pay your premium in full or in installments. There is no installment fee for the following billing plans: Full Pay, Annual 2-Pay. Installment fees for all other billing plans are listed below. If more than one policy is billed on the installment bill, only the highest fee is char~ed. The fee is: $0.00 per installment for recurring automatic deduction (EFT) $0.00 per installment for recurring credit card or debit card $2.00 per installment for all other payment methods CHO-6000/EP 9/06 G2 Page 1 of 1 ORIGINAL DATE PREPARED AUG. 23 2018 .... REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS •••• SCHEDULED PERSONAL PROPERTY ENDORSEMENT POLICY NUMBER: OA4088476 NAMED INSURED: NORA KENNEY PETER WHITLEY IMPORTANT NOTICE -LOSS SETTLEMENT FINE ARTS AND CATEGORY V JEWELRY: We will pay the amount shown for each scheduled article which is agreed, as stated on this endorsement, to be the value of the article. ALL OTHER PROPERTY AND CATEGORY J JEWELRY: The value of the property insured is not agreed upon but shall be ascertained at the time of loss or damage. Please refer to the Loss Settlement pro- visions within Option E -Scheduled Personal Property. THE ABOVE ARE SUBJECT TO ALL POLICY PROVISIONS. IF YOU NEED FURTHER EXPLANATION PLEASE REFER TO YOUR POLICY OR CONTACT YOUR AGENT. ITEM NO. I CAT.I DESCRIPTION OF PROPERTY COVERED I INSURED AMT. I 1 2 3 4 5 L L B L V MAC LAPTOP W88318LG092 APPLE MACBOOK PRO #CPWLQAFCDTY3 APPLE IPHONE 6 #C7JPGRC3G5MC VERIZON ELLIPSIS 8 TABLET 3 3536 100 6936 7869 14KT YELLOW GOLD LADY'S COMBINATION CAST & ASSEMBL ED DIAMOND ENGAGEMENT RING AND WEDDING BAND TOTAL AMOUNT OF INSURANCE BY CATEGORY A -FINE ARTS $ 500 1,577 650 249 3,435 B CELLULAR PHONES AND OTHER MOBILE EQUIPMENT $ 650 2,326 3,435 C CAMERAS, GUNS, STAMP AND COIN COLLECTIONS F FURS, MUSICAL INSTRUMENTS & PROPERTY NOT OTHERWISE CLASSIFIED L COMPUTERS AND OTHER MEDIA EQUIPMENT S SILVERWARE T FARM PERSONAL PROPERTY V VALUED JEWELRY CHO-6400/EP 5/98 G1 INSURED'S COPY DATE PREPARED: AUG. 23 2018 AMENDMENT NO. 1 TO EXTEND THE AGREEMENT FOR INDEPENDENT CONTRACTOR RESIDENT CARETAKER SERVICES BETWEEN THE CITY OF CARLSBAD AND PETER WHITLEY AND NORA KENNY FOR LEO CARRILLO RANCH HISTORIC PARK ~his . A1!1e1J.qment No. 1 is e~~~ed into and effective as of the i ltfJ day of U ~ , 20J.)1", extending the agreement dated May 3, 2017 (the "Agre~nf') by and between the City of Carlsbad, a municipal corporation, ("City"), and Peter Whitley and Nora Kenney (collectively, the "Parties") independent contractor resident caretaker services. RECITALS A. The Parties desire to extend the Agreement for a period of one year. NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, City and Contractor agree as follows: 1. The Agreement, as may have been amended from time to time, is hereby extended for a period of one year ending on May 3, 2019. 2. All other provisions of the Agreement, as may have been amended from time to time, shall remain in full force and effect. 3. All requisite insurance policies to be maintained by the Contractor pursuant to the Agreement, as may have been amended from time to time, shall include coverage for this Amendment. Ill Ill Ill Ill Ill Ill Ill Ill Ill Ill Ill City Attorney Approved Version 1/30/13 4. The individuals executing this Amendment and the instruments referenced on behalf of Contractor each represent and warrant that they have the legal power, right and actual authority to bind Contractor to the terms and conditions hereof of this Amendment. CONTRACTOR By:_~~ (sign here) Ni 1 ,'\. lLLlt\ V'\ l 1 By: (print narhe/title) (sign here) /JercR WM 1 ,l E1-J (print name/title) CITY OF CARLSBAD, a municipal corporation of the State of California By: ATTEST: \J~mm~L BARBARA ENGLESON I ._, \..- City Clerk If required by City, proper notarial acknowledgment of execution by Contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A Chairman, President, or Vice-President Group B Secretary, Assistant Secretary, CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CELIAA. BREWER, City Attorney BY:~%'""'"""'~=-------~ City Attorney City Attorney Approved Version 1/30/13 2 CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) 04/17/2017 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 ~~~?~~ David Miller -----~-------------- Dave Miller Insurance ;l)gNJ0 E_xl)~ J760) 717-1707 _ _ _ _1_1ifc Nol: (866) 477-0370 2318 Pio Pico Dr l;.~lJ~ss:_ dminsurance@gmail.com -::-:--~-:-:-:: HAM:~s:;:~;U_F~_o,_~_l~-~-c_o_V_E_AA-~e ~ ~~l~~"" = Carlsbad lt-lSURED Peter Whitley and Nora Kenney 6200 Flying L C Lane Carlsbad CA 92008 ------------------ CA 92009 COVERAGES CERTIFICATE NUMBER: INSURER D: ------------ INSURER E: INSURER F: 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 LTR A TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY ---=---CLAIMS-MADE [~_ OCCUR GEN'L AGGREGATE LIMIT APPLIES PER _2(_ POLICY ~J .m?i: ~ LOC OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY UMBRELLA LIAB -, SCHEDULED _ j AUTOS I NON-OWNED _ 1 AUTOS ONLY I OCCUR -ADDL.SUBR INSD ! WVD y EXCESS LIAB 1--CLAIMS-MADE I ---~ED r--R-ET_E_N_T,10--N---$- WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR:PARTNER/EXECUTIVE OFFICER MEMBER EXCLUDED? (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS below YIN [ D N/A POLICY NUMBER 479922322 04/17/2017 04/17/2018 ----------- LIMITS ' EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300,000 PREMISES (E~ occurc~~c_~) $ I MED EXP (Any one person) $ 10,000 i -1,000,000 PERSONAL & ADV INJURY $ GENERAL AGGREGATE ! 2,000,000 PRODUCTS -COMP OP AGG ,$ 2,000,000 ---- !$ fil~~~~~~~1tNG~MIT 1 $ BODILY INJURY (Per pe_r_so_n_) -,1-$-------- 00DILYINJ-URY (P~;acc,dent) 1 $ PROPERTY DAMAGE I JPer a~,ci,de_ntJ ----+-i$ ____ _ 1$ EACH OCCURRENCE _$_ ___________ _ AGGREGATE $ -------+--------- $ I PER I I OTH-' STATUTE ER ! _E'.L. EACH ACCIDENT I $ - ~ E.L. DISEASE -EA EMPLOYEE: $ I E.L. DISEASE -POLICY LIMIT ; $ i DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is added as additional insured for designated premises 6200 Flying Leo Carrillo Lane Carlsbad CA 92009 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Carlsbad ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1200 Carlsbad Village Drive David Miller Carlsbad CA 92008 I © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Policyholder Peter Whitley and Nora Kenney POLICY NUMBER: 479922322 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 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 Additional Insured Person(s) Or Organization(s): City of Carlsbad 1200 Carlsbad Village Drive Carlsbad CA 92008 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as a n additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily inju ry", "prope rty damage" or "personal and advertising injury" caused, in whole or in part, by your act s or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of yo ur ongoing operations; or 2. In connection with your premise s owned by or rented to you. However: 1. The insuran ce afforded to such additional insured only applies to th e extent permitted by law; and 2. If coverage provided to the additional insured is required by a contra ct or agree ment, the insurance afforded to su ch ad ditional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional in sureds, the following is added to Section Ill -Limits Of Insurance: If coverage provide d to the additional insured is required by a contra ct or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available un der the ap plicable Limi ts of Insurance shown in the De clarations; whichever is less. This end orsement shall not incre ase the applicable Li mits of lnsuran ce sho wn in the Declaration. CG 20 26 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 .... REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS .... CRIST FRITSCH! & PATERSON INS 101 YGNACIO VALLEY RD STE 200 WALNUT CREEK CA 94596-4087 NORA KENNEY PETER WHITLEY 6200 FL YING LEO CARRILLO LN CARLSBAD CA 92009-3042 August 23, 2017 Policy Number: OA4088476 24-Hour Claims: 1-800-332-3226 Policy Service: (925) 956-7700 Online Account Services: www.safeco.com THIS IS NOT A BILL. Thank you for allowing us to continue serving your home insurance needs. We appreciate your business and the trust that you have placed in us. This renewal reflects adjustments to your personal property limit. This adjustment is based on a Consumer Price Index average. You should review whether your coverage is adequate at least annually, and after each significant personal property purchase. If you would like to change your limits, or schedule any of your high value items, please contact your agent. With this renewal the following changes were made, including those requested by you or your agent or broker: -Personal Property Limits (Coverage C) changed from $28,100 to $29,200. We would also like to draw your attention to the following: • Your new policy period begins October 22, 2017. The 12-month premium for this policy is $306.00 for the October 22, 2017 to October 22, 2018 policy term. • This is not a bill. Your bill will be sent in a separate mailing approximately 25 days before it is due. It will provide an explanation of any money owed, your payment options with applicable fees and your payment due date. If you have any questions or wish to make any changes to your policy, you can do so by calling your agent at (925) 956-7700. We have made changes to our program that impact both coverage and premium. The impact on individual customers will vary. Please review the declarations page, the policy and any enclosed notices carefully to see how these changes affect you. PLEASE SEE REVERSE FIRST NATIONAL INSURANCE COMPANY OF AMERICA (A SAFECO Company) PO BOX 515097, LOS ANGELES, CA 90051 OC-429/EP 10/13 "" REPRINTED FROM THE ARCHIVE. THE ORIGINAL T~ANSACTION MAY INCLUDE ADDITIONAL FORMS "'' We appreciate the opportunity to serve you. Thank you. Matthew D. Nickerson President, Safeco Insurance OC-430/EP 5/98 G1 .... REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS •••• CRIST FRITSCH! & PATERSON INS 101 YGNACIO VALLEY RD STE 200 WALNUT CREEK CA 94596-4087 NORA KENNEY PETER WHITLEY 6200 FLYING LEO CARRILLO LN CARLSBAD CA 92009-3042 AUGUST 23, 2017 POLICY NUMBER: OA4088476 AGENT TELEPHONE: (925) 956-7700 EARTHQUAKE COVERAGE OFFER Your residential property insurance policy does not cover earthquake damage to your rented home or its contents. To cover earthquake damage to your personal property and assist with additional living expenses if your rented home needs repair or rebuilding, you need to purchase a separate earthquake insurance policy. The coverage provided by an earthquake insurance policy is different from, and typically more limited than, the coverage provided by your residential property insurance policy. California law requires insurance companies to offer earthquake insurance in conjunction with a residential property insurance policy. If you do not accept the offer of earthquake insurance below within 30 days of the mailing of this notice, your insurance company shall presume that you have not accepted this offer of earthquake insurance. You may purchase earthquake insurance coverage on the following terms: LIMITS: A. Contents Coverage Limit: $ 5,000 B. Deductible: $ 750 C. Additional Living Expenses Coverage Limit: $ 1,500* NO DEDUCTIBLE D. Estimated Annual Premium: $ 35.00 The deductible represents the amount of damage your covered property must incur before the earthquake insurance coverage begins. If your covered loss is less than the applicable deductible, you may not receive any payment. If you choose not to accept this offer within the 30-day period, you may apply for earthquake coverage at a later date. Your insurance company contracts with the California Earthquake Authority (CEA) to offer earthquake insurance to its customers. For an additional premium, you can choose CEA coverage options such as higher limits for Contents or Additional Living Expenses, increased building code upgrade limits, or a lower deductible. You can also choose to buy certain CEA coverages separately. Contact your insurance agent or your insurance company to obtain details regarding this offer of earthquake insurance and other coverage options. EQ-0201/CAEP 1/16 Page 1 of 1 .... REPRINTED FROM THE ARCHIVE. THE ORIGINAL rnANSACTION MAY INCLUDE ADDITIONAL FORMS .... IMPORTANT NOTICE -ADD A PARTY TO RECEIVE NOTICE California law gives you the right to identify an additional person to receive a duplicate copy of any notice of lapse, termination, expiration, nonrenewal or cancellation we send to you due to non-payment of premium. To assign a designee, simply complete the form below and mail the form to: Safeco Insurance Companies Personal Lines Underwriting PO Box 515097 Los Angeles, CA 90051-5097 Email· dac11meots@safeca cam Fax: 877-344-5107 You may also deliver the form to your independent Safeco agent. Agent contact information is shown on your policy Declarations. Please keep a copy of the completed form for your records. You may also change or terminate the third party designee by sending us written notification or completing the relevant section below. Request to Designate a Third Party to Receive a Copy of Policy Termination Notices for Non-Payment of Premium. Policy Insured Name _____________________ Number(s)* ___________ _ Address ____________________ _ *List all applicable policy numbers. I designate the following person to receive a duplicate copy of any notice of lapse, termination, expiration, non renewal or cancellation that you send me due to non-payment of premium for the policy number shown above. I understand the third party designee does not have any right, whether as an additional insured or otherwise, to any benefits under the policy other than the right to receive the notice of lapse, termination, expiration, nonrenewal, or cancellation for nonpayment of premium. Designee Name _________________ _ Street ______________ _ City ________ _ State ___ _ Zip ____ _ Signature of Insured Date P-4537 /CAEP 1/16 Page 1 of 2 .... REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS •••• Request to Change a Third Party to Receive a Copy of Policy Termination Notices for Non-Payment of Premium. Policy Insured Name _____________________ Number(s)* ___________ _ Address _____________________ _ *List all applicable policy numbers. I would like to replace my prior third party designee with the following person to receive a duplicate copy of any notice of lapse, termination, expiration, nonrenewal or cancellation that you send me due to non-payment of premium for the policy number shown above. I understand the third party designee does not have any right, whether as an additional insured or otherwise, to any benefits under the policy other than the right to receive the notice of lapse, termination, expiration, nonrenewal, or cancellation for nonpayment of premium. Designee Name __________________ _ Street _______________ _ City ________ _ State ___ _ Zip ____ _ Signature of Insured Date Request to Delete a Third Party from Receiving a Copy of Policy Termination Notices for Non-Payment of Premium. Policy Insured Name _____________________ Number(s)* ___________ _ Address _____________________ _ *List all applicable policy numbers. I would like to delete my previously selected third party designee from receiving a duplicate copy of any notice of lapse, termination, expiration, nonrenewal or cancellation that you send me due to nonpayment of premium for the policy number shown above. Designee Name __________________ _ Street _______________ _ City _________ _ State ___ _ Zip ____ _ Signature of Insured Date P-4537/CAEP 1/16 Page 2 of 2 .... REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS .... CALIFORNIA RESIDENTIAL PROPERTY INSURANCE BILL OF RIGHTS A consumer is entitled to receive information regarding homeowner' s insurance. The following is a limited overview of information that your insurance company can provide: The insurance company's customer service telephone number for underwriting, rating, and claims inquiries. A written explanation for any cancellation or non renewal of your policy. A copy of the insurance policy. An explanation of how your policy limits were established. In the event of a claim, an itemized, written scope of loss report prepared by the insurer or its adjuster within a reasonable time period. In the event of a claim, a copy of the Unfair Practices Act and, if requested, a copy of the Fair Claims Practices Regulations. In the event of a claim, notification of a consumer's rights with respect to the appraisal process for resolving claims disputes. An offer of coverage and premium quote for earthquake coverage, if eligible. A consumer is also entitled to select a licensed contractor or vendor to repair, replace, or rebuild damaged property covered by the insurance policy. The information provided herein is not all inclusive and does not negate or preempt existing California law. If you have any concerns or questions, contact your agent, broker, insurance company, or the California Department of Insurance consumer information line (800) 927-HELP (4357) or at www.insurance.ca.gov for free insurance assistance. This insurer reports claim information to one or more claims information databases. The claim information is used to furnish loss history reports to insurers. If you are interested in obtaining a report from a claims information database, you may do so by contacting: Choicepoint (CLUE) 1-800-456-6004 www caos11merdisclas1 ire cam ISO Claimsearch 1-800-888-44 76 CN-2121/CAEP 1/12 .... REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS •••• NOTICE OF PRIVACY PRACTICES -CALIFORNIA We appreciate the trust you place in us when you buy insurance from one of our companies. We want you to know how we gather information about you, how we protect it, and how you can make sure it's correct. WHAT WE COLLECT Most of the information we obtain comes directly from you and your insurance agent. For example, your application gives us your name, address and Social Security number. We may also ask for data from other outside sources, including: Your transactions with our affiliates or other insurance companies (such as your payment history or claims history); or Data we receive from a consumer reporting agency or insurance support organization ("Organization"), such as your credit history, driving record, claims history or value and condition of your property. Organizations from which we obtain information may keep it and disclose it to others as permitted by law. If we obtain medical information about you, it is generally received in connection with the administration or management of your insurance policy or claim or for the detection and prevention of fraud. We will not share your medical information with our affiliates or non-affiliates for marketing purposes. We treat information about our former customers in the same manner that we treat information about current customers. HOW WE USE DATA ABOUT YOU We only disclose personal data about you as permitted by law. Generally, this includes sharing it with third parties to administer your transactions with us, service your insurance policy or claim, detect and prevent fraud, or with your authorization. We require these parties to use your personal data only for the reasons we gave it to them. These third parties may include: Agents and brokers authorized to sell Safeco insurance products; Independent contractors (such as auto repair facilities, towing companies, property inspectors and independent adjusters); Auditors, attorneys, courts and government agencies; Other companies which may reinsure your policy or with which you have other coverage; Group policyholders (for reporting claims data or an audit); and/or, Other companies and Organizations for actuarial or research studies. We may also share data with other companies with which we have joint marketing agreements for products offered by Safeco. We may also share information about our transactions (such as payment history) and experiences (such as claims made) with you within the Safeco family of companies. Finally, we may share data in response to court orders, such as subpoenas. We do not sell your information to others, nor do we provide it to third parties for their own marketing purposes. SECURITY We maintain physical, electronic, and administrative safeguards to protect your data from unauthorized access. Our employees are authorized to access customer files only for legitimate business purposes. YOUR AGENT OR BROKER Your agent or broker is not a Safeco employee and is not subject to our privacy policy. Because your agent or broker has a unique business relationship with you, he or she may have data about you that Safeco does not have. Your agent or broker may use this information differently than Safeco. Contact your agent or broker to learn more about their privacy practices. CN-2/CAEP 11/11 G1 Page 1 of 2 •••• REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS •••• REVIEWING YOUR FILE You can request a copy of the data about you in our files to review. Your request must be in writing. We will respond within 30 business days of receiving your request. We will advise you of third parties to whom we have given the data during the last two years. We will also give you the name and address of any reporting organization from which we received data about you. There are certain types of information, such as the information collected for a claim or when the possibility of a lawsuit exists, that we are not required to provide you. If the law allows you to review records supplied by a medical provider, you can direct us to send the records to you or to a provider of your choice (as long as the provider is licensed in the area related to the records being provided). We may send mental health records directly to you only with your medical provider's approval. IF YOU DISAGREE WITH OUR RECORDS If you believe information in our files is wrong, you can notify us in writing. We will review your file within 30 business days of receiving your notice. If we agree with you, we will amend our records and notify you about the change. This change will become part of the file. It will be included in any future disclosures to others and will be sent to: Anyone you designate who may have received the data during the previous two years. Anyone who received the data from us during the previous seven years. Organizations that provided the data that was changed pursuant to your request. If we disagree with you, we will explain why. You can provide us with a written statement explaining why you believe the data is wrong. This statement will become part of the file and will be included in any future disclosures of the disputed subject matter. Your statement will also be sent to the parties listed above. SAFECO'S WEB SITE If you have Internet access and want to learn more about our online security practices, click on the Privacy Policy link on www safeca cam. American Economy Insurance Company American States Insurance Company American States Insurance Company of Texas American States Preferred Insurance Company First National Insurance Company of America General Insurance Company of America Insurance Company of Illinois Safeco Insurance Company of America Safeco Insurance Company of Illinois Safeco Surplus Lines Insurance Company (For mailing address, please contact your agent or nearest local Safeco office.) @ 2011 Safeco Insurance Company of America, Member of Liberty Mutual Group. All Rights Reserved. CN-2/CAEP 11 /11 Page 2 of 2 .... REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS .... FIRST NATIONAL INSURANCE COMPANY OF AMERICA (A SAFECO Company) Home Office: 62 Maple Ave, Keene, NH 03431 (A stock insurance company.) RENTERS POLICY DECLARATIONS INSURED: NORA KENNEY PETER WHITLEY 6200 FLYING LEO CARRILLO LN CARLSBAD CA 92009-3042 RESIDENCE PREMISES: 6200 FLYING LEO CARRILLO LN CARLSBAD CA 92009-3042 I IMPORTANT NOTICES POLICY NUMBER: POLICY PERIOD FROM: AT: TO: AGENT: OA4088476 OCT. 22 2017 12:01 A.M. OCT. 22 2018 CRIST FRITSCH! & PATERSON INS 101 YGNACIO VALLEY RD STE 200 WALNUT CREEK CA 94596-4087 TELEPHONE: (925) 956-7700 -Your policy has renewed effective October 22, 2017. -THIS POLICY DOES NOT PROVIDE EARTHQUAKE COVERAGE. I COVERAGES SECTION I -PROPERTY COVERAGES C -Personal Property D -Loss of Use SECTION II -LIABILITY COVERAGES E -Personal Liability (each occurrence) F -Medical Payments (each person) INCLUDED COVERAGES Full Value on Personal Property California Workers Compensation I OPTIONS Option E -Scheduled Personal Property Option Q -Valued Jewelry (Category V) Option KK -Special Personal Property Option ID -Identity Recovery -$250 deductible I CREDITS Account Credit I DEDUCTIBLE CS) PERCENTAGE Section I N/A LIMIT $ 29,200 $ 24 MONTHS 300,000 2,000 LIMIT 6,411 25,000 PERCENTAGE 15% AMOUNT $ 500 TOTAL ANNUAL PREMIUM $ $ $ i $ PREMIUM 178.00 32.00 Included 5.00 PREMIUM 113. 00 Included 2 5. 00 12.00 SAVINGS -54.00 306.oo 1 You may pay your premium in full or in installments. There is no installment fee for the following billing plans: Full Pay, Annual 2-Pay. Installment fees for all other billing plans are listed below. If more than one policy is billed on the installment bill, only the highest fee is char~ed. The fee is: $0.00 per installment for recurring automatic deduction (EFT) $0.00 per installment for recurring credit card or debit card $2.00 per installment for all other payment methods CHO-6000/EP 9/06 G2 Page 1 of 1 ORIGINAL DATE PREPARED AUG. 23 2017 "" REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS .... SCHEDULED PERSONAL PROPERTY ENDORSEMENT POLICY NUMBER: OA4088476 NAMED INSURED: NORA KENNEY PETER WHITLEY IMPORTANT NOTICE -LOSS SETTLEMENT FINE ARTS AND CATEGORY V JEWELRY: We will pay the amount shown for each scheduled article which is agreed, as stated on this endorsement, to be the value of the article. ALL OTHER PROPERTY AND CATEGORY J JEWELRY: The value of the property insured is not agreed upon but shall be ascertained at the time of loss or damage. Please refer to the Loss Settlement pro- visions within Option E -Scheduled Personal Property. THE ABOVE ARE SUBJECT TO ALL POLICY PROVISIONS. IF YOU NEED FURTHER EXPLANATION PLEASE REFER TO YOUR POLICY OR CONTACT YOUR AGENT. ITEM NO. I CAT. I DESCRIPTION OF PROPERTY COVERED I INSURED AMT. I 1 L MAC LAPTOP W88318LG092 2 L APPLE MACBOOK PRO #CPWLQAFCDTY3 3 B APPLE IPHONE 6 #C7JPGRC3G5MC 4 L VERIZON ELLIPSIS 8 TABLET 3 3536 100 6936 7869 5 V 14KT YELLOW GOLD LADY'S COMBINATION CAST & ASSEMBL ED DIAMOND ENGAGEMENT RING AND WEDDING BAND TOTAL AMOUNT OF INSURANCE BY CATEGORY A -FINE ARTS $ 500 1,577 650 249 3,435 B CELLULAR PHONES AND OTHER MOBILE EQUIPMENT $ 650 C CAMERAS, GUNS, STAMP AND COIN COLLECTIONS F FURS, MUSICAL INSTRUMENTS & PROPERTY NOT OTHERWISE CLASSIFIED L COMPUTERS AND OTHER MEDIA EQUIPMENT S SILVERWARE T FARM PERSONAL PROPERTY V VALUED JEWELRY CHO-6400/EP 5/98 G1 2,326 3,435 INSURED' S COPY DATE PREPARED: AUG. 23 2017 AGREEMENT FOR INDEPENDENT CONTRACTOR RESIDENT CARETAKER SERVICES BETWEEN CITY OF CARLSBAD AND PETER WHITLEY AND NORA KENNEY FOR LEO CARRILLO RANCH HISTORIC PARK This Agreement for Independent Contractor Resident Caretaker (Agreement) is entered into on ·1Y]r~ ,3) 2017 ("Effective Date") between the City of Carlsbad (City) and Peter 1tley and Nora Kenney, for the position of Resident Caretaker(s) at the Leo Carrillo Ranch Historic Park. WHEREAS, the City owns and operates parks throughout the City of Carlsbad, including Leo Carrillo Ranch Historic Park; and WHEREAS, the City has a Resident Caretaker program that is administered by the Parks & Recreation Department (Department) whereby the City contracts for an Independent Contractor to provide 30-35 hours of work service per week at Leo Carrillo Ranch Historic Park, 6200 Flying LC Lane, Carlsbad, CA, 92009 (Property) in exchange for the financial benefit of living in the City owned residence located on the Property; and WHEREAS, the City desires to procure an Independent Contractor to be the Resident Caretaker of the Property and to provide 30-35 hours of work per week at the Property; and WHEREAS, the City will compensate the Independent Contractor (Resident Caretaker) with use and occupancy of an unfurnished two bedroom/two bathroom manufactured home (ResidenceL with all utilities (electric, water, sewer, and trash) paid as compensation for the work performed on the Property; and WHEREAS, the purpose of this Agreement is to set forth the terms and conditions that will govern the relationship of the parties and the work to be performed by the Resident Caretaker(s) while occupying the Residence. NOW, THEREFORE, the parties agree as follows: 1. The Resident Caretakers are not City employees and this Agreement shall not be construed to create an employer-employee relationship. The parties acknowledge and agree that Resident Caretaker is an Independent Contractor hired to perform the services at the Property as described herein. Resident Caretakers will be under the control of City only as to the results to be accomplished. -I - 2. The Resident Caretakers shall provide the services as detailed below. It is estimated that the Resident Caretakers will spend approximately 30-35 hours of service per week at the Property. It is understood that the Resident Caretakers shall be responsible for the end results; and that it is conceivable that depending on the Resident Caretakers efforts, it may take more or less than the estimated number of hours per week to perform the services required under this Agreement. The Resident Caretakers' scope of duties shall include: Grounds Maintenance: Raking, sweeping, and trash collection associated with pre-and post-special event and facility rentals at the Property; and, Building and Facility Maintenance: Restroom cleaning, reflecting pool cleaning and maintenance; maintain Residence, and surrounding grounds in good condition; and, "Eyes and Ears" Security and Non-confrontational Patrol: Patrol, surveillance, and condition report of the Property and structures within the designated park boundaries, and respond to building alarms unless personal safety is at risk; and, The Resident Caretakers shall meet with the department's special projects manager, at least once per month, to discuss any specific issues or tasks that the special projects manager needs addressed and completed by the Resident Caretakers; and, The City may, in its sole discretion, provide tools and equipment to the Resident Caretakers to assist the Resident Caretakers in the performance of their duties. The parties agree that should the City provide any tools and equipment to the Resident Caretakers for use in performing the Resident Caretakers' services, the City's providing of tools and equipment shall not create an employee-employer relationship. In the event that the Resident Caretakers uses any tools or equipment provided by the City, Resident Caretakers shall be solely responsible for any loss or damage to the tools or equipment and shall replace or repair the lost or damaged tools or equipment provided by the City. 3. The City will provide an unfurnished two bedroom/two bathroom (1,752 square foot) manufactured Residence on the Property where the Resident Caretakers may live. Utilities will be provided (water, sewer, trash and electricity) at no cost to the Resident Caretakers. - 2 - The appraised value of lodging ($26,000} will be reported annually to the Internal Revenue Service (IRS} on form 1099-MISC and state Franchise Tax Board. 4. Resident Caretakers shall not make any improvements or other modifications to the Residence or to the Property without the express written consent of the City. Violation of this section shall be grounds for immediate termination of this Agreement. 5. Security Deposit. The Resident Caretakers shall post to the City, prior to occupancy of the Residence, a security deposit in the sum of one thousand ($1,000.00} dollars, the receipt of which is hereby acknowledged as having been heretofore deposited with the City in conjunction with the Agreement of 8011 , to be held as security for any damages to the Residence r as payment, in whole or in part, for any costs or expenses incurred by the City resulting from the failure of the Resident Caretakers to surrender the Residence and the surrounding premises in the condition described in Paragraph 18 herein. Unless withheld by the City, in whole or in part, by reason of any damage to the Residence, the security deposit shall be returned to the Resident Caretakers within thirty calendar days after the termination of this Agreement, provided that the Resident Caretakers have delivered to the City a forwarding address, in writing, at or prior to the date the Resident Contractors surrendered the Residence to the City. 6. Liability Insurance. Resident Caretakers shall have personal liability insurance to cover the use and occupancy of the Residence on the Property, in an amount of not less than $500,000. The City of Carlsbad shall be added as Additional Insured by separate endorsement. All Risk Insurance. A standard fire policy including all risk or special form perils, providing Replacement Cost Coverage, without deduction for depreciation for (i} Resident Caretaker's personal property, (ii} fixtures owned by Resident Caretaker, and (iii) any items identified in this Agreement as improvements to the Residence constructed and owned by Resident Caretaker(s). The deductible for the required fire insurance policy shall not exceed $1,000 per occurrence and shall be borne by the Resident Caretaker( s). Incidental Worker's Compensation. A policy of California Workers' Compensation coverage in statutory amount and Employer's Liability coverage for no less than $500,000 per occurrence for all employees of the Resident Caretaker(s) engaged in services or operations at the direction of Resident Caretaker(s) at the Residence and/or Property. '") -_) - Evidence of Insurance. No later than the effective date of the Agreement, Resident Caretakers shall provide to the City a certificate of insurance and copy of the General Liability Additional Insured endorsement. Thereafter, certificates and separate Additional Insured endorsement shall be provided to the City within 30 calendar days of expiration of the required policy. Policy Provisions. Resident Caretakers shall provide the City with at least 30 calendar days written notice before any cancellation, lapse, reduction or other adverse change in the insurance policies specified above is effective. Ten-day notice of cancellation for non-payment of premium is acceptable. Right to Review. The City retains the right to review the coverage, form and amount of insurance required and may require Resident Caretakers to obtain insurance reasonably sufficient in coverage, form and amount to provide adequate protection against the kind and extent of risk which exists at the time a change in insurance is required. City requirements shall be reasonable. City retains the right to receive a certified copy of any required insurance policy after 15 calendar days' notice to Resident Caretakers. 7. Resident Caretakers must be well groomed with a high standard of attire that is clean, neat and professional in appearance at all times. Resident Caretakers must wear name tags provided while performing duties at the Property. 8. The Resident Caretakers will comply with all state and federal laws and City laws and policies regarding appropriate behavior while under contract with the City. This includes The City's Respectful Workplace Policy valuing respectfulness at all City Facilities, and prohibits any form of discrimination and harassment that would otherwise conflict with these values. The Resident Caretakers will conduct themselves with the highest standards of professional and ethical conduct. Resident Caretakers shall not, for personal benefit, use the name, emblem, endorsement, services or property of the City, nor seek any financial advantage or gain as the result of City affiliation. Resident Caretakers may not utilize any City affiliation in connection with the promotion of partisan policies, religious matters or positions on any issue not in conformity with the position of the City. Disclosure of confidential City information that is available solely as a result of your Resident Caretaker efforts is prohibited. 9. Resident Caretakers are responsible for monitoring their own work per week and keeping accurate records. If a dispute arises over the performance of this Agreement, the City reserves the right, but not the obligation, to audit the -4- Resident Caretakers hours. Misrepresentation of the hours worked or services performed shall be grounds for immediate termination of this Agreement. 10. It is the policy of the City to promote a safe work environment for all. In support of this policy, the City takes the position that a threat of violence or any violent act at Leo Carrillo Ranch Historic Park is in no way permitted. All threats or acts of violence will be taken seriously and acted upon. Personal safety is of paramount importance. The City never wants to put the Resident Caretakers in harm's way. If you believe the situation is unsafe in any way, remove yourself from the location. This includes the "eyes and ears" responsibility under this Agreement. The special projects manager is expected to educate and enforce the safety rules for all persons, including the Resident Caretakers at Leo Carrillo Ranch Historic Park. If you are unfamiliar with any City equipment or observe a safety hazard, please contact the special projects manager. Safety is everyone's responsibility. 11. City will evaluate the Resident Caretakers' duties pursuant to this Agreement to determine whether disclosure under the Political Reform Act and City's Conflict of Interest Code is required of the Resident Caretakers. Should it be determined that disclosure is required, Resident Caretakers will complete and file with the City Clerk those schedules specified by City and contained in the Statement of Economic Interests Form 700. Resident Caretakers warrant that by execution of this Agreement, that they have no interest, present or contemplated, in the projects affected by this Agreement. Resident Caretakers further warrant that the Resident Caretakers do not have any ancillary real property, business interests or income that will be affected by this Agreement or, alternatively, that Resident Caretakers will file with the City an affidavit disclosing this interest. 12. Resident Caretakers warrant that they possess sufficient strength and stamina to lift, carry and manipulate objects weighing up to 25 pounds and to perform sustained physical labor. Further that they are willing to work outdoors in all weather conditions, and be exposed to potentially hazardous conditions. 13. If at any time after the effective date of this Agreement, any Resident Caretakers who develop a condition or circumstance that might adversely impact the performance of their duties shall notify the special projects manager immediately. -5 - 14. Resident Caretakers are responsible for their own self-employment, income and other taxes that may be incurred as a result of this Agreement. For purposes of federal and state income tax, the City will report to the federal and state taxing authorities the fair market value of the Resident Caretakers' residence, utilities and annual stipend as the total value of the compensation received by the Resident Caretakers under this Agreement. 15. Resident Caretakers are responsible for their own benefits, not otherwise specifically provided for in this Agreement. 16. Termination. Termination of Agreement for Cause: The City may terminate this Agreement for cause without any ability to cure a breach. These grounds may include, but are not limited to: • Substance abuse, stealing, physical and verbal abuse, weapons in the park, or any criminal activity. • Performance, behavior or conduct incompatible with City vision, goals, objectives or mission. Termination of Agreement for Noncompliance: The City may terminate this Agreement for noncompliance, upon written notice of termination to the Resident Caretakers. Termination for noncompliance includes without limitation, when the Resident Caretakers has failed to fulfill his/her obligations under this Agreement. In such an event, said termination may either be effective immediately or City may, in its sole discretion allow an opportunity for the Resident Caretakers to cure the breach within five days of the notice of termination. In the event of immediate termination, Resident Caretakers shall immediately vacate the City owned Residence located at 6200 Flying LC Lane, Carlsbad, CA, 92009. Examples of noncompliance may include, but are not limited to: • Ineffective/deficient work performance • Failure to adhere to scope of work outlined in Paragraph 2 of Agreement • Inability to get along with staff or the public • Inability to perform job • Unexcused or extensive absences from the Property 17. At termination of the Agreement, the Resident Caretakers shall vacate the residence on the Property IMMEDIATELY WITHOUT FURTHER NOTICE. To vacate the Residence, the Resident Caretakers shall remove all of their personal property and move any personal vehicles out of the park. Any and - 6 - all personal property not removed by the Resident Caretakers after termination may be disposed of by the City pursuant to law. 18. The Resident Caretakers acknowledge that: (i) they are not a tenant of the City; (ii) this Agreement does not convey an estate or other possessory interest in real property or the Residence; (iii) their occupancy of the City owned Residence on the Property is incidental to their Resident Caretaker Status; (iv) upon or at termination of the Agreement, the Resident Caretakers' right to occupy the Residence on the Property is automatically terminated and simultaneously surrendered without further notice or grounds; and. (v) Resident Caretakers are not entitled to any relocation benefits upon or at the termination of Agreement. 19. The Resident Caretakers shall keep the Residence and the surrounding grounds adjacent to the Residence clean and orderly at all times. This shall include, but not be limited to the following: • A neat, clutter-free interior and exterior, with Fire Code approved accessibility and storage of household hazardous materials; • Sanitary conditions within the interior and exterior, compliant with all applicable Health Code provisions; • Interior window coverings that do not permanently block natural light or ventilation to the residence; • A litter-free and debris-free exterior porch/patio, with proper maintenance of all wood surfacing; • A dirt and dust rinsed exterior, which will include all siding, doors, and windows; • A healthy, watered, fertilized, and neatly maintained exterior landscape, and; • The lack of storage of abandoned/inoperable vehicles, trailers, equipment, or large tools on site. 20. The Resident Caretakers shall not keep any pets or other animals at the Residence or on the Property. Dogs are prohibited on park property (CMC § 11.32.030{23) ). 21. The Resident Caretakers shall not park or store a non-operable vehicle of any kind at the Residence or on the Property. -7- 22. The Resident Caretakers shall not have anyone living with them at the Residence or on the Property. 23. All overnight guests visiting the site must be registered in advance with the special projects manager. Overnight guests are limited to a cumulative maximum of 14 days, per calendar year. 24. The Park's Conditional Use Permit (CUP) requires that designated quiet hours must be observed. Quiet hours are 8 p.m. to 7:30a.m. Sunday through Thursday, and 10 p.m. to 7:30a.m. on Friday and Saturday. 25. Resident Caretakers shall be required to remain on the Property 50 weeks per year. Resident Caretaker(s) will provide a minimum of two weeks written notice to the special projects manager as to the dates that the Resident Caretakers will be off the Property. Resident Caretakers shall remain on the property for all city observed holidays. 26. The special projects manager is responsible for conducting a review of the Resident Caretakers adherence to the Agreement and scope of work. This review will be used, in part, to determine whether the Agreement should be extended for an additional term. 27. The term of this Agreement shall be one year, from the Effective Date. This Agreement may be extended for four additional one year terms, or a portion thereof, so long as the parties execute a written amendment amending the term of this Agreement. SEEATTAOHEDFOAMFOR NOTARY CEATfFICATE ---!Y--P--!;.-<'~9'----·+----)-v::-::,__-City Manager for the City of Carlsbad Approved as to Form g. Assistant City Attorney - 8 - CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT • State of California County of __ _,__S_II_r.J_U_i,_E -=-G-=-u ______ _ } On tiPP.t.l 2ot1 before me, Date personally appeared _ ___,fJE'---=--Ti'-"E'""""'R-'---___._fl1~11'-'-'(2'-'-'Pfl__,____k=--lf(=t_r_L..,£ '1~~=:;-:-;------------ Nb.me(s) of Signer(s) t0t:l4 L '(NN KE#N£'1 4~••++•+•44+4++A~ 3 • Candelario Resendez -•• Comm. #2099862 z :::: Notary Public -California ;:::: z -. ~nrn~c~~ ~ l Comm. explres feb. 12, 2019 t W¥WV¥"'!* r. . ...,'(w-·\:O"IW'"~~=;..·-.-~~..,., . .-"' Place Notary Seal Above who proved to me on the basis of satisfactory evidence to . be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. :J -----------------------------------------OPTIONAL---------------------------- Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: !lotzEEMf;NT fo11. ~E77lNDE'NT cO;vrnAt::frote ResiVFIVT C:ttrztrnl~ER.. ) Document Date: ___________________ Number of Pages: R ftf§t?S /1/otVE Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ____________ _ 0 Individual 0 Corporate Officer-Title(s): 0 Partner - 0 Limited 0 General 0 Attorney in Fact 0 Trustee 0 Guardian or Conservator 0 Other: ________ _ Signer Is Representing: ___ _ RIGHT THUMBPRINT OF SIGNER Top of thumb here Signer's Name: ______________ _ 0 Individual 0 Corporate Officer-Title(s): ________ _ 0 Partner - 0 Limited 0 General 0 Attorney in Fact 0 Trustee 0 Guardian or Conservator 0 Other: _________ _ Signer Is Representing: ____ _ RIGHT THUMBPRINT OF SIGNER Top of thumb here • ©2007 National Notary Association • 9350 De Soto Ave .. PO. Box 2402 • Chatsworth, CA 91313-2402 • www.NationaiNotary.org Item #5907 Reorder: Call Toll-Free 1-800-876-6827 CITY OF CARLSBAD PARKS & RECREATION DEPARTMENT LEO CARRILLO RANCH HISTORIC PARK 6200 Flying LC Lane Carlsbad, CA 92009 ACKNOWLEDGEMENT OF INDEPENDENT CONTRACTOR STATUS AGREEMENT We, the undersigned agree and understand that any work we perform at Leo Carrillo Ranch Historic Park ("Property") on behalf of the City of Carlsbad will be provided by us as independent contractors. We agree that we will not expect or receive any compensation other than what is provided for in the Agreement for Independent Contractor Resident Caretaker Services that is concurrently signed herewith for performing such work. We further understand and agree that functioning as an independent contractor does not constitute an employee-employer relationship with the City of Carlsbad, and that we serve at the discretion of the Parks & Recreation Director. We understand that we are not entitled to any relocation benefits upon the termination of my independent contractor status and to the extent that any relocations benefits are required under any applicable law, we hereby waive any and all relocation benefits. We understand that as independent contractors, we are responsible for providing all of our own needs, including without limitation, paying for our own health and insurance benefits and all federal and state income taxes. 0 4 I 0 \ /2. () I l- Signature of Independent Contractor Date L. Printed Name of Independent Contractor ignature of Independent Contractor Date Printed Name of Independent Contractor Special Projects Manager Date