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Go Be Rewarded Inc; 2022-11-07;
1 City Attorney Approved 8/2/2022 ASSIGNMENT AND ASSUMPTION AGREEMENT FOR AGREEMENT FOR VIDEO PRODUCTION SERVICES RYAN VIDEO PRODUCTIONS LLC THIS ASSIGNMENT AND ASSUMPTION AGREEMENT (“Assignment Agreement”) is made and entered into this _______ day of ___________ 2022, by and between the CITY OF CARLSBAD, a political subdivision of the State of California (“City”), Ryan Video Productions LLC, a limited liability corporation in the State of California, (“Assignor”) and Go Be Rewarded, Inc., a corporation in the State of California, (“Assignee”), and is made with reference to the following facts: RECITALS A. On June 16, 2021, the City and Assignor entered into that certain Professional Services Agreement concerning video production services, (the “Agreement”). B. Paragraph 24 of the Agreement allows Assignor to assign rights and obligations under the Agreement upon written approval of the City. C. Assignor desires to assign its interest in the Agreement to Assignee. Further, Assignee desires to accept assignment of Assignor’s interest in the Agreement and City consents to the assignment of the interest in the Agreement from Assignor to Assignee. NOW THEREFORE, incorporating the above recitals and in consideration of the covenants and obligations set forth herein, the parties hereto agree as follows: 1. Assignment. Assignor hereby assigns to Assignee all of Assignor’s rights and obligations as set forth in the Agreement. 2. Assumption. Assignee hereby assumes all of Assignor’s rights and obligations as set forth in the Agreement. 3. City Consent. City hereby agrees and consents to the assignment of all of Assignor’s rights and obligations as set forth in the Agreement to Assignee. 4. General Terms and Conditions. The following general terms and conditions shall apply to this Assignment Agreement. 4.1 Hold Harmless. In addition to the hold harmless provisions contained within the Agreement, and except as to the sole negligence, or willful misconduct of City, Assignee shall defend, indemnify and hold the City, its officers and employees, harmless from any and all loss, damage, claim for damage, liability, expense or cost, including attorneys’ fees, which arises out of or is in any way connected with this Assignment Agreement, notwithstanding that City may have benefitted from this Assignment Agreement. The hold harmless provision shall apply to any acts or omissions, willful misconduct or negligent conduct, whether active or passive, on the part of Assignee. The parties expressly agree that this section shall survive the expiration or early termination of this Agreement. DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B November7th 2 City Attorney Approved 8/2/2022 4.2. Counterparts. This Assignment Agreement may be executed in counterparts, each of which shall be deemed an original, but all of which, together, shall constitute one and the same instrument. 4.3. Successors and Assigns. It is mutually understood and agreed that this Assignment Agreement shall be binding upon City, Assignor and Assignee and their respective successors. Neither this Assignment Agreement or any part hereof nor any monies due or to become due hereunder may be assigned by Assignee without the prior consent of City. 4.4. Governing Law. This Assignment Agreement shall be governed by, interpreted under, and construed and enforced in accordance with, the laws of the State of California. 4.5. Venue. Any action at law or in equity brought by either of the parties hereto for the purpose of enforcing a right or rights provided for by this Assignment Agreement shalt be tried in a court of competent jurisdiction in the County of San Diego, State of California, and the parties hereby waive all provisions of law providing for a change of venue in such proceedings to any other county. 4.6. Notices. Service of any notices, bills, invoices or other documents required or permitted under this Assignment Agreement shall be sufficient if sent by one party to the other by United States mail, postage prepaid and addressed as follows: City: City Manager City of Carlsbad 1635 Faraday Avenue Carlsbad, CA 92008 Assignor: Ryan Video Productions LLC 368 Hidden Lake Lane Vista, CA 92084 Assignee: Go Be Rewarded, Inc. 249 S. Indiana Ave. Vista, CA 92084 4.7. Nondiscrimination. During the term of this Assignment Agreement, the parties shall comply with the state and federal laws regarding non-discrimination. 4.8 Authority. The parties executing this Assignment Agreement on behalf of City, Assignor and Assignee each represent and warrant that they have the legal power, right and actual authority to bind the City, Assignor and Assignee, respectively, to the terms and conditions hereof. 4.9 Severability. Each provision, term, condition, covenant, and/or restriction, in whole and in part, in this Assignment Agreement shall be considered severable. In the event any provision, term, condition, covenant, and/or restriction, in whole and in part, in this Assignment Agreement is declared invalid, unconstitutional, or void for any reason, such provision or part DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B 3 City Attorney Approved 8/2/2022 thereof shall be severed from this Assignment Agreement and shall not affect any other provision, term, condition, covenant, and/or restriction, of this Assignment Agreement and the remainder of this Assignment Agreement shall continue in full force and effect. 4.10 Effective Date. This Assignment Agreement shall be effective upon the date and year first above written. ASSIGNOR: RYAN VIDEO PRODUCTIONS LLC CITY OF CARLSBAD, a municipal corporation of the State of California *By: By: CHRISTOPHER L. RYAN President SCOTT CHADWICK City Manager **By: CHRISTOPHER L. RYAN Chief Financial Officer ASSIGNEE: By: GO BE REWARDED, INC. FAVIOLA MEDINA City Clerk Services Manager *By: AARON GOBIDAS President **By: AARON GOBIDAS Secretary 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: CINDIE K. McMAHON, City Attorney By:_____________________________ Deputy / Assistant City Attorney DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 THISCERTIFICATE 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 09/09/2022 Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA 5 Concourse Parkway Suite 2150Atlanta GA, 30328 (888) 202-3007 contact@hiscox.com Hiscox Insurance Company Inc 10200 GOBEREWARDED 249 S Indiana AveVista, CA 92084 X X X CGL is on BOP Form A X Y UDC-4002829-BOP-21 11/21/2021 11/21/2022 2,000,000 100,000 5,000 S/T Each Occ. 2,000,000 S/T Gen. Agg. The City of Carlsbad, its officials, employees and volunteers are named as an additional insured with respect to liability arising out of activities performed by or on behalf of GOBER EWARDED City of Carlsbad 1635 Faraday Ave CA 92008 DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B ACORD® I ~ I ~ □ □ ~ ~ Fl □ □ ~ ~ - ~ - ~ - ~ H I I I I I □ I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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 THISCERTIFICATE 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATIONAND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 09/09/2022 Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA 5 Concourse Parkway Suite 2150Atlanta GA, 30328 (888) 202-3007 contact@hiscox.com Hiscox Insurance Company Inc 10200 GOBEREWARDED 249 S Indiana AveVista, CA 92084 A Professional Liability Y UDC-4002829-EO-21 11/21/2021 11/21/2022 Each Claim: Aggregate: The City of Carlsbad, its officials, employees and volunteers are named as an additional insured with respect to liability arising out of activities performed by or on behalf of GOBER EWARDED City of Carlsbad 1635 Faraday Ave CA 92008 $ 2,000,000 $ 2,000,000 DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B ACORD® I ~ I ~ □ □ ~ ~ Fl □ □ ~ ~ - ~ - ~ - ~ H I I I I I □ I Goberewarded, LLC 1939 W Vista Way Fl 2 Vista, CA 92083 GOWC347995 - Insured's Copy DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B RegisterToday! www.guard.com/pscregister/ We value our policyholders, so we take advantage of technology to offer fast and easy online self-service solutions. Available from www.guard.com/pscregister/ or mobile app, our Policyholder Service Center is the gateway to a wide range of resources used by our customers to manage their insurance with us. From reporting a claim to making a payment online to reviewing helpful loss control information, our service center is designed to off er convenient access to the tools you use most! Our BHGUARD mobile app off ers many of the same features with the latest technology always in mind. Get the app on Google Play or download from the Apple App Store, today! Need help? Contact 1-800-673-2465 or csr@guard.com. COVERAGE-SPECIFIC FEATURES Workers’ Compensation • Find a physician • Complete a premium audit • Download state posting notices • Implement a return-to-work program • Report payroll (self-reporting policy) Commercial Auto • Access vehicle insurance ID cards • View all vehicles under a policy ACCOUNT MANAGEMENT View and print policy documents Generate a Certifi cate of Insurance (COI) Download loss control materials Search our video library Chat online with a representative Go paperless Access other news and resources BILLING & PAYMENTS Make a credit card payment Transfer funds from your bank Submit multi-policy payments Set up re-occurring payments View billing history CLAIMS Report a new claim Upload photos and documents View policy loss history Monitor the status of a claim Chat with an adjuster Policyholder Service Center w Visit www.guard.com/pscregister/ or download the BHGUARD app today! Some features and resources are only available for specifi c lines of insurance. Not all features may be currently available on the mobile app. Insurance is underwritten by AmGUARD Insurance Company®, AZGUARD™ Insurance Company (non-admitted in California), EastGUARD Insurance Company®, NorGUARD Insurance Company® or WestGUARD® Insurance Company, members of Berkshire Hathaway GUARD Insurance Companies (”GUARD”) with principal place of business at 39 Public Square, Wilkes-Barre, PA 18701. DOWNLOAD OUR MOBILE APP! SSPSC052721 DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B ..J/serkshire Hathaway ~'GUARD ;::;;;::;:: ::::.::.---c:ai ! ✓-'. •il''Berkshire Hathaway ,J.'A\ GUARD Insuran_ce l.,. Companies > > > > > > > > > > > > > > > > > Download the BHGUARD app j POLICYHOLDER SERVICE CENTER , · > GETITON Google Play We encourage policyholders to inform us of incidents, accidents, and potential claims as soon as possible so that we can get right to work! Prompt reporting can be key to a successful resolution. Only the administration of emergency care comes fi rst. WAYS TO REPORT A CLAIM Call 1-888-NEW-CLMS (1-888-639-2567) Log into our Policyholder Service Center at guard.com/pscregister Get the BHGUARD app from the App Store or Google Play Visit guard.com to complete an online form HELPFUL INFORMATION FOR EXPEDITING YOUR CLAIM • Policy number • Description of how, when, and where the incident occurred • Names, addresses, phone numbers of any injured/involved parties or witnesses • The insured driver’s name, address, phone number (for Commercial Auto claims) • The employer’s tax ID number, the injured/ill employee’s SSN and personnel fi le and any accident reports (for Workers’ Compensation claims) • Legal correspondence (for Liability claims) • Special forms for Disability claims available on guard.com TIPS FOR CONTROLLING THE LOSS Take reasonable steps to protect any covered persons, property, autos, etc., from immediate further harm or damage and keep a record of any expenses incurred in the process for consideration in the settlement. If possible, set property aside for examination. Allow our adjusters to offi cially inspect the property/auto before any non-immediate repairs or disposition take place. Promptly notify the police of any stolen property or suspected illegal activity. Preserve any closed-circuit surveillance video. If possible, photograph the scene; cell phone pictures can be helpful. CONTACT US 1-888-NEW-CLMS GUARDClaimsTeam@guard.com Fax: 570-825-0611 Berkshire Hathaway GUARD P.O. Box 1368 Wilkes-Barre, PA 18703-1368 Insurance may be underwritten by AmGUARD Insurance Company®, AZGUARD™ Insurance Company, EastGUARD Insurance Company®, NorGUARD Insurance Company®, or WestGUARD® Insurance Company, members of Berkshire Hathaway GUARD Insurance Companies (“GUARD”) with principal place of business at 39 Public Square, Wilkes-Barre, PA 18701. All claims will be evaluated upon submission. We will not pay for any subsequent loss or damage resulting from an occurrence that is not a “Covered Cause of Loss.” Only the relevant insurance policy and endorsements can provide the actual terms and conditions for an insured. Some restrictions, all state laws, and all company claims/underwriting guidelines apply. © May 2021. OUR SERVICESClaims Reporting CLRP052721 DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B ! ✓-.1 /Berkshire Hathaway '-~~\GUARD Insuran_ce l.. Companies > < Report a New Claim 0 Identify (gj G contactlnfo 8 Add Description f)Attachflles 1B ::~~,~~:;~""'nto,lma,g~lhat 0 > ••• II II > > > Alentamos a los tenedores de pólizas a que nos informen de incidentes, accidentes y reclamos potenciales lo antes posible, para que ponernos a trabajar inmediatamente. Una rápida denuncia puede ser importante para una resolución exitosa. Únicamente la administración de la atención de emergencias es más importante. FORMAS DE DENUNCIAR UN RECLAMO Llame al 1-888-NEW-CLMS (1-888-639-2567) Regístrese en nuestro Centro de Servicio a tenedores de pólizas en guard.com/pscregister Obtenga la aplicación BHGUARD en la App Store o de Google Play Visite guard.com para completar el formulario online INFORMACIÓN ÚTIL PARA ACELERAR SU RECLAMO • Número de póliza • Descripción acerca de cómo, cuándo y dónde ocurrió el incidente • Nombres, direcciones, números telefónicos de alguna de las partes involucradas/lesionadas o de testigos • El nombre, dirección, número telefónico del conductor asegurado (para reclamos comerciales de vehículos) • El número federal del negocio, el número de seguro social del empleado enfermo/lesionado y el archivo personal y cualquier denuncia de accidente (para el reclamo de indemnización del empleado) • Correspondencia legal (para reclamos de responsabilidad) • Formularios especiales para reclamos por discapacidad disponibles en guard.com CONSEJOS PARA CONTROLAR LAS PÉRDIDAS Dé pasos razonables para proteger a cualquier persona, propiedad, vehículos, etc. cubiertos, de un daño mayor o perjuicio inmediato y lleve un registro de cualquier gasto en el que incurra en el proceso para su consideración en el acuerdo. De ser posible, reserve la propiedad para su examen. Permita que nuestros ajustadores inspeccionen de manera oficial la propiedad/vehículo antes de dar lugar a cualquier reparación o disposición de carácter no inmediato. Notifique inmediatamente a la policía acerca de la propiedad robada o de sospecha de actividad ilegal Preserve cualquier video de circuito cerrado de vigilancia. De ser posible, tome fotografías de la escena; las fotos del teléfono celular pueden ser útiles. CONTÁCTENOS 1-888-NEW-CLMS GUARDClaimsTeam@guard.com Fax: 570-825-0611 Berkshire Hathaway GUARD P.O. Box 1368 Wilkes-Barre, PA 18703-1368 El seguro podrá ser cubierto por AmGUARD Insurance Company®, EastGUARD Insurance Company®, NorGUARD Insurance Company®, WestGUARD® Insurance Company, o AZGUARDTM Insurance Company, miembros de las Compañías de Seguros Berkshire Hathaway GUARD (BHGIC) con sede central en 39 Public Square, Wilkes-Barre, PA 18701. Todos los reclamos serán evaluados una vez presentados. No pagaremos ninguna pérdida o daño sobreviniente como consecuencia de un incidente que no configure una «Causa de pérdida cubierta». Únicamente las pólizas de seguro y los endosos relevantes pueden proporcionar los términos y condiciones efectivos a un asegurado. Son aplicables algunas restricciones, todas las leyes estatales y todos los reclamos de empresas/guías de cobertura. © BHGIC 2020. NUESTROS SERVICIOSReporte de Reclamos CFES052821 DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B ( Report a New Claim 8 Identify 8 Contact Info 0 Add Description 0 Attach files 0 Iii II Ii ! ✓-.1 /Berkshire Hathaway '-~~\GUARD Insuran_ce l.. Companies > > > > > The Security You Need. The Name You Trust. H Q : CA / XX D E C T O I www.guard.com In cooperation with AP INTEGO INSURANCE GROUP Goberewarded, LLC 1939 W Vista Way Fl 2 Vista, CA 92083 Policy Number: GOWC347995 Customer Number: 2890785 Insurance Company: PAAMGU10 Effective Date: 04/01/2022 Workers Compensation Policy Renewal Offer We are pleased to offer to renew your policy. Enclosed are your policy renewal documents. The policy is underwritten by PAAMGU10, a member of Berkshire Hathaway GUARD Insurance Companies. Manage Your Policy Online We provide fast and easy online self-service solutions through our Policyholder Service Center (PSC) and BHGUARD mobile app. Here you can: view and print policy documents make online payments find information to report a claim (use our app to upload photos and documents) GO GREEN – set up electronic document delivery If you haven’t already, register at www.guard.com/pscregister or get the BHGUARD app today! Who to Contact Call your insurance agent at 888-289-2939 to make changes to your policy or with billing questions if you are using automatic payroll billing. If you are under a direct bill payment plan and receive statements in the mail from us, you can direct billing inquiries to Customer Service at 1-800-673-2465, via chat through our PSC, or through email at csr@guard.com. To report fraud or suspicious activity, contact our Fraud Investigative Unit at 800-673-2465, ext. 8477 (TIPS) or via email at fraudsiu@guard.com. Report a Claim 24/7 You can report a claim 24/7 by calling 888-NEW-CLMS. Look for information on claims reporting on our Policyholder Service Center accessible at www.guard.com. Upload claims documents and photos using our mobile app or online at our PSC. Workers’ Compensation Resources To obtain a copy of your state’s Posting Notices as well as managed care and/or claims information that may need to be shared with your employees, visit: www.guard.com/postingnotices Thanks for your continued business with Berkshire Hathaway GUARD Insurance Companies. Please keep a copy of this letter with your policy for future reference. If you are enrolled in direct draft, payroll billing, or any other type of automated billing, your payment will be sent to us automatically. Otherwise, please review the information above about making payments and managing your policy online. A billing statement, sent separately, will have additional information. Please note payment is required to maintain uninterrupted insurance coverage. enclosed: Workers Compensation Policy #GOWC347995 DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B .I/Berkshire Hathaway ,_Y,~~\ GUARD Insuran_ce l.. Companies Register for our Policyholder Service Center at www.guard.com/pscregister/ or download the BHGUARD app today! Download lhe BHGUARD app 11•. POLICYHOLDER , SERVICE CENTER ...... GETITON V"" Google Play Policy Information Page Worker's Compensation and Employer's Liability Policy AmGUARD Insurance Company - A Stock Co. Policy Number GOWC347995 Renewal of GOWC115766 NCCI No. [21873] Named Insured and Mailing Address AP INTEGO INSURANCE GROUP 375 Woodcliff Drive Suite 103 Fairport, NY 14450 Agency Code: NYINTE10 [1]Agency Goberewarded, LLC1939 W Vista Way Fl 2Vista, CA 92083 Federal Employer's ID Insured is Limited Liability Co. (LLC)XX-XXX7079 From April 1, 2022 to April 1, 2023, 12:01 AM, standard time at the insured's mailing address. Policy Period[2] Coverage[3] A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation Law of the following states: California B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed in item [3]A. The limits of our liability under Part Two are: Bodily Injury by Accident - each accident $1,000,000 Bodily Injury by Disease - each employee $1,000,000 Bodily Injury by Disease - policy limit $1,000,000 C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming. D.This policy includes these endorsements and schedules: See Extension of Information Page - Schedule of Forms - WC 040004 The Premium Basis and, therefore, the premium will be determined by our Manual of Rules, Classifications, Rates, and Rating Plans. All required information is subject to verification and change by audit. (Continued on another page) Premium[4] 650Total Estimated Policy Premium $ Total Surcharges/Assessments $$39.00 $689.00$Total Estimated Cost INTERNAL USE XXMGA : GOWC347995 Date : 03/02/2022 Page - 1 -Information PageWC 000001A Issuing Office: P.O. Box AH, 39 Public Square, Wilkes-Barre, PA 18703-0020 • www.guard.com DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B .l/serkshire Hathaway '-~~\GUARD Insuran_ce l.. Companies GOWC347995 Applicable States PN049901I - CA YOUR RIGHT TO RATING AND DIVIDEND INF All PN049902B - CA POLICYHOLDER NOTICE - WC RATING LAWS*All PN049904 - CA INS. GUARANTEE ASSOC.(CIGA) SURCHARGE*All WC000000C - STANDARD POLICY All WC000001A - INFORMATION PAGE All WC000403 - EXPERIENCE RATING MODIFICATION FACTOR*All WC000421E - CATASTROPHE (OTHER THAN CERT ACTS OF TER All WC000422C - TERR RISK INS PROG REAUTHORIZATION ACT All WC040004 - CA EXT OF INFO PAGE-SCHEDULE OF FORMS*All WC040301D - POLICY AMENDATORY ENDORSEMENT-CALIFORNIA*All WC040310 - CA DUTY TO DEFEND*All WC040318C - CA LLC COVERAGE/EXCLUSION ENDORSEMENT*All WC040410A - CA ESTIMATED ANNUAL PREMIUM ENDORSEMENT All WC040422 - CALIFORNIA SHORT-RATE CANCELLATION END'T All WC040601B - CA CANCELATION ENDORSEMENT All WC040604 - COVID-19 REPORTING REQUIREMENT ENDT*All WC990000 - AUTHORIZATION AND ATTESTATION END'T*All WC990014 - CALIFORNIA CHANGES - AMENDATORY END'T*All * As part of our ongoing commitment to environmental responsibility throughout our operations, we have chosen not to reprint those forms (marked with an asterisk) that have not changed and were previously sent to you. You can obtain a new copy of any of these forms by accessing your account information at our Policyholder Service Center (a selection available via our web site at https://policyholder.guard.com). Please be aware that you will be asked to enter your policy number, policy inception date, and federal ID number in order to log on to this secure portion of our site. Alternatively, you can contact us via phone at 800-673-2465; our Customer Service Representatives will either be able to help you locate a document yourself or can send a copy to you. As always, we thank you for selecting us as your insurer. We look forward to serving you! Page - 2 - DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY EXTENSION OF INFORMATION PAGE Schedule of Forms ITEM 30 WC 0400 04 (Ed. 7-98) POLICY NO. _______ _ Form Numbers ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. Policy Information Page Worker's Compensation and Employer's Liability Policy AmGUARD Insurance Company - A Stock Co. Policy Number GOWC347995 Renewal of GOWC115766 NCCI No. [21873] Premium (cont.)[4] California Classification Estimated Annual Premium Rate per $100 Remuneration Premium Basis: Total Estimated Annual Remuneration Code Effective: 04/01/2022-04/01/2023 COMPUTER PROGRAMMING OR SOFTWARE 8859 300,000.00 0.07 210 Territorial Rating, San Diego and Imperial Valley 0.93 -15 Total Estimated Annual Premium for CA 195 Policy Totals Total Estimated Standard Premium for California 195 Amt to Bal Min Prem 145 Catastrophe 9741 0.02 300,000 60 Terrorism CA 9740 0.03 300,000 90 Expense Constant 160 Minimum Premium CA $500 Total Estimated Annual Premium 650 CA SIBTF Assessment 04/01/2022-04/01/2023 1.7451%11 CA OSHF Assessment 04/01/2022-04/01/2023 0.9177%6 CA LECF Assessment 04/01/2022-04/01/2023 0.7102%5 CA Fraud Surcharge 04/01/2022-04/01/2023 0.4856%3 CA WCARF Assessment 04/01/2022-04/01/2023 1.9277%13 CA UEBTF Assessment 04/01/2022-04/01/2023 0.1455%1 Total Estimated Cost for GOWC347995 689 INTERNAL USE XXMGA : GOWC347995 Date : 03/02/2022 Page - 3 -Information PageWC 000001A Issuing Office: P.O. Box AH, 39 Public Square, Wilkes-Barre, PA 18703-0020 • www.guard.com DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B .l/serkshire Hathaway '-~~\GUARD Insuran_ce l.. Companies Policy Information Page Worker's Compensation and Employer's Liability Policy AmGUARD Insurance Company - A Stock Co. Policy Number GOWC347995 Renewal of GOWC115766 NCCI No. [21873] Policy Payment Terms Payment Option: Payroll Interface Billing As you requested, we have matched your premium payments to your schedule for processing payroll. Your premium will be determined in accordance with "Part Five - Premium" based upon your reported payroll and other remuneration. This payment option features several benefits and obligations. Specifically, we have waived our usual down payment requirement and are allowing you to pay in smaller increments over a longer period of time provided your payroll is continuous and uninterrupted. If payroll deduction is terminated or suspended for any reason or if you fail to generate payroll or to maintain sufficient funds in your account to meet your obligations to us, you agree your policy will be cancelled for non-payment of premium with proper advance notice as required by the state. If an affiliated carrier of Berkshire Hathaway GUARD Insurance Companies has provided you with workers' compensation insurance during a prior policy period, you also agree as a condition of continued coverage to pay any premium owed with respect to such policy in addition to the premium set forth above. INTERNAL USE XXMGA : GOWC347995 Date : 03/02/2022 Page - 4 - Issuing Office: P.O. Box AH, 39 Public Square, Wilkes-Barre, PA 18703-0020 • www.guard.com DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B .l/serkshire Hathaway '-~~\GUARD Insuran_ce l.. Companies Catastrophe (Other Than Certified Acts of Terrorism) Premium Endorsement This endorsement is notification that your insurance carrier is charging premium to cover the losses that may occur in the event of a Catastrophe (Other Than Certified Acts of Terrorism) as that term is defined below. Your policy provides coverage for workers compensation losses caused by a Catastrophe (Other Than Certified Acts of Terrorism). This premium charge does not provide funding for Certified Acts of Terrorism contemplated under the Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement (WC 00 04 22 C), attached to this policy. For purposes of this endorsement, the following definitions apply: • Catastrophe (Other Than Certified Acts of Terrorism): Any single event, resulting from an Earthquake, Noncertified Act of Terrorism, or Catastrophic Industrial Accident, which results in aggregate workers compensation losses in excess of $50 million. • Earthquake: The shaking and vibration at the surface of the earth resulting from underground movement along a fault plane or from volcanic activity. • Noncertified Act of Terrorism: An event that is not certified as an Act of Terrorism by the Secretary of the Treasury pursuant to the Terrorism Risk Insurance Act of 2002 (as amended) but that meets all of the following criteria: a. It is an act that is violent or dangerous to human life, property, or infrastructure; b. The act results in damage within the United States, or outside of the United States in the case of the premises of United States missions or air carriers or vessels as those terms are defined in the Terrorism Risk Insurance Act of 2002 (as amended); and c. It is an act that has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. • Catastrophic Industrial Accident: A chemical release, large explosion, or small blast that is localized in nature and affects workers in a small perimeter the size of a building. The premium charge for the coverage your policy provides for workers compensation losses caused by a Catastrophe (Other Than Certified Acts of Terrorism) is shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate Premium WC 00 04 21 E (Ed. 01-2021) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY ) CA 0.020 60.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by WC 00 04 21 E (Ed. 01-2021) 1 of 1 © Copyright 2020 National Council on Compensation Insurance, Inc. All Rights Reserved. GOWC347995 DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B Terrorism Risk Insurance Program Reauthorization Act Disclosure Endorsement This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2019. It serves to notify you of certain limitations under the Act, and that your insurance carrier is charging premium for losses that may occur in the event of an Act of Terrorism. Your policy provides coverage for workers compensation losses caused by Acts of Terrorism, including workers compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. Definitions The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act. If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply. “Act” means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments thereto, including any amendments resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2019. “Act of Terrorism” means any act that is certified by the Secretary of the Treasury, in consultation with the Secretary of Homeland Security, and the Attorney General of the United States, as meeting all of the following requirements: a. The act is an act of terrorism. b. The act is violent or dangerous to human life, property, or infrastructure. c. The act resulted in damage within the United States, or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels. d. The act has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. “Insured Loss” means any loss resulting from an act of terrorism (and, except for Pennsylvania, including an act of war, in the case of workers compensation) that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. “Insurer Deductible” means, for the period beginning on January 1, 2021, and ending on December 31, 2027, an amount equal to 20% of our direct earned premiums during the immediately preceding calendar 1 of 2 © Copyright 2020 National Council on Compensation Insurance, Inc. All Rights Reserved. WC 00 04 22 C (Ed. 01-2021) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B WC 00 04 22 C (Ed. 01-2021) WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY Limitation of Liability The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a calendar year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we will pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury. Policyholder Disclosure Notice 1. Insured Losses would be partially reimbursed by the United States Government. If the aggregate industry Insured Losses occurring in any calendar year exceed $200,000,000, the United States Government would pay 80% of our Insured Losses that exceed our Insurer Deductible. 2. Notwithstanding item 1 above, the United States Government will not make any payment under the Act for any portion of Insured Losses that exceed $100,000,000,000. 3. The premium charge for the coverage your policy provides for Insured Losses is included in the amount shown in Item 4 of the Information Page or in the Schedule below. Schedule State Rate Premium CA 0.030 $90.00 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Premium Insurance Company Countersigned by WC 00 04 22 C (Ed. 01-2021) 2 of 2 © Copyright 2020 National Council on Compensation Insurance, Inc. All Rights Reserved. GOWC347995 DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 04 10 A (Ed. 01-18) ESTIMATED ANNUAL PREMIUM ENDORSEMENT—CALIFORNIA The premium with respect to the insurance provided by this policy by reason of the designation of California in item 3 of the Information Page is subject to experience modification. Your experience modification, when issued, will be effective on ____________________, your rating effective date determined by the Workers’ Compensation Insurance Rating Bureau of California (WCIRB) in accordance with California law. Pending the issuance of your experience modification by the WCIRB, the estimated annual premium shown below is based on an estimated experience modification. The estimated annual premium will be revised when the WCIRB issues your applicable experience modification. ESTIMATED ANNUAL PREMIUM $ ____________________ NOTE: THE ESTIMATED ANNUAL PREMIUM MAY BE INCREASED WHEN THE WCIRB ISSUES THE EXPERIENCE MODIFICATION APPLICABLE TO THIS POLICY. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Insurance Company Countersigned By 04/01/2022 $689.00 DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY CALIFORNIA SHORT-RATE CANCELATION ENDORSEMENT WC 04 04 22 (Ed. 01-12) It is agreed that, anything in the policy to the contrary notwithstanding, such insurance as is afforded by this policy by reason of the designation of California in Item 3 of the Information Page is subject to the following provisions: If you cancel the policy and a disclosure was provided in accordance with Section 481 ( c) of the California Insurance Code, final premium will be based on the time this policy was in force and increased by the short- rate cancelation table below: Short Rate Cancelation Table Factor to Factor to Factor to Apply to Apply to Apply to Earned Earned Earned Premium for Premium for Premium for Days in Short Rate Period Policy in Days in Short Rate Period Policy in Days in Short Rate Period Policy Policy Period Percentaqes Effect Policy Period Percentaqes Effect Policy Period Percentaqes in Effect 1 5% 18.2482 46 23% 1.8250 91 35% 1.4038 2 6 10.9489 47 23 1.7861 92 36 1.4283 3 7 8.5158 48 24 1.8250 93 36 1.4129 4 7 6.3869 49 24 1.7877 94 36 1.3979 5 8 5.8394 50 24 1.7520 95 37 1.4216 6 8 4.8662 51 24 1. 7176 96 37 1.4068 7 9 4.6924 52 25 1.7548 97 37 1.3923 8 9 4.1058 53 25 1.7216 98 37 1.3781 9 10 4.0552 54 25 1.6899 99 38 1.4010 10 10 3.6496 55 26 1.7255 100 38 1.3870 11 11 3.6496 56 26 1.6947 101 38 1.3733 12 11 3.3455 57 26 1.6650 102 38 1.3598 13 12 3.3689 58 26 1.6362 103 39 1.3820 14 12 3.1283 59 27 1.6704 104 39 1.3688 15 13 3.1630 60 27 1.6425 105 39 1.3557 16 13 2.9653 61 27 1.6156 106 40 1.3774 17 14 3.0056 62 27 1.5895 107 40 1.3645 18 14 2.8386 63 28 1.6222 108 40 1.3519 19 15 2.8818 64 28 1.5969 109 40 1.3395 20 15 2.7377 65 28 1.5723 110 41 1.3605 21 16 2.7812 66 29 1.6038 111 41 1.3482 22 16 2.6547 67 29 1.5799 112 41 1.3362 23 17 2.6980 68 29 1.5566 113 41 1.3243 24 17 2.5856 69 29 1.5341 114 42 1.3447 25 17 2.4821 70 30 1.5643 115 42 1.3330 26 18 2.5270 71 30 1.5423 116 42 1.3215 27 18 2.4334 72 30 1.5208 117 43 1.3414 28 18 2.3465 73 30 1.5000 118 43 1.3301 29 18 2.2656 74 31 1.5291 119 43 1.3189 30 19 2.3117 75 31 1.5087 120 43 1.3079 31 19 2.2371 76 31 1.4888 121 44 1.3273 32 19 2.1672 77 32 1.5169 122 44 1.3164 33 20 2.2121 78 32 1.4974 123 44 1.3057 34 20 2.1471 79 32 1.4785 124 44 1.2951 35 20 2.0857 80 32 1.4600 125 45 1.3140 36 20 2.0278 81 33 1.4870 126 45 1.3036 37 21 2.0716 82 33 1.4689 127 45 1.2933 38 21 2.0171 83 33 1.4512 128 46 1.3117 39 21 1.9654 84 34 1.4774 129 46 1.3016 40 21 1.9162 85 34 1.4600 130 46 1.2916 41 22 1.9585 86 34 1.4430 131 46 1.2817 42 22 1.9119 87 34 1.4264 132 47 1.2996 43 22 1.8674 88 35 1.4517 133 47 1.2899 44 23 1.9079 89 35 1.4354 134 47 1.2802 45 23 1.8655 90 35 1.4194 135 47 1.2708 DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B WC 04 04 22 (Ed. 01 -12) Days in Short Rate Policy Period Percentages 136 48% 137 48 138 48 139 49 140 49 141 49 142 49 143 50 144 50 145 50 146 50 147 51 148 51 149 51 150 52 151 52 152 52 153 52 154 53 155 53 156 53 157 54 158 54 159 54 160 54 161 55 162 55 163 55 164 55 165 56 166 56 167 56 168 57 169 57 170 57 171 57 172 58 173 58 174 58 175 58 176 59 177 59 178 59 179 60 180 60 271 80 272 80 273 80 274 81 275 81 276 81 277 81 278 81 279 82 280 82 281 82 Factor to Apply to Earned Premium for Period Policy in Effect 1.2882 1.2788 1.2696 1.2867 1.2775 1.2684 1.2595 1.2762 1.2674 1.2586 1.2500 1.2663 1.2578 1.2493 1.2653 1.2569 1.2487 1.2405 1.2562 1.2481 1.2401 1.2554 1.2475 1.2396 1.2319 1.2469 1.2392 1.2316 1.2241 1.2388 1.2313 1.2240 1.2384 1.2311 1.2238 1.2167 1.2308 1.2237 1.2167 1.2097 1.2236 1.2167 1.2098 1.2235 1.2167 1.0775 1.0735 1.0696 1.0790 1.0751 1.0712 1.0673 1.0635 1.0728 1.0689 1.0651 Short Rate Cancelation Table (Cont'd) Factor to Factor to Apply to Apply to Earned Earned Premium for Premium for Days in Short Rate Period Policy in Days in Short Rate Period Policy Policy Period Percentages Effect Policy Period Percentages in Effect 181 60% 1.2099 226 70% 1.1305 182 60 1.2033 227 70 1.1255 183 61 1.2167 228 70 1.1206 184 61 1.2101 229 71 1.1317 185 61 1.2035 230 71 1.1267 186 61 1.1970 231 71 1.1219 187 61 1.1906 232 71 1.1170 188 62 1.2037 233 72 1.1279 189 62 1.1974 234 72 1.1231 190 62 1.1910 235 72 1.1183 191 62 1.1848 236 72 1.1136 192 63 1.1977 237 72 1.1089 193 63 1.1914 238 73 1.1195 194 63 1.1853 239 73 1.1149 195 63 1.1792 240 73 1.1102 196 63 1.1732 241 73 1.1056 197 64 1.1858 242 74 1 .1161 198 64 1.1798 243 74 1.1115 199 64 1.1739 244 74 1.1070 200 64 1.1680 245 74 1.1025 201 65 1.1804 246 74 1.0980 202 65 1.1745 247 75 1.1083 203 65 1.1687 248 75 1.1038 204 65 1.1630 249 75 1.0994 205 65 1.1573 250 75 1.0950 206 66 1.1694 251 76 1.1052 207 66 1.1638 252 76 1.1008 208 66 1.1582 253 76 1.0964 209 66 1.1526 254 76 1.0921 210 67 1.1645 255 76 1.0878 211 67 1.1590 256 77 1.0979 212 67 1.1535 257 77 1.0936 213 67 1.1481 258 77 1.0893 214 67 1.1428 259 77 1.0851 215 68 1.1544 260 77 1.0810 216 68 1.1491 261 78 1.0908 217 68 1.1438 262 78 1.0866 218 68 1.1385 263 78 1.0825 219 69 1.1500 264 78 1.0784 220 69 1.1448 265 79 1.0881 221 69 1.1396 266 79 1.0840 222 69 1.1345 267 79 1.0800 223 69 1.1294 268 79 1.0759 224 70 1.1406 269 79 1.0719 225 70 1.1356 270 80 1.0815 316 90 1.0396 361 100 1.0111 317 90 1.0363 362 100 1.0083 318 90 1.0330 363 100 1.0055 319 90 1.0298 364 100 1.0027 320 91 1.0380 365 100 1.0000 321 91 1.0347 322 91 1.0315 323 91 1.0283 324 92 1.0364 325 92 1.0332 326 92 1.0301 GOWC347995 DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B WC 04 04 22 (Ed. 01 -12) Days in Short Rate Policy Period Percentages 282 82 283 83 284 83 285 83 286 83 287 83 288 84 289 84 290 84 291 84 292 85 293 85 294 85 295 85 296 85 297 86 298 86 299 86 300 86 301 86 302 87 303 87 304 87 305 87 306 88 307 88 308 88 309 88 310 88 311 89 312 89 313 89 314 89 315 90 Factor to Apply to Earned Premium for Period Policy in Effect 1.0614 1.0705 1.0667 1.0630 1.0593 1.0556 1.0646 1.0609 1.0572 1.0536 1.0625 1.0589 1.0553 1.0517 1.0481 1.0569 1.0534 1.0498 1.0463 1.0429 1.0515 1.0480 1.0446 1.0411 1.0497 1.0462 1.0429 1.0395 1.0361 1.0445 1.0412 1.0379 1.0346 1.0429 Short Rate Cancelation Table (Cont'd) Factor to Apply to Earned Premium for Days in Short Rate Period Policy in Days in Short Rate Policy Period Percentages Effect Policy Period Percentages 327 92 1.0269 328 92 1.0238 329 93 1.0318 330 93 1.0286 331 93 1.0255 332 93 1.0224 333 94 1.0303 334 94 1.0272 335 94 1.0242 336 94 1.0211 337 94 1.0181 338 95 1.0259 339 95 1.0229 340 95 1.0198 341 95 1.0169 342 95 1.0139 343 96 1.0216 344 96 1.0186 345 96 1.0156 346 96 1.0127 347 97 1.0203 348 97 1.0174 349 97 1.0145 350 97 1.0116 351 97 1.0087 352 98 1.0162 353 98 1.0133 354 98 1.0105 355 98 1.0076 356 99 1.0150 357 99 1.0122 358 99 1.0094 359 99 1.0065 360 99 1.0038 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Insured Policy No. Insurance Company. Endorsement No. Factor to Apply to Earned Premium for Period Policy in Effect Countersigned By _______________________ _ WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 06 01 B (Ed. 01-22) WC 04 06 01 B (Ed. 01-22) CALIFORNIA CANCELATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. The cancelation condition in Part Six (Conditions) of the policy is replaced by these conditions: Cancelation: 1.You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancelation is to take effect. 2.We may cancel this policy for one or more of the following reasons: a.Non-payment of premium; b.Failure to report payroll; c.Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issued by us; d.Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or any previous policy issued by us; e.Material misrepresentation made by you or your agent; f.Failure to cooperate with us in the investigation of a claim; g.Material failure to comply with federal or state safety orders or written recommendations of our designated loss control representatives; h.The occurrence of a material change in the ownership of your business; i.The occurrence of any change in your business or operations that materially increases the hazard for frequency or severity of loss; j.The occurrence of any change in your business or operation that requires additional or different classification for premium calculation; k.The occurrence of any change in your business or operation which contemplates an activity excluded by our reinsurance treaties. 3.If we cancel your policy for any of the reasons listed in (a) through (f), we will give you 10 days advance written notice, stating when the cancelation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. If we cancel your policy for any of the reasons listed in Items (g) through (k), we will give you 30 days advance written notice; however, we agree that in the event of cancelation and reissuance of a policy effective upon a material change in ownership or operations, notice will not be provided. 4.If we mail the notice to you, the stated periods of notice and your right to remedy the condition will be extended by 5 days if the place of mailing and your mailing address is within California, 10 days if the place of mailing or your mailing address is outside of California and 20 days if the place of mailing or your mailing address is outside of the United States. 5.The policy period will end on the day and hour stated in the cancelation notice. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Insurance Company Countersigned By GOWC347995 DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B Loss ControlOUR SERVICES 1 ONLINE RESOURCES Self-help tools available from our Agency and Policyholder Service Centers include: Guides and educational materials Online video library The GUARD Wire – Offers useful safety information and best practices for both businesses and individuals Training Videos We have over 350 topics available through Training Network Now, such as: • CONSTRUCTION SAFETY • DIVERSITY & DISCRIMINATION • FLEET MAINTENANCE • FOOD SAFETY & RESTAURANTS • HOSPITALITY • OSHA COMPLIANCE • RETAIL SAFETY • WORKPLACE COMMUNICATIONS At Berkshire Hathaway GUARD, we understand the importance of preventing claims. That’s why we offer our policyholders a wide range of loss control resources – all free of charge – that can help keep your interests protected. From online materials to onsite consults, we can help “a little” or “a lot” depending upon the needs of customers. WE CAN HELP “A LITTLE” or “A LOT.” DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B > > > ! ✓-• i .t Berkshire Hathaway ,_~\GUARD Insuran_ce l.. Companies ........... ® Not all Berkshire Hathaway GUARD Insurance Companies provide the services described herein nor are all available in all states or for all lines of coverage. This information is intended to present an general overview and should not replace the guidance, advice, or recommendations from licensed insurance or legal professionals, other industry experts, or state and federal authorities. Insurance is underwritten by AmGUARD Insurance Company, EastGUARD Insurance Company, NorGUARD Insurance Company, or WestGUARD Insurance Company, members of Berkshire Hathaway GUARD Insurance Companies (BHGIC) with principal place of business at 39 Public Square, Wilkes-Barre, PA 18701. © BHGIC October 2020. Loss ControlOUR SERVICES 2 SMART RISK MANAGEMENT The “Internet of Things” (IoT) has particular value to the insurance industry because of the impact it can have on risk management. Not only can controlling losses lower claims costs, and thereby, insurance premiums, it can also save lives. We are excited to be working with loss control engineers from around the country to provide our policyholders with convenient access to Smart Risk-Management devices (like those shown right) — often at a discounted price! 3 PROFESSIONAL SUPPORT For certain insurance coverages, we partner with outside experts to offer our policyholders assistance through professional help lines and websites. From cyber security to liability issues, these venues feature a wide range of resources, tips, and “real-time” advice that can help mitigate common and, sometimes, not-so-common causes of claims. 4 CUSTOMIZED PLANS For more customized needs, the scope of our activities can include many sorts of components, such as: Onsite, telephonic, and virtual surveys Facility audits and ongoing consults Analysis of loss patterns Safety committee training Systems analysis (i.e., sprinklers, fire alarms) Ergonomic evaluations and OSHA inspections Help with implementing a return-to-work program “Smart” Devices Water Leak Prevention & Shut-Off Systems Detects and prevents water leaks by closing the water main; wireless options enable monitoring anytime, anywhere. Advanced Driver Assistance Systems Developed to automate, adapt, and enhance vehicle systems for safety and better driving; real-time alerts can help minimize human error. Cooktop Fire Suppressors Designed for residential use, easy to install, and useful in minimizing property damage. LCOS102220 Contact Us 1-800-673-2465 x 1475 losscontrol@guard.com www.guard.com DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B > > > > > > > Drllm Policyholder: Policy #: Dear Policyholder: Thank you for selecting us as your Workers’ Compensation insurer. In addition to secure coverage, we provide extensive services as part of our effort to achieve complete customer satisfaction. If a claim should happen to occur, our medical management activities are handled through another Berkshire Hathaway partner selected for this program. To better acquaint you with the information and procedures you need to know, we provide the following important Workers’ Compensation and Medical Provider Network (MPN) materials: • Notice to Employees - Injuries Caused By Work (DWC 7) • English and Spanish Time-of-Hire Pamphlet • Workers' Compensation Claim Form and Notice of Potential Eligibility (DWC 1 and NOPE) • English and Spanish MPN Employee Notification • (The MPN ID# is 2397, and the Medical Access Assistant Phone Number is: 1-844-752-1144.) • On-line Directory of Managed Care Providers Each of these resources can be found on-line at: {HeaderAddress_WebsiteClaimsCA} (Hard copies are available upon request.) PROVIDING IMPORTANT WORKERS’ COMPENSATION INFORMATION Be sure to complete the Notice to Employees (DWC-7) and post in a conspicuous location frequented by employees during the hours of the workday. USING THE MPN MATERIALS An English and a Spanish version of the MPN Employee Notification have been supplied for you to download so you can post in proximity to the DWC-7 and distribute to each person enrolled. If you have any questions, do not hesitate to contact our office at 1-800-673-2465 or csr@GUARD.com Thank you, Customer Service Department Berkshire Hathaway GUARDP.O. Box AH Wilkes-Barre, PA 18703-0020 FAX 570-823-2059 www.guard.com 570-825-9900 (Toll-Free 800-673-2465) Goberewarded, LLCGOWC347995 http://www.guard.com/claims-CA.htm 800-673-2465 csr@GUARD.com Goberewarded, LLC 1939 W Vista Way Fl 2 Vista, CA 92083 DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B .~/Berkshire Hathaway '-~~\GUARD Insuran_ce l.._ Companies FAX 570-823-2059 570-825-9900 (Toll-Free 800-673-2465) P.O. Box AH l 39 Public Square Wilkes-Barre, PA 18703-0020 Berkshire Hathaway GUARD www.guard.com Important Alert for Policy #GOWC347995 Please read this important advance notice which outlines our policy for handling Workers' Compensation premium for subcontractors*. If you have any questions or do not understand any portion of the explanation, we suggest you contact your agent immediately because the cost of your coverage may be affected at final audit time. Premium Charge for Subcontractors If you hire subcontractors who do not have their own Workers' Compensation insurance, your premium calculation will be modified to include any amounts paid for their labor. This additional premium is addressed in Part Five C 2 of your policy and compensates us for the risk that one or more of these subcontractors (or one of the subcontractor's employees) will file a claim for benefits under your coverage. Although subcontractors may appear to be independent businesses, claims filed by them (or their employees) are common after an injury. Under Workers' Compensation law, the legal definition of "employee" is much broader than the common understanding of that term. In addition, many states make you – as the contractor – automatically responsible for certain expenses due to work-related injuries to your independent subcontractors or their employees. Regardless of the state law, Berkshire Hathaway GUARD Insurance Companies must pay legal fees under Part One of your policy to defend these claims and must also pay Workers' Compensation benefits in many cases. For these reasons and in accordance with Part Five C 2 of your policy, we will charge appropriate additional premium unless the subcontractors have their own in-force Workers' Compensation coverage during your entire policy period, and you are able to provide acceptable proof of this coverage to us prior to completion of your final audit. Evidence of general liability insurance, pre-determinations or statements of independent contractor status, hold harmless agreements, etc. are not acceptable substitutes, and no exceptions will be made for sole proprietors or others on the grounds that such parties are not required to purchase (or cannot purchase) Workers' Compensation insurance. The risk of a claim against your policy from an uninsured subcontractor is the same, regardless of his or her reason for having no coverage. Furthermore, these additional charges will be imposed when applicable, even if exceptions have been granted to you by us or by another carrier in the past. Please realize that premium may be charged for subcontractors hired by uninsured entities owned or controlled by you. Premium will be charged if the Rating Bureau rules in your state require the related entity to be combined in a single policy with the company we are insuring. Ultimately, we believe this policy is in the best interests of all parties, and we hope that this advance notification will prevent any misunderstandings at a later date. As always, we thank you for selecting Berkshire Hathaway GUARD Insurance Companies, and we look forward to serving you during the upcoming policy year. *Note: A "subcontractor" is a person or organization paid to assist you in providing a product or service to your customer or client (and not just to you). Workers' Compensation laws in most states presume that such vendors are "employees" who, therefore, often file claims seeking benefits. PolAlert Ed. 3 2/12 DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B .I/Berkshire Hathaway '-~'GUARD Insuran_ce l.. Companies FAX 570-823-2059 570-825-9900 (Toll-Free 800-673-2465) P.O. Box A-H Wilkes-Barre, PA 18703-0020 Berkshire Hathaway GUARD www.guard.com IMPORTANT NOTICE About Exclusion from Workers’ Compensation Coverage In 2017, changes in regulation prompted us to get new “Waiver of Workers’ Compensation Coverage” exclusion forms from our California policyholders who had previously elected this option. The information you provided to us at that time remains valid and in place until you decide (or need) to initiate a change in your status. Since that circumstance can occur for a variety of reasons, we wanted you to be aware that new versions of the Waiver have been put into place effective July 1st, 2018 so we would remain in compliance with the latest regulations from the state. While we fully expect that the vast majority of you will not need these forms at this time because no action is required, we wanted to let you know that the new documents are available in several different ways. If you need to initiate a change in status, you can get the new Waiver by: Going to our Policyholder Service Center at https://policyholder.guard.com and downloading the required version. (Look for the “Message to CA Policyholders” in the center of the page upon logging in.) Asking your agent to provide a copy. (We have given all of our agents access to our new forms.) Contacting our Customer Service Representatives, who can be reached by phone at 570-825-9900 or by e-mail at csr@guard.com. • • • Please note that five different versions of the form replace the earlier three, and you should be careful to submit the appropriate one for your circumstances. If you are unsure about the process or about the need to submit a new form, we suggest you speak with your agent. As always, we appreciate that you selected us as your insurer and look forward to serving you throughout the upcoming year. DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B .l/Berkshire Hathaway '-~~\GUARD Insuran_ce l.._ Companies Includes Copyrighted Material of the National Association of Insurance Commissioners BHGIC-672-08-19 P.O. Box A-H Wilkes-Barre, PA 18703-0020 570-825-9900 800-673-2465 www.guard.com PRIVACY POLICY Rev. August, 2019 WHAT DO BERKSHIRE HATHAWAY GUARD INSURANCE COMPANIES DO WITH YOUR PERSONAL INFORMATION? FACTS Berkshire Hathaway GUARD Insurance Companies include: AmGUARD Insurance Company, AZGUARD Insurance Company, EastGUARD Insurance Company, NorGUARD Insurance Company, WestGUARD Insurance Company, GUARDCo, Inc., (a medical management affiliate). Why? Financial Companies choose how they share your personal information. Federal and State law gives consumers the right to limit some, but not all, sharing. Federal law also requires us to tell you how we collect, share, and protect your personal information. Please read this notice carefully to understand what we do. What? The types of personal information we collect and share depend upon the product or service you have with us. This information can include: Social Security Number, date of birth, driving record, income Credit history, credit-based insurance scores, insurance claim history, payment history When you are no longer our customer, we continue to share your information as described in this notice. How? All financial companies may need to share customers’ personal information to run their everyday business. In the section below, we list the reasons insurance companies share their customers’ personal information; the reasons we choose to share; and whether you can limit this sharing. REASONS WE CAN SHARE YOUR PERSONAL INFORMATION Does Berkshire Hathaway GUARD share? Can you limit this sharing? For our everyday business purposes– such as to process your transactions, maintain your account(s), respond to court orders and legal investigations, comply with government agency examinations/procedures, or report your creditworthiness. Yes No For our marketing/processing purposes– to offer our products and services to you. (We may also disclose information received from you with companies that perform services for us.) Yes No For our affiliates’ everyday business purposes– information about your transactions and experiences. Yes No For our affiliates’ everyday business purposes– information about your creditworthiness. Yes Yes For our affiliates to market to you Yes Yes For non-affiliates to market to you Yes Yes To limit our sharing Call Customer Service at 1-800-673-2465 or visit us online at www.guard.com/privacy. Please note: If you are a new customer, we can begin sharing your information 30 days from the date we provided this notice. When you are no longer our customer, we continue to share your information as described in this notice in accordance with applicable law. However, you can contact us at any time to limit our sharing in accordance with the table above. Questions? Call Customer Service at 1-800-673-2465. DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B I./ •i.{Berkshire Hathaway l~'GUARD Insuran_ce ,... Companies Includes Copyrighted Material of the National Association of Insurance Commissioners BHGIC-672-08-19 PAGE 2 What we do How do we protect your personal information? To protect your personal information from unauthorized access and use, we implement security measures that comply with applicable law. These measures include computer safeguards and secured files and buildings. How do we collect your personal information? We collect your personal information, for example, when you: apply for insurance pay insurance premiums file an insurance claim give us your income information give us your contact information. We also collect your personal information from others (such as credit bureaus, affiliates, or other companies) including, for example, from: your insurance agent or producer your transactions with our affiliates listed below or other consumer reporting agencies. Why can’t I limit all sharing? Applicable law gives you the right to limit only: sharing for affiliates everyday business purposes – information about your creditworthiness and insurability affiliates from using your information to market to you sharing for non-affiliates to market to you. What happens when I limit sharing for a policy I hold jointly with someone else? Your choices will apply to everyone on your policy. Definitions Affiliates Companies (other than the companies identified in “Facts” above) that are related to us by common ownership or control of Berkshire Hathaway Inc. Affiliates can be financial and nonfinancial companies. Non-affiliates Companies not related to us by common ownership or control, which can be financial and nonfinancial companies. Marketing The promotion or advertising of insurance products or services to you. Marketing partners may include, but are not limited to, insurance licensees such as insurance agents appointed by us or their affiliates. Other Important Information Important Information about Credit Reporting: We may report information about your account to credit bureaus. Late payments, missed payments or other defaults on your account may be reflected in your credit report. For California Residents: If you opt out, we will not share information we collect about you with nonaffiliated third parties, except as permitted by California law, such as to process your transactions or to maintain your account. For Vermont Residents: We will not disclose information about your creditworthiness to our affiliates and will not disclose your personal information, financial information, credit report, or health information to nonaffiliated third parties to market to you, other than as permitted by Vermont law, unless you authorize us to make those disclosures. Who we are Who is providing this notice? Berkshire Hathaway GUARD Insurance Companies (including property and casualty licensees AmGUARD Insurance Company, AZGUARD Insurance Company, NorGUARD Insurance Company, EastGUARD Insurance Company, and/or WestGUARD Insurance Company as well as GUARDCo, Inc.) is providing this notice. References in this form to “us”, “we” or “our” refers to these companies. DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B SEPARATOR PAGE PN049901I WC000000C WC000001A DocuSign Envelope ID: 42298B7F-D063-4E19-B65C-70F17FF0BA0B City Attorney Approved Version 6/12/18 1 AGREEMENT FOR VIDEO PRODUCTION SERVICES RYAN VIDEO PRODUCTIONS LLC THIS AGREEMENT is made and entered into as of the ______________ day of _________________________, 2021, by and between the CITY OF CARLSBAD, a municipal corporation, ("City"), and Ryan Video Productions LLC, a limited liability company (“Contractor”). RECITALS A. City requires the professional services of a video production professional that is experienced in videography, editing, lighting, graphic design, audio, writing and technical and pre-production support related to city video productions, the city government channel and website. B. Contractor has the necessary experience in providing professional services and advice related to video production services. C. Contractor has submitted a proposal to City and has affirmed its willingness and ability to perform such work. NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, City and Contractor agree as follows: 1. SCOPE OF WORK City retains Contractor to perform, and Contractor agrees to render, those services (the "Services") that are defined in attached Exhibit "A", Exhibit “B” and Exhibit “C” which are incorporated by this reference in accordance with this Agreement’s terms and conditions. 2. STANDARD OF PERFORMANCE While performing the Services, Contractor will exercise the reasonable professional care and skill customarily exercised by reputable members of Contractor's profession practicing in the Metropolitan Southern California Area, and will use reasonable diligence and best judgment while exercising its professional skill and expertise. 3. TERM The Agreement will be effective for a period of three (3) years from the date first above written. The City Manager may amend the Agreement to extend it for one (1) additional two (2) year period or parts thereof. Extensions will be based upon a satisfactory review of Contractor's performance, City needs, and appropriation of funds by the City Council. The parties will prepare a written amendment indicating the effective date and length of the extended Agreement. 4. TIME IS OF THE ESSENCE Time is of the essence for each and every provision of this Agreement. 5. COMPENSATION The total fee payable for the Services to be performed during the initial Agreement term will not exceed sixty thousand dollars ($60,000.00) per Agreement year and shall be billed at the following rates: • Shooting: Full day* (5 hours or more) $995 DocuSign Envelope ID: 9B3151C4-3379-42AA-A440-3484E3172CC0 16th June City Attorney Approved Version 6/12/18 2 • Shooting: Half day (up to 5 hours) $525 • Editing & Post Production $75 per hour • Green Screen, Keying and Masking edit $15 per hour • Voice Over (under 3 minutes) $75 • Voice Over (3-5 minutes) $125 • Discovery, Strategy, Script or Storyboard** $95 per hour • Travel time $25 per hour • Teleprompter (1/2 day operator) $500 • 2nd camera for alternative angles (Full day) $400 • 2nd camera (Half day) $250 • Drone video capture $450 (2 x 20 minute flights one location, FAA cert. pilot) No other compensation for the Services will be allowed except for items covered by subsequent amendments to this Agreement. If the City elects to extend the Agreement, the amount shall not exceed sixty thousand dollars ($60,000.00) per Agreement year. The City reserves the right to withhold a ten percent (10%) retention until City has accepted the work and/or Services specified in Exhibit "A". Incremental payments, if applicable, should be made as outlined in attached Exhibit "A". 6. STATUS OF CONTRACTOR Contractor will perform the Services in Contractor's own way as an independent contractor and in pursuit of Contractor's independent calling, and not as an employee of City. Contractor will be under control of City only as to the result to be accomplished, but will consult with City as necessary. The persons used by Contractor to provide services under this Agreement will not be considered employees of City for any purposes. The payment made to Contractor pursuant to the Agreement will be the full and complete compensation to which Contractor is entitled. City will not make any federal or state tax withholdings on behalf of Contractor or its agents, employees or subcontractors. City will not be required to pay any workers' compensation insurance or unemployment contributions on behalf of Contractor or its employees or subcontractors. Contractor agrees to indemnify City within thirty (30) days for any tax, retirement contribution, social security, overtime payment, unemployment payment or workers' compensation payment which City may be required to make on behalf of Contractor or any agent, employee, or subcontractor of Contractor for work done under this Agreement. At the City’s election, City may deduct the indemnification amount from any balance owing to Contractor. 7. SUBCONTRACTING Contractor will not subcontract any portion of the Services without prior written approval of City. If Contractor subcontracts any of the Services, Contractor will be fully responsible to City for the acts and omissions of Contractor's subcontractor and of the persons either directly or indirectly employed by the subcontractor, as Contractor is for the acts and omissions of persons directly employed by Contractor. Nothing contained in this Agreement will create any contractual relationship between any subcontractor of Contractor and City. Contractor will be responsible for payment of subcontractors. Contractor will bind every subcontractor and every subcontractor of a subcontractor by the terms of this Agreement applicable to Contractor's work unless specifically noted to the contrary in the subcontract and approved in writing by City. DocuSign Envelope ID: 9B3151C4-3379-42AA-A440-3484E3172CC0 City Attorney Approved Version 6/12/18 3 8. OTHER CONTRACTORS The City reserves the right to employ other Contractors in connection with the Services. 9. INDEMNIFICATION Contractor agrees to indemnify and hold harmless the City and its officers, officials, employees and volunteers from and against all claims, damages, losses and expenses including attorneys fees arising out of the performance of the work described herein caused by any negligence, recklessness, or willful misconduct of the Contractor, any subcontractor, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable. The parties expressly agree that any payment, attorney’s fee, costs or expense City incurs or makes to or on behalf of an injured employee under the City’s self-administered workers’ compensation is included as a loss, expense or cost for the purposes of this section, and that this section will survive the expiration or early termination of this Agreement. 10. INSURANCE Contractor will obtain and maintain for the duration of the Agreement and any and all amendments, insurance against claims for injuries to persons or damage to property which may arise out of or in connection with performance of the services by Contractor or Contractor’s agents, representatives, employees or subcontractors. The insurance will be obtained from an insurance carrier admitted and authorized to do business in the State of California. The insurance carrier is required to have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California’s List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best’s Key Rating Guide of at least “A:X”; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. 10.1 Coverage and Limits. Contractor will maintain the types of coverage and minimum limits indicated below, unless the Risk Manager or City Manager approves a lower amount. These minimum amounts of coverage will not constitute any limitations or cap on Contractor's indemnification obligations under this Agreement. City, its officers, agents and employees make no representation that the limits of the insurance specified to be carried by Contractor pursuant to this Agreement are adequate to protect Contractor. If Contractor believes that any required insurance coverage is inadequate, Contractor will obtain such additional insurance coverage, as Contractor deems adequate, at Contractor's sole expense. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. 10.1.1 Commercial General Liability (CGL) Insurance. Insurance written on an “occurrence” basis, including personal & advertising injury, with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. 10.1.2 Automobile Liability. (if the use of an automobile is involved for Contractor's work for City). $2,000,000 combined single-limit per accident for bodily injury and property damage. 10.1.3 Workers' Compensation and Employer's Liability. Workers' Compensation limits as required by the California Labor Code. Workers' Compensation will not be required if Contractor has no employees and provides, to City's satisfaction, a declaration stating this. DocuSign Envelope ID: 9B3151C4-3379-42AA-A440-3484E3172CC0 City Attorney Approved Version 6/12/18 4 10.1.4 Professional Liability. Errors and omissions liability appropriate to Contractor’s profession with limits of not less than $1,000,000 per claim. Coverage must be maintained for a period of five years following the date of completion of the work. 10.2 Additional Provisions. Contractor will ensure that the policies of insurance required under this Agreement contain, or are endorsed to contain, the following provisions: 10.2.1 The City will be named as an additional insured on Commercial General Liability which shall provide primary coverage to the City. 10.2.2 Contractor will obtain occurrence coverage, excluding Professional Liability, which will be written as claims-made coverage. 10.2.3 This insurance will be in force during the life of the Agreement and any extensions of it and will not be canceled without thirty (30) days prior written notice to City sent by certified mail pursuant to the Notice provisions of this Agreement. 10.3 Providing Certificates of Insurance and Endorsements. Prior to City's execution of this Agreement, Contractor will furnish certificates of insurance and endorsements to City. 10.4 Failure to Maintain Coverage. If Contractor fails to maintain any of these insurance coverages, then City will have the option to declare Contractor in breach, or may purchase replacement insurance or pay the premiums that are due on existing policies in order to maintain the required coverages. Contractor is responsible for any payments made by City to obtain or maintain insurance and City may collect these payments from Contractor or deduct the amount paid from any sums due Contractor under this Agreement. 10.5 Submission of Insurance Policies. City reserves the right to require, at any time, complete and certified copies of any or all required insurance policies and endorsements. 11. BUSINESS LICENSE Contractor will obtain and maintain a City of Carlsbad Business License for the term of the Agreement, as may be amended from time-to-time. 12. ACCOUNTING RECORDS Contractor will maintain complete and accurate records with respect to costs incurred under this Agreement. All records will be clearly identifiable. Contractor will allow a representative of City during normal business hours to examine, audit, and make transcripts or copies of records and any other documents created pursuant to this Agreement. Contractor will allow inspection of all work, data, documents, proceedings, and activities related to the Agreement for a period of three (3) years from the date of final payment under this Agreement. 13. OWNERSHIP OF DOCUMENTS All work product produced by Contractor or its agents, employees, and subcontractors pursuant to this Agreement is the property of City. In the event this Agreement is terminated, all work product produced by Contractor or its agents, employees and subcontractors pursuant to this Agreement will be delivered at once to City. Contractor will have the right to make one (1) copy of the work product for Contractor’s records. 14. COPYRIGHTS Contractor agrees that all copyrights that arise from the services will be vested in City and Contractor relinquishes all claims to the copyrights in favor of City. DocuSign Envelope ID: 9B3151C4-3379-42AA-A440-3484E3172CC0 City Attorney Approved Version 6/12/18 5 15. NOTICES The name of the persons who are authorized to give written notice or to receive written notice on behalf of City and on behalf of Contractor under this Agreement. For City For Contractor Name Kristina Ray Name Christopher L. Ryan Title Director Title President Department Communication & Engagement Address 368 Hidden Lake Lane City of Carlsbad Vista, CA 90284 Address 1200 Carlsbad Village Drive Phone No. 760-410-4443 Phone 760-434-2957 Email 4chrisryan@gmail.com Each party will notify the other immediately of any changes of address that would require any notice or delivery to be directed to another address. 16. CONFLICT OF INTEREST Contractor shall file a Conflict of Interest Statement with the City Clerk in accordance with the requirements of the City of Carlsbad Conflict of Interest Code. The Contractor shall report investments or interests in all categories. Yes No 17. GENERAL COMPLIANCE WITH LAWS Contractor will keep fully informed of federal, state and local laws and ordinances and regulations which in any manner affect those employed by Contractor, or in any way affect the performance of the Services by Contractor. Contractor will at all times observe and comply with these laws, ordinances, and regulations and will be responsible for the compliance of Contractor's services with all applicable laws, ordinances and regulations. Contractor will be aware of the requirements of the Immigration Reform and Control Act of 1986 and will comply with those requirements, including, but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants whose services are required by this Agreement. 18. DISCRIMINATION AND HARASSMENT PROHIBITED Contractor will comply with all applicable local, state and federal laws and regulations prohibiting discrimination and harassment. 19. DISPUTE RESOLUTION If a dispute should arise regarding the performance of the Services the following procedure will be used to resolve any questions of fact or interpretation not otherwise settled by agreement between the parties. Representatives of Contractor or City will reduce such questions, and their respective views, to writing. A copy of such documented dispute will be forwarded to both parties involved along with recommended methods of resolution, which would be of benefit to both parties. The representative receiving the letter will reply to the letter along with a recommended method of resolution within ten (10) business days. If the resolution thus obtained is unsatisfactory to the aggrieved party, a letter outlining the disputes will be forwarded to the City Manager. The X DocuSign Envelope ID: 9B3151C4-3379-42AA-A440-3484E3172CC0 □ □ City Attorney Approved Version 6/12/18 6 City Manager will consider the facts and solutions recommended by each party and may then opt to direct a solution to the problem. In such cases, the action of the City Manager will be binding upon the parties involved, although nothing in this procedure will prohibit the parties from seeking remedies available to them at law. 20. TERMINATION In the event of the Contractor's failure to prosecute, deliver, or perform the Services, City may terminate this Agreement for nonperformance by notifying Contractor by certified mail of the termination. If City decides to abandon or indefinitely postpone the work or services contemplated by this Agreement, City may terminate this Agreement upon written notice to Contractor. Upon notification of termination, Contractor has five (5) business days to deliver any documents owned by City and all work in progress to City address contained in this Agreement. City will make a determination of fact based upon the work product delivered to City and of the percentage of work that Contractor has performed which is usable and of worth to City in having the Agreement completed. Based upon that finding City will determine the final payment of the Agreement. Either party upon tendering thirty (30) days written notice to the other party may terminate this Agreement. In this event and upon request of City, Contractor will assemble the work product and put it in order for proper filing and closing and deliver it to City. Contractor will be paid for work performed to the termination date; however, the total will not exceed the lump sum fee payable under this Agreement. City will make the final determination as to the portions of tasks completed and the compensation to be made. 21. COVENANTS AGAINST CONTINGENT FEES Contractor warrants that Contractor has not employed or retained any company or person, other than a bona fide employee working for Contractor, to solicit or secure this Agreement, and that Contractor has not paid or agreed to pay any company or person, other than a bona fide employee, any fee, commission, percentage, brokerage fee, gift, or any other consideration contingent upon, or resulting from, the award or making of this Agreement. For breach or violation of this warranty, City will have the right to annul this Agreement without liability, or, in its discretion, to deduct from the Agreement price or consideration, or otherwise recover, the full amount of the fee, commission, percentage, brokerage fees, gift, or contingent fee. 22. CLAIMS AND LAWSUITS By signing this Agreement, Contractor agrees that any Agreement claim submitted to City must be asserted as part of the Agreement process as set forth in this Agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that if a false claim is submitted to City, it may be considered fraud and Contractor may be subject to criminal prosecution. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act applies to this Agreement and, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of information. If City seeks to recover penalties pursuant to the False Claims Act, it is entitled to recover its litigation costs, including attorney's fees. Contractor acknowledges that the filing of a false claim may subject Contractor to an administrative debarment proceeding as the result of which Contractor may be prevented to act as a Contractor on any public work or improvement for a period of up to five (5) years. Contractor acknowledges debarment by another jurisdiction is grounds for City to terminate this Agreement. 23. JURISDICTION AND VENUE Any action at law or in equity brought by either of the parties for the purpose of enforcing a right or rights provided for by this Agreement will be tried in a court of competent jurisdiction in the DocuSign Envelope ID: 9B3151C4-3379-42AA-A440-3484E3172CC0 City Attorney Approved Version 6/12/18 7 County of San Diego, State of California, and the parties waive all provisions of law providing for a change of venue in these proceedings to any other county. 24. SUCCESSORS AND ASSIGNS It is mutually understood and agreed that this Agreement will be binding upon City and Contractor and their respective successors. Neither this Agreement nor any part of it nor any monies due or to become due under it may be assigned by Contractor without the prior consent of City, which shall not be unreasonably withheld. 25. ENTIRE AGREEMENT This Agreement, together with any other written document referred to or contemplated by it, along with the purchase order for this Agreement and its provisions, embody the entire Agreement and understanding between the parties relating to the subject matter of it. In case of conflict, the terms of the Agreement supersede the purchase order. Neither this Agreement nor any of its provisions may be amended, modified, waived or discharged except in a writing signed by both parties. 26. AUTHORITY The individuals executing this Agreement 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 Agreement. CONTRACTOR: CITY OF CARLSBAD, a municipal corporation of the State of California By: By: Christopher L. Ryan GEOFF PATNOE President Assistant City Manager ATTEST: By: Christopher L. Ryan BARBARA ENGLESON Secretary 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 Group B Chairman, Secretary, President, or Assistant Secretary, Vice-President CFO or Assistant Treasurer DocuSign Envelope ID: 9B3151C4-3379-42AA-A440-3484E3172CC0 (,fu,i s ~OJA, City Attorney Approved Version 6/12/18 8 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 BY: _____________________________ Assistant City Attorney DocuSign Envelope ID: 9B3151C4-3379-42AA-A440-3484E3172CC0 City Attorney Approved Version 6/12/18 9 EXHIBIT “A” SCOPE OF SERVICES Contractor shall provide video production services to include videography, photography, editing, lighting, graphic design, audio, writing and pre-production support related to city video productions, the city government channel and website. Contractor shall also provide scheduling services for the city government channel and administrative support related to updating the city government channel. Communications Department will provide Contractor with detailed instructions to achieve end results to include direction on scheduling the channel, pre-production, writing, videography, directing, editing, lighting, audio recording, photography, and graphic design. Contractor will provide video archival support on an as needed basis. Contractor is responsible for providing all of its own editing and camera equipment as needed for the various assigned projects. Services under this contract are non-exclusive and if Contractor is unavailable for a given project; the city reserves the right to choose an alternate contractor to provide described service. Contractor shall bill hourly fees as set forth in this Agreement, Section 5, Compensation: • Shooting: Full day* (5 hours or more) $995 • Shooting: Half day (up to 5 hours) $525 • Editing & Post Production $75 per hour • Green Screen, Keying and Masking edit $15 per hour • Voice Over (under 3 minutes) $75 • Voice Over (3-5 minutes) $125 • Voice Over (long form narration) TBD • Discovery, Strategy, Script or Storyboard** $95 per hour • Travel time $25 per hour • Teleprompter (1/2 day operator) $500 • Rentals (Studio or equipment) TBD • 2nd camera for alternative angles (Full day) $400 • 2nd camera (Half day) $250 • Drone video capture $450 (2 x 20 minute flights one location, FAA cert. pilot) ________________________________________ Not to exceed $60,000 per agreement year. Other considerations: • All works submitted to and accepted by the city must be original material created by the Contractor. • All works submitted by the Contractor must be in standard U.S. English and adhere to the City of Carlsbad Writing Style Guide. A copy of this guide will be provided. • All written works must be submitted in Microsoft Word format. The work should appear in a non-bolded Calibri, 12 point font. Please see below for Exhibit B for Video Format Acquisition Specifications and Exhibit C File Naming Conventions. The city reserves the right to use all submitted works in perpetuity and in all current and/or future forms of current media and/or media to be developed. DocuSign Envelope ID: 9B3151C4-3379-42AA-A440-3484E3172CC0 City Attorney Approved Version 6/12/18 10 Exhibit B – Video Format Specifications Final Output for Distribution City Television Channel Master Format MPEG-2 - .mpg, .mpeg QuickTime - .mov Fps 29.97 29.97 Video Frame Size 720x480 1080p29.97 Aspect Ratio 4:3, .9 pixel aspect ratio 16:9 square pixels Codec MPEG-2 H.264 Bitrate 4-15 Mbps 8 Mbps Field Order Lower Progressive Notes Letterbox or center-cut widescreen PGMs. Do NOT deliver anamorphic. Observe safe title areas & broadcast safe levels. Audio Codec MPEG-1 (layer I,II, or III) or MPEG-2 AAC Bitrate 192 kbps or better 192 kbps or better Sample Rate 48 kHz, 16-bit stereo 48 kHz, 16-bit stereo DocuSign Envelope ID: 9B3151C4-3379-42AA-A440-3484E3172CC0 City Attorney Approved Version 6/12/18 11 Video Acquisition and Shooting Style Please use the following City of Carlsbad established guidelines for acquiring all video. • Acquire all video using best practices • Use a tripod for interviews and b-roll as conditions permit or as script requires • All b-roll should have audio (natural sound) • Shots should have sufficient pad at the beginning and end for editing and archiving purposes (minimum 30 frames) • Pans, tilts or zooms should be no longer than five to seven seconds • Use sufficient light, white balance and be sure the subject is properly exposed • When choosing between subject and background, expose for the subject • Shots should be well-composed, natural, depicting lifestyle with a focus on people • Subjects should look professional and interesting • Camera movements should be smooth, steady, dynamic, flowing and intentional • Provide proper headroom and look space for interviews (i.e. screen right/screen left) • Do not place interview subjects in the center of the screen. There should be enough room during a close-up to allow space for a lower third • Gather establishing shots and ample cutaways to support interviews and narration • Framing should vary between MS and CU during interviews to allow for cutting between answers • When acquiring video footage please shoot in 1080p29.97 or 720p59.94 Audio • Use proper microphones when interviewing talent (i.e. lavaliere with windscreen properly placed) • no cables visible (handheld or shotgun microphone should be out of frame, lavaliere microphone and cable should not be visible) Editing • Please edit at 1080p29.97 • Project and file names need to match ( i.e. Grilling Safety/Grilling Safety) • Fonts Utopia (serif) Myriad Pro (sans serif) please do not used condensed or bold • Lower thirds are available via download – please request the link at the beginning of the project. DocuSign Envelope ID: 9B3151C4-3379-42AA-A440-3484E3172CC0 City Attorney Approved Version 6/12/18 12 Deliverables Finished programs are to be delivered in the following formats. High definition digital video files with 30 frames of black at the head and 40 frames at the tail: 1. QuickTime Master (H.264) 2. Channel files: (MPEG-2) Producer will deliver the following for each program according to established specifications: 1. All consolidated project files e.g. Final Cut/Avid/Premiere, Illustrator, Photoshop, After Effects, etc. and a digital version (Word file) of script reconciled to the final program. 2. All physical and digital media source files (Camera Master Volume, ingested video media, narration, graphics, music, animations and any other elements created for the project). Please transcode all raw files delivered to 1920x1080 ProRes422LT. 3. Digital media source files are to be delivered at the completion of the program via hard drive, DVD (data discs) or hard drive within two weeks of completion of the project. All video files must be named according to project, shot description and type of shot (i.e. Crosswalk Safety – guard crosses with child – MS). Only deliver files that are useable. Multiple clips of the same action should be significantly different in their content to warrant being included. The project will not be considered complete for final invoicing until files are delivered properly named. Please Exhibit C for more details on file naming. DocuSign Envelope ID: 9B3151C4-3379-42AA-A440-3484E3172CC0 City Attorney Approved Version 6/12/18 13 Exhibit C – File Naming Conventions Starting a Project Please use the following file structure for all programs to ensure the project will be ready for archiving. When the video is complete, it will be delivered to the city on a hard drive to be transferred a central storage system. AUDIO – Imported VO files, recordings, sound effects. DOCs – Scripts, transcripts, instructions, information. GFX Prepped – Images modified for video, i.e. editable Photoshop MASTERs, PNG outputs used in programs, resized photos, logos, lower thirds. GFX Source– Native source files: EPS, Photo JPEGs, PowerPoint. MOV – Supplied video files not from tape, i.e. DVD rips, animations. RENDERS – Animations created out of After Effects or Motion for this project. WORK – Project files for content created for this project. Create folders for LiveType, Maya, etc. AE – After Effects project files MOTN – Motion project files EXPORTS - QT ref, Audio, full res QTs for Compressor use The project will not be considered complete until delivered in this format. File Naming The City of Carlsbad video footage library contains thousands of clips that are searchable by data. To make it easy to find a particular clip it is important that they are named consistently and efficiently. Please follow the instructions below when naming clips for the file footage library. Please transcode all raw files to 1920x1080 ProRes422LT for editing and archiving. Naming Tape/Cards All tapes and cards are entered into a cataloging system. Please make sure the tape or card number (x of x) is listed in notes. The following information is listed on all media. Naming clips Every shoot has a name that closely conforms to the project name. Examples have been provided below to show the relationship between the project name, location and how files are named. Keep the name as brief as possible to make it easier to identify clips in editing. Projects will not be considered complete until clips are labeled using these file naming conventions. Name of shoot Name of the project: Crosswalk Safety Event Subject of the shoot: School crossing guard interview and b-roll DocuSign Envelope ID: 9B3151C4-3379-42AA-A440-3484E3172CC0 Name ... AllDIO ... ... ► ► C X Sou uoe ... MDV ... RE [) IRS ... WORK ► AIE ► Ol"N ... XPOIR s City Attorney Approved Version 6/12/18 14 Location Calavera Elementary School Date Date/dates of shoots in notes Description of video in time code order Examples: 01:01:15 - Kids cross street, car speeds through light 01:01:30 - Crossing Guard interview – describe question (i.e. John Smith – crossing guard responsibilities) Videographer Who shot the footage – last name and first initial please (in notes) and if possible in the camera metadata i.e. SmithW_09_03_14 Additional Notes: Please note any additional shots that do not pertain to the project, but were acquired while on the shoot. For example, trail with flowers in bloom Please keep the names of clips as short and detailed as possible in this order. Naming Order: Project Prefix – Description of Action, ANGLE Example: Crosswalk Safety – guard crosses with kids MS The project prefix can also be the location of the shoot. For example, if you’re recording B-Roll of airplanes at the airport, Airport – jet takes off MS would be the file name. Example: If the project name is “Crosswalk Safety” there is no need to include crosswalks in the clip description as it is already listed. Crossing guard would be “guard” because it’s included in the project prefix. This will help to keep clip names shorter. When there are multiple takes of the same action, add a number to differentiate. Only clip out the best useable footage for delivery and provide the best two takes of the action. When naming clips use WS = wide shot, MS = medium shot and CU = close up. Please use the descriptors below - do not use symbols i.e. (/<>\) as they do not read in searches and can result in corrupt clips. Rack Focus = RF Over the Shoulder = OTS Pan Right = PR Pan Left = PL Tilt UP = TU Tilt Down = TD Push/Zoom in = ZI Push/Zoom out = ZO Interview = INTVW People = ppl Camera = cam With = w Interior = INT Exterior = EXT Foreground = FG Background = BG DocuSign Envelope ID: 9B3151C4-3379-42AA-A440-3484E3172CC0 INSR ADDLSUBRLTRINSR WVD DATE (MM/DD/YYYY) PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE INSURER(S) AFFORDING COVERAGE NAIC # Y / N N / A (Mandatory in NH) ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? EACH OCCURRENCE $ DAMAGE TO RENTED $PREMISES (Ea occurrence)CLAIMS-MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ $ PRO- OTHER: LOCJECT COMBINED SINGLE LIMIT $(Ea accident) BODILY INJURY (Per person) $ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS AUTOS ONLYHIRED PROPERTY DAMAGE $AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below POLICY NON-OWNED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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 any rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) ACORDTM CERTIFICATE OF LIABILITY INSURANCE Sentinel Insurance Company (Hartford) 02/24/2021 Couch Braunsdorf Insurance Grp PO BOX 888 701 Martinsville Rd. Liberty Corner, NJ 07938-0888 800 223-5433 908-580-1274 Ryan Video Productions LLC 368 Hidden Lake Lane Vista, CA 92084 11000 A X X X X 13SBAAA6947 05/03/2020 05/03/2021 2,000,000 1,000,000 10,000 2,000,000 4,000,000 4,000,000 City of Carlsbad, it's officials, employees and volunteers is included as an Additional Insured in accordance with the terms, conditions and exclusions of the policy. City of Carlsbad, it's officials, employees and volunteers 1200 Carlsbad Village Drive Carlsbad, CA 92008 1 of 1 #S277271/M277269 RYANVClient#: 205653 LRICH 1 of 1 #S277271/M277269 I I f--D □ f-- f-- f-- Fl n n f-- f--- f--- f--- f--H I I I I I □ J 5: .A I . ' - ACORD11; CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIYYYY) ~ 03/11/2021 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 Marilyn Furbush NAME: Marilyn Furbush Insurance Agency fa~~N,rn .,.,1• 760-597-9800 I rt~ Nol: 818-686-5110 1920 Shadowridge Drive Ste 109 ~ilJ~cc. mfurbush@farmersagent.com Vista CA 92081 INSURER(SI AFFORDING COVERAGE NAIC# License# OC89761 INSURER A: Sentinel Insurance Company (Hartford) 11000 INSURED INSURER B : Ryan Video Productions LLC INSURER C: 368 Hidden Lake Lane INSURER D: -Vista, CA 92084 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER· REVISION NUMBER· THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR 1 POLICY EFF POLICY EXP LTR ,.,._ l ~n,n POLICY NUMBER MM/DD/YYYYI IMM/DDIYYYYI LIMITS lX COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 D CLAIMS-MADE [Z] OCCUR DAMAGE TO·RENTED $ 1,000,000 >--PREMISES (Ea occurrence\ -MED EXP (Anv one person) $ 10,000 A 13SBAAA694 7 05/03/2020 05/03/2021 PERSONAL & ADV INJURY $ 2,000,000 -GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 fZl □PRO-□ 4,000,000 POLICY JECT LOC PRODUCTS -COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY fE~~~~~~l1NGLE LIMIT $ -ANY AUTO BODILY INJURY (Per person) $ >---SCHEDULED OWNED BODILY INJURY (Per accident) $ >--AUTOS ONLY >--AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY 1<>~, accident\ --$ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ -EXCESS LIAB CLAIMS-MADE AGGREGATE s OED I I RETENTION s s WORKERS COMPENSATION I ~~fTuTE I I OTH-AND EMPLOYERS" LIABILITY ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE □ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N /A (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE $ ~li~~~t-IT~ ~n;PERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Carlsbad, it's officials, employees and volunteers is included as an Additional Insured with respect to the liability arising out of the activities performed by or on behalf of Ryan Video Productions LLC in accordance with the terms, conditions and exclusions of the policy. CERTIFICATE HOLDER City of Carlsbad, it's officials, employees and volunteers 1200 Carlsbad Village Drive Carlsbad, CA 92008 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ORD 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 Chris Ryan Owner and President I,--------------~' am the ______________ _ [ title l [insert name] Ryan Video Productions of ______________ _ Ryan Video Productions I hereby certify that __________ _ [ name of company) [ name of company] has no employees and is not required by law to maintain workers' compensation or employers' liability insurance. Ryan Video Productions Should ________________ employ any person [name of company] any video project during the term of the Agreement with the City of Carlsbad for ___________ _ [description of project or work that is being contracted] then workers' compensation and employers' liability insurance will be obtained. [Name] Owner and President, Ryan Video Productions [Title and name of company or corporation]