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Whitley, Peter & Kenney, Nora; 2023-08-14;
CITY OF CARLSBAD LEO CARRILLO RANCH HISTORIC PARK VOLUNTEER CARETAKER AGREEMENT WITH PETER WHITLEY AND NORA KENNEY-WHITLEY This Agreement for Volunteer Caretaker Services (Agreement) is entered into on _________________, 2023 (Effective Date) between the City of Carlsbad (City) and Peter Whitley and Nora Kenney, for the volunteer positions of Volunteer Caretaker(s) at the Leo Carrillo Ranch Historic Park. WHEREAS, the City owns and operates parks throughout the City of Carlsbad, including Leo Carrillo Ranch Historic Park; and WHEREAS, the City has a Volunteer On-site Caretaker program that is administered by the Parks & Recreation Department (Department), which selects volunteers to provide up to 20 hours per week, per volunteer, of service at Leo Carrillo Ranch Historic Park, 6200 Flying LC Lane, Carlsbad, CA 92009 (Property), including overnight “eyes and ears” security and non- confrontational patrol; and WHEREAS, the Property includes an unfurnished two bedroom/two bathroom manufactured home located on the Property (Residence) where volunteers must reside in order to provide overnight monitoring of the Property; and WHEREAS, the propose of this Agreement is to set forth the terms and conditions that will govern the relationship of the parties and the work to be performed by the volunteers while occupying the City-owned residence. NOW, THEREFORE, the parties agree as follows: 1. The Volunteer Caretakers are not City employees and this Agreement shall not be construed to create an employer-employee relationship. The parties acknowledge and agree that the Volunteer Caretakers are city volunteers retained to perform the services at the Property as described herein and without promise, expectation or receipt of compensation for services rendered. DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 August 14 2. The Volunteer Caretakers shall provide the services detailed below. It is estimated that each Volunteer Caretaker will spend approximately 15-20 hours of service per week at the Property. It is understood that Volunteer Caretakers shall be responsible for the end results; and that it is conceivable that depending on the Volunteer Caretakers efforts, it may take more or less than the estimated number of hours per week to perform the volunteer services under this Agreement. The Volunteer Caretakers’ scope of duties shall include: a. Grounds Maintenance: Raking, sweeping, and trash collection associated with pre- and post-special event and facility rentals at the Property; and, b. Building and Facility Maintenance: Restroom cleaning, reflecting pool cleaning and maintenance; maintain Residence, and surrounding grounds in good condition; and, c. “Eyes and Ears” Security and Non-confrontational Patrol: Patrol, surveillance, and condition report of the Property and structures within the designated park boundaries, and respond to building alarms unless personal safety is at risk; and, d. The Volunteer Caretakers shall meet with the department’s senior program manager, at least once per month, to discuss any specific issues or tasks that the senior program manager needs addressed and completed by the Volunteer Caretakers. i. Volunteer supervisor: Senior Program Manager: 442-339-2855 majka.penner@carlsbadca.gov 3. The City may provide tools and equipment to the Volunteer Caretakers to assist the Volunteer Caretakers in the performance of their duties. The parties agree that should the City provide any tools and equipment to the Volunteer Caretakers for use in performing the Volunteer Caretakers’ services, the City’s providing of tools and equipment shall not create an employee-employer relationship. 4. Residence. Volunteer Caretakers shall reside in an unfurnished two bedroom/two bathroom (1,752 square foot) manufactured Residence located on the Property. Utilities will be provided (water, sewer, trash and electricity) at no cost to the Volunteer Caretakers. a. It is essential that the Volunteer Caretakers reside at the Property to provide “Eyes and Ears” Security and Non-confrontational Patrol, particularly overnight and when the Property is otherwise closed to the public. b. Volunteer Caretakers shall not make any improvements or other modifications to the Residence or to the Property without the express written consent of the City. Violation of this section shall be grounds for immediate termination of this Agreement. DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 c. The appraised value of lodging ($26,000) will be reported annually to the Internal Revenue Service (IRS) on form 1099-MISC and state Franchise Tax Board. Volunteer Caretakers are solely responsible for determining the tax treatment for city provided housing and for associated tax obligations, if applicable. 5. Security Deposit. The Volunteer Caretakers shall post to the City, prior to occupancy of the Residence, a security deposit in the sum of one thousand ($1,000.00) dollars, the receipt of which is hereby acknowledged as having been heretofore deposited with the City in conjunction with the prior agreement dated May 3, 2017 to be held as security for any damages to the Residence, or as payment, in whole or in part, for any costs or expenses incurred by the City resulting from the failure of the Volunteer Caretakers to surrender the Residence and surrounding premises in the condition described in Paragraphs 17 - 19 herein. Unless withheld by the City, in whole or in part, be reason of any damage to the Residence, the security deposit shall be returned to the Volunteer Caretakers within thirty calendar days after the termination of this Agreement, provided that the Volunteer Caretakers have delivered to the City a forwarding address, in writing, at or prior to the date the Volunteer Caretakers surrendered the Residence to the City. 6. Stipend. City shall provide Volunteer Caretakers with an annual stipend in the total amount of $5,000 ($2,500 per volunteer), which represents the approximate out-of- pocket expenses the Volunteer Caretakers will incur incidental to the provision of volunteer services under this Agreement. 7. Liability Insurance. Volunteer Caretakers shall have personal liability insurance to cover the use and occupancy of the Residence on the Property, in an amount of not less than $500,000. The City of Carlsbad shall be added as an Additional Insured by separate endorsement. All Risk Insurance. A standard fire policy including all risk or special form perils, providing Replacement Cost Coverage, without deduction for depreciation for (i) Volunteer Caretaker’s personal property, (ii) fixtures owned by Volunteer Caretaker, and (iii) any items identified in this Agreement as improvements to the Residence constructed and owned by Volunteer Caretaker(s). The deductible for the required fire insurance policy shall not exceed $1,000 per occurrence and shall be borne by the Volunteer Caretaker(s). Evidence of Insurance. No later than the effective date of the Agreement, Volunteer Caretakers shall provide to the City a certificate of insurance and copy of the General Liability Additional Insured endorsement. Thereafter, certificates and separate Additional Insured endorsement shall be provided to the City within 30 calendar days of expiration of the required policy. Policy Provisions. Volunteer Caretakers shall provide the City with at least 30 calendar days written notice before any cancellation, lapse, reduction or other adverse change in the insurance policies specified above is effective. Ten-day notice of cancellation for non-payment of premium is acceptable. DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 8. Right to Review. The City retains the right to review the coverage, form and amount of insurance required and may require Volunteer Caretakers to obtain insurance reasonably sufficient in coverage, form and amount to provide adequate protection against the kind and extent of risk which exists at the time a change in insurance is required. City requirements shall be reasonable. City retains the right to receive a certified copy of any required insurance policy after 15 calendar days’ notice to Volunteer Caretakers. Volunteer Caretakers must be well groomed with high standard of attire that is clean, neat and professional in appearance at all times. Volunteer Caretakers must wear name tags provided by the City while performing duties at the Property. 9. The Volunteer Caretakers will comply with all state, federal and local laws and policies regarding appropriate behavior while working as a Volunteer Caretaker for the City. This includes all applicable provisions of the City of Carlsbad Volunteer Handbook, Council Policy No. 69 (Volunteer Use Policy) and Administrative Order No. 45 (Respectful Workplace and Non-Discrimination Policy). The Volunteer Caretakers acknowledge they have received a copy of these documents. 10. The Volunteer Caretakers will conduct themselves with the highest standards of processional and ethical conduct. Volunteer Caretakers shall not, for personal benefit, use the name, emblem, endorsement, services or property of the City, nor seek any financial advantage or gain as the result of City affiliation. Volunteer Caretakers may not utilize any City affiliation in connection with the promotion of partisan policies, religious matters or positions on any issue not in conformity with the position of the City. Disclosure of confidential City information that is available solely as a result of your Volunteer Caretaker efforts is prohibited. 11. Volunteer Caretakers are responsible for monitoring their own work per week and keeping accurate records. If a dispute arises over the performance of this Agreement, the City reserves the right, but not the obligation, to audit the Volunteer Caretakers’ hours. Misrepresentation of the hours worked or services performed shall be grounds for immediate termination of this Agreement. 12. It is the policy of the City to promote a safe work environment for all. In support of this policy, the City takes the position that a threat of violence or any violent act at Leo Carrillo Ranch Historic Park is in no way permitted. All threats or acts of violence will be taken seriously and acted upon. Personal safety is of paramount importance. The City never wants to put the Volunteer Caretakers in harms’ way. If you believe the situation is unsafe in any way, remove yourself from the location. This includes the “eyes and ears” responsibility under this Agreement. The senior program manager is expected to educate and enforce the safety rules for all persons, including the Volunteer Caretakers at Leo Carrillo Ranch Historic Park. If you are unfamiliar with any City equipment or observe a safety hazard, contact the senior program manager, at the contact information provided in Paragraph 2.d of this Agreement. Safety is everyone’s responsibility. DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 13. The City will evaluate the Volunteer Caretakers’ duties pursuant to this Agreement to determine whether disclosure under the Political Reform Act and City’s Conflict of Interest Code is required of the Volunteer Caretakers. Should it be determined that disclosure is required, Volunteer Caretakers will complete and file with the City Clerk those schedules specified by City and contained in the Statement of Economic Interests Form 700. Volunteer Caretakers warrant that by execution of this Agreement, that they have no financial interest, present or contemplated, in the projects affected by this Agreement. Volunteer Caretakers further warrant that the Volunteer Caretakers do not have any ancillary real property, business interests or income that will be affected by this Agreement, or alternatively, that Volunteer Caretakers will file with the City an affidavit disclosing this interest. 14. Volunteer Caretakers warrant that they possess sufficient strength and stamina to lift, carry and manipulate objects weighing up to 25 pounds and to perform sustained physical labor. Further that they are willing to perform volunteer work outdoors in all weather conditions and be exposed to potentially hazardous conditions. 15. If at any time after the effective date of this Agreement, any Volunteer Caretakers who develop a condition or circumstance that might adversely impact the performance of their duties shall notify the senior program manager immediately. 16. Volunteer Caretakers are responsible for all taxes that may be incurred as a result of this Agreement. For purposes of federal and state income tax, the City will report to the federal and state taxing authorities the fair market value of the Volunteer Caretakers residence, utilities and annual stipend as the total amount received by the Volunteer Caretakers under this Agreement. 17. Termination. Either party may terminate the Volunteer Caretaker’s status as a volunteer at any time. Upon termination of this status, the Volunteer Caretaker’s right to occupy the City owned Residence is automatically and simultaneously surrendered without further notice or grounds. Upon termination by either party of the Volunteer Caretaker’s status as a volunteer, the Volunteer Caretaker shall vacate the Residence IMMEDIATELY WITHOUT FURTHER NOTICE or by the date specified by the senior program manager. To vacate the Residence, the Volunteer Caretakers shall remove all their personal property and move any personal vehicles out of the park. All personal property not removed by the Volunteer Caretakers after termination may be disposed of by the City pursuant to law. 18. The Volunteer Caretakers acknowledge that: (i) they are not a tenant of the City; (ii) this Agreement does not convey an estate or other possessory interest in real property or the Residence; DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 (iii) their occupancy of the City owned Residence on the Property is incidental to their Volunteer Caretaker Status; (iv) upon or at termination of the Agreement or the Volunteer Caretaker’s status as a volunteer, the Volunteer Caretakers’ right to occupy the Residence on the Property is automatically terminated and simultaneously surrendered without further notice or grounds; and. (v) Volunteer Caretakers are not entitled to any relocation benefits upon or at the termination of Agreement. 19. The Volunteer Caretakers shall keep the Residence and the surrounding grounds adjacent to the Residence clean and orderly at all times. This shall include, but not be limited to the following: • A neat, clutter-free interior and exterior, with Fire Code approved accessibility and storage of household hazardous materials; • Sanitary conditions within the interior and exterior, compliant with all applicable Health Code provisions; • Interior window coverings that do not permanently block natural light or ventilation to the residence; • A litter-free and debris-free exterior porch/patio, with proper maintenance of all wood surfacing; • A dirt and dust rinsed exterior, which will include all siding, doors, and windows; • A healthy, watered, fertilized, and neatly maintained exterior landscape, and; • The lack of storage of abandoned/inoperable vehicles, trailers, equipment, or large tools on site. 20. The Volunteer Caretakers shall not keep any pets or other animals at the Residence or on the Property. Dogs are prohibited on park property (CMC § 11.32.030(23)). 21. The Volunteer Caretakers shall not park or store a non-operable vehicle of any kind at the Residence or on the Property. 22. The Volunteer Caretakers shall not have anyone living with them at the Residence or on the Property. 23. All overnight guests visiting the site must be registered in advance with the senior program manager. Overnight guests are limited to a cumulative maximum of 14 days, per calendar year. 24. The Park’s Conditional Use Permit (CUP) requires that designated quiet hours must be observed. Quiet hours are 8 p.m. to 7:30 a.m. Sunday through Thursday, and 10 p.m. to 7:30 a.m. on Friday and Saturday. DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 25. Volunteer Caretakers shall be required to remain on the Property 50 weeks per year. Volunteer Caretaker(s) will provide a minimum of two weeks written notice to the senior program manager as to the dates that the Volunteer Caretakers will be off the Property. Volunteer Caretakers shall remain on the property for all city observed holidays. 26. The senior program manager is responsible for conducting a review of the Volunteer Caretakers adherence to the Agreement and scope of work. This review will be used, in part, to determine whether the Agreement should be extended for an additional term. 27. The term of this Agreement shall be three years, from the Effective Date. This Agreement may be extended for two additional three-year terms, or a portion thereof, provided the parties execute a written amendment amending the term of this Agreement. _______________________________ Volunteer Caretaker _______________________________ Volunteer Caretaker _______________________________ Parks & Recreation Director _______________________________ City Manager for the City of Carlsbad Approved as to Form CINDIE K. McMAHON, City Attorney ______________________________ Deputy/Assistant City Attorney DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 p J-t,y W(u~ ~~ ~~cf-~ S lbfr ~j,wick City of Carlsbad Volunteer Waiver: Revised September 20, 2022 City of Carlsbad Volunteer Waiver & Release Agreement Last Name First Name E-mail address Compliance with city COVID-19 protocols By signing this waiver to volunteer with the City of Carlsbad, I agree to not volunteer while experiencing a fever or other COVID-19 symptoms and will comply with the city’s sanitation and health screening requirements. Verification of receipt of volunteer handbook I acknowledge that I have received the City of Carlsbad Volunteer Handbook that includes the volunteer guidelines and policies. I further understand that, by signing this statement, I have read or will read the Volunteer Handbook and will discuss all questions of its contents that I have with the community services manager prior to the start of my volunteer service. I also realize that this statement will become a permanent part of my volunteer personnel file. Volunteer Service I understand that as a volunteer I will not be paid for my services. I confirm that I am volunteering my services with the understanding that these services are provided for civic reasons and that there is no promise or expectation of compensation for services rendered. My volunteer work is not related to the paid work I do for the city, if applicable. I offer my services freely and without pressure or coercion. Confidentiality Agreement I respect the confidentiality of City of Carlsbad, herein after “city,” information and will discuss or give official information only as directed by a supervisor. No confidential information will be provided to the public except within the guidelines of the city. Background Checks I authorize fingerprinting, photographing and criminal background checks as necessary for specific positions that I have volunteered to perform. On behalf of myself, my heirs and representatives, I hereby release the City of Carlsbad, its elected officials, employees and agents from all liability for any damages that may result from my reference verification and background check(s). The background check policy is available upon request. Insurance Information and Release I understand that there is some risk and that I may be injured while performing volunteer activities or services for the city. I understand that the city’s policy is to cover volunteers as “employees” of the city for the sole purpose of California workers’ compensation benefits. I also understand that under workers’ compensation laws, workers’ compensation benefits will be the sole and exclusive remedy in the event I am injured while performing volunteer activities and services. I further understand and agree that I will only be entitled to medical expenses under the city’s workers’ compensation program. I will not be entitled to any other workers’ compensation benefits which may include, but are not limited to, permanent or temporary loss of use damages, replacement income or vocational rehabilitation benefits. With the exception of workers’ compensation benefits as set out above, I hereby agree that I, my heirs, guardians, legal representatives and assigns will not make a claim against or file an action against the City of Carlsbad or any of its agents, officers, employees or other volunteers, for injury or damage resulting from negligence, howsoever caused, by any employee, agent, officer or volunteer of the City of Carlsbad as a result of my participation in volunteer activities or service. In addition, I hereby release and discharge the City of Carlsbad, its agents, officers, employees and other volunteers from all actions, claims and demands that I, my heirs, guardians, legal representatives or assigns now have or may hereafter have for injury or damage resulting from my participation in volunteer activities or services. I have carefully read this agreement and fully understand its contents. I am aware that this is a partial release of liability and an agreement between the City of Carlsbad and myself. I sign it on my own free will. I understand that as a volunteer I will not be paid for my volunteer service. Name (please print) Date Signature Signature of parent/guardian, if volunteer is under 18 years of age DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 Whitley Petermwhitley@gmail.com Peter Whitley 7/19/2023 Peter C cityof Carlsbad City of Carlsbad Volunteer Waiver: Revised September 20, 2022 City of Carlsbad Volunteer Waiver & Release Agreement Last Name First Name E-mail address Compliance with city COVID-19 protocols By signing this waiver to volunteer with the City of Carlsbad, I agree to not volunteer while experiencing a fever or other COVID-19 symptoms and will comply with the city’s sanitation and health screening requirements. Verification of receipt of volunteer handbook I acknowledge that I have received the City of Carlsbad Volunteer Handbook that includes the volunteer guidelines and policies. I further understand that, by signing this statement, I have read or will read the Volunteer Handbook and will discuss all questions of its contents that I have with the community services manager prior to the start of my volunteer service. I also realize that this statement will become a permanent part of my volunteer personnel file. Volunteer Service I understand that as a volunteer I will not be paid for my services. I confirm that I am volunteering my services with the understanding that these services are provided for civic reasons and that there is no promise or expectation of compensation for services rendered. My volunteer work is not related to the paid work I do for the city, if applicable. I offer my services freely and without pressure or coercion. Confidentiality Agreement I respect the confidentiality of City of Carlsbad, herein after “city,” information and will discuss or give official information only as directed by a supervisor. No confidential information will be provided to the public except within the guidelines of the city. Background Checks I authorize fingerprinting, photographing and criminal background checks as necessary for specific positions that I have volunteered to perform. On behalf of myself, my heirs and representatives, I hereby release the City of Carlsbad, its elected officials, employees and agents from all liability for any damages that may result from my reference verification and background check(s). The background check policy is available upon request. Insurance Information and Release I understand that there is some risk and that I may be injured while performing volunteer activities or services for the city. I understand that the city’s policy is to cover volunteers as “employees” of the city for the sole purpose of California workers’ compensation benefits. I also understand that under workers’ compensation laws, workers’ compensation benefits will be the sole and exclusive remedy in the event I am injured while performing volunteer activities and services. I further understand and agree that I will only be entitled to medical expenses under the city’s workers’ compensation program. I will not be entitled to any other workers’ compensation benefits which may include, but are not limited to, permanent or temporary loss of use damages, replacement income or vocational rehabilitation benefits. With the exception of workers’ compensation benefits as set out above, I hereby agree that I, my heirs, guardians, legal representatives and assigns will not make a claim against or file an action against the City of Carlsbad or any of its agents, officers, employees or other volunteers, for injury or damage resulting from negligence, howsoever caused, by any employee, agent, officer or volunteer of the City of Carlsbad as a result of my participation in volunteer activities or service. In addition, I hereby release and discharge the City of Carlsbad, its agents, officers, employees and other volunteers from all actions, claims and demands that I, my heirs, guardians, legal representatives or assigns now have or may hereafter have for injury or damage resulting from my participation in volunteer activities or services. I have carefully read this agreement and fully understand its contents. I am aware that this is a partial release of liability and an agreement between the City of Carlsbad and myself. I sign it on my own free will. I understand that as a volunteer I will not be paid for my volunteer service. Name (please print) Date Signature Signature of parent/guardian, if volunteer is under 18 years of age DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 7/19/2023 noralkenney@gmail.comNora Nora Kenney-Whitley Kenney-Whitley ~f?.-Jh; C cityof Carlsbad CITY OF CARLSBAD PARKS & RECREATION DEPARTMENT LEO CARRILLO RANCH HISTORIC PARK 6200 Flying LC Lane Carlsbad, CA 92009 ACKNOWLEDGEMENT OF VOLUNTEER STATUS AGREEMENT We, the undersigned agree and understand that any work we perform at Leo Carrillo Ranch Historic Park (“Property”) on behalf of the City of Carlsbad will be provided by us as volunteers. We agree that we will not expect or receive any compensation other than what is provided for in the Volunteer Caretaker Agreement that is concurrently signed herewith for performing such work. We further understand and agree that functioning as an volunteer does not constitute an employee-employer relationship with the City of Carlsbad, and that we serve at the discretion of the Parks & Recreation Director. We understand that we are not entitled to any relocation benefits upon the termination of my volunteer status and to the extent that any relocations benefits are required under any applicable law, we hereby waive any and all relocation benefits. We understand that as volunteers, we are responsible for providing all of our own needs, including without limitation, paying for our own health and insurance benefits and all federal and state income taxes. __________________________________________ ___________________ Signature of Volunteer Date __________________________________________ Printed Name of Volunteer __________________________________________ ___________________ Signature of Volunteer Date __________________________________________ Printed Name of Volunteer __________________________________________ _________________ Special Projects Manager Date DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 Peter Whitley 7/19/2023 Nora Kenney-Whitley 7/19/2023 7/19/2023 Revised June 2023 Page 1 Welcome to the Volunteer Team! We are excited for you to join the City of Carlsbad’s Volunteer Team! We extend a warm welcome to you as a city volunteer and thank you for wanting to give back to your city and community. The time and talents you will give while you volunteer allow the city to enhance the quality of the services and programs we offer our residents and community members. Each volunteer for the City of Carlsbad is considered a valued and important member of the team. The city extends every effort to ensure volunteers will have a positive experience in a considerate environment. This handbook is intended to provide you with an overview of information that will help you be successful during your volunteer assignment. Whether this is your first-time volunteering, or you are a seasoned volunteer, you should look forward to a truly rewarding and positive experience! Organizational Values Character: We conduct ourselves with integrity, openness, courage and professionalism, driven by a calling to serve others. Innovation: We are thoughtful, resourceful and creative in our quest for continuous improvement, always looking for better, faster ways to get things done. Stewardship: We responsibly manage the public resources entrusted to us and provide the best value to our community. Excellence: We hold ourselves to the highest standards because our community deserves the best. Empowerment: We help people achieve their personal best by creating an environment where they feel trusted, valued and inspired. Communication: We communicate openly and directly. Promoting engagement and collaboration makes our organization better and our community stronger. DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 {'Cityof Carlsbad Revised June 2023 Page 2 Volunteer Handbook Policies & Guidelines COVID Precautions Volunteers are required to read the city COVID-19 Prevention Plan located within the Injury & Illness Prevention Plan. Volunteers are not permitted to assist the city while experiencing COVID-19 symptoms or symptoms of other illness. Please stay home if you are feeling sick. In the event you have been exposed to COVID, have tested positive for COVID or are experiencing symptoms of COVID, please contact the Volunteer Program Manager for guidance. Code of Conduct Each of us is responsible, every day, for our own behavior and the decisions we make. As a volunteer for the city, you directly affect the residents and the community. We ask you to be responsible for conducting yourself with the highest standards of professional and ethical conduct while representing the City of Carlsbad. Activities that could raise questions as to the City of Carlsbad’s honesty and impartiality are strictly reviewed. To maintain its high standards of conduct, the City of Carlsbad operates under the following Code of Conduct: No volunteer shall: for personal benefit, use the name, emblem, endorsement, services or property of the city, nor seek any financial advantage or gain as a result of city affiliation. Volunteers may not utilize any city affiliation in connection with the promotion of partisan policies, religious matters or positions on any issue not in conformity with the position of the city. Disclosure of confidential city information that is available solely as a result of your volunteer efforts is prohibited. Respectful Workplace Environment The city values respectfulness, collaboration and teamwork in the workplace and prohibits any form of discrimination or harassment that would otherwise conflict with these values. The city also values a diverse volunteer force and is committed to providing equal volunteer opportunities to all. Sexual harassment prevention Sexual harassment will not be tolerated. Volunteers who feel they are victims of harassment should contact their supervisor or the Volunteer Program Manager. All harassment complaints will be handled in a confidential manner and we will not retaliate against any individual for reporting a claim of harassment or cooperating with an investigation. It is the policy to provide protection to all staff, volunteers and individuals served against sexual harassment and/or hostile work environments. Sexual harassment is described as unsolicited, unwelcome, non-reciprocal behavior. It may range from inappropriate sexual innuendoes to coerced sexual relations. Sexual harassment may also include, but is not limited to, the behaviors or actions below, which are directed at the victim or said in the victim’s presence: ▪ Unsolicited verbal sexual comments and harassment. ▪ Inappropriate sexual or gender-related jokes. ▪ Inappropriate discussion of sexual interactions. ▪ Subtle pressure for sexual activity. ▪ Inappropriate comments about a person’s body or sexual activities. Distribution of or sharing of sexually related materials (i.e., cartoons, magazines, videos). ▪ Sexually related communications via email or voicemail. ▪ Patting, pinching, or unnecessary touching. ▪ Demanding sexual favors. DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 Revised June 2023 Page 3 Workplace security It is the policy of the city to promote a safe work environment for all. In support of this policy, the city takes the position that a threat of violence or any violent act within the workplace is not permitted. All threats or acts of violence will be taken seriously and acted upon. Workplace safety Your personal safety is important to us. We never want to put our volunteers in harm’s way. Safety is of primary importance in every aspect of a volunteer activity. Volunteers are expected to obey safety rules, follow safe work practices and procedures, and exercise caution in all activities. Volunteers must report any injury, unsafe conditions and any equipment or situation that may pose a safety hazard immediately to their supervisor. Conflict of Interest The city has a legal obligation to operate in the best interests of our residents. If you have an affiliation or financial interest with an organization that may present a conflict with those interests, disclose that conflict to the Volunteer Program Manager at 442-359-6212. Refrain from being involved in any decision-making process relating to the other organization. In addition, do not knowingly take action or make any statement intended to influence the conduct of the city in such a way as to confer any financial benefit to a person or corporation or entity in which you have a significant interest or affiliation. After acceptance and assignment by the City of Carlsbad, a volunteer who enters a course of health- related treatment that might adversely impact the performance of volunteer duties should consult with immediate supervisor and/or the Volunteer Program Manager. Confidentiality We have respect for the public we serve and fellow volunteers. Whatever you learn during your time volunteering is private and confidential. Please do not disclose confidential information that is available as a result of your volunteer efforts. Background Check Due to the nature of certain volunteer roles, a background check may be required. If a background check is required for the volunteer service you will be providing, you will be notified and will need to complete the background check prior to commencing volunteer duties. A background check will consist of fingerprinting (Live Scan at the city’s expense). If you are a licensed professional, the appropriate governing board for the State of California will be contacted to ensure your license is in good standing. Political Activities Volunteers are not permitted to participate in political activities while in their role volunteering for the City of Carlsbad. In addition, volunteers may not use city resources (i.e., office supplies, copiers, volunteer time) for or in support or opposition of political activities including supporting a candidate or advocating for a ballot measure. Use of Technology Any person who is required to use a city computer in the course of their volunteer work, will be required to have a Live Scan clearance on file with the city. All persons who use a city computer are to adhere to Administrative Order 53 and any IT security policies. City computers are to be used in a lawful, ethical, and professional manner and be used for city business only. There is no expectation of privacy in anything created, stored, sent, or received on the computer system that is the property of the City of Carlsbad. DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 Revised June 2023 Page 4 Publicity/Statements to the Media All media inquiries regarding the City of Carlsbad and its operations must be referred to your supervisor or the Community Services Manager. No volunteer, unless specifically designated, is authorized to make public statements on behalf of the city, its departments, programs, etc. Photo Release By volunteering with the city, you are giving the City of Carlsbad, free of any compensation, unlimited permission to use any photo or video images of you related to any aspect of your volunteer service with the city. Training All new volunteers must attend a city volunteer orientation prior to the start of their volunteer assignment. The volunteer will be provided a copy of the volunteer handbook and volunteer activity description. After attending the volunteer orientation and meeting any other pre-volunteer requirements, e.g., Live Scan clearance, the volunteer will meet with the on-site supervisor for site or program specific training. The training will include: ▪ Review of Volunteer Activity Description ▪ Walk thru of site and volunteer area ▪ Site health screening area and procedures ▪ Health and safety requirements ▪ For volunteers returning to their volunteer site, what has changed at the site since last volunteering with the city. Volunteers may be required to attend additional training to ensure compliance with State of California, CalOSHA or city requirements. Scheduling Volunteers are typically assigned duties that require a regular schedule. If expecting to be absent from a scheduled assignment, please notify your supervisor as far in advance as possible. If you are off on a long vacation, your supervisor will need time to make other arrangements to cover the loss of your services. Unexpected absenteeism limits our ability to provide needed services to the community. The City of Carlsbad will be closed on major holidays. Please check with your supervisor and/or the Volunteer Program Manager for the holiday schedule. Recording Your Time A valid record of volunteer hours is one of the clearest ways to show the benefits of your volunteer efforts. Volunteers are responsible for keeping track of their own hours including those given off-site. Please enter your total hours after each time you volunteer on your volunteer account at www.VolunteerinCarlsbad.net on a regular basis. If you need assistance tracking your hours, please reach out to the Volunteer Program Manager. Expense Reimbursement Policy Some of the costs related to volunteering for the City of Carlsbad may be deductible from your income tax and may include automobile mileage to and from your volunteer work; parking fees and purchase and care of special uniforms. A complete description of federal tax deductions for volunteers can be obtained from your local IRS office or your tax advisor. Ask for Publication #526: “Charitable Contributions.” DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 Revised June 2023 Page 5 Dress Code/Identification As a representative of the city, volunteers are responsible for presenting a positive and professional image to the community. Please dress appropriately for the conditions and tasks involved. Volunteers may be issued some type of volunteer identification, such as a badge. ID badges or other identification are property of the city and must be returned upon resignation. Volunteers are asked to wear this badge only while volunteering. Youth Volunteers Volunteers who are not yet 18 years old must have the written consent of a parent or guardian prior to volunteering. The volunteer work assigned to a minor shall be performed in a non-hazardous environment and will comply with all appropriate requirements. Special care is taken to assure the safety of volunteers under the age of 15. Employees who volunteer for the city A city employee, to include paid interns, may volunteer for the city with the following conditions: 1. The volunteer position must be substantially different from employee’s paid city work and cannot be closely related to actual duties performed by or responsibilities assigned to the employee. 2. Employees may not volunteer to do what they are otherwise paid to do by the city. The employee provides the volunteer services with the understanding the services are provided for civic reasons and there is no promise or expectation of compensation for the services rendered and are offered freely without pressure or coercion. Recognition Recognition of the many and varied contributions of volunteer staff is accomplished both formally and informally. Informal recognition, including positive feedback for a job well done, is the responsibility of your supervisor. Formal activities may be coordinated in cooperation with designated staff at individual departments and/or as a citywide event. Please let your supervisor know how you personally like to be acknowledged for your service. If you do not feel appreciated, please let your supervisor or the Volunteer Program Manager know. Ending Your Volunteer Assignment If you need to end your volunteer relationship with the city, please tell your supervisor or the Volunteer Program Manager with as much advance warning as possible. All city property, such as identification badge, keys, etc. must be returned at that time. If desired, any volunteer may request copies of own volunteer profile to use in any future affiliation with the City of Carlsbad. The City of Carlsbad accepts the services of all volunteers with the understanding that such service is at the sole discretion of the city. At any time and for whatever reason, the City of Carlsbad may decide to terminate a volunteer’s relationship, just as the volunteer may at any time and for whatever reason decide to end relationship with the city. When possible, interviews will be conducted with volunteers who are leaving their positions. The city is interested in learning why you are leaving the position, elicit your suggestions to improve the volunteer program and examine the possibility of involving you in some other capacity with the City of Carlsbad. DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 Revised June 2023 Page 6 Accidents or Injuries While Volunteering You are covered under the City of Carlsbad’s Workers’ Compensation program for injuries received while volunteering for the city. If you are injured, report the accident immediately to your site supervisor. If immediate medical treatment is required call 911. Instructions for volunteer related injuries or illnesses 1. Immediately report your work-related injury/illness to your site supervisor. 2. During business hours, your supervisor will direct you to a city designated occupational health clinic. After business hours, see instructions on list of clinics for instructions. 3. To ensure timely processing of worker compensation claim benefits, submit the following documents to your site supervisor or Volunteer Program Manager: a. Volunteer Report of Injury or Illness b. Workers Compensation Claim form – DWC-1 c. Fill out an incident report within 24 hours of the injury or illness. d. Provide the Human Resource Manager with all doctor’s reports, appointment notices, and/or work restrictions. After a work-related injury/illness you may experience one or all of the following: 1. Release to Full Duty 2. Total Temporarily Disabled 3. Temporary Modified/Restricted Duty You, your site supervisor and Human Resources coordinate every change in volunteer status based on the Doctor’s Work Status Reports. All modified/restricted duty assignments require coordination with your site supervisor and Human Resources before you return to your assignment. For Total Temporarily Disabled injuries, the volunteer will not be able to return to their assignment until released to modified/restricted duty or cleared by the doctor. If you cannot keep an appointment, notify the medical provider and AdminSure at (909) 861-0816. Missed appointment may result in loss of benefits and your eligibility to participate as a volunteer with the city. DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 Revised June 2023 Page 7 List of Approved Occupational Medical Clinics Work Partners Occupational Health Specialists Monday-Friday 8:00 a.m. until 6:00 p.m. 3156 Vista Way, Suite 100 Saturdays 9:00 a.m. until 2:00 p.m. Oceanside, CA 92056 (760) 681-5222 Work Partners Occupational Health Specialists Monday-Friday 8:00 a.m. until 6:00 p.m. 2365 S. Melrose Drive Vista, CA 92081 (760) 571-5910 Work Partners Occupational Health Specialists Monday-Friday 8:30 a.m. until 5:00 p.m. 7485 Mission Valley Road, Suite 100 San Diego, CA 92108 (619) 900-1330 Work Partners Occupational Health Specialists Monday-Friday 8:00 a.m. until 6:00 p.m. 1510 Sweetwater Road, Suite B National City, CA 91950 (619) 552-2870 Carlsbad Urgent Care – San Marcos Monday-Friday 9:00 a.m. until 9:00 p.m. 295 S. Rancho Santa Fe Road Saturday-Sunday 9:00 a.m. until 5:00 p.m. San Marcos, CA 92078 Holidays 9:00 a.m. until 5:00 p.m. (760) 471-1111 Closed December 25 Palomar Health Monday-Friday 8:00 a.m. until 7:00 p.m. Corporate Health Services 120 Craven Road Suite 207 San Marcos, CA 92078 Office (760) 510 7373 (Across from Cal State San Marcos) Palomar Health Monday-Friday 8:00 a.m. until 5:00 p.m. Corporate Health Services 15611 Pomerado Road Suite 580 Poway, CA 92064 Office: (858) 613-6280 (Located in Pomerado outpatient department adjacent to Pomerado Hospital) Healthpointe 8:00 a.m. until 5:00 p.m. 27455 Tierra Alta Way Suite A Temecula, CA 92590 Office: (951)-699-5282 For after hours, please seek treatment at Tri-City Medical Ctr. Emergency Department or the nearest Emergency Room or Urgent Care Facility Tri-City Medical Ctr. Emergency Department 4002 Vista Way Oceanside, CA 92056 (760) 940-3505 DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 Revised June 2023 Page 8 How to log your volunteer hours 1.Log on to MyVolunteerPage.com 2.Click on the HOURS tab 3.Select the organization you volunteered for from the drop-down list and click the Select Organization button. i.e., Trails – City of Carlsbad 4.Choose the activity that you are logging hours from the drop-down list next to Activity. Make sure that the Recent button immediately underneath is highlighted. 5.Enter the date you volunteered in the field beside Date Volunteered 6.Enter the number of hours and minutes – to the nearest 15 minutes – volunteered 7.Click the Save button to create the hours log entry I have read the City of Carlsbad Volunteer Handbook and agree to follow its policies and guidelines: DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 Peter Whitley Nora Kenney-Whitley C cityof Carlsbad Hours Log Hours www.VolunteerlnCarlsbad.net Volunteer Resources Please select an organization to log hours forL..cl T.:..:r•ccils=--•-=C:.::ity,_o:.;.f..::C.:::ar.=ls::..:ba:..::d _____________ ,_,I • I Select Organization Activity mwPbtiMIM®IM,HU ii-EB Show these activities In 111!!11 Date Volunteered 10/27/2015 1• Hours -0 --Minutes 0 Ill Most Recent Entries ,\ 1 r I ''I,· DATE VOLUNTEERED DATE CREATED STATUS ACTIONS P/JJ 5/6/2023 4/17/2023 4/17/2024 DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYYY) ~ 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 David Miller NAME: Dave Miller Insurance pA~~NJ_ c-"· (760) 717-1707 I FAX IA/C Nol: (866) 477-0370 2318 Pio Pico Dr E-MAIL dminsurance@gmail.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# Carlsbad CA 92008 INSURER A: Nautilus Insurance Company INSURED INSURER B : Peter Whitley INSURER C: 6200 Flying L C Lane INSURER D : INSURER E: Carlsbad CA 92009 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR ,.,~n WHn POLICY NUMBER IMMIDD/YYYYl IMMIDD/YYYYl X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ~ □ CLAIMS-MADE [X] OCCUR DAMAGE TO RENTED PREMISES IEa occurrence\ $ 300,000 ~ MED EXP (Any one person) $ 10,000 A y NN1230419 ~ -PERSONAL & ADV INJURY $ 1,000,000 GEN"L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 ~ □PRO· D Loc PRODUCTS· COMP/OP AGG $ 2,000,000 POLICY JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ IEa accidentl f-- ANY AUTO BODILY INJURY (Per person) $ ~ OWNED -SCHEDULED BODILY INJURY (Per accident) $ f--AUTOS ONLY -AUTOS HIRED NON-OWNED iP~~~Zc~d~~t~AMAGE $ ~ AUTOS ONLY -AUTOS ONLY $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ ~ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION I PER I I OTH- AND EMPLOYERS" LIABILITY STATUTE ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE □ E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is added as additional insured for designated premises 6200 Flying Leo Carrillo Lane Carlsbad CA 92009 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Carlsbad ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1200 Carlsbad Village Drive David Miller Carlsbad CA 92008 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 POLICY NUMBER: NN1230419 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization{s): City of Carlsbad 1200 Carlsbad Village Drive Carlsbad CA 92008 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as a n additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily inju ry", "prope rty damage" or "personal and advertising injury" caused, in whole or in part, by your act s or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of yo ur ongoing operations; or 2. In connection with your premise s owned by or rented to you. However: 1. The insuran ce afforded to such additional insured only applies to th e extent permitted by law; and 2. If coverage provided to the additional insured is required by a contra ct or agree ment, the insurance afforded to su ch ad ditional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional in sureds, the following is added to Section Ill -Limits Of Insurance: If coverage provide d to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available un der the ap plicable Limi ts of Insurance shown in the De clarations; whichever is less. This end orsement shall not incre ase the applicable Li mits of lnsuran ce sho wn in the Declaration. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 CRIST FRITSCHI & PATERSON INS 101 YGNACIO VALLEY RD STE 200 WALNUT CREEK CA 94596-4087 August 23, 2022 Policy Number: OA4088476 24-Hour Claims: 1-800-332-3226 Policy Service: (925) 956-7700 Online Account Services: www.safeco.com THIS IS NOT A BILL. NORA KENNEY PETER WHITLEY 6200 FLYING LEO CARRILLO LN CARLSBAD CA 92009-3042 Thank you for allowing us to continue serving your home insurance needs. We appreciate your business and the trust that you have placed in us. This renewal reflects adjustments to your personal property limit. This adjustment is based on a Consumer Price Index average. You should review whether your coverage is adequate at least annually, and after each significant personal property purchase. If you would like to change your limits, or schedule any of your high value items, please contact your agent. With this renewal the following changes were made, including those requested by you or your agent or broker: - Personal Property Limits (Coverage C) changed from $33,500 to $36,500. We would also like to draw your attention to the following: · Your new policy period begins October 22, 2022. The 12-month premium for this policy is $370.00 for the October 22, 2022 to October 22, 2023 policy term. · This is not a bill. Your bill will be sent in a separate mailing approximately 25 days before it is due. It will provide an explanation of any money owed, your payment options with applicable fees and your payment due date. If you have any questions or wish to make any changes to your policy, you can do so by calling your agent at (925) 956-7700. PLEASE SEE REVERSE We have made changes to our program that impact both coverage and premium. The impact on individual customers will vary. Please review the declarations page, the policy and any enclosed notices carefully to see how these changes affect you. FIRST NATIONAL INSURANCE COMPANY OF AMERICA (A SAFECO Company) P O BOX 704000, SALT LAKE CITY, UT 84170 OC-429/EP 10/13 **** REPRINTEDFROM THE ARCHIVE. THE ORIGINAL TRANSACTIONMAY INCLUDE ADDITIONAL FORMS ****DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 A Liberty Mutual Company We appreciatethe opportunityto serve you. Thank you. OC-430/EP 5/98 G1 **** REPRINTEDFROM THE ARCHIVE. THE ORIGINAL TRANSACTIONMAY INCLUDE ADDITIONAL FORMS ****DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 ~~ President, Safeco Insurance P-4537/CAEP 1/16 Page 1 of 2 G1 IMPORTANT NOTICE —ADD A PARTY TO RECEIVE NOTICE California law gives you the right to identify an additional person to receive a duplicate copy of any notice of lapse, termination,expiration,nonrenewal or cancellation we send to you due to non-payment of premium. To assign a designee,simply complete the form below and mail the form to: Safeco Insurance Companies Personal Lines Underwriting PO Box 704000 Salt Lake City,UT 84170-4000 Email:documents@safeco.com Fax:877-344-5107 You may also deliver the form to your independent Safeco agent.Agent contact information is shown on your policy Declarations. Please keep a copy of the completed form for your records.You may also change or terminate the third party designee by sending us written notification or completing the relevant section below. Request to Designate a Third Party to Receive a Copy of Policy Termination Notices for Non-Payment of Premium. Insured Name Policy Number(s)* Address *List all applicable policy numbers. I designate the following person to receive a duplicate copy of any notice of lapse,termination,expiration, nonrenewal or cancellation that you send me due to non-payment of premium for the policy number shown above. I understand the third party designee does not have any right,whether as an additional insured or otherwise,to any benefits under the policy other than the right to receive the notice of lapse,termination,expiration, nonrenewal,or cancellation for nonpayment of premium. Designee Name Street City State Zip Signature of Insured Date DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 P-4537/CAEP 1/16 Page 2 of 2 Request to Change a Third Party to Receive a Copy of Policy Termination Notices for Non-Payment of Premium. Insured Name Policy Number(s)* Address *List all applicable policy numbers. I would like to replace my prior third party designee with the following person to receive a duplicate copy of any notice of lapse,termination,expiration,nonrenewal or cancellation that you send me due to non-payment of premium for the policy number shown above. I understand the third party designee does not have any right,whether as an additional insured or otherwise,to any benefits under the policy other than the right to receive the notice of lapse,termination,expiration, nonrenewal,or cancellation for nonpayment of premium. Designee Name Street City State Zip Signature of Insured Date Request to Delete a Third Party from Receiving a Copy of Policy Termination Notices for Non-Payment of Premium. Insured Name Policy Number(s)* Address *List all applicable policy numbers. I would like to delete my previously selected third party designee from receiving a duplicate copy of any notice of lapse,termination,expiration,nonrenewal or cancellation that you send me due to nonpayment of premium for the policy number shown above. Designee Name Street City State Zip Signature of Insured Date DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 CN-2121/CAEP 1/12 CALIFORNIA RESIDENTIAL PROPERTY INSURANCE BILL OF RIGHTS A consumer is entitled to receive information regarding homeowner’s insurance.The following is a limited overview of information that your insurance company can provide: •The insurance company’s customer service telephone number for underwriting,rating,and claims inquiries. •A written explanation for any cancellation or nonrenewal of your policy. •A copy of the insurance policy. •An explanation of how your policy limits were established. •In the event of a claim,an itemized,written scope of loss report prepared by the insurer or its adjuster within a reasonable time period. •In the event of a claim,a copy of the Unfair Practices Act and,if requested,a copy of the Fair Claims Practices Regulations. •In the event of a claim,notification of a consumer’s rights with respect to the appraisal process for resolving claims disputes. •An offer of coverage and premium quote for earthquake coverage,if eligible. A consumer is also entitled to select a licensed contractor or vendor to repair,replace,or rebuild damaged property covered by the insurance policy. The information provided herein is not all inclusive and does not negate or preempt existing California law.If you have any concerns or questions,contact your agent,broker,insurance company,or the California Department of Insurance consumer information line (800)927-HELP (4357)or at www.insurance.ca.gov for free insurance assistance. This insurer reports claim information to one or more claims information databases.The claim information is used to furnish loss history reports to insurers.If you are interested in obtaining a report from a claims information database,you may do so by contacting: Choicepoint (CLUE) 1-800-456-6004 www.consumerdisclosure.com ISO Claimsearch 1-800-888-4476 DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 Version 2.0 (last updated December 11, 2020) 1 CN-2/CAEP 12/20 Safeco Insurance Privacy Notice — California Effective December 11, 2020 Safeco Insurance, its affiliates and subsidiaries (collectively “Safeco”or “we”,“us”and “our”) provide insurance to individuals. We strive to protect your privacy. This notice applies to you if you are a California resident and are contacting us to learn about our products, to buy insurance for yourself (for example, auto insurance), or if you are filing a claim against a policy. In this notice, we explain how we gather, use, share, and protect your data. What Personal Data Do We Collect? The types of personal data we gather and share depends on both the product and your relationship to us. For example, we may gather different data if you are a claimant reporting an injury than if you want a quote for auto insurance. The data we gather can include your social security number, income, transaction data such as account balances and payment history, and data from consumer reports. It may also include data gathered in connection with our provision of insurance services, when you apply for such services, or resulting from other contacts with you. It may also include: •Identifiers, including a real name, alias, postal address, unique personal identifier, online identifier, Internet Protocol address, email address, account name, Social Security number, driver’s license number, or other similar identifiers; •Personal data, such as your name, signature, Social Security number, physical characteristics or description, address, telephone number, driver’s license or state identification card number, insurance policy number, education, employment, employment history, bank account number, financial data, medical data, or health insurance data; •Protected classification characteristics described in California Civil Code § 1798.80(e), including age, race, color, national origin, citizenship, religion or creed, marital status, medical condition, physical or mental disability, sex (including gender, gender identity, gender expression, pregnancy or childbirth and related medical conditions), sexual orientation, veteran or military status; •Commercial data, including records of personal property, products or services purchased, obtained, or considered, or other purchasing or consuming histories and tendencies; •Internet or other similar network activity, including browsing history, search history, data on a consumer’s interaction with a website, application, or advertisement; •Professional or employment related data, including current or past job history or performance evaluations; •Inferences drawn from other personal data, such as a profile reflecting a person’s preferences, characteristics, psychological trends, predispositions, behavior, attitudes, intelligence, abilities, and aptitudes; •Risk data, including data about your driving and/or accident history; this may include data from consumer reporting agencies, such as your motor vehicle records and loss history data, health data, or criminal convictions; •Claims data, including data about your previous and current claims, which may include data regarding your health, criminal convictions, third party reports, or other personal data. For information about the types of personal data we have gathered in the past twelve months, please go to libertymutual.com/privacy and click on the link for the California Supplemental Privacy Policy. How Do You Gather my Data? We gather your personal data directly from you. For example, you provide us with data when you: We also gather your personal data from other people. For example: • ask about, buy insurance or file a claim • your insurance agent or broker • pay your policy • your employer, association or business (if you are insured through them) • visit our websites, call us, or visit our office • our affiliates or other insurance companies about your transactions with them **** REPRINTEDFROM THE ARCHIVE. THE ORIGINAL TRANSACTIONMAY INCLUDE ADDITIONAL FORMS ****DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 lnsuranceN Version 2.0 (last updated December 11,2020) 2 CN-2/CAEP 12/20 •consumer reporting agencies,Motor Vehicle Departments,and inspection services,to gather your credit history,driving record,claims history,or value and condition of your property •other public directories and sources •third parties,including other insurers,brokers and insurance support organizations who you have communicated with about your policy or claim,anti- fraud databases,sanctions lists,court judgments and other databases,government entities,open electoral register,advertising networks,data analytics providers,social networks,data brokers,or in the event of a claim,third parties including other parties to the claim,witnesses,experts,loss adjustors,and claim handlers •other third parties who take out a policy with us and are required to provide your data such as when you are named as a beneficiary or where a family member has taken out a policy which requires your personal data Organizations that share data with us may keep it and share it to others as permitted by law.For data about how we have gathered personal data in the past twelve months,please go to libertymutual.com/privacy and click on the link for the California Supplemental Privacy Policy. How Do We Use Your Personal Data? Safeco uses your data to provide you our products and services and as otherwise provided in this notice.We may use your data and the data of our former customers for our business purposes.Our business purposes include: Business Purpose Data Categories Market,sell and provide insurance. This includes for example: •calculating your premium; •determining your eligibility for a quote; •confirming your identity and service your policy; •Identifiers •Personal Information •Protected Classification Characteristics •Commercial Information •Internet or other similar network activity •Professional or employment related information •Inferences drawn from other personal information •Risk data •Claims data Manage your claim. This includes for example: •managing your claim,if any; •conducting claims investigations; •conducting medical examinations; •conducting inspections,appraisals; •providing roadside assistance; •providing rental car replacement,or repairs; •Identifiers •Personal Information •Protected Classification Characteristics •Commercial Information •Internet or other similar network activity •Professional or employment related information •Inferences drawn from other personal information •Risk data •Claims data DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 Version 2.0 (last updated December 11,2020) 3 CN-2/CAEP 12/20 Day to Day Business and Insurance Operations. This includes,for example: •creating,maintaining,customizing and securing accounts; •supporting day-to-day business and insurance related functions; •doing internal research for technology development; •marketing and creating products and services; •conducting audits related to a current contact with a consumer and other transactions; •as described at or before the point of gathering personal data or with your authorization; •Identifiers •Personal Information •Protected Classification Characteristics •Commercial Information •Internet or other similar network activity •Professional or employment related information •Inferences drawn from other personal information •Risk data •Claims data Security and Fraud Detection. This includes for example: •detecting security issues; •protecting against fraud or illegal activity,and to comply with regulatory and law enforcement authorities; •managing risk and securing our systems,assets, infrastructure and premises;roadside assistance, rental car replacement,or repairs •help to ensure the safety and security of Safeco staff, assets and resources,which may include physical and virtual access controls and access rights management; •supervisory controls and other monitoring and reviews,as permitted by law;and emergency and business continuity management; •Identifiers •Personal Information •Protected Classification Characteristics •Commercial Information •Internet or other similar network activity •Professional or employment related information •Inferences drawn from other personal information •Risk data •Claims data Regulatory and Legal Requirements. This includes for example: •controls and access rights management; •to evaluate or conduct a merger,divestiture, restructuring,reorganization,dissolution,or other sale or transfer of some or all of Safeco’s assets, whether as a going concern or as part of bankruptcy, liquidation,or similar proceeding,in which personal data held by Safeco is among the assets transferred; •exercising and defending our legal rights and positions; •to meet Safeco contract obligations; •to respond to law enforcement requests and as required by applicable law,court order,or governmental regulations; •as otherwise permitted by law •Identifiers •Personal Information •Protected Classification Characteristics •Commercial Information •Internet or other similar network activity •Professional or employment related information •Inferences drawn from other personal information •Risk data •Claims data Improve Your Customer Experience and Our Products. This includes for example: •improve your customer experience,our products and service; •to provide,support,personalize and develop our website,products and services; •create and offer new products and services; •Identifiers •Personal Information •Commercial Information •Internet or other similar network activity •Professional or employment related information •Inferences drawn from other personal information •Risk data •Claims data DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 Version 2.0 (last updated December 11,2020) 4 CN-2/CAEP 12/20 Analytics to identify,understand and manage our risks and products. This includes for example: •conducting analytics to better identify,understand and manage risk and our products; •Identifiers •Personal Information •Protected Classification Characteristics •Commercial Information •Internet or other similar network activity •Professional or employment related information •Inferences drawn from other personal information •Risk data •Claims data Customer service and technical support: •answer questions and provide notifications; •provide customer and technical support. •Identifiers •Personal Information •Commercial Information •Internet or other similar network activity •Professional or employment related information •Inferences drawn from other personal information •Risk data •Claims data Do We Share Your Personal Data? Safeco does not sell your personal data as defined by California law. Safeco may share personal data with affiliated and non-affiliated third parties,including: •Liberty Mutual affiliates; •Service Providers (such as auto repair facilities,towing companies,property inspectors,and independent adjusters); •Insurance support organizations; •Brokers and agents; •Government entities (e.g.regulatory,quasi-regulatory,tax or other authorities,law enforcement agencies,courts,arbitrational bodies,and fraud prevention agencies); •Consumer reporting agencies; •Advisors including law firms,accountants,auditors,and tax advisors; •Insurers,re-insurers,policy holders,and claimants; •Group policyholders (for reporting claims data or an audit); •Advertising networks,data analytics providers,and social networks; •Service providers and affiliates for actuarial or research studies;and •As permitted by law. We may also share data with other companies that provide marketing services on our behalf or as part of a joint marketing agreement for products offered by Safeco.We will not share your personal data with others for their own marketing purposes. We may also share data about our transactions (such as payment history)and experiences (such as claims made)with you to our affiliates. Safeco may share the following categories of personal data as needed for business purposes: Identifiers Personal Data Protected Classification Characteristics Commercial Data Internet of other similar network activity Professional,employment and education data Inferences drawn from personal data Risk Data Claims Data DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 Version 2.0 (last updated December 11,2020) 5 CN-2/CAEP 12/20 For information about how we have shared personal data in the past twelve months,please go to libertymutual.com/privacy and click on the link for the California Supplemental Privacy Policy. Your Agent or Broker Your agent or broker is not a Safeco employee and is not subject to our privacy policy.Because your agent or broker works with you directly,he or she may have data about you that Safeco does not have.Your agent or broker may use this data differently than Safeco.Contact your agent or broker to learn more about their privacy practices. How Do We Keep your Personal Data Safe? We maintain physical,electronic,and administrative safeguards created to protect your data from unauthorized access.Our employees are authorized to access your data only for legitimate business purposes. What Rights Do I Have to Learn More About My Personal Data? You may have rights under California laws to learn more about our privacy practices. For example,under the California Insurance Code you may request a copy of certain information about you to review its completeness and accuracy.You must make this request in writing by contacting us as indicated below. We have 30 business days after receiving your request to send the data to you. To the extent required by law,we will also tell you of any persons to whom we have shared the data in the last two years.We will also share the name and address of any consumer reporting agency from which we have received information about you.Some data we are not required to share. If you believe the data we have about you is incorrect,you may notify us in writing of what you would like to correct and why.We will respond within 30 business days. If we agree,we will change our records.We will send the change to any organization that has received the inaccurate information from us.It will also be included in any later disclosures to others. If we disagree,we will tell you why.You can write us with a short statement explaining why you believe that the data is incorrect.This will become part of the file.We will also send it to any persons that have received the disputed information from us.It will also be included in any later disclosures to others. You may have additional rights under other California laws.For more information about these rights,please go to libertymutual.com/privacy and click on the link California Supplemental Privacy Notice.If you cannot access the link,please contact us. How to Contact Us: You can submit requests,seek additional information,or obtain a copy of our privacy notice in an alternative format by either: Calling:800-344-0197 Email:Privacy@libertymutual.com Online:libertymutualgroup.com/privacy-policy/data-request Mail:Liberty Mutual Insurance Company 175 Berkeley St.,6th Floor Boston,MA 02116 Attn:Privacy Office Who is Providing this Notice? This Privacy Notice is provided on behalf of the following Safeco companies and affiliates: American Economy Insurance Company,American States Insurance Company,American States Insurance Company of Texas,American States Lloyds Insurance Company,American States Preferred Insurance Company,First National Insurance Company of America,General Insurance Company of America,Insurance Company of Illinois,Safeco Insurance Company of America,Safeco Insurance Company of Illinois,Safeco Insurance Company of Indiana,Safeco Insurance Company of Oregon,Safeco Lloyds Insurance Company, Safeco National Insurance Company,Safeco Surplus Lines Insurance Company. DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 FIRST NATIONAL INSURANCE COMPANY OF AMERICA (A SAFECO Company) Administrative office: 175 Berkeley St., Boston, MA 02116 (A stock insurance company.) RENTERS POLICY DECLARATIONS INSURED: NORA KENNEY PETER WHITLEY 6200 FLYING LEO CARRILLO LN CARLSBAD CA 92009-3042 RESIDENCE PREMISES: 6200 FLYING LEO CARRILLO LN CARLSBAD CA 92009-3042 POLICY NUMBER:OA4088476 POLICY PERIOD FROM:OCT. 22 2022 AT:12:01 A.M. TO:OCT. 22 2023 AGENT: CRIST FRITSCHI & PATERSON INS 101 YGNACIO VALLEY RD STE 200 WALNUT CREEK CA 94596-4087 TELEPHONE: (925) 956-7700 - Your policy has renewed effective October 22, 2022. SECTION I - PROPERTY COVERAGES C - Personal Property $ 36,500 $ 177.00 D - Loss of Use 24 MONTHS SECTION II - LIABILITY COVERAGES E - Personal Liability (each occurrence)300,000 37.00 F - Medical Payments (each person)2,000 INCLUDED COVERAGES Full Value on Personal Property Included California Workers Compensation Included Option E - Scheduled Personal Property $ 6,441 $ 119.00 Option Q - Valued Jewelry (Category V)Included Option KK - Special Personal Property 25.00 Option ID - Identity Recovery - $250 deductible 25,000 12.00 Section I N/A $ 500 You may pay your premium in full or in installments. There is no installment fee for the following billing plans: Full Pay, Annual 2-Pay. Installment fees for all other billing plans are listed below. If more than one policy is billed on the installment bill, only the highest fee is charged. The fee is: $0.00 per installment for recurring automatic deduction (EFT) $0.00 per installment for recurring credit card or debit card $2.00 per installment for all other payment methods IMPORTANT NOTICES - THIS POLICY DOES NOT PROVIDE EARTHQUAKE COVERAGE. COVERAGES LIMIT PREMIUM OPTIONS LIMIT PREMIUM DEDUCTIBLE(S)PERCENTAGE AMOUNT TOTAL ANNUAL PREMIUM $ 370.00 ORIGINAL DATE PREPARED AUG. 23 2022CHO-6000/EP 9/06 Page 1 of 1 G2 **** REPRINTEDFROM THE ARCHIVE. THE ORIGINAL TRANSACTIONMAY INCLUDE ADDITIONAL FORMS ****DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 lnsuranceN i i SCHEDULED PERSONAL PROPERTY ENDORSEMENT POLICY NUMBER:OA4088476 NAMED INSURED:NORA KENNEY PETER WHITLEY IMPORTANT NOTICE Ð LOSS SETTLEMENT FINE ARTS AND CATEGORY V JEWELRY:We will pay the amount shown for each scheduled article which is agreed,as stated on this endorsement,to be the value of the article. ALL OTHER PROPERTY AND CATEGORY J JEWELRY:The value of the property insured is not agreed upon but shall be ascertained at the time of loss or damage.Please refer to the Loss Settlement pro- visions within Option E Ð Scheduled Personal Property. THE ABOVE ARE SUBJECT TO ALL POLICY PROVISIONS.IF YOU NEED FURTHER EXPLANATION PLEASE REFER TO YOUR POLICY OR CONTACT YOUR AGENT. ITEM NO.CAT.DESCRIPTION OF PROPERTY COVERED INSURED AMT. 1 2 5 6 L L V B MAC LAPTOP W88318LG092 APPLE MACBOOK PRO #CPWLQAFCDTY3 14KT YELLOW GOLD LADY'S COMBINATION CAST &ASSEMBL ED DIAMOND ENGAGEMENT RING AND WEDDING BAND APPLE IPHONE 13 $500 1,577 3,435 929 A -FINE ARTS B -CELLULAR PHONES AND OTHER MOBILE EQUIPMENT C -CAMERAS,GUNS,STAMP AND COIN COLLECTIONS F -FURS,MUSICAL INSTRUMENTS &PROPERTY NOT OTHERWISE CLASSIFIED L -COMPUTERS AND OTHER MEDIA EQUIPMENT S -SILVERWARE T -FARM PERSONAL PROPERTY V -VALUED JEWELRY TOTAL AMOUNT OF INSURANCE BY CATEGORY $929 2,077 3,435 INSURED'S COPY CHO-6400/EP 5/98 G1 DATE PREPARED:AUG.23 2022 DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 Cut Along the Dotted Line Cut Along the Dotted Line PETER WHITLEY AND NORA L KENNEY 6200 FLYING LEO CARRILLO LN CARLSBAD CA 92009-3042 Important Information Here are your Policy Identification Cards We’ve provided two (2) cards for each vehicle on your policy. Need additional ID cards? The GEICO Mobile app is the quickest way to get additional ID cards. You can also send a copy of your ID cards to anyone that needs them right from the app! Evidence of Insurance Here are your Evidence of Liability Insurance Cards. Two cards have been provided for each vehicle insured. One card must be carried in the proper insured vehicle. Proof of insurance is required to register or renew the registration of your vehicle. A law enforcement officer can ask you to prove that you have liability insurance meeting the basic requirements of California law. A violation of these requirements can result in a fine of up to: $1,000 for the first time; $2,000 for additional times. Also, a judge can have your vehicle impounded. False proof of insurance may result in a fine up to $750 and 30 days in prison. California Evidence of Liability Insurance GEICO General Insurance Company P.O. Box 509090 • San Diego, CA 92150-9090 NAIC Code 2023 HONDA ACCORD 35882 Vehicle ID No. 1HGCY2F6XPA018248 Policy Number Effective Date Expiration Date 4397-06-06-35 06/10/23 12/10/23 Named Insured(s)Address Peter Whitley Nora Lynn Kenney 6200 Flying Leo Carrillo Ln Carlsbad CA 92009-3042 FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE 2023 HONDA ACCORD Additional Drivers The coverage provided by this policy meets the minimum requirements of section 16056 or 16500.5 of the California Vehicle Code, minimum liability limits prescribed by law. California Evidence of Liability Insurance GEICO General Insurance Company P.O. Box 509090 • San Diego, CA 92150-9090 NAIC Code 2023 HONDA ACCORD 35882 Vehicle ID No. 1HGCY2F6XPA018248 Policy Number Effective Date Expiration Date 4397-06-06-35 06/10/23 12/10/23 Named Insured(s)Address Peter Whitley Nora Lynn Kenney 6200 Flying Leo Carrillo Ln Carlsbad CA 92009-3042 FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE 2023 HONDA ACCORD Additional Drivers The coverage provided by this policy meets the minimum requirements of section 16056 or 16500.5 of the California Vehicle Code, minimum liability limits prescribed by law. DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 GEICO~ GEICO. GEICO. Cut Along the Dotted Line Cut Along the Dotted Line Need another form of proof of insurance? You may need the Insurance Binder for most finance companies, dealerships or vehicle registrations. Scan this code to get another form of proof of insurance immediately! If your address changes, update it using the app or log in to geico.com. By keeping your information up-to-date, you’ll continue to receive important policy documents. 2023 HONDA ACCORD FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE If you're in an accident: ·Stay at the scene and find a safe area. ·Do not admit fault or disclose your coverage limits. ·Call the police, and gather driver and vehicle information. ·Find any witnesses and get their contact information. To report a claim Go to geico.com/claims, use the GEICO Mobile app or call 1-800-841-3000. U4CA (06-20) 2023 HONDA ACCORD FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE If you're in an accident: ·Stay at the scene and find a safe area. ·Do not admit fault or disclose your coverage limits. ·Call the police, and gather driver and vehicle information. ·Find any witnesses and get their contact information. To report a claim Go to geico.com/claims, use the GEICO Mobile app or call 1-800-841-3000. U4CA (06-20) DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 GEICO~ GEICO. GEICO. Cut Along the Dotted Line Cut Along the Dotted Line PETER WHITLEY AND NORA L KENNEY 6200 FLYING LEO CARRILLO LN CARLSBAD CA 92009-3042 Important Information Here are your Policy Identification Cards We’ve provided two (2) cards for each vehicle on your policy. Need additional ID cards? The GEICO Mobile app is the quickest way to get additional ID cards. You can also send a copy of your ID cards to anyone that needs them right from the app! Evidence of Insurance Here are your Evidence of Liability Insurance Cards. Two cards have been provided for each vehicle insured. One card must be carried in the proper insured vehicle. Proof of insurance is required to register or renew the registration of your vehicle. A law enforcement officer can ask you to prove that you have liability insurance meeting the basic requirements of California law. A violation of these requirements can result in a fine of up to: $1,000 for the first time; $2,000 for additional times. Also, a judge can have your vehicle impounded. False proof of insurance may result in a fine up to $750 and 30 days in prison. California Evidence of Liability Insurance GEICO General Insurance Company P.O. Box 509090 • San Diego, CA 92150-9090 NAIC Code 2015 HONDA FIT 35882 Vehicle ID No. 3HGGK5H81FM706126 Policy Number Effective Date Expiration Date 4397-06-06-35 06/10/23 12/10/23 Named Insured(s)Address Peter Whitley Nora Lynn Kenney 6200 Flying Leo Carrillo Ln Carlsbad CA 92009-3042 FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE 2015 HONDA FIT Additional Drivers The coverage provided by this policy meets the minimum requirements of section 16056 or 16500.5 of the California Vehicle Code, minimum liability limits prescribed by law. California Evidence of Liability Insurance GEICO General Insurance Company P.O. Box 509090 • San Diego, CA 92150-9090 NAIC Code 2015 HONDA FIT 35882 Vehicle ID No. 3HGGK5H81FM706126 Policy Number Effective Date Expiration Date 4397-06-06-35 06/10/23 12/10/23 Named Insured(s)Address Peter Whitley Nora Lynn Kenney 6200 Flying Leo Carrillo Ln Carlsbad CA 92009-3042 FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE 2015 HONDA FIT Additional Drivers The coverage provided by this policy meets the minimum requirements of section 16056 or 16500.5 of the California Vehicle Code, minimum liability limits prescribed by law. DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 GEICO~ GEICO. GEICO. Cut Along the Dotted Line Cut Along the Dotted Line Need another form of proof of insurance? You may need the Insurance Binder for most finance companies, dealerships or vehicle registrations. Scan this code to get another form of proof of insurance immediately! If your address changes, update it using the app or log in to geico.com. By keeping your information up-to-date, you’ll continue to receive important policy documents. 2015 HONDA FIT FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE If you're in an accident: ·Stay at the scene and find a safe area. ·Do not admit fault or disclose your coverage limits. ·Call the police, and gather driver and vehicle information. ·Find any witnesses and get their contact information. To report a claim Go to geico.com/claims, use the GEICO Mobile app or call 1-800-841-3000. Need a tow or roadside assistance? Using the GEICO Mobile app is a quick and easy way to request Emergency Road Service. U4CA (06-20) 2015 HONDA FIT FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE FOLD HERE If you're in an accident: ·Stay at the scene and find a safe area. ·Do not admit fault or disclose your coverage limits. ·Call the police, and gather driver and vehicle information. ·Find any witnesses and get their contact information. To report a claim Go to geico.com/claims, use the GEICO Mobile app or call 1-800-841-3000. Need a tow or roadside assistance? Using the GEICO Mobile app is a quick and easy way to request Emergency Road Service. U4CA (06-20) DocuSign Envelope ID: 9A28E5F2-4D16-4C54-A252-93ED0667F985 GEICO~ GEICO. GEICO.