HomeMy WebLinkAboutBetter Choice Vending NC LLC; 2023-12-05;City Attorney Approved Version 4/24/2023
1
AGREEMENT FOR VENDING SERVICES
BETTER CHOICE VENDING NC, LLC
THIS AGREEMENT is made and entered into as of the ______________ day of
___________________, 20___, by and between the City of Carlsbad, California, a municipal
corporation, ("City"), and Better Choice Vending NC, LLC, a Wyoming Limited Liability
Corporation, ("Contractor”).
RECITALS
City requires the professional services of a vending machine provider that is experienced
in vending services. Contractor has the necessary experience in providing these professional
services, 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 Exhibit “A”, attached and incorporated by this reference in
accordance with the terms and conditions set forth in this Agreement.
2. TERM
This Agreement will be effective for a period of two (2) years from the date first above written. The
City may amend the Agreement to extend it for two (2) additional two (2) year periods thereof.
Extensions will be based upon a satisfactory review of the 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.
3. COMPENSATION
The total fee payable for the Services to be performed will be 15% of all vending machine
proceeds. No other compensation for the Services will be allowed except for items covered by
subsequent amendments to this Agreement.
4. STATUS OF CONTRACTOR
Contractor will perform the Services as an independent contractor and in pursuit of Contractor’s
independent calling, and not as an employee of City. Contractor will be under the control of City
only as to the results to be accomplished.
5. INDEMNIFICATION
Contractor agrees to defend at its own cost, 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.
DocuSign Envelope ID: BE7D281F-8072-4CCC-A6EB-08CF59D72580DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
23December
5th
City Attorney Approved Version 4/24/2023
2
6. INSURANCE
Contractor will obtain and maintain policies of commercial general liability insurance, automobile
liability insurance, a combined policy of workers' compensation, employers liability insurance, and
professional liability insurance from an insurance company authorized to transact the business of
insurance in the State of California which has 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, in an amount of not less than one million dollars ($1,000,000) each,
unless otherwise authorized and approved by the Risk Manager or the City Manager. Contractor
will obtain occurrence coverage, excluding Professional Liability, which will be written as claims-
made coverage. The insurance will be in force during the life of this Agreement and will not be
canceled without thirty (30) days prior written notice to the City by certified mail. City will be named
as an additional insured on General Liability which shall provide primary coverage to the City. The
full limits available to the named insured shall also be available and applicable to the City as an
additional insured. Contractor will furnish certificates of insurance to the Contract Department,
with endorsements to City prior to City’s execution of this Agreement.
7. 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 Bridget Desmarais Name Ahmed Ismail
Title Management Analyst Title Co-owner/Operator
Department Administrative Services Address 18543 Caminito Pasadero Unit 379
City of Carlsbad San Diego, CA 92128
Address 1635 Faraday Avenue Phone No. 858-380-8696
Carlsbad, CA 92008 Email info@sdbetterchoice.com
Phone No. 442-339-2413
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.
8. 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 as required in the City of Carlsbad Conflict of Interest Code.
Yes No
If yes, list the contact information below for all individuals required to file:
Name Email Phone Number
DocuSign Envelope ID: BE7D281F-8072-4CCC-A6EB-08CF59D72580DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
□ QI
City Attorney Approved Version 4/24/2023
3
9. COMPLIANCE WITH LAWS
Contractor will comply with all applicable local, state and federal laws and regulations prohibiting
discrimination and harassment and will obtain and maintain a City of Carlsbad Business License
for the term of this Agreement.
10. TERMINATION
City or Contractor may terminate this Agreement at any time after a discussion, and written notice
to the other party. City will pay Contractor's costs for services delivered up to the time of
termination, if the services have been delivered in accordance with the Agreement.
11. CLAIMS AND LAWSUITS
By signing this Agreement, Contractor agrees it may be subject to civil penalties for the filing of
false claims as set forth in the California False Claims Act, Government Code sections 12650, et
seq., and Carlsbad Municipal Code Sections 3.32.025, et seq. Contractor further acknowledges
that debarment by another jurisdiction is grounds for the City of Carlsbad to terminate this
Agreement.
12. JURISDICTIONS AND VENUE
Contractor agrees and stipulates that the proper venue and jurisdiction for resolution of any disputes
between the parties arising out of this Agreement is the State Superior Court, San Diego County,
California.
13. ASSIGNMENT
Contractor may assign neither this Agreement nor any part of it, nor any monies due or to become
due under it, without the prior written consent of City.
14. AMENDMENTS
This Agreement may be amended by mutual consent of City and Contractor. Any amendment will
be in writing, signed by both parties, with a statement of estimated changes in charges or time
schedule.
///
///
///
///
///
///
///
///
///
///
DocuSign Envelope ID: BE7D281F-8072-4CCC-A6EB-08CF59D72580DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
City Attorney Approved Version 4/24/2023
4
15. 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:
(sign here) Scott Chadwick, City Manager
Ahmed Ismail, Operating Manager
(print name/title)
ATTEST:
By:
(sign here) SHERRY FREISINGER
Eric Visselli, Operating Manager City Clerk
(print name/title)
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
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 City Attorney
DocuSign Envelope ID: BE7D281F-8072-4CCC-A6EB-08CF59D72580DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
City Attorney Approved Version 4/24/2023
5
EXHIBIT “A”
SCOPE OF SERVICES
The Contractor will set sale prices to cover all costs related to providing this service, including
but not limited to licensing required for the performance of the contract. No costs will be borne
by the City.
The Contractor will furnish, install, maintain, supply and remove, as needed, various vending
machines in designated locations of the City for the term of the agreement.
Vending Machine Locations and Quantity
a. The Contractor will install, as noted below, vending machines which must not be more than
three (3) years old and must be fully reconditioned. The City has the right to determine at any
time during the period of this agreement that any of the vending machines are no longer
required. Machines that are no longer required will be removed by the Contractor at the
Contractor’s expense.
b. Contractor will maintain the specific numbers and types of machines to be installed in the
respective locations requested by the City.
c. The Contractor will always, at its expense, maintain the vending machines, including any
meters, electronic monitoring systems, electronic sales equipment, and special attachments,
in proper working order and promptly make all necessary repairs and replacements of parts.
d. Contractor will maintain the vending machines, material handling equipment and service
vehicles in a clean, attractive and sanitary condition to the satisfaction of the City.
e. The Contractor will bear the full responsibility for all risk of loss to their equipment, and
money or product loss resulting from vandalism or theft and will not penalize the City for any
losses incurred. The City will cooperate with Contractor in devising a mutually agreeable
arrangement in the event problems arise regarding the security of machines, vending
products, or receipts. Any malfunctioning machine will be repaired or replaced within three (3)
business days of notification.
f. Any damage to existing utilities, equipment, or finished surfaces resulting from the
performance of this contract will be repaired to the City’s satisfaction at the Contractor’s
expense.
Vending machine locations
Utilities Department
Carlsbad City Library
City Administrative Offices
Streets Department
Calavera Hills Community Center
Stagecoach Community Center
Pine Avenue Community Center
Alga Norte Aquatics Complex
Monroe Street Pool
Future vending machine location(s)
Veterans Memorial Park – anticipated online date of late summer 2025
DocuSign Envelope ID: BE7D281F-8072-4CCC-A6EB-08CF59D72580DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
City Attorney Approved Version 4/24/2023
6
Energy Efficient Requirements
a. Contractor must adhere to the regulations and prohibitions as detailed by the 17 CCR §§
95374(a) and 95375(a).
b. Contractor will offer new Energy Star machines with a low-power mode option that allows the
machine to be placed in low-energy lighting and/or low-energy refrigeration states during
times of inactivity.
c. All vending machines furnished will be equipped to provide thermal overload protection. In
addition, all machines should be equipped with all necessary safety devices which should be
always maintained in operating condition.
Service
a. Vending machines will be serviced often enough to prevent “out of stock” items.
b. Vending machines will be kept clean at all times.
c. Product will be rotated to ensure freshness.
d. Contractor must provide the location(s) or business where stocking/re-stocking will be based
and schedule of proposed servicing.
Names and phone numbers of servicing contacts:
• Eric Visselli: 760-670-8165
• Hugh Martin: 760-390-4160
• Amy Martin: 619-315-1703
• Ahmed Ismail: 858-380-8696
Locations and servicing schedule
• 3317 Dorado Pl, Carlsbad, CA 92023 (Primary Location)
• 2484 Starlight Glen, Escondido, CA, 92026 (Secondary Location)
• 18543 Caminito Pasadero, San Diego, 92128 (Tertiary Location)
The servicing schedule is subject to change based on volume of sales at each location and
our product level guarantees. Each machine will be serviced at a minimum of once per week
and more as inventory levels require.
Refunds
a. Contractor will provide a written refund policy including a timeline for refunds to be issued
(not to exceed 10 calendar days). Each vending machine will have contact information for
refund on damaged goods or when customers do not receive product for their money due to
a malfunction of the machine.
b. Contractor will ensure machines are marked with refund procedures and ensure refunds are
handled expeditiously. A 24-hour message line will be affixed to each machine in a visible
place. Contractor will respond to refund and/or service calls within one (1) working day to the
person(s) who have left a message. The refund procedure is to read as follows:
“For refund or service, call [insert 24-hour telephone/message center number]”.
c. City reserves the right to terminate the contract if Contractor does not respond to service calls
for inoperative machines within 48 hours, machines are not maintained and kept in working
order, and malfunctioning machines are not replaced or repaired within three (3) business
days.
DocuSign Envelope ID: BE7D281F-8072-4CCC-A6EB-08CF59D72580DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
City Attorney Approved Version 4/24/2023
7
Products
Contractor will provide procedures of assuring the freshness of products that are for sale in the
vending machine(s).
a. Contractor will ensure that no out-of-date product(s) remain in machines. Expiration dates
should be on each of the products offered for sale in the vending machine and should
clearly show the month and the year of expiration.
b. City has “automatic” product protection recourse against suppliers for product safety.
According to federal regulations, the supplier whose name and address appear on the
package is the responsible party. Contractor is expected to take immediate action to correct
any situation in which product integrity is violated.
c. All food and beverage products must be delivered and placed in machines in their original
wrappers or in a sanitized bulk dispenser that fits on the machine as a unit.
d. Snack food items offered in each vending machine will meet the following criteria for each
individual package:
1. No gum to be sold in public vending machines.
2. Healthy alternatives should be provided.
Sustainability Requirements
a. Contractor must adhere to the regulations and prohibitions as detailed by Chapters 6.20 &
6.22 of the Carlsbad Municipal Code.
b. Contractor will ensure that all beverage products that are one liter or less in size are not
made of plastic.
1. Plastic bottled beverages one liter or less in size will not be sold or dispensed in the
vending machines.
c. Contractor will ensure that all snack and beverage products do not contain single-use
plastics (ex. plastic straws) or polystyrene (Styrofoam) material.
Product List and Pricing
a. Contractor will provide to City’s Management Analyst, Administrative Services Branch, retail
price lists for the products that will be sold in the vending machines.
b. Pricing must be consistent across public facing vending machines. Any increase in pricing
request will be sent to City’s Management Analyst, Administrative Services Branch, one time
annually (January) and be subject to approval by City prior to the increase being published.
Taxes
a. Contractor is responsible for all federal, state, and local taxes and other charges related to the
performance of this contract.
Commission
a. City will require a minimum 15% commission of sales per vending machine. Note: The
commission must be without deduction of gross receipts or tax imposed by any federal, state,
municipal or governmental authority directly on sales and collected from customers. No
franchise or capital stock tax and no income or similar tax based upon income or profits as
such may be deducted from gross receipts.
Equipment
a. Machines will be installed, stocked, and ready for operation within 30 days of contract
execution.
b. All machines installed outdoors shall be approved by the manufacturer for outdoor use and
include features such as 1) triple pane glass; 2) anti-vandalism protection; and 3) water-
resistant electrical equipment.
DocuSign Envelope ID: BE7D281F-8072-4CCC-A6EB-08CF59D72580DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
City Attorney Approved Version 4/24/2023
8
c. Upon expiration or termination of the contract, Contractor will remove all machines within ten
(10) business days of notification.
d. All food vending machines must comply with all federal, state, county and City codes.
e. Vending machines must have non-resettable cash accounting meters, bill validators, large
bill changers and credit card readers. All equipment must be UL rated and equipped with
Contractor-furnished “Vending Miser” units or energy efficiency equivalent technology.
f. The Contractor shall provide vending machines that are able to accept coin, dollar bills and
the capability of accepting debit/credit cards. Contractor would need to set-up a secure
reader and transaction capabilities that is PCI compliant for debit/credit card transactions at
their machines. The City will not be able to provide any network access and as a result, any
new utility services required for debit/credit card transactions would need to be pre-
approved by City staff and implemented at Contractor’s expense. Ability for machine to
accept U.S. currency and receive change is required.
Placement of Vending Machines
a. Vending machines will not in any way obstruct or otherwise interfere with emergency exits or
access areas as determined by the Fire Marshall.
b. Vending machines must be securely fastened to the wall, floor or other structure, or
otherwise secured in such a way as to prevent it from being rocked, bounced or tipped.
Placement of vending machines will not obstruct the flow of foot traffic and will comply with
ADA requirements as set forth through federal, state, and local guidelines.
c. Failure to comply with these provisions may result in removal or disablement of the vending
machine at Contractor’s expense.
Facility Requirements
a. General Facility Requirements: No modification to building structure, electrical systems,
plumbing, and any other part of the physical plant of any City building may be performed
without prior approval from the designated City staff. All authorized modifications will be at the
expense of the vending machine owner, unless otherwise agreed upon by the City.
b. Plumbing: For machines that require an external water source, connections must be made
from a City portable water supply. In the event this is not possible, Contractor will be
responsible for establishment of an alternative source with prior approval from the City.
Plumbing installation, when needed, will include valves and backflow prevention devices that
comply with State and local code requirements. Fixtures and other installations are expected
to appear neat and professional.
c. Electrical: All vending machines utilizing electrical power will be grounded with an approved
three-wire cord and plug. All machines vending perishable foods have a lock on the power
cord plug to prevent accidental or intentional disconnection.
d. Vending machines must be properly wired and grounded to prevent electrical shock and
must comply with applicable federal, state, and local codes and standards. The vending
machine owner is responsible for installation of electrical circuits when there are no existing
circuits available or if existing circuits are inadequate.
Food and Beverage Operations
a. The areas surrounding all machines are to be kept clean and proper waste and recycling
receptacles will be provided in the immediate area.
b. All food vending machines must comply with all applicable Health and Safety Codes.
Machines not complying with the above criteria must be removed from service.
c. Vending machines should be well stocked with no more than 10% of the shelves being
empty of product for more than five (5) calendar days.
DocuSign Envelope ID: BE7D281F-8072-4CCC-A6EB-08CF59D72580DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
City Attorney Approved Version 4/24/2023
9
Reporting
a. Usage, product and monetary reporting is required. Commissions remitted shall be based
on monthly gross sales and accompanied by an accounting report by machine and location.
The report must include sales data for each vending machine.
b. Reports will be generated and provided quarterly to the City. The Contractor is responsible
for gathering information for all commission reports. Reports must be submitted with all
payments to ensure proper crediting of all commissions. The City must receive the payment
and report by the tenth day of the month for the preceding quarter.
c. Payments and required reports must be submitted and received on time. Any payment (or
portion thereof) of that quarter’s payment not paid within five (5) calendar days from the due
date, a late payment charge equal to five percent (5%) of such past payment will be
assessed and shall be immediately payable.
d. All commission checks are to be made payable to the City of Carlsbad and forwarded with
three (3) copies of the gross receipts and commission reports. Payment must be received
by the 10th day of the month for the preceding quarter.
e. Reports will be submitted to and payments made via check are to:
City of Carlsbad
ATTN: Revenue Manager
Finance Department
1635 Faraday Ave
Carlsbad, CA 92008
DocuSign Envelope ID: BE7D281F-8072-4CCC-A6EB-08CF59D72580DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
CERTIFICATE OF EXEMPTION
WORKERS’ COMPENSATION/EMPLOYERS’ LIABILITY INSURANCE
I, , am the
[insert name] [title]
of . 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. Should employ any person during the term
[name of company]
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]
[Title and name of company or corporation]
06/15/2006 25
Better Choice VendingBetter Choice Vending
Vending Machine Services
Better Choice Vending
DocuSign Envelope ID: BE7D281F-8072-4CCC-A6EB-08CF59D72580
Co-owner/operator
Co-owner/OperatorAhmed Ismail
DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
Renewal Page 7 of 51
Continued on Back
DEC_PAGE (03-14) (Page 1 of 4)
Declarations Page
This is a description of your coverage.
Please retain for your records.
OLGA Y BRESHEVA AND AHMED Y
ISMAIL
18543 CAMINITO PASADERO
UNIT 379
SAN DIEGO CA 92128-1074
Email Address: olgabresheva7@gmail.com
Date Issued: April 13, 2023
GEICO General Insurance Company
P.O. Box 509090
San Diego, CA 92150-9090
Tel: 1-800-841-3000
Policy Number:4390-82-47-22
Coverage Period:
05-17-23 through 11-17-23
12:01 a.m.standardtime at the address of the named
insured.
Named Insured
Olga Yuryevna Bresheva
Ahmed Yousryaly Ismail
Additional Drivers
None
Vehicles VIN Vehicle Location Finance Company/
Lienholder
1 2009 Toyota Camry 4T1BB46K49U075840 SAN DIEGO CA 92128-1074
2 2020 Honda CR-V 2HKRW1H81LH428477 SAN DIEGO CA 92128-1074 HONDA LEASE TRUST
Coverages*Limits and/or Deductibles Vehicle 1 Vehicle 2
Bodily Injury Liability
Each Person/Each Occurrence
State Minimum $15,000/$30,000 $300,000/$500,000 $117.40 $101.00
Property Damage Liability
State Minimum $5,000 $100,000 $85.40 $68.80
Medical Payments $1,000 $4.90 $4.50
Uninsured & Underinsured Motorists
Each Person/Each Occurrence $300,000/$300,000 $66.40 $58.60
Uninsured Motorists Property Damage $3,500 $3.30 -
Comprehensive (Excluding Collision)$500 Ded - $21.60
Collision $1,000 Ded - $116.40
Emergency Road Service Full - $6.50
DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
GEICDu
ga1co.,co'm
Renewal Page 8 of 51
Continued on Next Page
DEC_PAGE (03-14)(Page 2 of 4)
Coverages*Limits and/or Deductibles Vehicle 1 Vehicle 2
Rental Reimbursement $50 Per Day
$1,500 Max -$29.60
Mechanical Breakdown $250 Ded -$32.20
Six Month Premium Per Vehicle $277.40 $439.20
Total Six Month Premium $716.60
*Coverage applies where a premium or $0.00 is shown for a vehicle.
If you elect to pay your premium in installments, you may be subject to an additional fee for each installment. The fee
amount will be shown on your billing statements and is subject to change.
Discounts
California Persistency (All Vehicles)
Passive Restraint/Air Bag (All Vehicles)
California Good Driver (All Vehicles)
Subclass Factor (All Vehicles)
Multi-Car (All Vehicles)
Anti-Theft Device (Veh 2)
Group Insurance Plan:
Professional Group Insurance Plan
Contract Type:A30CA
Contract Amendments:ALL VEHICLES - A30CA A54CA
Unit Endorsements:UE30(VEH 2); UE316C(VEH 2); A426(VEH 1); A115(VEH 2); A431(VEH 2); A180(VEH 2)
Class:A -M -14MM - W (VEH 1);A -L -14MF - T (VEH 2)
Important Policy Information
-You have elected to receive your insurance documents via electronic delivery at the electronic mail address
displayed on this Declarations Page. To change the address where you receive your policy documents, visit
geico.com or call 1-800-841-3000.
-No coverage is provided in Mexico.
DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
Renewal Page 9 of 51
DEC_PAGE (03-14) (Page 3 of 4)
Important Policy Information
- Reminder - Physical damage coverage will not cover loss for custom options on an owned automobile, including
equipment, furnishings or finishings including paint, if the existence of those options has not been previously reported
to us. This reminder does NOT apply in VIRGINIA, however, in Virginia coverage is limited for custom furnishings or
equipment on pick-up trucks and vans but you may purchase coverage for this equipment. Please call us at
1-800-841-3000 or visit us at geico.com if you have any questions.
- Congratulations! Your policy qualifies for the Professional Group Insurance Plan and includes a savings of $158.30.
- As your vehicle ages, the Multi-Risk Coverage you carry becomes nearly impossible to replace. Renew your policy
today and enjoy continuous coverage against costly mechanical breakdowns.
- For your protection, California law requires the following to appear on this form: ''Any person who knowingly presents
false or fraudulent information to obtain or amend insurance coverage or to make a claim for the payment of a loss is
guilty of a crime and may be subject to fines and confinement in state prison.''
- Confirmation of coverage has been sent to your lienholder and/or additional insured.
- In California, you have the right to designate one person to receive notices from GEICO if your policy is about to
cancel or expire for non-payment. Your designee will not have any rights or benefits under your policy other than the
right to receive the notice or make a payment. You can change or remove the designee at any time. If you would like
to add, change or remove a designee from your policy, simply log into your account at geico.com or call us at
1-800-841-3000.
- Claims incurred while an insured vehicle is being used to carry passengers for hire may not be covered by this
contract. Please review the contract for a full list of exclusions and contact us if you plan to use any of your insured
vehicles for this purpose.
- The mailing address on your policy was updated.
- Please verify that the coverages you requested are accurately reflected on your Declarations Page. Visit geico.com to
review additional coverages and/or limits available to you.
- In accordance with Section 1872.87 of the California Insurance Code, in addition to your premium, a $0.88 charge per
vehicle is assessed to fund auto insurance fraud reduction initiatives. This charge is applied once per policy term per
vehicle.
-The estimated annual mileage figures applicable to the vehicles on your policy for the current and upcoming
policy periods are:
Vehicle Current Mileage Upcoming Mileage
2009 Toyota Camry 15,000 15,000
2020 Honda CR-V 12,000 12,000
DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
Renewal Page 10 of 51
DEC_PAGE (03-14)(Page 4 of 4)
DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
U-176 CA 03/2023 Page 1 of 4
Amended Auto Policy Declarations
To report a claim please call (800) 503-3724
PADECL01##Insured##IN-229450174##C295A4D08FA34321B8EFD4D2797D3DF0##1
Policy Period Policy Number
From:10/29/2023 12:01 AM
To:04/29/2024 12:01 AM
CAAP0000640901
Standard time at the address of the Named Insured
Agent Company
SGL INSURANCE SERVICES (04C462)
250 S PACIFIC ST STE 104
SAN MARCOS, CA 92078
(760) 290-3288
Mercury Insurance Company
P.O. BOX 10730
SANTA ANA, CA 92711-0730
Named Insured
ERIC R VISSELLI
2484 STARLIGHT GLN
ESCONDIDO, CA 92026-3859
(760) 670-8165
EVISSELLI@YAHOO.COM
Important Information Date Sent: 10/31/2023
Policy change(s) effective 10/29/2023
Reason:Add Vehicle(s), Delete Vehicle(s), Change Driver Information, Update Driving Activity
This policy change has resulted in an additional premium of $521.88.
This Declaration supersedes any previous Declaration bearing the same policy number for this policy period.
This Declaration provides only a summary of coverage. All coverage is subject to the terms, conditions, and exclusions of
the policy contract.
Discounts
2018 ALFA ROMEO GIULIA TI #74718 - Good Driver, Group Discount, Multi-Car, Multi-Policy
2019 TOYOTA TACOMA DBCBSR5/T #96702 - Exceptional Driver, Good Driver, Group Discount, Multi-Car, Multi-Policy
2019 HONDA CIVIC SPORT #23006 - Group Discount, Multi-Car, Multi-Policy
2022 LEXUS NX 350H #04078 - Good Driver, Group Discount, Multi-Car, Multi-Policy
2017 MAZDA MAZDA3 TOURING #16434 - Group Discount, Multi-Car, Multi-Policy
Listed Drivers
ERIC R VISSELLI - Years License Experience: 40
TRACI VISSELLI - Years License Experience: 38
KYLE R VISSELLI - Years License Experience: 7
ALEX VISSELLI - Years License Experience: 1
Excluded Drivers
None
The Designated Excluded Drivers – Coverage Exclusion is applicable to all coverages, including but not limited to, liability
and uninsured motorists, provided now or later.It is agreed that the insurance afforded by this policy shall not apply nor
accrue to the benefit of any insured or any third-party claimant when any motor vehicle is being used or operated by an
Excluded Driver designated above, regardless of where the person resides or whether the person is licensed to drive.
Please refer to the terms of your auto policy.
Additional Household Members
DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
A MERCURY ~~ INSURANCE
U-176 CA 03/2023 Page 2 of 4
None
Vehicles and Coverage Limits
2018 ALFA ROMEO GIULIA TI SED 4DR, VIN:ZARFAECN7J7574718
Garaging Address:2484 Starlight Gln, Escondido, CA,92026-3859
Primary Use of the Vehicle:Commuting
Annual Mileage:12,000
Mileage Program:Estimated
Loss Payee/Additional Interest SAN DIEGO COUNTY CREDIT UNION, PO BOX 58590,SEATTLE,WA,98138
Coverages Limits Premium
Bodily Injury Liability
Property Damage Liability
$250,000 each Person/$500,000 each Accident
$100,000 each Accident
$281.00
Uninsured/Underinsured Motorist Bodily
Injury
$250,000 each Person/$500,000 each Accident $62.00
Uninsured Motorist Property
Damage/Collision Deductible Waiver
Collision Deductible Waiver Applies $3.00
Comprehensive Actual Cash Value Less $1,000 Deductible $60.00
Collision Actual Cash Value Less $1,000 Deductible $238.00
Rental $40 each Day/Maximum 30 Days $25.00
Non-Factory Equipment $1,000 Included
Total Premium for 2018 ALFA ROMEO GIULIA TI SED 4DR $669.00
2019 TOYOTA TACOMA DBCBSR5/T PKP 4X2 4D, VIN:3TMAZ5CN6KM096702
Garaging Address:2484 Starlight Gln, Escondido, CA,92026-3859
Primary Use of the Vehicle:Commuting
Annual Mileage:10,298
Mileage Program:Estimated
Loss Payee/Additional Interest SAN DIEGO COUNTRY CREDIT UNION,790 W SAN MARCOS BLVD,SAN
MARCOS,CA,92078
Coverages Limits Premium
Bodily Injury Liability
Property Damage Liability
$250,000 each Person/$500,000 each Accident
$100,000 each Accident
$520.00
Uninsured/Underinsured Motorist Bodily
Injury
$250,000 each Person/$500,000 each Accident $74.00
Uninsured Motorist Property
Damage/Collision Deductible Waiver
Collision Deductible Waiver Applies $3.00
Comprehensive Actual Cash Value Less $1,000 Deductible $54.00
Collision Actual Cash Value Less $1,000 Deductible $378.00
Rental $40 each Day/Maximum 30 Days $23.00
Non-Factory Equipment $1,000 Included
Total Premium for 2019 TOYOTA TACOMA DBCBSR5/T PKP 4X2 4D $1,052.00
2019 HONDA CIVIC SPORT HCHBK 4DR, VIN:SHHFK7H40KU423006
Garaging Address:2484 Starlight Gln, Escondido, CA,92026-3859
Primary Use of the Vehicle:Pleasure
Annual Mileage:12,000
Mileage Program:Estimated
Loss Payee/Additional Interest HONDA FINANCIAL SERVICES, PO BOX 997515,SACRAMENTO,CA,95899
Coverages Limits Premium
Bodily Injury Liability
Property Damage Liability
$250,000 each Person/$500,000 each Accident
$100,000 each Accident
$830.00
DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
U-176 CA 03/2023 Page 3 of 4
Uninsured/Underinsured Motorist Bodily
Injury
$250,000 each Person/$500,000 each Accident $156.00
Uninsured Motorist Property
Damage/Collision Deductible Waiver
Collision Deductible Waiver Applies $5.00
Comprehensive Actual Cash Value Less $1,000 Deductible $56.00
Collision Actual Cash Value Less $1,000 Deductible $680.00
Rental $40 each Day/Maximum 30 Days $32.00
Non-Factory Equipment $1,000 Included
Total Premium for 2019 HONDA CIVIC SPORT HCHBK 4DR $1,759.00
2022 LEXUS NX 350H UTL 4DR, VIN:JTJGKCEZXN5004078
Garaging Address:2484 Starlight Gln, Escondido, CA,92026-3859
Primary Use of the Vehicle:Pleasure
Annual Mileage:15,000
Mileage Program:Estimated
Loss Payee Lexus Financial Service, PO Box 22171,Tempe,AZ,85285
Coverages Limits Premium
Bodily Injury Liability
Property Damage Liability
$250,000 each Person/$500,000 each Accident
$100,000 each Accident
$379.00
Uninsured/Underinsured Motorist Bodily
Injury
$250,000 each Person/$500,000 each Accident $68.00
Uninsured Motorist Property
Damage/Collision Deductible Waiver
Collision Deductible Waiver Applies $3.00
Comprehensive Actual Cash Value Less $1,000 Deductible $65.00
Collision Actual Cash Value Less $1,000 Deductible $378.00
Rental $40 each Day/Maximum 30 Days $25.00
Non-Factory Equipment $1,000 Included
Total Premium for 2022 LEXUS NX 350H UTL 4DR $918.00
2017 MAZDA MAZDA3 TOURING HCHBK 4DR, VIN:JM1BN1L33H1116434
Garaging Address:2484 Starlight Gln, Escondido, CA,92026-3859
Primary Use of the Vehicle:Commuting
Annual Mileage:15,000
Mileage Program:Estimated
Coverages Limits Premium
Bodily Injury Liability
Property Damage Liability
$250,000 each Person/$500,000 each Accident
$100,000 each Accident
$261.00
Uninsured/Underinsured Motorist Bodily
Injury
$250,000 each Person/$500,000 each Accident $62.00
Uninsured Motorist Property
Damage/Collision Deductible Waiver
Collision Deductible Waiver Applies $5.00
Comprehensive Actual Cash Value Less $1,000 Deductible $45.00
Collision Actual Cash Value Less $1,000 Deductible $228.00
Rental $40 each Day/Maximum 30 Days $32.00
Non-Factory Equipment $1,000 Included
Total Premium for 2017 MAZDA MAZDA3 TOURING HCHBK 4DR $633.00
Subtotal Policy Premium (All Vehicles)$5,031.00
Fraud Fee $4.40
Total 6 Month Policy Premium (All Vehicles)$5,035.40
DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
U-176 CA 03/2023 Page 4 of 4
Policy Contract and Endorsements
Your insurance policy and any endorsement(s)contain a full explanation of your coverage.The policy contract is form U-10 MIC
California Auto Policy (03/2023). The contract is modified by endorsement(s):
DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
H M <marleydog.ent@gmail.com>
Auto Insurance Confirmation
1 message
USAA <USAA.Customer.Service@mailcenter.usaa.com>Mon, Oct 30, 2023 at 3:23 PM
Reply-To: USAA <USAA.Customer.Service@mailcenter.usaa.com>
To: marleydog.ent@gmail.com
To ensure delivery to your inbox, please add USAA.Customer.Service@mailcenter.usaa.com to your address book.
Auto Insurance Confirmation
Please use this as confirmation of auto insurance; however, this doesn’t take the place of an insurance
identification card.
Registered owner:HUGH JAMES MARTIN
Address:3317 DORADO PL
CARLSBAD CA 92009
Policy number:GAR 025204881 7101
Policy effective date:June 14, 2023
Policy expiration date:December 14, 2023
Vehicle:2012 HONDA PILOT 4D EXL
VIN:5FNYF3H55CB042737
Bodily injury liability limit:$300,000
each person /
$500,000 each accident
DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
Gmail
Property damage liability limit:$100,000 each accident
Comprehensive deductible:$500
Collision deductible:$500
Lienholder:MISSION FEDERAL CREDIT UNION
294 N EL CAMINO REAL
ENCINITAS
CA 92024 2866
Meets California minimum statutory liability requirements
This confirmation of coverage neither affirmatively nor negatively amends, extends or alters the coverage given
by the policy issued by Garrison Property and Casualty Insurance Company.
How to Contact Us
Thank you for choosing us for your auto insurance needs. If you have any questions, please contact us using
one of the following options:
Phone:210-531-USAA (8722), our mobile shortcut #8722 or 800‑531‑8722
Fax:800-531-8877
Thank you,
Garrison Property and Casualty Insurance Company
Garrison Property and Casualty Insurance Company, a subsidiary of USAA Casualty Insurance Company, is authorized to
use the USAA logo, a registered trademark of United Services Automobile Association.
Go Digital
Review and edit your online document preferences at usaa.com.
DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
□ GO MOBILE
apps & more
Please do not reply to this e-mail.
To contact USAA, visit our secure contact page.
Privacy Promise
Garrison Property and Casualty Insurance Company, 9800 Fredericksburg Road, San Antonio, Texas 78288
93127-0111
DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
--USAA®
H M <marleydog.ent@gmail.com>
Auto Insurance Confirmation
1 message
USAA <USAA.Customer.Service@mailcenter.usaa.com>Mon, Oct 30, 2023 at 3:23 PM
Reply-To: USAA <USAA.Customer.Service@mailcenter.usaa.com>
To: marleydog.ent@gmail.com
To ensure delivery to your inbox, please add USAA.Customer.Service@mailcenter.usaa.com to your address book.
Auto Insurance Confirmation
Please use this as confirmation of auto insurance; however, this doesn’t take the place of an insurance
identification card.
Registered owner:HUGH JAMES MARTIN
AMY B MARTIN
Address:3317 DORADO PL
CARLSBAD CA 92009
Policy number:GAR 025204881 7101
Policy effective date:June 14, 2023
Policy expiration date:December 14, 2023
Vehicle:2014 VOLKS JETTA SW TDI
VIN:3VWPL7AJ3EM600258
Bodily injury liability limit:$300,000
each person /
DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
Gmail
$500,000 each accident
Property damage liability limit:$100,000 each accident
Comprehensive deductible:$500
Collision deductible:$500
Meets California minimum statutory liability requirements
This confirmation of coverage neither affirmatively nor negatively amends, extends or alters the coverage given
by the policy issued by Garrison Property and Casualty Insurance Company.
How to Contact Us
Thank you for choosing us for your auto insurance needs. If you have any questions, please contact us using
one of the following options:
Phone:210-531-USAA (8722), our mobile shortcut #8722 or 800‑531‑8722
Fax:800-531-8877
Thank you,
Garrison Property and Casualty Insurance Company
Garrison Property and Casualty Insurance Company, a subsidiary of USAA Casualty Insurance Company, is authorized to
use the USAA logo, a registered trademark of United Services Automobile Association.
Go Digital
Review and edit your online document preferences at usaa.com.
Please do not reply to this e-mail.
To contact USAA, visit our secure contact page.
Privacy Promise
Garrison Property and Casualty Insurance Company, 9800 Fredericksburg Road, San Antonio, Texas 78288
DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059
□ GO MOBILE
apps & more
_,_
USAA®
93127-0111 DocuSign Envelope ID: 4452B891-395C-460B-8E40-E4C3B0796059