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HomeMy WebLinkAboutMarin Consulting Associates; 2024-10-22;City Attorney Approved Version 6/5/2024 Page 1 AGREEMENT FOR ON-SITE LAW ENFORCEMENT TRAINING SERVICES MARIN CONSULTING ASSOCIATES, INC. 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 Marin Consulting Associates, a California corporation ("Contractor”). RECITALS City requires the professional services of a consultant that is experienced in law enforcement training. 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. 3. COMPENSATION The total fee payable for the Services to be performed during the initial Agreement term shall not exceed ten thousand dollars ($10,000.00). No other compensation for the Services will be allowed except for items covered by subsequent amendments to this Agreement. City reserves the right to withhold a ten percent (10%) retention until City has accepted the work and/or the Services specified in Exhibit “A.” 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 (with counsel approved by the City), indemnify, and hold harmless the City and its officers, elected and appointed 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 willful misconduct or negligent act or omission 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. If Contractor’s obligation to defend, indemnify, and/or hold harmless arises out of Contractor’s performance as a “design professional” (as that term is defined under Civil Code section 2782.8), then, and only to the extent required by Civil Code Section 2782.8, which is fully incorporated herein, Contractor’s indemnification obligation shall be limited to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Contractor, and, upon Contractor obtaining a Docusign Envelope ID: 633C834F-F68B-4F76-99FA-9E98EA0F5185 22nd 24October City Attorney Approved Version 6/5/2024 Page 2 final adjudication by a court of competent jurisdiction. Contractor’s liability for such claim, including the cost to defend, shall not exceed the Contractor’s proportionate percentage of fault. 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. 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 Heather Hutchinson Name Larry Ellsworth Title Training Coordinator Title Owner and Director Department Police Address P.O. Box 1761 City of Carlsbad Rocklin, CA 95677 Address 2560 Orion Way Phone No. 916-755-1486 Carlsbad, CA 92010 Email marinconsultingassociates@gmail. com Phone No. 442-339-2181 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. Docusign Envelope ID: 633C834F-F68B-4F76-99FA-9E98EA0F5185 City Attorney Approved Version 6/5/2024 Page 3 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 9. COMPLIANCE WITH LAWS Contractor will comply with all applicable local, state and federal laws and regulations prohibiting discrimination and harassment. 10. CALIFORNIA AIR RESOURCES BOARD (CARB) ADVANCED CLEAN FLEETS REGULATIONS Contractor’s vehicles with a gross vehicle weight rating greater than 8,500 lbs. and light-duty package delivery vehicles operated in California may be subject to the California Air Resources Board (CARB) Advanced Clean Fleets regulations. Such vehicles may therefore be subject to requirements to reduce emissions of air pollutants. For more information, please visit the CARB Advanced Clean Fleets webpage at https://ww2.arb.ca.gov/our-work/programs/advanced-clean-fleets. 11. 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. 12. 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. 13. JURISDICTIONS AND VENUE This Agreement shall be interpreted in accordance with the laws of the State of California. 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. 14. 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. Docusign Envelope ID: 633C834F-F68B-4F76-99FA-9E98EA0F5185 Docusign Envelope ID: 633C834F-F68B-4F76-99FA-9E98EA0F5185 15. THIRD PARTY RIGHTS Nothing in this Agreement should be construed to give any rights or benefits to any party other than the City and Contractor. 16. 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. 17. ENTIRE AGREEMENT This Agreement, together with any other written document referred to or contemplated by it, along with the purchase order for this Agreement and its provisions, embody the entire Agreement and understanding between the parties relating to the subject matter of it. In case of conflict, the terms of the Agreement supersede the purchase order. Neither this Agreement nor any of its provisions may be amended, modified, waived or discharged except in a writing signed by both parties. This Agreement may be executed in counterparts. 18. 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 Marin Consulting Associates, a California corporation By: Larry Ellsworth, Owner and Director/ p,e,,,·J&tiT (print name/title) By: CITY OF CARLSBAD, a municipal corporation of the State of California By: Police Chief ATTEST: SHERRY FREISINGER, City Clerk By: tt I }WO r=fh C Fo /1,:ect,/tr • Deputy City Clerk (print name/title) If required by City, proper notarial acknowledgment of execution by contractor must be attached. !LA corporation, Agreement must be signed by one corporate officer from each of the following two groups: Group A. Group B. City Attorney Approved Ver5ion 6/5/2024 Page4 City Attorney Approved Version 6/5/2024 Page 5 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: _____________________________ Assistant City Attorney Docusign Envelope ID: 633C834F-F68B-4F76-99FA-9E98EA0F5185 City Attorney Approved Version 6/5/2024 Page 6 EXHIBIT A SCOPE OF SERVICES AND FEE On-site training will be held at the Safety Training Center, 5750 Orion Street Carlsbad, CA 92010. The below training courses are provided by Marin Consulting Associates Inc. Course Description Cost per Student Assertive Supervision California POST and STC certified training for sworn and civilian supervisors and aspiring supervisors in law enforcement and corrections. This 24 hour workshop delivers the technical training and helps develop the interpersonal skills necessary to effectively deal with poor performing and difficult employees. $375 Leadership and Accountability A 16 hour California POST certified training workshop for command staff holding the rank of Lieutenant (or equivalent) and above. This workshop examines performance and accountability as a means of shaping the organizational work ethic and challenging organizational culture. $250 Trainings will be booked on an as-needed basis. Training sessions have been scheduled for December 2024 and June 2025. In exchange for being the host agency, Carlsbad Police Department will receive two (2) free seats per training course. Docusign Envelope ID: 633C834F-F68B-4F76-99FA-9E98EA0F5185 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THISCERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED?(Mandatory in NH) DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE $DAMAGE TO RENTED PREMISES COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIREDAUTOS ONLY 10/15/2024 East Main Street Insurance Services, Inc. Will Maddux PO Box 1298 Grass Valley CA 95945 Will Maddux (530) 477-6521 info@theeventhelper.com Marin Consulting Associates, Inc. c/o Larry Ellsworth 4508 Nashua Ct Rocklin CA 95765 Evanston Insurance Company 35378 A Host Liquor Liability Retail Liquor Liability Y N 3DS5475-M3847927 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 Deductible None Certificate holder listed below is named as additional insured per attached MEGL 2217 01 19 for the following dates: 12/02/2024, 12/03/2024, 12/04/2024, 06/02/2025, 06/03/2025, 06/04/2025, 06/05/2025 & 06/06/2025. Attendance: 280, Event Type: Lecture. Carlsbad CA 92010 5750 Orion Way Carlsbad Police Dept Safety Training Ctr (Ea occurrence) SEE BELOWSEE BELOW 12:01 AM 12:01 AM Docusign Envelope ID: 633C834F-F68B-4F76-99FA-9E98EA0F5185 ACORD® I ~ I lX □ [Z] X ~ P9 □ □ ~ ~ ~ ~ ~ ~ ~ ~ H I I I I I □ I COMMERCIAL GENERAL LIABILITY POLICY NUMBER: EVANSTON INSURANCE COMPANY 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 FORM SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): A.Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule of this endorsement, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by the acts or omissions of any insured listed under Paragraph 1. or 2. of Section II – Who Is An Insured: 1.In the performance of your ongoing operations; or 2.In connection with your premises owned by or rented to you. However: 1.The insurance afforded to such additional insured only applies to the extent permitted by law; and 2.If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. MEGL 2217 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 2 Carlsbad Police Dept Safety Training Ctr 5750 Orion Way Carlsbad, CA 92010 3DS5475-M3847927 Docusign Envelope ID: 633C834F-F68B-4F76-99FA-9E98EA0F5185 111 MARKEL® B.With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided 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 under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. All other terms and conditions remain unchanged. MEGL 2217 01 19 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 2 Docusign Envelope ID: 633C834F-F68B-4F76-99FA-9E98EA0F5185 Docusign Envelope ID: 633C834F-F68B-4F76-99FA-9E98EA0F5185 PO Box 2358 Bloomington IL 61702-2358 AT2 014214 0009 A-2CF7 ELLSWORTH, LAWRENCE & JULIA PO BOX 1761 ROCKLIN CA 95677-7761 111lll1l•ll•l11ll1l1 111l111111111111 1111ll1!11l1ll11l1111ll1ll 111 Policy Number: 000 1181-E01-55O Policy Period: November 1, 2024 to May 1, 2025 Vehicle: 2020 FORD F150 Principal Driver: JULIA ELLSWORTH A Notice of insurance information collection practices - personal, family, or household insurance transactions: We may collect customer information from persons other than the indivie:Jual-er indiviauals-applying-for coverage. Such customer information as well as other personal or privileged information subsequently collected may, in certain circumstances, be disclosed to third parties without your authorization as permitted by law. Policy Number: 000 1181-E01-55O Prepared September 10, 2024 1004583 038973 A State Farm· AUTO RENEWAL PREMIUM PAID: $623.00 DO NOT PAY. Your premium is billed through the State Farm Payment Plan State Farm Payment Plan Number: 007 4155202 Your State Farm Agent SCOTT YUILL INS FIN SER INC Office: 916-772-2131 Address: 2160 SUNSET BLVD STE 504 ROCKLIN, CA 95765-4790 If you have a new or different car, have added any dtfl/e,s, or have moved, please contact your agent Thank you for choosing State Farm. You have the right to submit a written request to access, correct, amend, or delete your personal information and the right to receive a response within 30 days of submitting your request. If we deny y.our request, you have the right to file a statement with us containing the information you feel is accurate and fair along with the reasons you disagree with our denial. Instructions on how to file such request and our full privacy notice can be found (continued on next page) Page number 1 of 4 143562 202 01-15-2018 Thanks for being part of our neighborhood. □ You mean a lot to us . If you need anything, cal l State Farm® Agent SCOTT YUILL INS FIN SER INC at 916-772-2131. TP31 Docusign Envelope ID: 633C834F-F68B-4F76-99FA-9E98EA0F5185 www. statef arm. com/customer-care/privacy-security/privacy or contact your State Farm Agent. Location used to determine rate charged-4508 NASHUA CT, ROCKLIN CA 95765. Your policy has the Guaranteed Renewal Endorsement. When you provide a check as payment, you authorize us either to use information from your check to make a VEHICLE INFORMATION A State Farm~ one-time electronic fund transfer from your account or to process the payment as a check transaction. When we use information from your check to make an electronic fund transfer, funds may be withdrawn from your account as soon as the same day we receive your payment, and you will not receive your check back from your financial institution. Review your policy information carefully. If anything is incorrect, or if there are any changes to your vehicle information, please let us know right away. Vehicle Description Vehicle Identification Number (VIN) Who principally drives this vehicle? How is this vehicle normally used? 2020 FORD F150 1FTEW1E42LKE96885 JULIA ELLSWORTH, a married individual, To Work, School or Pleasure. who will have 49 years of driving experience as of November 01, 2024. Other Household Vehicle(s) Your premium may be influenced by other State Farm policies that currently insure the following vehicle(s) in your household: 2016 TOYOTA PRIUS The premium on the expiring policy term was based on 10,600 miles per year. The premium on the renewal policy term was based on 10,600 miles per year. Premium Adjustment Each year, we review our medical payments and personal injury protection coverages claim experience to determine the vehicle safety discount that is applied to each make and DRIVER INFORMATION Assigned Driver(s) The following driver(s) are assigned to the vehicle(s) on this policy. Name LAWRENCE P ELLSWORTH Principal Driver & Assigned Drivers Driving Experience as of November 01, 2024 50 years For each automobile, the Principal Driver is the individual who most frequently drives it. Each driver is designated as an Assigned Driver on the household automobile that they most frequently drive. Your Policy Number: 000 1181-E01-55O Prepared September 10, 2024 model. In addition, we review the comprehensive, collision, bodily injury and property damage claim experience annually to determine which makes and models have earned decreases or increases from State Farm's standard rates. If any changes result from our reviews, adjustments are reflected in the rates shown on this renewal notice. Marital Status Married premium may be influenced by the information shown for these drivers. Page number 2 of 4 Docusign Envelope ID: 633C834F-F68B-4F76-99FA-9E98EA0F5185 CD <( r;; ;! (f) D AStateFarme CO VE RAGE AND LIMITS See your policy for an explanation of these coverages. A Liability Bodily Injury 250,000/500,000 Property Damage 100,000 C Medical Payments 5,000 D Comprehensive G 1000 Deductible Collision R1 Car Rental & Travel Expense $25 Per Day, $600 Max u Uninsured Motor Vehicle Bodily Injury 250,000/500,000 U1 Uninsured Motor Vehicle Property Damage Total Premium If any coverage you carry is changed to give broader protection with no additional premium charge, we will give DISCOUNTS These adjustments have already been applied to your premium. Multiple Line Multicar Vehicle Safety Driving Safety Record California Good Driver Loyalty Total Discounts Other Available Discount(s) You may be eligible for additional discounts See the enclosed insert for more information. Mature Driver SURCHARGES AND DISCOUNTS Driving Safety Record Rating Plan Your driving safety record, along with other rating factors, determines what you pay for Liability, Medical Payments, Comprehensive, Collision, and Uninsured Motor Vehicle Coverages. Policyholders with no accidents and convictions pay less than those with accidents and convictions. The Driving Safety Record Rate Level that is assigned to your policy moves up, down, or stays the same every policy renewal, depending upon your driving record. For every 12 Policy Number: 000 1181-E01-550 Prepared September 10, 2024 038974 $228.14 $9.57 $122.24 $176.17 $21.83 $60.83 $4.22 $623.00 you the broader protection without issuing a new policy, starting on the date we adopt the broader protection. ✓ ✓ ✓ ✓ ✓ ✓ $2,585.86 months since the renewal following the occurrence of a chargeable accident or the conviction of a minor violation, the initial assigned Driver Record Level for that chargeable accident or conviction shall be lowered by 1 level. For each 12 month period since the conviction of a major violation, the initial assigned Driver Record Level for that conviction shall be lowered by 2 levels. The Rate Level is increased if there are subsequent chargeable accidents or convictions. Definition of Chargeable Accidents (continued on next page) Page number 3 of 4 Docusign Envelope ID: 633C834F-F68B-4F76-99FA-9E98EA0F5185 Chargeable accidents for new business are those which resulted in bodily injury or death or in payment(s) by an insurer due to damage to any property in the amount of more than $1000. For accidents occurring prior to December 11, 2011, an accident shall be chargeable provided it resulted in death or in payment(s) by an insurer due to damage to any property in the amount of more than $750. For applicants without prior insurance at the time of the accident, an accident shall be chargeable provided ii resulted in damage to any property in the amount of more ADDITIONAL INFORMATION IMPORTANT NOTICE For your protection California law requires the following to appear with this policy: 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 crim e and may be subject to fines and confinement in state prison. Important Notice Regarding Your Premium A State Farm~ than $1000 (more than $750 if the accident occurred prior to December 11, 2011 ). Chargeable accidents for renewal business are those which resulted in bodily injury or death or State Farm claim payments totaling more than $1000 (more than $750 for accidents occurring prior lo December 11, 2011) under property damage liability coverage and collision coverage combined. For more information about the rating plan, please contact your State Farm agent. Superior Driver Rate Level If any information on this renewal notice is incomplete or inaccurate, or if you want to confirm the information we have in our records, please contact your agent. For additional information regarding discounts or coverages, see your State Farm agent or visit statefarm.com®. State Farm works hard to offer you the best combination of price, service, and protection. The amount you pay for automobile insurance is determined by many factors including: • The coverage you have • Where you live • The kind of car you drive • How the car is used • Who drives the car Any premium adjustment is reflected on this Auto Renewal. If you have any questions, please contact your agent. Buying a new car? Remember to contact your agent! When you buy an additional car or one that replaces a car already on your policy, you need to report the change to your agent promptly. Even though the dealership you purchased the car from may offer to notify your agent or insurance company, you, as the named insured, are responsible for reporting all changes to your auto policy. By contacting your agent, you can help: • avoid any complications or lack of coverage in the event of an accident or loss, • avoid insurance verification problems with a lienholder, the police, or the department of motor vehicles, and • ensure that you receive any new discounts you may be entitled to. Your current State Farm policy automatically provides certain coverages for a new or replacement car for up to a specified, limited number of days after you take possession of the car. Please refer to your policy for the number of days that applies in your state. If you have any questions about coverage for a newly acquired car, please contact your State Farm agent. Disclaimer: This message is provided for informational purposes only and does not grant any insurance coverage. The terms and conditions of coverage are set forth in your State Farm Car Policy booklet, the most recently issued Declarations Page, and any applicable endorsements. Policy Number: 000 1181-E01-55O Prepared September 10, 2024 Page number 4 of 4 WAIVER REQUEST FORM FACTORS IN SUPPORT OF REQUEST TO MODIFY INSURANCE REQUIREMENT(S) Generally, a modification to the coverage requirement will be accepting a lower limit of coverage or waiving the requirement(s). Requested by: (Name and Department) (Date) Proposed modification(s) to the __________________ requirement(s) for (Type of insurance) (Name of contract) Reduce coverage to the amount of: $ . Waive coverage Other: FACTOR(S) IN SUPPORT OF MODIFICATION(S) (check those that apply) Significance of Contractor: Contractor has previous experience with the City that is important to the efficiency of completing the scope of work and the quality of the work-product. [explain] Significance of Contractor: Contractor has unique skills and there are few if any alternatives. [explain: include number of candidates RFP sent to and number responded if applicable] Contract Amount/Term of Contract: $ . Work will be completed over a period of . Professional Liability coverage is not available to this contractor or would increase the cost of the contract by $ [explain]. Other (e.g. explain why exposures are minimal, how exposures are covered in another policy, exposure control mechanisms, and any other information pertinent to your request): Approved by Risk Manager for this contract only: (Signature) (Date) Amanda Simpson, Police Department 10/21/2024 Work Comp/Auto/PL on-site law enforcement training ■ ■ Marin Consulting Associates, Inc. does not have any employees and is therefore not required to carry workmans compensation insurance. This is a classroom only training with minimal liability. Docusign Envelope ID: 633C834F-F68B-4F76-99FA-9E98EA0F5185 10/22/2024 □ □ □ □ □