SERVICE PROVIDER AGREEMENT
This SERVICE PROVIDER AGREEMENT (“Agreement”) is entered into this 5th day of June 2024 (“Effective Date”), by and between the CITY OF ALAMEDA, a municipal corporation (“the City”), and Hinderliter De Llamas & Associat es, a Corporation, whose address is 120 S STATE COLLEGE BLVD STE 200 BREA, CA 92821 (“Provider”), in reference to the following facts and circumstances:
RECITALS
A. The City is a municipal corporation duly organized and validly existing under the laws of the State of California with the power to carry on its business as it is now being conducted under the statutes of the State of California and the Charter of the City.
B. The City is in need of the following services: Transfer the existing Business License database to HDL for full Business tax administration, including but not limited to, revenue discovery, compliance collection services and audits.
C. Provider is specially trained, experienced and competent to perform the special services which will be required by this Agreement.
D. The City and Provider desire to enter into an agreement for full administration of Business Licenses, including revenue discovery, compliance collection services and audits as further described in Attachment A, upon the terms and conditions herein.
AGREEMENT
NOW, THEREFORE, in consideration of the fo rgoing, which are incorporated herein by reference, and for good and valuable consideration, the receipt and adequacy of which are hereby acknowledged, the City and Provider agree as follows:
1. TERM:
The term of this Agreement shall commence on the 1st day of June 2024 and shall terminate in three years, with two optional one-year extensions, unless terminated earlier as set forth herein.
2. SERVICES TO BE PERFORMED:
Provider agrees to do all necessary work at its own cost and expense, to furnish all labor, tools, equipment, materials, except as otherwis e specified, and to do all necessary work included in Exhibit A as requested. Provider acknowledges that the work plan included in Exhibit A is tentative and does not commit the City to request Provider to perform all tasks included therein.
3. COMPENSATION TO PROVIDER:
4. Provider shall submit to the City an invoice for the total amount of work and services to be done. The provider will honor the discounted rate of $17.00 per processed account plus CPI, for Business License Administration, and the following percentages for the services provided:
EXHIBIT 2
40% of the revenue collected for Discovered accounts, 25% of Collections and 40% of revenue collected from Audits.
5. TIME IS OF THE ESSENCE:
Provider and the City agree that time is of the essence regarding the performance of this Agreement.
6. STANDARD OF CARE:
Provider agrees to perform all services hereunder in a manner commensurate with the prevailing standards of like professionals or service providers, as applicable, in the San Francisco Bay Area and agrees that all services shall be performed by qualified a nd experienced personnel who are not employed by the City.
7. INDEPENDENT PARTIES:
Provider hereby declares that Provider is engaged as an independent business and Provider agrees to perform the services as an independent contractor. The manner and means of conducting the services and tasks are under the control of Pr ovider except to the extent they are limited by statute, rule or regulation and the express terms of this Agreement. No civil service status or other right of employment will be acquired by virtue of Provider’s services. None of the benefits provided by the City to its employees, including but not limited to unemployment insurance, workers’ compensation plans, vacation and sick leave, are available from the City to Provider, its employees or agents. Deductions shall not be made for any state or federal taxes, FICA payments, PERS payments, or other purposes normally asso ciated with an employer-employee relationship from any compensation due to Provider. Paymen ts of the above items, if required, are the responsibility of Provider.
8. IMMIGRATION REFORM AND CONTROL ACT (IRCA):
Provider assumes any and all responsibility for verifying the identity and employment authorization of all of its employees performing work hereunder, pursuant to all applicable IRCA or other federal, or state rules and regulations. Provider shall indemnify, defend, and hold the City harmless from and against any loss, damage, liability, costs or expenses arising from any noncompliance of this provision by Provider.
9. NON-DISCRIMINATION:
Consistent with the City’s policy and state and federal law that harassment and discrimination are unacceptable conduct, Provider and its employees, contractors, and agents shall not harass or discriminate against any job applicant, City employee, or any other person on the basis of any kind of any statutorily (federal, state or local) protected class, including but not limited to: race, religious creed, color, national origi n, ancestry, disability (both mental and physical) including HIV and AIDS, medical condition (e.g. cancer), genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, pregnancy, political affiliation, military and veteran status or legitimate union activities. Provider agrees that any violation of this provision shall constitute a material breach of this Agreement.
10. HOLD HARMLESS:
a. To the fullest extent permitted by law, Provider shall indemnify, defend (with counsel acceptable to the City) and hold harmless the City, its City Council, boards, commissions, officials, employees, agents a nd volunteers (“Indemnitees”) from and against any and all loss, damages, liability, obligations, claims, suits, judgments, costs and expenses whatsoever, including reasonable attorney’s fees and costs of litigation (“Claims”), arising from or in any manner connected to Provider’s performance of its obl igations under this Agreement or out of the operations conducted by Provider even if the City is found to have been negligent. If the Claims filed against Indemnitees allege negligence, recklessness or w illful misconduct on the part of Provider, Provider shall have no right of reimbursement agai nst Indemnitees for the costs of defense even if negligence, recklessness or willful misconduct is not found on the part of Provider.
Provider shall not have any obligations to indemnify Indemnitees if the loss or damage is found to have resulted solely from the negligence or the willful misconduct of the City. The defense and indemnification obligations of this Agreement ar e undertaken in addition to, and shall not in any way be limited by, the insurance obligations contained in this Agreement. b. As to Claims for professional liability only, Provider’s obligation to defend Indemnitees (as set forth above) is limited as provided in California Civil Code Section 2782.8. c. Provider’s obligation to indemnify, defend and hold harmless Indemnities shall expressly survive the expiration or early termination of this Agreement. In no event will any of Consultant Group be liable for any Client moni es not collected by Consultant Group, or any special, incidental, or consequentia l damages of any nature whatsoev er, even if such restrictions deprive one or more remedies of their essential purpose. This damage exclusion is independent of any remedies provided for herein.
d. Notwithstanding anything to the contrary, in no event will Consultant be liable for claims, liabilities or damages (i) that could not reasonably have been foreseen upon entry into this Agreement; (ii) arising from any action or inaction by Consultant in response to specific direction from Client; (iii) in connection with any Client monies not collected by Consultant; nor (iv) in connection with the issuance, non-issuance or re vocation of any registra tion, license, permit, or exemption.
11. INSURANCE:
a. On or before the commencement of the terms of this Agreement, Provider shall furnish the City’s Risk Manager with certificat es showing the type, amount, class of operations covered, effective dates and dates of expiration of insurance coverage in compliance with Sections
10.b. (1) through (5). The Certificate Holder shou ld be The City of Alameda, 2263 Santa Clara, Ave., Alameda, CA 94501. Such certificates, which do not limit Provider’s indemnification, shall also contain substantially the following statement:
“Should any of the above insuran ce covered by this certificate be canceled or coverage reduced before the expiration date thereof, the insurer affording coverage shall pr ovide thirty (30) days’ advance written notice to the City of Alameda. Attention: Risk Manager.” Provider shall maintain in force at all times during the performance of this Agreement all appropriate coverage of insurance required by this Agreement with an insurance company licensed
to offer insurance business in the State of Califor nia with a current A.M. Best’s rating of no less than A:VII or Standard & Poor’s Rating (if rated) of at least BBB unless otherwise acceptable to the City. Provider shall deliver updated insurance certificates to the City at the address described in Section 17.f. prior to the expiration of the exis ting insurance certificate for the duration of the term of Agreement. Endorsements naming th e City, its City Council, boards, commissions, officials, employees, agents, and volunteers as additional insured shall be submitted with the insurance certificates.
_____________
Provider Initials
b. COVERAGE REQUIREMENTS:
Provider shall maintain insurance coverage and limits at least as broad as:
(1) Workers’ Compensation:
Statutory coverage as required by the State of California, as well as a Waiver of Subrogation (Rights of Recovery) endorsement. (2) Liability:
Commercial general liability coverage in the following minimum limits:
Bodily Injury: $1,000,000 each occurrence
$2,000,000 aggregate - all other
Property Damage: $1,000,000 each occurrence
$2,000,000 aggregate
If submitted, combined single limit policy with per occurrence limits in the amounts of $2,000,000 and aggregate limits in the amounts of $4,000,000 will be considered equivalent to the required minimum limits shown above. Provider shall also submit declarations and policy e ndorsements pages. Additional Insured Endorsement naming the City, its City Council, boards, commissions, officials, employees, agents, and volunteers is required. The Additional Insured Endorsement shall include primary and non-contributory coverage at least as broad as the CG 2010.
(3) Automotive:
Comprehensive automobile liability coverage (any auto) in the following minimum limits:
Bodily injury: $1,000,000 each occurrence
Property Damage: $1,000,000 each occurrence
or
Combined Single Limit: $2,000,000 each occurrence
Additional Insured Endorsement naming the City, its City Council, boards, commissions, officials, employees, agents, and volunteers is required.
(4) Professional Liability:
Professional liability insurance which includes coverage appropriate for the professional acts, errors and omissions of Provider’s profession and work hereunder, including, but not limited to, technology professional liability errors and omissions if the services being provide d are technology-based, in the following minimum limits:
$2,000,000 each claim
Technology professional liability errors and omissions shall include, or be endorsed to include, proper ty damage liability coverage for damage to, alteration of, loss of, or destruction of electronic da ta and/or information “property” of the City in the care, custody, or control of Provider. If not covered under Provider’s liability policy, such “property” covera ge of the City may be endorsed onto Provider’s Cyber Liability Policy as covered property as follows: cyber liability coverage in an amount sufficient to cover the full replacement value of damage to, alteration of, loss of, or destruction of electronic data and/or information “property” of the City that will be in the care, custody, or control of Provider.
(5) Cyber Liability:
Coverage shall be sufficiently broad to respond to the duties and obligations as are undertaken by Provider in this Ag reement and shall include, but not be limited to, claims involving infringement of intellectual property, copyright, trademark, trade dress, invasion of privacy violations, information theft, damage to or destruction of electroni c information, release of pr ivate information, alteration of electronic information, extortion and network security. The policy shall provide coverage for breach response costs as well as regulatory fines and penalties as well as credit monitoring expenses with limits sufficient to respond to these obligations with the following minimum limits:
$2,000,000 per occurrence or claim.
As to commercial general liability and automob ile liability insurance, such insurance will provide that it constitutes primary insurance with respect to claims insured by such policy, and, except with respect to limits, that insurance applies separately to each insured against whom claim is made or suit is brought. Such insurance is not additional to or contributing with any other insurance carried by or for the benefit of the City.
c. SUBROGATION WAIVER:
Provider hereby agrees to waive rights of subrogation that any insurer of Provider may acquire from Provider by virtue of the pa yment of any loss. Provider agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation, but this provision applies regardless of whether the City has received a waiver of subrogati on endorsement from the insurer. The Workers’ Compensation policy shall be endorsed with a waiver of subrogation in favor of the City for all work performed by Provider, its employees, agents and subcontractors. d. FAILURE TO SECURE:
If Provider at any time during th e term hereof should fail to secure or maintain the foregoing insurance, the City shall be permitted to obtain such insurance in Provider’s name or as an agent of Provider and shall be compensated by Provider for the costs of the insurance premiums at the maximum rate permitted by law and computed from the date written notice is received that the premiums have not been paid.
e. ADDITIONAL INSUREDS:
The City, its City Council, boards, commi ssions, officials, em ployees, agents, and volunteers shall be named as additional insured(s) under all insurance coverages, except workers’ compensation and professional liability insurance. The naming of an additional insured shall not affect any recovery to which such additional insured would be entitled under this policy if not named as such additional insured. An additional insured named herein shall not be held liable for any premium, deductible portion of any loss, or expense of any nature on this policy or any extension thereof. Any other insurance held by an additional insured sh all not be required to contribute anything toward any loss or expense covered by the insurance provided by this policy.
Additional Insured coverage under Provider’s pol icy shall be primary and non-contributory and will not seek contribution from the City’s insurance or self-insurance. Any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be available to the additional insured(s). f. SUFFICIENCY OF INSURANCE:
The insurance limits required by the City are not represented as being sufficient to protect Provider. Provider is advised to consult Provider’s insurance broker to determine adequate coverage for Provider. The coverage and limits shall be (1) the minimum coverage and limits specified in this Agreement; or (2) the broader coverage and maximum limits of the coverage carried by or available to Provider; whichever is greater. g. EXCESS OR UMBRELLA LIABILITY:
If any Excess or Umbrella Liability policies are used to meet the limits of liability required by this Agreement, then said policies shall be true “following form” of the underlying policy coverage, terms, conditions, and provisions and shall meet all of the insurance requirements stated in this Agreement, including but not limited to, the additional insured, SIR, and primary insurance requirements stated therein. No insurance policies maintained by the indemnified parties or Additional Insureds, whether primary or excess, and which also apply to a loss covered hereunder, shall be called upon to contribute to a loss until all the primary and excess liability policies carried by or available to the Provider are exhausted.
12. CONFLICT OF INTEREST:
Provider warrants that it is not a conflict of interest for Provider to perform the services required by this Agreement. Provider may be required to fill out a conflict of interest form if the services provided under this Agreement require Provider to make certain governmental decisions or serve in a staff capacity as defined in Title 2, Division 6, Section 18700 of the California Code of Regulations.
13. PROHIBITION AGAINST TRANSFERS:
a. Provider shall not assign, sublease, hypothecate, or transfer this Agreement, or any interest therein, directly or i ndirectly, by operation of law or otherwise, without prior written consent of the City Manager. Provider shall submit a written request for consent to transfer to the City Manager at least thirty (30) days in advance of the desired transfer. The City Manager or their designee may consent or reject such request in their sole and absolute discretion. Any attempt to do so without said consent shall be null and void, and any assignee, sublessee, hypothecate or transferee shall acquire no right or interest by reason of such attempted assignment, hypothecation or transfer. However, claims for money agains t the City under this Agreement may be assigned by Provider to a bank, trust company or other financial institution without prior written consent. b. The sale, assignment, transfer or othe r disposition of any of the issued and outstanding capital stock, membership interest, partnership interest, or the equivalent, which shall result in changing the control of Provider, shall be construed as an assignment of this Agreement.
Control means fifty percent or more of the voting power of Provider.
14. APPROVAL OF SUB-PROVIDERS:
a. Only those persons and/or businesses whose names and resumés are attached to this Agreement shall be used in the performance of this Agreement. However, if after the start of this Agreement, Provider wishes to use sub-providers, at no additional costs to the City, then Provider shall submit a written request for consent to add sub-providers including the names of the sub- providers and the reasons for the request to the City Manager at least five (5) days in advance. The City Manager may consent or reject such requests in their sole and absolute discretion. b. Each sub-provider shall be required to furnish proof of workers’ compensation insurance and shall also be required to carry general, automobile and professional liability insurance (as applicable) in reasonable conformity to the insurance carried by Provider. c. In addition, any tasks or services perform ed by sub-providers shall be subject to each provision of this Agreement. Provider shall include the following language in their agreement with any sub-provider: “Sub-pr oviders hired by Provider agree to be bound to Provider and the City in the same manner and to the same extent as Provider is bound to the City.” d. The requirements in this Section 13 sha ll not apply to persons who are merely providing materials, supplies, data or information that Provider then analyzes and incorporates into its work product.
15. PERMITS AND LICENSES:
Provider, at its sole expense, shall obtain and maintain during the term of this Agreement, all appropriate permits, certificates and licenses, including a City business license that may be required in connection with the performance of the services and tasks hereunder.
16. REPORTS:
a. Each and every report, draft, work product, map, record and other document produced, prepared or caused to be prepared by Provider pursuant to or in connection with this Agreement shall be the exclusive property of the City.
b. No report, information or other data given to or prepared or assembled by Provider pursuant to this Agreement shall be made available to any individual or organization by Provider without prior approval of the City Manager or their designee. c. Provider shall, at such time and in such form as City Manager or their designee may require, furnish reports concerning the status of services and tasks required under this Agreement.
17. RECORDS:
a. Provider shall maintain complete and accurate records with respect to the services, tasks, work, documents and data in sufficient detail to permit an evaluation of Provider’s performance under the Agreement, as well as mainta in books and records rela ted to sales, costs, expenses, receipts and other such information requ ired by the City that relate to the performance of the services and tasks under this Agreement (collectively the “Records”). b. All Records shall be maintained in accordance with generally accepted accounting principles and shall be clearly identified and readily accessible. Provider shall provide free access to the Records to the representatives of the City or its designees during regular business hours upon reasonable prior notice. The City has the right to examine and audit the Records, and to make copies or transcripts therefrom as necessary, and to allow inspection of all proceedings and activities related to this Agreement. Such Records, together with supporting documents, shall be kept separate from other documents and records and shall be maintained by Provider for a period of three (3) years after receipt of final payment.
c. If supplemental examination or audit of th e Records is necessary due to concerns raised by the City’s preliminary examination or audit of record s, and the City’s supplemental examination or audit of the record s discloses a failure to adhere to appropriate internal financial controls, or other breach of this Agreement or failure to act in good faith, then Provider shall reimburse the City for all reasonable costs an d expenses associated with the supplemental examination or audit.
18. NOTICES:
a. All notices shall be in writing and delivered: (i) by hand; or (ii) sent by registered, express, or certified mail, with return receipt requested or with deliver y confirmation requested from the U.S. postal service; or (iii) sent by overnight or same day courier service at the party’s respective address listed in this Section.
b. Each notice shall be deemed to have been received on the earlier to occur of: (x) actual delivery or the date on whic h delivery is refused; or (y) three (3) days after notice is deposited in the U.S. mail or with a courier se rvice in the manner described above (Sundays and City holidays excepted).
c. Either party may, at any time, change its notice address (other than to a post office box address) by giving the other party three (3) days prior written notice of the new address. d. All notices, demands, requests, or approvals from Provider to the City shall be addressed to the City at:
City of Alameda
Finance Department
2263 Santa Clara Ave Rm 220
Alameda, CA 94501
ATTENTION: Carlos Figueroa
Ph: (510) 747-4864
e. All notices, demands, requests, or approvals from the City to Provider shall be addressed to Provider at:
Hinderliter De Llamas & Associates
120 S. State College Blvd Ste 200
Brea, CA 92821
ATTENTION: George Bonnin
Ph: (714) 879-5000
f. All updated insurance certificates from Provider to the City shall be addressed to the City at:
City of Alameda
City Attorney’s Office
2263 Santa Clara Ave Rm 280
Alameda, CA 94501
ATTENTION: Lisa Cooper / Administrative Services Coordinator Ph: (510) 747-4750/ [email protected]
19. SAFETY:
a. Provider will be solely and completely responsible for conditions of all vehicles owned or operated by Provider, including the safety of all persons and property during performance of the services and tasks under this Agreement. This requirement will apply continuously and not be limited to normal working hours. In addition, Provider will comply with all safety provisions in confor mance with U.S. Department of Labor Occupational Safety and Health Act, any equivalent state law, and all other applicable federal, state, county and local laws, ordinances, codes, and any regulations that may be detailed in other parts of the Agreement. Where any of these are in conflict, the more stringent requirements will be followed. Provider’s failure to thoroughly familiarize itself with the aforementi oned safety provisions will not relieve it from compliance with the obligations and penalties set forth herein. b. Provider will immediately notify the City within 24 hours of any incident of death, serious personal injury or subs tantial property damage that occurs in connection with the performance of this Agreement. Provider will promptly submit to the City a written report of all incidents that occur in connection with this Agreement. This report must include the following information: (i) name and address of injured or deceased person(s); (ii) name and address of Provider’s employee(s) involved in the incident; (iii) name and address of Provi der’s liability insurance carrier; (iv) a detailed description of the incident; and (v) a police report.
20. TERMINATION:
a. In the event Provider fails or refuses to perform any of the provisions hereof at the time and in the manner required hereunder, Provider shall be deemed in default in the performance of this Agreement. If such default is not cured within two (2) business days after receipt by Provider from the City of written notice of default, specifying the nature of such default and the steps necessary to cure such default, the City may thereafter immediately terminate the Agreement forthwith by giving to Provider written notice thereof. b. The foregoing notwithstanding, the City shall have the option, at its sole discretion and without cause, of terminating this Agreemen t by giving thirty (30) days’ prior written notice to Provider as provided herein.
c. Upon termination of this Agreement either for cause or for convenience, each party shall pay to the other party that portion of compensation specified in this Agreement that is earned and unpaid prior to the effective date of termination. The oblig ation of the parties under this Section 19.c. shall survive the expiration or early termination of this Agreement.
21. ATTORNEYS’ FEES:
In the event of any litigation, including administrative proceedings, relating to this Agreement, including but not limited to any actio n or suit by any party, assignee or beneficiary against any other party, beneficiary or assignee, to enforce, interpret or seek relief from any provision or obligation arising out of this Agreement, the parties and litigants shall bear their own attorney’s fees and costs. No party or litigant shall be entitled to recover any attorneys’ fees or costs from any other party or litigant, regardless of which party or litigant might prevail.
22. HEALTH AND SAFETY REQUIREMENTS.
Provider acknowledges that the C ity shall have the right to impose, at the City’s sole discretion, requirements that it deem s are necessary to protect the health and safety of the City employees, residents, and visitors. Provider ag rees to comply with all such requirements, including, but not limited to, mandatory vaccinati ons, the use of personal protective equipment (e.g. masks), physical distancing, and health screenings. Provider also agrees to make available to the City, at the City’s request, records to demonstrate Provider’s compliance with this Section.
23. COMPLIANCE WITH ALL APPLICABLE LAWS:
During the term of this Agreement, Provider shall keep fully informed of all existing and future state and federal laws and all municipal ordinances and regulations of the City of Alameda which affect the manner in which the services or tasks are to be performed by Provider, as well as all such orders and decrees of bodies or tribuna ls having any jurisdiction or authority over the same. Provider shall comply with all applicable laws, state and federal and all ordinances, rules and regulations enacted or issued by the City.
24. CONFLICT OF LAW:
This Agreement shall be interpreted under, and enforced by the laws of the State of California without regard to any c hoice of law rules which may dir ect the application of laws of another jurisdiction. The Agreement and obligations of the parties are subject to all valid laws, orders, rules, and regulations of the authorities having jurisdiction over this Agreement (or the
successors of those authorities). Any suits brought pursuant to this Agreement shall be filed with the courts of the County of Alameda, State of California.
25. WAIVER:
A waiver by the City of any breach of any term, covenant, or cond ition contained herein shall not be deemed to be a waiver of any subs equent breach of the sa me or any other term, covenant, or condition contained herein, whether of the same or a different character.
26. INTEGRATED CONTRACT:
Subject to the language of Secti on 30, the Recitals and exhibits are a material part of this Agreement and are expressly incorporated here in. This Agreement represents the full and complete understanding of every ki nd or nature whatsoever betwee n the parties hereto, and all preliminary negotiations and agreements of whatsoever kind or nature are merged herein. No verbal agreement or implied covenant shall be held to vary the provisions hereof. Any modification of this Agreement will be effective only by written execution signed by both the City and Provider.
26. CAPTIONS:
The captions in this Agreement are for convenience only, are not a part of the Agreement and in no way affect, limit or amplify the terms or provisions of this Agreement.
27. COUNTERPARTS:
This Agreement may be executed in any numbe r of counterparts (including by fax, PDF, DocuSign, or other electronic means), each of which shall be deemed an original, but all of which shall constitute one and the same instrument.
28. SIGNATORY:
By signing this Agreement, signatory warrants and represents that they executed this Agreement in their authorized capacity and that by their signature on this Agreement, they or the entity upon behalf of which they acted, executed this Agreement.
29. OTHER SIMILAR SERVICES TO PUBLIC ENTITIES NOT PROHIBITED:
Client acknowledges and agrees that an y other public agency (including, without limitation, any participating government agency) located within or outside of the State (e.g., city, municipality, county, district, public authority or other political subdivision) may procure services for fees and other terms and conditions that are s ubstantially similar to any of the Services, Fees and other terms and conditions set forth in this Agreement, provided that such other public agency executes a separate agreement with Consultant wherein the services rendered to such other public agency, the fees payable by such other public agen cy, and the other terms and conditions of such separate agreement are the responsibility of Cons ultant and such other public agency and not Client.
30. CONTROLLING AGREEMENT:
In the event of a conflict between the terms and conditions of this Agreement (as amended, supplemented, restated or othe rwise modified from time to time) and any other terms and conditions wherever contained, including, without limitation, terms and conditions included within exhibits, the terms and conditions of this Agreement shall control and be primary.
[REMAINDER OF PAGE INTENTIONALLY LEFT BLANK]
IN WITNESS WHEREOF, the parties have each caused this Agreement to be duly executed on its behalf as of the Effective Date.
Hinderliter De Llamas & Associates CITY OF ALAMEDA
Corporation a municipal corporation
Robert Gray Jennifer Ott
VP Technology City Manager
RECOMMENDED FOR APPROVAL
Richard Park
C F O
Margaret O’Brien
Finance Director
APPROVED AS TO FORM:
City Attorney
L e n A s l a n i a n
Assistant City Attorney
Hinderliter De Llamas & Associates
Tax and Fee Administration Services and Fees
Business License Tax and Fees
City of Alameda, CA
1211802.2 Page 1 of 3
(;+,%,7$SCOPE OF SERVICES
Consultant will provide the following Services relative to Client’s business license tax administration.
1. Operations Management Services
1.1. Establish and maintain database of Client businesses.
1.2. Receive and process applications, renewals and payments in a timely fashion.
1.3. Send renewal notices to active businesses within 30 days of the renewal period end date or at another interval specified by Client.
1.4. Provide businesses multiple options for submittin g applications, renewals, payments, or support requests (including via website, email, mail, phone, and fax. Consultant license specialists will be available for live interactions Monday through Friday, 8:00am to 5:00pm Pacific).
1.5. Remit revenue to Client no less than monthly.
1.6. Provide Client staff access to website portal offe ring business registry inquiry, reporting, and electronic department approval capabilities.
2. Compliance Services: 1) Identify and register businesses which are subject to licensure or taxation, 2) collect known debt as pertains to business license or tax, and 3) identify under-reported tax liability.
2.1. Discovery Services
2.1.1.Develop a list of businesses subject to Client licensure or taxation.
2.1.2.Notify non-compliant businesses of their options to comply or dispute their non-compliant status.
Notification and support to businesses will be facilitated through the website, mail, email, phone and fax.
2.1.3.Review information and forms submitted by the business for completion and accuracy, inclusive of any additional required documentation (i.e. home occupation permit). All submissions are filed and stored electronically and made available to Client upon request.
2.1.4.Provide businesses with detailed invoicing and options to pay via website, mail, and phone.
2.1.5.Remit revenue to Client no less than monthl y, along with all business applications and any additional documentation.
2.2. Collection Services
2.2.1.Identify businesses subject to Client licensure or taxation which have known debt to Client and have failed to pay within an appropriate time frame.
2.2.2.Notify businesses of their options to comply or dispute their non-compliant status.
2.2.3.Provide businesses with detailed invoicing and options to pay via website, mail and phone.
2.2.4.Remit revenue to Client no less than monthly.
2.3. Audit Services
2.3.1. Identify potential under-reporting and/or misclassified businesses.
2.3.2.Audit businesses mutually agr eed to by Client and Consultant th at are identified as potential under-reporting businesses.
2.3.3.Submit audit summaries to Client and discuss further actions.
2.3.4.Educate businesses on proper reporting practices.
2.3.5.Invoice and collect identified deficiencies.
3. Online Payment Processing – Consultant’s services include PCI compliant payment processing services which supports both credit card and eCheck transactions.
3.1. Client Responsibilities
3.1.1.As a condition to its receipt of the Service, Client shall execute and deliver any and all applications, agreements, certifications or other documents required by HdL’s payment processor, Networks or other third parties wh ose consent or approval is necessary for the
Hinderliter De Llamas & Associates
Tax and Fee Administration Services and Fees
Business License Tax and Fees
City of Alameda, CA
1211802.2 Page 2 of 3
processing of Transactions by HdL’s payment processor. “Network” is an entity or association that operates, under a common se rvice mark, a system which permits participants to authorize, route, and settle Transactions among themselves, including, for example, networks operated by VISA USA and Mastercard, Inc., NYCE Corporation, American Express, and Discover.
3.1.2. Client hereby grants Consultant the full right, power and authority to request, receive and review any Data or records reflected in a Transaction re port. Client represents and warrants that it has the full right and authority to grant these rights.
FEES
4. Operations Management Services
4.1. Fees for performing operations management Service s shall be $17.00 for each processed account, which is any account for which an application or renewal/return was processed, or active account which was sent a renewal notice + CPI.
4.2. Fees will be increased as of January 1st of each calendar year with reference to the 12-month percent change in the most recently published annual Con sumer Price Index for as per the Riverside-San Bernardino-Ontario Region, as reported by the U.S. Bureau of Labor Statistics (the “CPI Change”).
Each annual increase in the Fees will be equal to the greater of two percent (2%) or the actual CPI Change and the lesser of ten percent (10%) or the actual CPI Change. For example, if the actual CPI Change is 1.5%, then the annual increase will be 2%, if the actual CPI Change is 3.5%, then the annual increase will be 3.5%, and if the actual CPI Change is 12%, then the annual increase will be 10%.
4.3. Fees related to travel and lodging expenses are billed at cost and apply to all meetings (including implementation, training, operations and support). Trav el expenses only apply to out of scope travel and must therefore be pre-approved by Client.
4.4. Fees will be invoiced monthly to Client for Services performed during the prior month. Fees will be netted out of Client’s monthly revenue disbursement. Client will submit payment for any balance due to Consultant within 30 days of receiving the invoice.
5. Compliance Services
5.1. Fees for performing compliance Services apply to all monies received for the current tax/license period and any other prior period collected (inclu ding monies received for taxes, penalties, interest, and fees).
5.1.1. Fees for performing discovery Services shall be a contingency Fee of 40% of the revenues received as a result of the Services.
5.1.2. In the event that Client discovers a non-compliant business and reports the business to Consultant (including a calculation of all taxes/fees due), Consultant will categorize the business as a collection service effort and thus apply the lower collection Services contingency Fee rate.
5.1.3. Fees for performing collection Services shall be a contingency Fee of 25% of the revenues received as a result of the Services.
5.1.4. Fees for performing audit Services shall be a cont ingency Fee of 40% of the revenues received as a result of the Services.
5.2. Consultant recognizes Client’s au thority to waive or reduce the tax /fee debt of a business. Should Client decide to do so for a business whose deficiency was identified by Consultant, Consultant shall be entitled to compensation in the amount of one half (1/2) of the Fees Consultant would have otherwise earned. Deficiencies which are uncollect able due to insolvency or dissolution of the business, or for deficiencies which are otherwis e incapable of collection (i.e. statute of limitation or
Hinderliter De Llamas & Associates
Tax and Fee Administration Services and Fees
Business License Tax and Fees
City of Alameda, CA
1211802.2 Page 3 of 3
other legal defense) shall not be considered a Client voluntary election to waive, and thus, Consultant would not be entitled to compensation related thereto under this provision.
5.3. The fee shall be paid notwithstanding any related Client assistance, work in parallel, and/or incurrence of attorneys’ fees or other costs or expenses in connection, with the relevant Services.
5.4. Fees related to travel and lodging expenses are bi lled at cost and applied to all meetings (including implementation, training, operations, and support). Travel expenses only apply to out-of-scope travel and must therefore be pre-approved by Client.
5.5. Fees will be invoiced monthly to Client for Services performed during the prior month. Fees will be netted out of Client’s monthly revenue disbursement. Client will submit payment for any balance due to Consultant within 30 days of receiving the invoice.
6. Payment Processing – Consultant will configure payment processing services to utilize either a taxpayer funded model (convenience fee) or Client funded model, as directed by Client. Client may switch between these models upon written re quest to Consultant. Fees for each of these payment processing models are detailed here.
6.1. Taxpayer funded model – Client authorizes Consultant to collect each convenience fee from the taxpayer at time of payment.
6.1.1. Credit and debit card processing – 2.9% of transaction amount, minimum of $2.00
6.1.2. ACH/eCheck processing - $2.50 per transaction
6.2. Client funded
6.2.1. Credit and debit card processing – 2.9% of transaction amount
6.2.2. ACH/eCheck processing - $0.75 per transaction
6.3. Returned payments/NSF fee – Each occurrence of a card chargeback, returned payment or insufficient funds will incur a fee of $25.00, to be applied to the taxpayer’s account.
6.4. Consultant reserves the right to review and adjust pricing related to payment processing services on an annual basis. Consultant will communicate any such adjustment to Client in writing, with 60 days advance notice. Items that will be considered in th e review of fees may in clude, but are not limited to: regulatory changes, card association rate ad justments, card association category changes, bank/processor dues and assessments, average consumer payment amounts, card type utilization, and costs of service.
06/03/2024
Marsh Affinity
a division of Marsh USA LLC.
PO BOX 14404
Des Moines, IA 50306-9686
Marsh Affinity
800-743-8130
[email protected]
AIU Insurance Company 19399
A 07/01/2024 07/01/2025
2,000,000
2,000,000
2,000,000
ADP TotalSource DE IV, Inc.
5800 Windward Parkway
Alpharetta, GA 30005
L/C/F:
Hinderliter de Llamas & Associates
120 S State College Blvd Suite 200
Brea, CA 92821
WC 088412194 CAX
All worksite employees working for Hinderliter de Llamas & Associates paid under ADP TOTALSOURCE, INC.'s payroll, are covered under the above stated policy. WAIVER OF SUBROGATION IN FAVOR OF City of Alameda, its City Council, boards and commissions, officers, employees and volunteers AS RESPECTS OF JOB PERFORMED BY Hinderliter de Llamas & Associates AS REQUIRED BY WRITTEN CONTRACT.
City of Alameda, its City Council, boards and commissions, officers, employees and volunteers
2263 Santa Clara Ave
Alameda, CA 94501
X
WAIVER OF SUBROGATION IN FAVOR OF City of Alameda, its City Council, boards and commissions, officers, employees and volunteers AS RESPECTS OF JOB PERFORMED BY Hinderliter de Llamas & Associates AS REQUIRED BY WRITTEN CONTRACT.
City of Alameda, its City Council, boards and commissions, officers, employees and volunteers
2263 Santa Clara Ave
Alameda, CA 94501
07/01/2024 WC 088412194 CA
AIU Insurance Company
ADP TotalSource DE IV, Inc.
5800 Windward Parkway
Alpharetta, GA 30005
L/C/F:
Hinderliter de Llamas & Associates
120 S State College Blvd Suite 200
Brea, CA 92821
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-MAIL
ADDRESS:
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 e ndorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A st atement 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 PERIO D 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. $ $
$
$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 below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
$
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
UO S
:RRGUXII 6DZ\HU
3DUN 3OD]D 6XLWH
,UYLQH &$
:6 &HUWLILFDWHV
FHUWLILFDWHV#ZRRGUXIIVDZ\HUFRP
%HUNOH\ 1DWLRQDO ,QVXUDQFH &RPSDQ\
+'/&203 +XGVRQ ([FHVV ,QVXUDQFH &RPSDQ\
+LQGHUOLWHU GH /ODPDV $VVRFLDWHV
+G/ 6RIWZDUH //&
6 6WDWH &ROOHJH %OYG 6XLWH
%UHD &$
$ ;
;
;
< 7&3
$
;
< 7&3
$ ; ; 7&3
; 1RQH
% ( 2 &\EHU /LDELOLW\ ((7 3HU &ODLP$JJUHJDWH 5HWURDFWLYH 'DWH IRU 3URIHVVLRQDO /LDELOLW\ /LQH 2I &RYHUDJH
&ULPH
3ROLF\
(IIHFWLYH 'DWH
&DUULHU
)HGHUDO ,QVXUDQFH &RPSDQ\ 1$,&
&ULPH /LPLW
6HH $WWDFKHG
&LW\ RI $ODPHGD LWV &LW\ &RXQFLO ERDUGV DQG FRPPLVVLRQV RIILFHUV HPSOR\HHV DQG YROXQWHHUV
6DQWD &ODUD $YH
$ODPHGD &$
ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
© 2008 ACORD CORPORATION. All rights reserved.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE:
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY CUSTOMER ID:
LOC #:
AGENCY
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED
EFFECTIVE DATE:
+'/&203
:RRGUXII 6DZ\HU +LQGHUOLWHU GH /ODPDV $VVRFLDWHV
+G/ 6RIWZDUH //&
6 6WDWH &ROOHJH %OYG 6XLWH
%UHD &$
&(57,),&$7( 2) /,$%,/,7< ,1685$1&(
&LW\ RI $ODPHGD LWV &LW\ &RXQFLO ERDUGV DQG FRPPLVVLRQV RIILFHUV HPSO R\HHV DQG YROXQWHHUV DUH LQFOXGHG DV DGGLWLRQDO LQVXUHG DV UHVSHFWV *HQHU DO /LDELOLW\ DQG $XWRPRELOH /LDELOLW\ WR WKH H[WHQW SURYLGHG LQ WKH DWWDFKHG IRUPV
POLICY NUMBER: COMMERCIAL AUTO
CA 20 48 10 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1
DESIGNATED INSURED FOR
COVERED AUTOS LIABILITY COVERAGE
This endorsement modifies insurance provided under the following:
AUTO DEALERS COVERAGE FORM
BUSINESS AUTO COVERAGE FORM
MOTOR CARRIER COVERAGE FORM
With respect to coverage provided by this endorsemen t, the provisions of the Coverage Form apply unless modified by this endorsement.
This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.
Named Insured:
Endorsement Effective Date:
SCHEDULE
Name Of Person(s) Or Organization(s):
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Each person or organization shown in the Schedule is
an "insured" for Covered Autos Liability Coverage, but
only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured
provision contained in Paragraph A.1. of Section II –
Covered Autos Liability Coverage in the Business
Auto and Motor Carrier Coverage Forms and
Paragraph D.2. of Section I – Covered Autos
Coverages of the Auto Dealers Coverage Form.
7&3
&LW\ RI $ODPHGD LWV &LW\ &RXQFLO ERDUGV DQG FRPPLVVLRQV RIILFHUV HPSO R\HHV DQG YROXQWHHUV &$ 6DQWD &ODUD $YH $ODPHGD
32/,&<180%(5
&200(5&,$/*(1(5$//,$%,/,7<
&*
7+,6(1'256(0(17&+$1*(67+(32/,&<3/($6(5($',7&$5()8//< &*
,QVXUDQFH6HUYLFHV2IILFH,QF 3DJHRI $'',7,21$/,1685('±'(6,*1$7('
3(56212525*$1,=$7,21
7KLVHQGRUVHPHQWPRGLILHVLQVXUDQFHSURYLGHGXQGHUWKHIROORZLQJ
&200(5&,$/*(1(5$//,$%,/,7<&29(5$*(3$57
6&+('8/(
1DPH2I$GGLWLRQDO,QVXUHG3HUVRQ
V
2U2UJDQL]DWLRQ
V
,QIRUPDWLRQUHTXLUHGWRFRPSOHWHWKLV6FKHGXOHLIQRWVKRZQDERYHZLOOEHVKRZQLQWKH'HFODUDWLRQV $ 6HFWLRQ ,, ± :KR ,V $Q ,QVXUHG LV DPHQGHG WR LQFOXGH DV DQ DGGLWLRQDO LQVXUHG WKH SHUVRQ
V
RU
RUJDQL]DWLRQ
V
VKRZQ LQ WKH 6FKHGXOH EXW RQO\
ZLWKUHVSHFWWROLDELOLW\IRUERGLO\LQMXU\SURSHUW\ GDPDJH RU SHUVRQDO DQG DGYHUWLVLQJ LQMXU\
FDXVHG LQ ZKROH RU LQ SDUW E\ \RXU DFWV RU
RPLVVLRQVRUWKHDFWVRURPLVVLRQVRIWKRVHDFWLQJ
RQ\RXUEHKDOI
,QWKHSHUIRUPDQFHRI\RXURQJRLQJRSHUDWLRQV
RU
,Q FRQQHFWLRQ ZLWK \RXU SUHPLVHV RZQHG E\ RU
UHQWHGWR\RX
+RZHYHU
7KH LQVXUDQFH DIIRUGHG WR VXFK DGGLWLRQDO
LQVXUHGRQO\DSSOLHVWRWKHH[WHQWSHUPLWWHGE\
ODZ
DQG
,IFRYHUDJHSURYLGHGWRWKHDGGLWLRQDOLQVXUHGLV
UHTXLUHG E\ D FRQWUDFW RU DJUHHPHQW WKH
LQVXUDQFH DIIRUGHG WR VXFK DGGLWLRQDO LQVXUHG
ZLOO QRW EH EURDGHU WKDQ WKDW ZKLFK \RX DUH
UHTXLUHG E\ WKH FRQWUDFW RU DJUHHPHQW WR
SURYLGHIRUVXFKDGGLWLRQDOLQVXUHG
% :LWK UHVSHFW WR WKH LQVXUDQFH DIIRUGHG WR WKHVH DGGLWLRQDO LQVXUHGV WKH IROORZLQJ LV DGGHG WR
6HFWLRQ,,,±/LPLWV2I,QVXUDQFH
,I FRYHUDJH SURYLGHG WR WKH DGGLWLRQDO LQVXUHG LV UHTXLUHGE\DFRQWUDFWRUDJUHHPHQWWKHPRVWZH
ZLOO SD\ RQ EHKDOI RI WKH DGGLWLRQDO LQVXUHG LV WKH DPRXQWRILQVXUDQFH
5HTXLUHGE\WKHFRQWUDFWRUDJUHHPHQW
RU
$YDLODEOH XQGHU WKH DSSOLFDEOH OLPLWV RI
LQVXUDQFH
ZKLFKHYHULVOHVV
7KLV HQGRUVHPHQW VKDOO QRW LQFUHDVH WKH
DSSOLFDEOHOLPLWVRILQVXUDQFH
7&3
&LW\ RI $ODPHGD LWV &LW\ &RXQFLO ERDUGV DQG FRPPLVVLRQV RIILFHUV HPSO R\HHV DQG YROXQWHHUV 6DQWD &ODUD $YH
$ODPHGD &$
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-MAIL
ADDRESS:
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 e ndorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A st atement 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 PERIO D 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. $ $
$
$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 below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
ER
OTH-
STATUTE
PER
LIMITS(MM/DD/YYYY)
POLICY EXP
(MM/DD/YYYY)
POLICY EFF
POLICY NUMBERTYPE OF INSURANCELTR
INSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
$
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED
$PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
UO S
:RRGUXII 6DZ\HU
3DUN 3OD]D 6XLWH
,UYLQH &$
:6 &HUWLILFDWHV
FHUWLILFDWHV#ZRRGUXIIVDZ\HUFRP
%HUNOH\ 1DWLRQDO ,QVXUDQFH &RPSDQ\
+'/&203 +XGVRQ ([FHVV ,QVXUDQFH &RPSDQ\
+LQGHUOLWHU GH /ODPDV $VVRFLDWHV
+G/ 6RIWZDUH //&
6 6WDWH &ROOHJH %OYG 6XLWH
%UHD &$
$ ;
;
;
< 7&3
$
;
7&3
$ ; ; 7&3
; 1RQH
% ( 2 &\EHU /LDELOLW\ ((7 3HU &ODLP$JJUHJDWH 5HWURDFWLYH 'DWH IRU 3URIHVVLRQDO /LDELOLW\ /LQH 2I &RYHUDJH
&ULPH
3ROLF\
(IIHFWLYH 'DWH
&DUULHU
)HGHUDO ,QVXUDQFH &RPSDQ\ 1$,&
&ULPH /LPLW
6HH $WWDFKHG
&LW\ RI $ODPHGD
6DQWD &ODUD $YH
$ODPHGD &$
ACORD 101 (2008/01)
The ACORD name and logo are registered marks of ACORD
© 2008 ACORD CORPORATION. All rights reserved.
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE:
ADDITIONAL REMARKS
ADDITIONAL REMARKS SCHEDULE Page of
AGENCY CUSTOMER ID:
LOC #:
AGENCY
CARRIER NAIC CODE
POLICY NUMBER
NAMED INSURED
EFFECTIVE DATE:
+'/&203
:RRGUXII 6DZ\HU +LQGHUOLWHU GH /ODPDV $VVRFLDWHV
+G/ 6RIWZDUH //&
6 6WDWH &ROOHJH %OYG 6XLWH
%UHD &$
&(57,),&$7( 2) /,$%,/,7< ,1685$1&(
&LW\ RI $ODPHGD LV LQFOXGHG DV DGGLWLRQDO LQVXUHG DV UHVSHFWV *HQHUDO /LDE LOLW\ WR WKH H[WHQW SURYLGHG LQ WKH DWWDFKHG IRUP
32/,&<180%(5
&200(5&,$/*(1(5$//,$%,/,7<
&*
7+,6(1'256(0(17&+$1*(67+(32/,&<3/($6(5($',7&$5()8//< &*
,QVXUDQFH6HUYLFHV2IILFH,QF 3DJHRI $'',7,21$/,1685('±'(6,*1$7('
3(56212525*$1,=$7,21
7KLVHQGRUVHPHQWPRGLILHVLQVXUDQFHSURYLGHGXQGHUWKHIROORZLQJ
&200(5&,$/*(1(5$//,$%,/,7<&29(5$*(3$57
6&+('8/(
1DPH2I$GGLWLRQDO,QVXUHG3HUVRQ
V
2U2UJDQL]DWLRQ
V
,QIRUPDWLRQUHTXLUHGWRFRPSOHWHWKLV6FKHGXOHLIQRWVKRZQDERYHZLOOEHVKRZQLQWKH'HFODUDWLRQV $ 6HFWLRQ ,, ± :KR ,V $Q ,QVXUHG LV DPHQGHG WR LQFOXGH DV DQ DGGLWLRQDO LQVXUHG WKH SHUVRQ
V
RU
RUJDQL]DWLRQ
V
VKRZQ LQ WKH 6FKHGXOH EXW RQO\
ZLWKUHVSHFWWROLDELOLW\IRUERGLO\LQMXU\SURSHUW\ GDPDJH RU SHUVRQDO DQG DGYHUWLVLQJ LQMXU\
FDXVHG LQ ZKROH RU LQ SDUW E\ \RXU DFWV RU
RPLVVLRQVRUWKHDFWVRURPLVVLRQVRIWKRVHDFWLQJ
RQ\RXUEHKDOI
,QWKHSHUIRUPDQFHRI\RXURQJRLQJRSHUDWLRQV
RU
,Q FRQQHFWLRQ ZLWK \RXU SUHPLVHV RZQHG E\ RU
UHQWHGWR\RX
+RZHYHU
7KH LQVXUDQFH DIIRUGHG WR VXFK DGGLWLRQDO
LQVXUHGRQO\DSSOLHVWRWKHH[WHQWSHUPLWWHGE\
ODZ
DQG
,IFRYHUDJHSURYLGHGWRWKHDGGLWLRQDOLQVXUHGLV
UHTXLUHG E\ D FRQWUDFW RU DJUHHPHQW WKH
LQVXUDQFH DIIRUGHG WR VXFK DGGLWLRQDO LQVXUHG
ZLOO QRW EH EURDGHU WKDQ WKDW ZKLFK \RX DUH
UHTXLUHG E\ WKH FRQWUDFW RU DJUHHPHQW WR
SURYLGHIRUVXFKDGGLWLRQDOLQVXUHG
% :LWK UHVSHFW WR WKH LQVXUDQFH DIIRUGHG WR WKHVH DGGLWLRQDO LQVXUHGV WKH IROORZLQJ LV DGGHG WR
6HFWLRQ,,,±/LPLWV2I,QVXUDQFH
,I FRYHUDJH SURYLGHG WR WKH DGGLWLRQDO LQVXUHG LV UHTXLUHGE\DFRQWUDFWRUDJUHHPHQWWKHPRVWZH
ZLOO SD\ RQ EHKDOI RI WKH DGGLWLRQDO LQVXUHG LV WKH DPRXQWRILQVXUDQFH
5HTXLUHGE\WKHFRQWUDFWRUDJUHHPHQW
RU
$YDLODEOH XQGHU WKH DSSOLFDEOH OLPLWV RI
LQVXUDQFH
ZKLFKHYHULVOHVV
7KLV HQGRUVHPHQW VKDOO QRW LQFUHDVH WKH
DSSOLFDEOHOLPLWVRILQVXUDQFH
7&3