HomeMy WebLinkAboutCHALLENGER SPORTS CORPORATION-2015City of Santa Ana
1 --' Clerk of the Council
AGREEMENT TERMINATION FORM ,----- .-.__-_-.-._-..-.-.-.-.-._-....-.-.-.-.------- ---- --_-.-.---.-.--
COTC Office Use .Only
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Please complete this form when the attached agreement and all CITY Q $6nPiiA gjiq
amendments (if any) are no longer in effect. CLERK S NTACOUAN
CIL
Return form to the Clerk of the Council Office (M-30).
Call 647-6520 if you have any questions. n —
The agreement with l �J,(u/1/PjJT 0,02 Q� C m,QmWLy
Na N-2015-085 was completed on l nl and final payment has been made.
(List all amendments. Use space below if needed.)
Department: RZF--,A
Phone/Ext.: 5a
Signature: G—�, Q,(`,Ift-Q k1VCV)
Date: F5(w�tg
Revised 08-23-10
N-2015-08s
INSURANCE ON FILE
WORK MAY PROCEED
UNTIL INSURANCE EXPIRES
GC4 WC: 1-1-16
CLERK OF COON C y 2 Q1 RECREATION SERVICES AGREEMENT
DATE., v'�`
j>R STHIS AGREEMENT is made, and entered into this 4!h of ;May 2015, by and between
Challenger Sports Corporation (hereinafter "Provider") and the City of Santa Ana, a charter city
and municipal corporation oxganized and existing under the Constitution and laws of the State of
California (hereinafter "City").
RECITALS
A. The City desires to retain a recreation service provider having special skills, resources and
knowledge to conduct various fitness classes in its leisure class program.
B. 'Provider represents that Provider is able and willing to provide such services to the City.
C. hi undertaking the performance of this Agreement, Provider represents that it is knowledgeable
in its field and that any services performed by Provider under this Agreement will be performed in
compliance with such standards as may reasonably be expected.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the
terms and conditions hereinafter set forth, the parties agree as follows:
I. SCOPE OF SERVICES
Provider shall perform those services as set forth in Exhibit A to this Agreement.
2. COMPENSATION
In consideration for the right to provide the programs sot :Cort'h in Exhibit A, City agrees
to pay the Provider seventy percent (70%) of all gross revenue received from program
participants. Total revenue to Provider shall not exceed $25,000 annually. Payment to Provider
shall be made within. thirty (30) days following completion of the last class taught by Provider
that month. City shall be responsible for collecting all fees from progrann participants. Provider
shall not collect fees but will refer all interested participants to City for registration information.
Provider agrees that City shall retain thirty percent (30%) of all gross revenue received from
program participants as an administrative fee,
3. TERM
This Agreement shall commence on August 1, 2015 and terminate on June 30, 2016,
unless terminated earlier in accordance with Section 12, below.
4. INDEPENDENT CONTRACTOR
Provider shall, during the entire torm of this Agreement, be construed to be an
independent contractor and not an employee of the City. This Agreement is not intended nor
shall it be construed to create an employer -employee relationship, a joint venture relationship, or
to allow the City to exercise discretion or control over the manner in which Provider performs
the services which are the subject matter of this Agreement; however, the services to be provided.
by Provider shall be provided in a. manner consistent with all applicable standards and
regulations governing such services. Provider shall pay all salaries and wages, employer's social
security taxes, unemployment insurance and sinular taxes relating to employees and shall be
responsible for all applicable withholding taxes, Provider is not an agent, representative or
employee of City and Provider shall have no authority to act on behalf of the City.
5. INSURANCE
Prior to undertaking performance of work under this Agreement, Provider shall maintain
and shall require its subcontractors, if any, to obtain and maintain insurance as described below:
a. Commercial General Liability Insurance. Provider shall maintain commercial general
liability insurance which shall include, but not be limited to protection against claims arising
from bodily and personal injury, including death resulting therefrom and damage to property,
resulting from any act or occurrence arising out of Provider's operations in the performance of
this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance
shall be not less than the following: single limit coverage applying to bodily and personal injury,
including death resulting therefrom, and property damage, in the total amount of $1,000,000 per
occurrence, and $ 2,000,000 aggregate. Such insurance shall (a) name the City, its officers,
employees, agents, volunteers and representatives as additional insured(s); (b) be primary and
not contributory with respect to insurance or self-insurance programs maintained by the City;
and (c) contain standard separation of insuured's provisions,
b. Worker's Compensation Insurance, In accordance with the provisions of Section 3300
of the Labor Code, Provider, if Provider has any employees, is required to be insured against
liability for worker's compensation or to undertake self-insurance, Prior to commencing the
performance of the work under this Agreement, Provider agrees to obtain and maintain any
employer's liability insurance with limits not less than $1,000,000 per accident.
c. The following requirements apply to the insurance to be provided by Provider pursuant
to this section:
(i) Provider shall maintain all insurance required above in fall force and
effect for the entire period covered by this Agreement. Certificates
of insurance shall be furnished to the City upon execution of this
Agreement and shall be approved in form by the City,
(ii) Certificates and policies shall state that the policies shall not be canceled
or reduced in coverage or changed in any other material aspect without
thirty (30) days prior written notice to the City.
d. If Provider fails or refuses to produce or maintain the insurance required by this
section or fails or refuses to furnish the City with required proof that insurance has been procured
and is in force and paid for, the City shall have the right, at the City's election, to forthwith
terminate this Agreement. Such termination shall not affect Provider's right to be paid for its
time and materials expended prior to notification of termination. Provider waives the right to
receive compensation and agrees to indenmify the City for any work performed prior to approval
of insurance by the City.
6, INDEMNII+ICATION
Provider agrees to and shall indemnify and hold harmless the City, its officers, agents,
employees, contractors, special counsel, and representatives from liability for pea:sonal injury,
damages, just compensation, restitution, judicial or equitable relief arising out of claims for
2
personal injury, including death, and claims for property damage, which may arise from the
direct or indirect operations of the Provider or its contractors, subcontractors, agents, employees,
or other persons acting on their behalf which relates to the services described in section 1 of this
Agreement. The Provider further agrees to indemnify, hold harmless, and pay all costs for the
defense of the City, including fees and costs for special counsel to be selected by the City,
regarding any action by a third party asserting that personal injury, damages, just compensation,
restitution, judicial or equitable relief due to personal or property rights arising by reason of the
terms of, or effects arising from this Agreement. City may make all reasonable decisions with
respect to its representation in any legal proceeding.
7. CONFLICT OF INTEREST
Provider covenants that it presently has no interests and shall not have interests, direct or
indirect, which would conflict in any manner with performance of services specified under this
Agreement.
8. LIVE SCAN BACKGROUND CHECK
Providers, and any employees, subcontractors or substitutes, in contact with minors under
eighteen (18) years of age shall arrange for and submit to a Live Scan electronic background
check for criminal history available through the California Department of Justice as a condition
of this Agreement and provide proof of compliance prior to performing services hereunder.
9. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this
Agreement shall be in writing and shall be deemed to be properly given if delivered in person or
mailed by first class or certified mail, postage prepaid, or sent by fax in the mamier provided in
this Section, to the following persons:
To City: Cleric of the Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Fax (714) 647-6956
With copy to: Executive Director of Parks, Recreation and Community Services
City of Santa Ana
26 Civic Center Plaza (M-75)
P.O. Box 1988
Santa Ana, California 92702
Fax (714) 571-4211
To Provider: Oli Sharp
Challenger Sports Corporation
707 Civic Center Dr., Ste. 205
Vista, CA 92084
Agent for Service: National Registered Agents, Inc.
818 W. Seventh Street
Los Angeles, CA 90017
A party may change its address by giving notice in writing to the other party. Thereafter,
any communication shall be addressed and transmitted to the new address. If sent by mail,
communication shall be effective or deemed to have been given three (3) days after it has been
deposited in the United States mail, duly registered or certified, with postage prepaid, and
addressed as set forth above. If sent by fax, communication shall be effective or deemed to have
been given twenty-four (24) hours after the time set forth on the transmission report issued by the
transmitting facsimile machine, addressed as set forth above. For purposes of calculating these
time frames, weekends, federal, state, County or City holidays shall be excluded.
10. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and
Provider, and supersedes any and all other agreements, oral or written, between the parties. In
the event of a conflict between the terms of this Agreement and any attachments hereto, the
terms of this Agreement shall prevail. This Agreement may not be modified except by written
instrument signed by the City and by an authorized representative of Provider. The parties agree
that any terms or conditions of any purchase order or other instrument that are inconsistent with,
or in addition to, the terms and conditions hereof, shall not bind or obligate Provider or the City,
Each party to this Agreement acknowledges that no representations, inducements, promises or
agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any
party, which is not embodied herein.
11. ASSIGNMENT/SUBSTITUTES
a. Assignment. The experience, knowledge, capability and reputation of Provider were a
substantial inducement for City to enter into this Agreement. Therefore, Provider may not assign,
transfer, delegate, or subcontract any interest herein without the prior written consent of the City
and any such assignment, transfer, delegation or subcontract without the City's prior written
consent shall be considered null and void.
b. Substitutes. In the event Provider is not able to teach a class clue to illness or some
other cause beyond Provider's reasonable control, Provider must procure, at its sole expense, a
qualified substitute instructor to teach the class at its regular time and place. Provider shall
ensure that substitute instructors are at least twenty-one (21) years of age and comply with the
City's insurance and live scan requirements contained herein. Evidence of compliance with
City's insurance and live scan requirements shall be provided upon request. Provider must
immediately notify the City of the substitute instructor's name, qualifications, address and phone
number. If Provider cannot procure a qualified substitute and the City is unable to assist in this
regard, then the class shall be canceled and a make-up class must be added to the session.
Provider must notify participants as soon as possible of any class cancellation and make-up class.
Provider must personally teach at least seventy-five percent (75%) of its offered classes.
12. TERMINATION
a. This Agreement maybe tenninated by the City upon thirty (30) clays written notice of
termination. In such event, Provider ,shall be entitled to receive,, and City shall pay Provider,
compensation for all services rendered prior to the effective date of termination.
b. Termination or cancellation of classes by the Provider outside of Section I Lb. must be
given to the City at least thirty (30) days prior to termi.nation/cancellation. Failure to provide
adequate cancellation notice to the City may put fixture contracting of business with the City at
risk and will result in the City's retention of ten (10%) percent of the final payment to Provider.
13. RECORDS
Provider shall use attendance sheets generated and supplied by the City to record
attendance in each class, Provider shall keep these and any other records in connection with the
work to be performed under this Agreement and shall permit City, upon request, to review such
records for a period of three (3) years from the date of final payment to Provider under this
Agreement.
14. NON-DISCRIMINATION
Provider shall not discriminate because of race, color, creed, religion, sex, marital status,
sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by
applicable law, in the recruitment, selection, teaching, training, utilization, promotion,
termination or other employment related activities. Provider affirms that it is an equal
opportunity employer and shall comply with all applicable federal, state and local laws and
regulations.
15. JURISDICTION - VENUE
This Agreement has been executed and delivered in the State of California and the
validity, interpretation, performance, and enforcement of any of the clauses of this Agreement
hallav determined and governed b_y_th.e_laws-ofthe_State_of California —Both partiesfurther--
agree that Orange County, California, shall be the venue for any action or proceeding that may
be brought or arise out of, in connection with or by reason of this Agreement.
16, LICENSES
Provider shall, throughout the tern of this Agreement, maintain all necessary licenses,
permits, approvals, waivers, and exemptions necessary for the provision of the services
hereunder and, required by the laws and regulations of the United States, the State of California,
the City of Santa Ana and all other governmental agencies.
17, SEVERA.BILITY
In the event that one or more of the phrases, sentences, clauses, paragraphs or sections
contained in this Agreement shall be declared invalid or unenforceable by valid judgment or
decree of a court of competent jurisdiction, such invalidity or unenforceability shall not affect
any of the remaining phrases, sentences, clauses, paragraphs or sections of this Agreement,
which shall be interpreted to carry out the intent of the parties hereunder,
18. EXHIBITS
All Exhibits referenced herein and attached hereto shall be incorporated as if fully set
forth in the body of this Agreement.
19. AUTHORITY
The person(s) executing this Agreement on behalf of the parties hereto warrant that they are
duly authorized to execute this Agreement on behalf of said parties and that by so executing this
Agreement, the parties hereto are formally bound to the provisions of this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written,
ATTEST:
/D I
Marra D, Huizar
Clerk- of the Council
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Attorney
By: GaLU, L44�4
John FAk.
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
Executive Director of Parks,
Recreation and Conammity Services Agency
CITY OF SANTA ANA
David (%vazo
City Manager
mummum
61i Sharp
Challenger Sports Corporation
Exhibit A
SCOPE OF SERVICES — Challenger Sports British Soccer Camp / Oli Sharp
A. Provider shall conduct Soccer Camp for children 3-16years.
B. Provider shall teach such or similar classes (1) at the times below at a facility to be designated by the City or
(2) on a schedule otherwise agreed upon by the parties for each class session or teen, including the location,
specific days and hours when classes will be held, and holidays to be observed,, in accordance with City's
needs.
• Soccer Camp -I week session, held 5 days per week, 1 hour per day, ages 3-4 yrs.
• Soccer Camp -I week session, held 5 days per week, 1 hour & 30 minutes per day, ages 4-5 yrs.
• Soccer Camp -1 week session, held 5 days per week, 3 hours per day, ages 6-16 yrs.
• Soccer Camp - I week session, held 5 days per week, 7 hours per day, ages 6-16 yrs.
C. Provider shall provide all materials, supplies, equipment, records and personnel. Provider shall be
responsible for clean-up of the facilities and materials and shall ensure the safety and effectiveness of
instruction.
CLASS SIZE REGISTRATION
A. All Soccer Camp classes mentioned above, must have a minimum of 5 paid students and no more than a
maximum of 100 paid students.
B. If the minimum registration has not been reached by the second class, the class maybe cancelled by mutual
agreement of Provider and City. Provider will be wider no obligation to provide services for the cancelled.
classes, and the City will have no further obligations to pay Provider compensation for die remaining
classes that were cancelled in that session.
CLASS FEES
A. Each participant shall pay class registration fees as established by City.
B. Any materials fee shall be established by mutual agreement of City and Provider and shall be payable
directly to Provider.
C. Only registered participants may participate in class.
D. Any refunds to participants will be made in accordance with City policy.
acoRo� CERTIFICATE OF LIABILITY INSURANCE
1..-�
OATE(MMIDOm Y,
F 3 / 6 / 2015
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(5), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER,
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
Risk 6 Insurance Consultants, Ina
5416 Glanridge Drive
Atlanta CIA 30342
ONANTACT Lyshon Jackson
PNONE"ESS (904)459-5975 FAXL,DI (AID Not' (404)459-5996
'MAIL . 1.a i.on@riskinsuranceco.com
INSURERS) AFFORDING COVERAGE
NAIC N
INSURER AMassachusetts Bay Ins
22306
INSURED
Challenger Sports Corp
8263 Flint St
Lenexa KS 66214
INSURER B Allmeri.ca Financial Benefit Ins
41840
INSURER C Hanover Insurance Co
22292
INSURER D:Technology Insurance Company
42376
INSURERE:9BE Ins Corp
39217
_
INSURER F:
COVERAGES CERTIFICATE NUMBER:CL1S1508135 REVISION NUMBER
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSRR
TYPE OF INSURANCE
AODL
V R
P Y BE
POLICY SEE
POLICY EXP
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
X COMMERCIAL GENERAL LIABILITY
UMA PREMISESa NI LUen
$ 100,000
A
CLAIMS -MADE ❑X OCCUR
ZDA 9436702-04
1/1/2015
1/1/2016
MED EXP(Any one person)
$ 5,000
PERSONAL& ADV INJURY
$ 1,000,000
GENERALAGGREGA'rE
$ 2,000,000
GENL AGGREGATE
LIMIT APPLIES PER:
PRODUCTS-COMPIOP AGO
$ 2,000,000
X POLICY
PIFr.TRO- LOG
$
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
(E..ormcntl
1,_000,000
B
X
ANY AUTO
BODILY INJURY (Per parson)ALL
BODILY INJURY (Per accidanl)
$
AUTOS AUTOS AUTOSULED
A9399093
1/1/2015
1/1/2016
NON -OWNED
HIRED, AUTOS
r
PROPERTY DAMAGE
Peraceldenl
$
Uninsured Melodist combined
$ 11000,000
-
X
UMBRELLA LIAB
X
OCCUR
-
EACH OCCVRRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
L,
EXCESS LIAB
CLAIMB�MADE
�HA9436692-03
DED I X I RETEN'rIDN
$
1/1/2015
/1/2016
D
WORKER$ COMPENSATION
WC STATU- OTH-
ANDEMPLOYERS'LIABILITY YINHOI
x
E.L. EACH ACCIDENT
$ 11000,000
ANY PRCPRIETOKPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED)
(Mandatory In NH)
NIA
TWC3395336
1/1/2015
1/1/2016
E.L. DISEASE - EA EMPLOYE
$ 11000,000
It yes. describe Intl.,
E.L.OISEASE POLICYLIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONSbat.
E
Participant Accident
UH006104
1/1/2015
1/1/2016
AccidentAl lcal $25,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
RE: British Soccer Camps
Dates: British Soccer camps; Aug 9th - 15th , 2015
City of Santa Ana, its officers, employees, agents and volunteers are recognized as Additional Insured,
with respect to General Liability and defense of suits arising from the operations and uses performed by
or on behalf of the named insured as required by written contract.
CAcosta@santa-ana.org
City of Banta Ana
Attn: Carmen Acosta
20 Civic Center Plaza
P.O. Box 1988 M-16
Santa Ana, CA 92702
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
REPRESENTATIVE
Kitchen/SK
INS025 omnnml n1 Th. Action name and Innn era r.ln cf,.r.A mar4c of Af npre,
V\\\" 4 i�K
\./- ry
•
POLICY NUMBER: 2DA 9436702 04
COMMERCIAL GENERAL LIABILITY
CG 20 26 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
•rr s - r r •
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
City of Santa Ana, its officers, agents, and employees
20 Civic Center Plaza
Santa Ana, CA 92701
Section II — Who Is An Insured is amended to in-
clude as an additional insured the person(s) or organi-
zations) shown in the Schedule, but only with respect
to liability for "bodily injury", "property, damage" or
"personal and advertising injury" caused, in whole or
in part, by your acts or omissions or the acts or omis-
sions of those acting on your behalf:
A. In the performance of your ongoing operations; or
B. In connection with your premises owned by or
rented to you
CG 20 26 07 04
,4) ISO Properties, Inc.. 2004
Page 1 of 1 0
ZDA 9436702 04 2901935
THIS ENDORSEMENTC1 ANGES11 E POILIC Y. PLEASE READ "I'CAREFULLY.
AMATEUR SPORTS BROADENING ENDORSEMENT
This endorsement rnodiflost insurance provided tinder the following:
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
rr
EINHOWM
1. Additional Insured by Gontnact, Agreement or Permit
Included
2. Additional Insured - Sponsors
Included
3. Additional Insured -- Subcontractor -- Aerobic Instructors, Massage
Therapists, and Personal Trainers
Included
at. Newly Acquired or Formed Organizations - Covered until end of
policy period
Included
5. Aggregate Limit per Location
Included
6, Alienated Promises
Included
7, Bodily Injury Redefined
Included
8. Broad Form Property Damage - Borrowed Equipment
Included
9, Incidental Malpractice (Employed nurses, EMT's & paramedics)
Included
10, Knowledge of Occurrence
Included
11. Medical Payments - Increased Limit
$
10,000
12, Non -owned Watercraft
51 feet
13. Personal Injury- Broad Form
Included
14. Property Damage Legal Liability (Fire, Lightning, Explosion,
$500,000
Smoke or Leakage Damage)
15. Supplementary Payments Increased Limits
- Bail Bonds
$
2,500
- Loss of Earnings
$
300
16, Unintentional Failirins to Disclose Hazards
Included
17. Unintentional Failure to Notify
Included
18. Liberalization Clause
Included
This endorsernentarnends coverages provided under the COrurnercel General Liability
Coverage Form
through
new coverages, higher limits and broader coverage grants,
ADDITIONAL INSURED BY CONTRACT,
AGREEMENT OR PERMIT
The following is added to SECTION If - WHO IS
AN INSURED, Paragraph 2.:
Each of the following is also an insured:
Any person or organization with whom you
agreed, in writing in a contract, agreement or
permit to provide insurance, that such person or
organization be added as an additional insured on
your policy. Such person or organization is an
additional insured only with respect to:
a, "Your work" for the additional insured(;)
designated in the contract, agreement or
permit;
b. Premises you own, rent, lease or occupy; of
Cr Your maintenance, operation or use of
equipment leased to YOU.
This insurance applies on a primary basis if
that is required by the written contract, written
agreement or pormit,
421-1383 10 10 locludos copyriqhted material of Inwiiance F,erviuus OffiG(a, ins. 2004
Page I of 5
ZDA 9436702 04 29gI935
This provision doo,,,, not apply:
& Unless the writer contract or written
agrearnent ties been executed or permit has
boor) issued prior to the "bodily injury",
'property darnage". "personal and advertising
inj rit Y"�
a. To any poison or organization included as an
additional insured by an endorsement issued
by (is and made part of this Coverage Part:
if To any person or organization included as an
additional insured under Paragraph 2. or 3. of
this ondorsernent;
D. To any lessor of equipment
(1) After the equipment lease expires; or
(2) If the "bodily intirrry", "property damage"
and advertising injury" arises out
of sole negligence of the lessor;
In, To any:
(1) Owners or other interests from whorn land
has been leased which takes place after
the lease for the land expires; or
(2) Managers or lessors of promises if:
(a) The 'accurrence" takes place after
YOU Cease to be a tenant in that
premises: or
(b) The "badfly injury", "property damage",
'personal and advertising injury"
arises out of structural alterations,
new construction or demolition
operations performed by or on behalf
of the manager or lessor;
I. To "bodily injury", "property damage" or
"personal and advertising injury" arising out of
the rendering of or the failure to render any
professional services; or
Additional insured coverage will not be provided
by this provision if an insured is otherwise
excluded in this policy.
Additional insured coverage provided by this
provision will not be broader than coverage
provided to any other insured. All other insuring
ng
agreements, exclusions, and conditions of this
policy apply.
The following is added to SECTION 11 — WHO IS
AN INSURED, Paragraph 2.:
Each of the following is also an insured;
Any financial sponsor with whom you agreed in a
written contract, agreement or ponnit to provide
insurance, that such person or Organization be
added as in additional insured on your policy.
Such person or organization is an additional
insured only with respect to liability for "bodily
injury', 'property damage", or "personal and
advertising injury" Caused, in whole or in part, by
Your acts or onlisstotrs, or the acts or Omissions of
those acting on your behalf.
ADDITIONAL INSURED — SUBCONTRACTOR --
AEROBIC INSTRUCTORS, MASSAGE
THERAPISTS, AND PERSONAL TRAINERS
SECTION 11 — WHO IS AN INSURED is amended
to add as an additional insured Aerobic
Instructors, Massage, Thorapiss, and Personal
Trainers, With WhOrn You agreed in a written
contract, agreement or permit to provide
insurance, that such person or organization be
added as an additional insured on your policy.
Such person is an additional insured only with
respect to liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whelp or in part, by your acts or
omissions or the acts or Omissions of those acting
on your behalf in the performance of your ongoing
operations, No Aerobic Instructor, Massage
Therapist, or Personal Trainer is an additional
insured with respect to any clairn arising Out Of the
rendering of or failure to render professional
services
4. NEWLY ACQUIRED OR FORMED
ORGANIZATIONS
SECTION 11 — WHO IS AN INSURED, Paragraph
3,a. is replaced by the following;
a. Coverage under this provision is afforded
only until the end of the policy period,
5. AGGREGATE LIMIT PER LOCATION
a. Under SECTION III — LIMITS OF
INSURANCE, the General Aggregate Limit
applies separately to each of your "locations"
owned by at, rented to you.
b, The following is added to SECTION V --
DEFINITIONS:
23, "Location" means promises involving the
same or connecting lots, or premises
whose connection is interrupted only by a
street, roadway, waterway or right-of-way
of a railroad,
6, ALIENATED PREMISES
Under SECTION I — COVERAGES, COVERAGE
A, Paragraph 2, Exclusions, j.(2) is replaced by
the following:
Page 2 of 5
421-1383 10 10 Includcs copydqhed maremi of Insurance survic(-s office, b1(; 200,1
rowin
ZDA 9436702 04 2901935
(2) Promises you sell, give away or abandon, if
the 'property damage" arises out of any part of
those premises and occurred from hazards
that were known by you, or s1horild have
reasonably been known by you, at the time the
property was transferred or abandoned.
7. BODILY INJURY REDEFINED
Under SECTION V — DEFINITIONS, Paragraph 3.
"bodily injury" is replaced by the following:
1 "Bodilyinjury" means bodily injury, disability,
sickness or disease Sustained by a person,
Including death resulting from any of these at
any time, "Bodily injury" includes mental
anguish or other mental injury resulting from
"bodily injury".
8, BROAD FORM PROPERTY DAMAGE —
BORROWED EQUIPMENT
a. Under SECTION I — COVERAGES,
COVERAGE A, Paragraph 2. Exclusions, item
j. is amended as follows:
Paragraph (4) does not apply to "property
damage" to borrowed equipment arising[ out of
your operations or while at your location.
In, The Insurance, afforded under this provalon is
excess over any other valid and collectible
property insurance (including deductible)
available to the insured whether primary,
excess, contingent or on any other basis.
9. INCIDENTAL MALPRACTICE
Employed Nurses, EMT's and Paramedics
Under SECTION 11 — WHO IS AN INSURED,
Paragraph 2.a.(1)(ch does not apply to a nurse,
emergency medical technician or paramedic
employed by you if you are not engaged in the
business or occupation of providing medical,
pararnedical, surgical, dental, x-ray or nursing
services,
10. KNOWLEDGE OF OCCURRENCE
Under SECTION IV — COMMERCIAL GENERAL
LIABILITY CONDITIONS, Paragraph 2, Duties In
The Event Of Occurrence, Offense, Claim or
Suit, Paragraph e, is added as follows.
e. Notice of an "occurrence", offense, claim or
"suit" will be considered knowledge of the
insurer[ if reported to an individual named
insured, partner, "executive officer" or an
"employee" designated by you to give LAS Such
a notice.
11, MEDICAL PAYMENTS — INCREASED LIMITS
a, Under SECTION I — COVERAGES,
COVERAGE C, Paragraph a.(2) is replaced
by the following:
(2) The expenses are incurred and reported
to LAS Within Inlet, years of the date of the
accident; and
b, Under SECTION III — LIMITS OF
INSURANCE, Paragraph 7. is replaced by the
following
T Subject to S. above, the higher of:
a. $ 10,000; or
lb. The amount shown in the Declarations
for Medical Expense Limit is the most
We Will Pay under COVERAGE C for
all medical expenses because of
"bodily injury" Sustained by one
person.
(3) This coverage does not apply if COVERAGE
C — MEDICAL PAYMENTS is excluded either
by the provisions of the Coverage, Form or by
endorsement.
12. NON -OWNED WATERCRAFT
Under SECTION I — COVERAGES, COVERAGE
A Paragraph 2. Exclusions, U.(2) is replaced by
tlo following:
(2) A watercraft you do not own that is:
(a) Lose than 51 feetlong; and
(b) Not being used to carry persons or
property for a charge;
This provision applies to any person, who with
your consent, either uses or is responsible for
the use of a watercraft,
13. PERSONAL INJURY — BROAD FORM
a. Under SECTION I — COVERAGES,
COVERAGE B, Paragraph 2,e. is deleted in
its entirely,
lb. Under SECTION V — DEFINITIONS, definition
14, "Personal and advertising injury":
(1) Paragraph b. is replaced by the
following;
b. Malicious prosecution or abuse of
process;
(2) Paragraph d, is replaced by the
following:
d. Oral or written publication, in any
manner, or televised or videotaped
publication of material that Slanders or
libels a parson or organization or
disparages a person's or
421-1383 10 10 Includes copyrighted malarial of insurance Services Offirri. Ino 2004
VAA
Page 3 of 5
ZIDA 9436702 04 2901935
organization's goods, products or
w-)rvices:
c. Under SECTION III — LIMITS OF
(3) Paragraph a. is replaced toy the
INSURANCE, Paragraph 6, is replaced by the
following:
following:
0. Oral or written publication, in any
6. Subject to 5. above, tho higher of:
Manner, or televised or videotaped
a. $500,000; or
publics tion of niatarial that violates a
'
person s right of privacy:
b� The FLightning, Explosion, Smoke
(4) Paragraph h. is added at, follows:
Or Leakage From Fire Protective
Systems Damage Limit shown in the
h. Discrimination (unless insurance
Declarations,
thereof is prohibited by law) that
is the most we will pay Linder COVERAGE
results in injury to the feelings or
A for damages because of "property
reputation of a natural person, but
damage" from fro, lightning, explosion,
Only if such discrimination is;
smoke and leakage from fire protective
(I) Not done intentionally by or at
systems to premises, while rented to you
the direction oh
or temporarily occupied by you with
(a) The insured;
permission of the Owner.
(b) Any officer of the corporation
all. Under SECTION IV — COMMERCIAL
director, stockholder, partner or �
GENERAL LIABILITY CONDITIONS,
(nerTmer, of the insured; and
Condition 4. Other Insurance, paragraph
b.(2) is replaced by the following:
(11) Not directly or indirectly related to
an "employee", nor to the
l (2) That is fire, lightning, explosion,
employment, prospective employment
smoke or leakage from fire protective
or termination of any person 014
systerns insurance for premises
persons by an insured.
rented to you or temporarily occupied
by you with permission of the owner;
c. This coverage does not apply if COVERAGE
01'
8 — PERSONAL AND ADVERTISING
INJURY is excluded either by the provisions of
e, Under SECTION V — DEFINITIONS, definition
the Coverage Form or by endorsoment,
9, 'Insured contract", Paragraph a. is replaced
by the following:
14. PROPERTY DAMAGE LEGAL LIABILITY (Fire,
Lightning, Explosion, Smoke or Leakage from
a� contract for a lease Of atomises.
Fire Protective Systems Damage)
However, that portion of the contract for a
a. The word fire is changedlease
to fire, lightning,
of premises that indemnifies any
person or organization for darnage by fire,
explosion, smoke and leakage from fire
lightning, explosion, smolo, or leakage
protective systems where it appears in the
train fire protective systems to premises
Limits of Insurance section of the Declarations
while rented to you or temporarily
for the Commercial General Liability Coverage
Occupied by you with permission of the
Fort m
owner is net an "insured contract".
b. Under SECTION I — COVERAGES,
C This coverage does not apply if Fire
COVERAGE A, the last paragraph (after the
Legal Liability of COVERAGE A is excluded
exclusions) is replaced by the following:
either by the provisions of the Coverage Part
Exclusions c. through n, do not apply to
or by endorsement,
damage by fire, lightning, explosion, smoke or
leakage from fire protective systems to
premises while rented to you Or temporarily
occupied by you with the permission of the
owner. A separate limit of insurance applies to
this coverage as described in SECTION H[ —
LIMITS OF INSURANCE. This limit will apply
to all damage proximately caused by the same
event, whether such damage results from fire,
fighting, explosion, smoke or leakage from
fire protective systerns, or any combination of
the five.
Page 4 of 5
421-1383 10 10 1 rodu d es copvrighted material of I osw a, ice Services Offk;e, Inc. 2004 `\\A
ZDA 9436702 04 2901935
15. SUPPLEMENTARY PAYMENTS INCREASED
LIMITS
Under SUPPLEMENTARY PAYMENTS
COVERAGES A AND 8, paragraphs 1.b. and
1.d. are replacod by the following:
1.b, Up to $2500 for cost of bail bonds required
because of accidents or traffic law violations,
arising out of the use of any vehicle to which
the Bodily Injury Liability Coverage applies,
We do not have to furnish these bonds,
1.d, All reasonable expenses incurred by the
insured at our request to assist us in the
investigation or defense of the claim or
"salt", including actual loss of earnings up to
$300 a day becauso of time off from work,
17. UNINTENTIONAL FAILURE TO DISCLOSE
WAZ,1'2DS
Under SECTION IV — COMMERCIAL GENERAL
LIABILITY CONDITIONS, Condition 61
Representations, Paragraph d. is added as
follows:
d. We will not disclaim coverage under this
Coverage Forrn if you fail to disclose all
hazards existing as of the inception date of the
policy provided such failure is not intentional,
'18. UNINTENTIONAL FAILURE TO NOTIFY
Under SECTION IV — COMMERCIAL GENERAL
LIABILITY CONDITIONS, Condition 2, DLItj09 In
The Event Of Occurrence, Offense, Claim or
Suit, Paragraph f. is added as follows:
C Your rights afforded under this policy shall not
be prejudiced if You fail to give LIS notice Of an
"oco.irrence", Offense, claim or "suit", solely
due to your reasonable and dOCUrnonted hollef
that the "bodily injury" or "property damage" is
not covered under this policy.
19, LIBERALIZATION CLAUSE
Under SECTION IV — COMMERCIAL GENERAL
LIABILITY CONDITIONS, the following condition
Is added:
Liberalization Clause
It we adopt any revision that would broaden the
coverage under this Coverage Form Without
additional premium, within 45 days prior to or
during the policy period, the broadened coverage
will Immediately apply to this Coverage Form.
Page 5 of 5
421.1383 10 10 htcludes nallyrighfad Inaienal nt 111surninoo Senvtoiti CsfirxInc 2004
r1/20/2016
ATE IMMIODIYYYY).
C" CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR. NEGATIVELY AMEND, EXTEND OR ALTER, THE COVERAGE AFFORDED BY THE POLICIES
BELOW', THIS CERTIFICATE, OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE. ISSUING INSURER,(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 niot confer rights to the
certificate holder In lieu of such endorsement(s).
PRODUCER CONTACT Lyshon ,Tackson
Risk & insurance Consultants, Inc PHO,N�o,Extj: (404)459-5975 {AC,Nnj:(404)a59-5976
541E Glenridge Drive aE,OMAIILSs:.ljackson@riskinsuranceco.com
INSURERIS) AFFORDING COVERAGE NANO tt
.Atlanta GA 30342 INSURER Massachusetts Hay Ins 22306
INSURED INSURER B Allmerica Financial Alliance Ins Co 10212
Challenger Sports Corp INSURERc:Hanover Insurance Co 22292
8263 Flint St INSURERD:Technology Insurance Company 42376
INSURER,E :QBZ Ins Corp 39217
Lenexa KS 66214 INSURER
C0VFRAC;F9 C.FPTIFIrATF NI IMRFP-CL15123111050 I?FVICIY9N NI IMRPP-
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR. MAY PERTAIN„ THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR LTR TYPE OF INSURANCE ADOINSDL.SU ®. POLICY NUMBER _-. MMlOC YXYY' MMID6YY'Y
... LIMITS
X COMMERCIAL. GENERAL LIABILITY
EACH OCCURRENCE ',.. $ 1,000,000
A CLAIMS -MADE X OCCUR '.....
.......... ..... .. ....
DAMAGE TO RENTSrr 100,000
PREMISE5(Ea.occurrence) $ _.....
ZDA 9436702-04 1/1/2016 1./1/2017
MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000' ..
GFN'L AGGREGATE LIMIT APPLIES PER::
... .......
GENERAL AGGREGATE $ 2,000,000
PRO-
POLICY
X2,000,000
......., _.... JECT LOC
PRODUCTS - COMP/OP AGO $ 2, 000 , 000...
OTHIER
Employee Benefits Liability $ 1, 000, 000
AUTOMOBILE LIABILITY
....._.
COMBINED SINGLE LIMIT $ 1,000,000
.LB. accident) ....._ _...
H X... ANY AUTO _.
BODILY INJURY {Per person) $ _.
ALL OWNED SCHEDULED ADA9394043 1/1/2016 1/1/2017
AUTOS AUTOS
BODILYINJURY (Per accident) $
NON -OWNED
PER nl} DAMAGE $ _.
PROPERTY
HIRED AUTOS AUTOS,
qP
Uninsured motorist combined $ 1,000,000
X.... UMBRELLA LIAR x OCCUR
EACH OCCURRENCE $ 5,000,000
C EXCESSLIAB .. CLAIMS -MADE.
AGGREGATE $ 5,000,000
DEC X RETENTION$ 0 UR.A9436692-04 1/1/2016 1/1/2017 :
$
WORKERS, COMPENSATION
x PER OTH-
AND EMPLOYERS' LIABILITY YIN
STATUTE ER.
ANY PROPRIETORYPARTNERIEXECUTIVE
E.L. EACH ACCIDENT $ 1,000,000
OFFICED ER EXCLUDED? N/A
TWC3451515 1/1/2016 1/1/2017 (Mandatory in NH)
Mandatory in
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
It yes, describe under
....
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT $ 1,000,000
E, Participant Accident AHH006104 1./1/2016 1/1/2017
Accident I Medical $25,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule,may be attached If more space Is required)
Minikickers
w
Dates: February 15th - March 30th 2016
(,:CK 111-I4;A I It HL)LIJ
SCuevas@santa--ana.org
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ATTN: Silvia Cuevas ACCORDANCE WITH THE POLICY PROVISIONS.
726 S Center Street
Santa Ana, CA 92704 AUTHORIZED REPRESENTATIVE
ISteve Mo1ir1a/IFCCKY -
Q 1988-2014 ACORD CORPORATION. All rights reserved..
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
INS025 0nt4ni i
Additional Named Insureds
Other Named Insureds
Challenger Sports Canada Corp, Insured Multiple Names
Challenger Sports Teamwear LLC Limited Liability Company, Insured Multiple Names
Soccer Pius inc Corporation, Insured Multiple Names
Sports Management Group LLC Limited Liability Company, Insured Multiple Names
Tetra Brazil Soccer LLC Limited Liability Company, Insured Multiple Games
QFAPPINF (02/2007) COPYRIGHT 2007, ANTS SERVICES ING I
ZDA 9436702 05 2901935
COMMERCIAL GENERAL LIABILITY
CG 20 26 04 13
N-16-RIMM A&Tdd 0
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):
City of Santa Ana its officers, employees, agents and volunteers, 20 Civic Center Plaza, Santa Ana, Ca
92702
Information required to complete this Schedule, if not shown above, will be shown in the Declarations. ___..__..__
__________
A. Section 11 — Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whole or in part, by your acts or
omissions or the acts or omissions of those acting
on your behalf:
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.
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,
Page 1 of I
CG 20 26 04 13 @ Insurance Services Office, Inc., 2012
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY,
Other insurance - Primary and Non -Contributory
(Additional Insured)
Tnis endorsement modifies m3ura-)ce provided Linder the following
C&N,]NIERCIAL GEiN'ERAL LIABILITY COVERAGE PART
The following is acided to Section IV— Commercial General Liability Conditions
4, Other Insurance
Additional Insureds
If you agree in a written contract, written
agreement or permit that the insurance
provided to any person or organization
included as an Additional Insured Under
Section 11 — Who is An Insured, is
primary and non-contributory, the
following applies;
if other valid and collectible insurance is
available to the Additional Insured for a
loss live cover under Coverages A or B
of this Coverage Part, our obligations
are limited as follosys�
0 1 � rimary Insurance
This insurance is primary to other
insurance that is available to the
Additional InSUred which covers the
Additional Insured as a Named
Insured. Yle will not seek
contribution frorn any other
insurance available to the Additional
Insured except:
i, For the sole negligence of the
Additional Insured-.
ii. when the Additional Insured is
an Additional Insured under
another primary liability policy-,
or
iii. when 2. below applies.
If this insurance is primary, our
obligations are not affected Unless
any of the other insurance is also
primary- Then we will share ,vith all
that Other insurance by the method
described in 3. below
2. Excess Insurance
This insurance is excess over:
(1) Any of the other insurance.
whether primary excess
contingent or on any other
basis,
(a) That is Fire, Extended
Coverage, Builder's
Risk, Installation Risk or
similar coverage for
"your work",
(b) That is Fire insurance
for premises rented to
the Additional Insured
or temporarily occupied
by the Additional
Insured with permission
of the owner;
(c) That is
insurance
Purchased
by the
Additional
Insured to
cover the
Additional
Insured's liability as a
tenant for
"property
damage" to premises
rented to the Additional
Insured or
temporarily
occupied
by the
Additional
with
permission
of the
owner; or
(d) If the loss arises out of
the maintenance or use
of aircraft, "autos" or
watercraft to the extent
not subject to Exclusion
gl, of Section I —
Coverage A — Bodily
Injury And Property
Damage Liability.
vVhen this insurance is excess, we will have
no duty Linder Coverages A or 8 to defend the
mSuired against any "suit" if any other insurer
has a duty to defend the insured against that
suit". if no other insurer defends, we will
undertake to do so. but We will be antited to
me insured's rights against all those other
insurers..
'Nhen this ns',�rance is excess over oflrer
insurance IN;-' .vl1Il Da'J 001 our Share Of the
afTIOunt Of t,'re loss if any �a! e6lo+ the
SUIT cf� that
Pa P
421.0452 06 07
ZDA '-436702 04 290', 1 �:j3-5
l I The total amount than all such other
I T-1 ' SUra nce y�voi.dd pay for the loss in We
af)sa-nce of th:s inSLKFlnce' and
(2) The total of afl deductble and sell -
insured amounts under all lhat other
insurance.
We �xill share the remaining loss, if any
with any other insurance that is not
described in this Excess Insurance
provision and was not bought specifically
to apply in excess of the Limits of
insurance shown in the Declarations of
this Coverage Part.
42 1-0452 06 07
3. Method Of Sharing
If al) of the other insurance permits
ccntrjbi-,iUon by equal shares, we will
follow this method also Under this
approach each insurer contributes equal
amounts Until it has paid its appkable
limit of insurance or none of the loss
remains, vilhichever comes first.
If any of the other insurance does not
permit contribution by equal shares. we
will contribute by limits. Under this
method, each insurer's share is based on
the ratio of its applicabie limit of insurance
to the total appticable limits of insurance
of all insurers.
A f �3 I' rI C' oe*'11'r' r f-F., r Jj'j, f
7)
ZOA9436702042901835
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the fo|lowing�
COMMERCIAL GENERAL LIABILITY COVERAGE FORM
SUMMARY OF COVERAGES
t Additional Insured byContract, Agreement orPermit
Included
2. Additional Insured —Sponsors
Included
3, Additional Insured — Subcontractor — Aerobic Instructors, Massage,
Therapists, and Personal Trainers
Included
4. Newly Acquired orFormed Orgun�zuUonu Covered until end cf
policy period
Included
5. Aggregate Limit per Location
Included
6. AWenahadPremiees
Included
7. Bodily Injury Redefined
Included
8. Broad Form PropertyDamage- Borrowed Equipment
Included
$. Incidental Malpractice (Employed oumea. EMT^m Q paramedics)
Included
10. Knowledge ofOccurrence
Included
11. Medical Payments Increased Limit
$ 10^000
12. Non'mwnedNateronaft
51 feet
13. Personal Injury Broad Form
Included
14. Property Damage Legal Liability (Fire, Lightning, Explosion,
$580.0010
Smoke orLeakage Damage)
16. Supplementary Payments Increased Limits
' Bail Bonds
$ 2.508
-LooaofEarningo
$ 308
16. Unintentional Failure to Disclose Hazards
Included
17. Unintentional Failure to Notify
Included
18. Liberalization Clause
Included
This endorsement amends coverages provided under the Commercial General Liability
Coverage Form through
new coverages, higher limits and broader coverage grants.
1. ADDITIONAL INSURED BY CONTRACT,
AGREEMENT ORPERMIT
The following is added to SECTION U —VVHO IS
ANINSURED, Paragraph 2.:
Each cfthe following iualso mninsured:
Any person or organization, with whom you
agnoad, in writing in m c:ntraot, agreement or
permit to provide inauranoe, that such person or
organization be added asamadditional insured on
your policy. Such person or organization is an
additional Insured only with respect to:
o. "Your work" for the additional insured(s)
designated inthe contract, agreement ur
permit;
lb� Premises you own. rent. lease or000mpy� or
o. Your roeinhananue, operation or use of
equipment 8eosedLoyou.
This insurance applies on a primary basis if
that iarequired bythe written contract, written
agreement orpermb ,
� v*�`
w�
tee
42113831010 Includes copyrighted materiai ofInsurance Services Office, Inc, 2004
This provision does not apply:
d. Unless the written contract or written
agreement has been executed or permit has
been issued prior to the "'bodily injury",
'' property demage^. "personal and advertising
injurY^; 3.
*. To any person or organization included as an
additional insured by an endorsement issued
byueand made part ofUnfmCoverage Part;
f. To any person or organization included as an
additional insured under Paragraph 2.or3. of
this endorsement;
g. To any lessor of equipment:
(1) After the equipment lease expires�mr
(2) M the "bodily injury", "property damage",
"personal and advertising injury" arises out
of sole negligence of the lessor-,
(1) Owners orother interests from whom hand
has been leased which takes place after
the lease for the land expires; or
(2) Managers orieaaonsofpremisesif:
(a) The ^nocunanoe^ takes place after
you cease to be a tenant in that
pnamioes�or
(b) The "bodily injury". "property damage",
"personal and advertising injury/
arises out of structural a|tensdono,
new construction or demolition
operations performed by or on behalf
ofthe manager or|eaeor�
i To "bodily injury", "property damage" or
"personal and advertising injury" arising out of
the rendering of or the failure to render any
professional services; or
Additional insured coverage will not be provided
by this provision if an insured in otherwise
excluded inthis policy.
Additional insured coverage provided by this
provision will not be broader than coverage
provided No any other insured. All other insuring
ognaemanta, exdusions, and conditions of this
policy apply.
Such person or organization is an additional
insured only with respect to Dmhi|hy for "bodily
injury. "property damage", or ^ponmmm| and
advertising injury" oeueed, in whobaurin part,by
your acts or omissions, or the acts or omissions of
those acting onyour beheif,
ADDITIONAL UNSURED— SUBCONTRACTOR —
AEROBIC INSTRUCTORS, MASSAGE
THERAPISTS, AND PERSONAL TRAINERS
SECTION O —VVHO IS AN INSURED is amended
to add as an additional insured Aerobic
Instructors, Massage Therapists, and Personal
Trainers, with whom you agreed in m written
oontrao1, agreement or permit to provide
inouranoe, that such person or organization be
added an an additional insured on your policy.
Such person is an additional insured only with
respect to liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whoIo or in part, by your mota or
omissions or the acts or omissions of those acting
onyour behalf inthe performance ofyour ongoing
operations, No Aerobic Instructor, K8goVage
Thecm9imL. or Personal Trainer is an addtimmm|
insured with respect to any claim arising out of the
rendering of or failure to render professional
services.
/L NEWLY ACQUIRED OR FORMED
ORGANIZATIONS
SECDONU—VVHO{S ANINSURED, Paragraph
3.a.|oreplaced bythe following:
a. Coverage under this provision is afforded
only until the end cfthe policy period.
5. AGGREGATE LIMIT PER LOCATION
a. Under SECTION N — LIMITS OF
INSURANCE, the General Aggregate Limit
applies separately to each ofyour ^lonobonm^
owned byorrented tuyou.
b. The following is added to SECTION V —
DEFINITIONS:
33. "Location" means premises involving the
same or connecting lnts, or premises
whose connection is interrupted only by
street, roadmmy, waterway or right-of-way
of railroad.
6. ALIENATED PREMISES
2. ADDITIONAL INSURED —SPONSORS Under SECTION {— COVERAGES, COVERAGE
The foIlowing is added to SECTION || —VVHC) IS A, Paragraph 2 Exclusions,
AN INSURED, Paragraph 2: the following:
Each of the following iealso am|noured�
Any financial sponsor with whom you agreed in a
written oontraot, agreement or permit to provide
insurance, that such person or organization be
added anmnaddibona|insured onyour policy,
aQe�of�
421-1�38310 10 Includes copyrighted material minsurance Services Office, mr,000* `
N.
41
(2) Premises you oeU, give away or abandmn, if
the "property damage" arIseaout mfany part of
those premises and occurred from hazards
that were known by you, or should have
reasonably been known byyou, a1the time the
property was transferred orabandoned.
BODILY INJURY REDEFINED
Under SECTION v— DEF|N|TUONS. Paragraph 3.
"bodily injury" isreplaced bythe foUovxing�
3. "Bodily injury" means bodily injury, disability,
sickness or disease sustained by a pemon,
including death resulting from any of these at
any time. "Bodily injury" includes mental
anguish or other mental injury resulting from
"bodily injury".
BROAD FORM PROPERTY DAMAGE —
BORROWED EQUIPMENT
m. Under SECTION U — COVERAGES,
COVERAGE A, Paragraph 2. Exclusions, item
].imamended asfollows:
Paragraph N@ does not apply to "property
damage" tuborrowed equipment arising out cf
your operations o/while mtyour location.
b. The imounenoo afforded under this provision is
excess over any other valid and collectible
property insurance (incIuding deductible)
available to the insured whether primary,
excess, contingent oronany other basis.
INCIDENTAL MALPRACTICE
Employed Munses, EN1T'sand Paramedics
Under SECTION |) — WHO IS AN INSURED,
Paragraph 2.u.(1)(d) does not apply to a nurae,
emergency medical technician or paramedic
employed by you if you are not engaged in the
business or occupation of providing, medical,
pammedium|, surgical, denta8, x-ray or nursing
services,
10\KNOWLEDGE OfOCCURRENCE
Under SECTION [V—COMMERCIAL GENERAL
LIABILITY CONDITIONS, Paragraph 2. Duties In
The Event Of Ooourr*nce, Offense, C|m|mn or
Suit, Paragraph o. is added as follows-.
e. Notice of an "occurrence", offenae, claim or
"suit" will be considered knowledge of the
insured If reported to on individual named
insured, partner' "executive officer" or an
"employee" designated byyou togive us such
ano*imm.
11. MEDICAL PAYMENTS —INCREASED LIMITS
e. Under SECTION | — COVERAGES,
COVERAGE C, Paragraph a.(2) is replaced
by the follow�ng:
(2) The expenses are incurred and reported
to us withhn three years of the date of the
accident-, and
b` Under SECTION U| — LIMITS OF
INSURANCE, Paragraph 7. is replaced bythe
7. Subject toS.above, the higher of:
b. The amount shown inthe Declarations
for Medical Expense Limit lsthe most
we will pay under COVERAGE C for
all me6ce| expenses because of
"bodily injury" sustained by one
person.
(3) This coverage does not apply if COVERAGE
C—MEDICAL PAYMENTS ieexcluded either
by the provisions ufthe Coverage Form or by
endorsement.
12. NON -OWNED WATERCRAFT
UmdarSECTKON|—COVERAGES, COVERAGE
A^ Paragraph 2. Exclusions, Q.(2) is replaced by
the following:
(2) A watercraft you do not own that is:
(a) Less than 61 feet long; and
(b) Not being used to carry persons or
property for acharge;
This pnuv�aion applies to any permon, who with
your consent, either uses orie maapunoibIefor
the use of a watercraft.
a. Under SECTION | — COVERAGES,
COVERAGE B' Paragraph 2.e. is deleted in
its entirety.
b Under SECTION V—DEFINITIONS, definition
14L"Personal and advertising injury":
(1) Paragraph b` is replaced by the
following:
b` &8mU6oua prosecution orabuse of
(2) Paragraph d., is replaced by the
following:
d. Oral or written publicaUon, in any
monney, or televised or videotaped
publication ofmaterial that slanders or
libels o person or organization or
disparages aperuon'sor
421438310 10 Includes copyrighted material mInsurance Services Office, |ouzon4
organizeiom's Aooda, products or
services;
CU Paragraph e. is replaced by the
following:
e. Oral orwritten pubHoetion, in any
mnanner, or televised or videotaped
publication of material thotvioiatea a
peraun'sright ofprivacy;
(4)Paragraph h.inadded mofollows:
h. Discrimination (unless insurance
thereof is prohibited by law) that
results in injury to the feelings or
reputation of a natural pennnn, but
only if such discrimination in:
(|) Not done intentionally by or at
the direction of
(e) Theinaured�
(b)Any officer of the corporation,
director, stockholder, partner or
member of the insured; and
(ii) Not directly or indirectly neiated to
an "employee", nor to the
amploymert, prospective employment
or &arm|nafiom of any person or
persons byaninsured.
c. This coverage duaa not apply if COVERAGE
B — PERSONAL AND ADVERTISING
INJURY inexcluded either bythe provisions Pf
the Coverage Form nrbyendorsement.
14. PROPERTY DAMAGE LEGAL LIABILITY (Fire,
Lightning' Explosion, Smoke or Leakage from
Fire Protective Systems Damage)
a The word fire inchanged tofire, lightning,
explosion, smoke and leakage from fire
protective systems where it appears in the
Limits ofInsurance section ofthe Declarations
for the Commercial General Liability Coverage
Form.
b. Under SECTION | — COVERAGES,
COVERAGE 4, the last paragraph (after the
exclusions) is replaced bythe following:
Exclusions o. through In. do not apply to
damage by fire, lightning, explosion, smoke or
leakage from fire protective systems to
premises while rented to you or tempormriXy
occupied by you with the permission of the
owner. Aaeparate limit ofinsurance applies to
this coverage as described in SECTION III —
LIMITS C}FINSURANCE. This limit will mppiy
toall damage proximately caused bythe same
eward, whether such damage results from fire,
lightning, oxp|oo[om, smoke or leakage from
fire protective systems nrany combination of
the five.
o. Under SECTION |U — LIMITS OF
INSURANCE, PmragrePh6. is replaced by the
6. Subject to 5. above, the higher of.
a. $500.000;ur
b. The Fire, LkJhhning, Explosion, Smoke
or Leakage From Fire Protective
Systems Damage Limit shown in the
0eo|anationa,
is the most wewill pay under COVERAGE
A for damages because of "property
damage" from One' |[0htning, exp|muiom,
smoke and leakage from fine protective
systems to premiaes, while rented to you
or temporarily occupied by you with
permission ofthe owner,
d. Under SECTION |V — COMMERCIAL
GENERAL LIABILITY CONDITIONS,
Condition 4. Other |nsuramn*, paragraph
b.(2)ioreplaced bythe following:
b. (2) That is fire. 0ghtmin8, expXnoion,
smoke orleakage from fire protective
systems insurance for premises
rented to you or temporarily occupied
by you with permission of the owner;
or
e. UnderSECTIONV—DEF|NOrIONS,definition
g."Insured contrect". Paragraph a.isreplaced
bythe following:
m. A contract for a lease of premises.
However, that portion ufthe contract for a
lease of premises that indemnifies any
person or organization for damage by fire.
Ughtning, mxp|nnion, smoke or leakage
from fire protective systems to ppem�oem
while rented to you or 0annponah|y
occupied by you with permission of the
owner imnot am"insured oontraot".
f. This coverage does not apply if Fire Damage
Legal Liability ofCOVERAGE Aieexcluded
either by the provisions of the Coverage Part
orbyendorsement.
421138,31010 Includes copyrighted material uvInsurance Services Office, Inc. zon4
Page 4 of 5
15.SUPPLEK@ENTARY PAYMENTS INCREASED 1D.UNINTENTIONAL FAILURE TO NOTIFY
U&UUTS //~^~.corrmwx/ rn1%,m00f1/^1 ,zCmCO^/
Under SUPPLEMENTARY PAYMENTS
COVERAGES A AND B, Paragraphs 1.b. and
1.d.are replaced bythe following:
1�z Up to $2500 for cost of bail bonds required
because of accidents or traffic law violations
arising out of the use of any vehicle to which
the Bodily Injury Liability Coverage applies.
VVednnot have hofurnish these bonds,
1,d. All reasonable expenses incurred by the
insured at our request to assist us in the
investigation or defense of the claim or
^mug., including actual loss of earnings up to
$3OOaday because oftime off from work.
Under SECTION [V—COMMERCIAL GENERAL
LIABILITY CONDITIONS, Condition 6.
Representations, Paragraph d. is added as
follows:
d. We will not disclaim coverage under this
Coverage Form if you fail to disclose all
hazards existing emofthe inception date ofthe
policy provided such failure in not intentional.
".~=. "�".°'" .° _�"�=�°"."�~,�"�°"�
LIABILITY CONDITIONS, Condition 2. Duties In
The Event Of Occurrence, Offense, Claim or
Suit, Paragraph tiaadded aafollows.
t Your rights afforded under this policy shall not
be prejudiced if you tmi[ to give us notice of an
^000urrenoe^, offense, claim or ^suit", solely
due toyour reasonable and documented belief
that the "bodily injury" or "property damage" in
not covered under this pofioy,
18.LIBERALIZATION CLAUSE
Under SECTION [V—COMMERCIAL GENERAL
LIABILITY COND|ThONS, the following condition
is added:
Liberalization Clause
If we adopt any revision that would broaden the
coverage under this Coverage Form without
additional premium, within 45 days prior to or
during the policy period, the broadened coverage
will immediately apply tothis Coverage Form.
Page 5 of 5
42143831010 Includes copyrighted material of Insurance Services Omnm |pczon*