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C09-07 - HARMSWORTH ASSOCIATES - BIOLOGICAL REPORTING SERVICES3/4/09 AGREEMENT FOR SERVICES BY INDEPENDENT CONTRACTOR Biological Reporting Services THIS AGREEMENT is made and effective as of the 5th day of May, 2009, by and between the CITY OF BEAUMONT ( "OWNER ") whose address is 550 E. 6`h Street, Beaumont, California 92223 and HARMSWORTH ASSOCIATES, whose address is 29 Vacaville, Irvine, CA, telephone 714- 389 -9527, fax 714 -287 -4986 e -mail pgalvin9 @cox.net, Fed. Tax Id. No. 330065210 ( "CONTRACTOR "). RECITALS This Agreement is entered into on the basis of the following facts, understandings and intentions of the parties to this Agreement: A. OWNER desires to engage the services of CONTRACTOR to perform such services as may be assigned, from time to time, by OWNER in writing for the purpose of assisting the OWNER with landscape architecture services. B. The specific services to be performed by CONTRACTOR shall be described in one or more written Task Orders issued by OWNER to CONTRACTOR pursuant to this Agreement. C. CONTRACTOR agrees to provide such services pursuant to, and in accordance with, the terms and conditions of this Agreement, and has represented and warrants to OWNER that CONTRACTOR possesses the necessary skills, qualifications, personnel and equipment to provide such services. AGREEMENT NOW, TBEREFORE, in consideration of the foregoing Recitals and mutual covenants contained herein, OWNER and CONTRACTOR agree as follows: 1. Term of Agreement. This Agreement is effective as of the date first above written and shall continue until April 30, 2015, unless extended or sooner terminated as provided for herein. 2. Services to be Performed by CONTRACTOR. CONTRACTOR agrees to provide such services as may be assigned, from time to time, in writing by the City Council of OWNER. Each such assignment shall be made in the form of a written Task Order. Each such Task Order shall include, but shall not be limited to, a description of the nature and scope of the services to be performed by CONTRACTOR, the amount of compensation to be paid, and the expected time of completion. Page 1 of 8 3. Associates and Subcontractors. CONTRACTOR may, at CONTRACTORs sole cost and expense, employ such competent and qualified independent associates, subcontractors and consultants as CONTRACTOR deems necessary to perform each such assignment; provided, however, that CONTRACTOR shall not subcontract any of the work to be performed without the prior written consent of OWNER. 4. Compensation. 4.01 In consideration for the services to be performed by CONTRACTOR, OWNER agrees to pay CONTRACTOR as provided for in each Task Order. 4.02 Each Task Order shall specify a total not -to- exceed sum of money and shall be based upon CONTRACTOR's schedule of regular hourly rates customarily charged by CONTRACTOR to its clients. 4.03 OWNER may reimburse CONTRACTOR for reasonable and necessary expenses incurred by CONTRACTOR in the performance of services for OWNER. Reimbursement shall be according to a schedule of reimbursable expenses included in each Task Order. 4.04 CONTRACTOR shall not be compensated for any services rendered nor reimbursed for any expenses incurred in excess of those authorized in any Task Order unless approved in advance by the City Council of OWNER, in writing. 4.05 Unless otherwise provided for in any Task Order issued pursuant to this Agreement, CONTRACTOR agrees that payment of compensation earned shall be made in monthly installments within 45 business days after receipt of a detailed, corrected, written invoice describing in reasonable detail, to the extent applicable, the services performed, the time spent performing such services, the hourly rate charged therefor, the identity of individuals performing such services for the benefit of OWNER, and materials consumed or used. Such invoice shall also include a detailed itemization of authorized expenses incurred. 5. Obligations of Contractor. 5.01 CONTRACTOR agrees to perform all assigned services in accordance with the terms and conditions of this Agreement and those specified in each Task Order. 5.02 Except as otherwise provided for in each Task Order, CONTRACTOR will supply all personnel, materials and equipment required to perform the assigned services. 5.03 CONTRACTOR shall keep OWNER informed as to the progress of the work assigned hereunder, by means of regular and frequent consultations. From time -to -time, when requested by the OWNER, CONTRACTOR shall prepare written status reports. Page 2 of 8 5.04 CONTRACTOR hereby agrees to be solely responsible for the health and safety of its employees and agents in performing the services assigned by OWNER. Therefore, CONTRACTOR hereby covenants and agrees to: a. Obtain a comprehensive general liability insurance policy in an amount of not less than $1,000,000.00 per occurrence for all coverage naming OWNER as an additional insured; b. Optional Insurance Coverage: Choose and check one: Required _/Not Required 4 ; Obtain a policy of errors and omissions insurance in a minimum amount of $ (N /A) per occurrence to cover any negligent acts or omissions committed by CONTRACTOR, its employees and/or agents in the performance of any services for OWNER; C. Comply with all applicable local (including OWNER's), state and federal laws, rules and regulations regarding, by way of example and not by limitation, nondiscrimination and payment of wages; d. Provide worker's compensation insurance for CONTRACTOR's employees and agents with limits as prescribed by law and custom. CONTRACTOR waives all rights of subrogation against OWNER. Evidence of all insurance coverage shall be provided to OWNER prior to issuance of the first Task Order. Such policies shall be issued by a highly rated insurer (minimum Best's Ins. Guide rating of "A:VII ") licensed to do business in California, and shall provide that they shall not be cancelled or amended without 30 days' prior written notice to OWNER. Self - insurance does not comply with these insurance specifications. CONTRACTOR acknowledges and agrees that all such insurance is in addition to CONTRACTOR's obligation to fully indemnify and hold OWNER completely free and harmless from and against any and all claims arising out of any, loss, injury or damage to property or persons caused by the negligent acts or omissions of CONTRACTOR in performing services assigned by OWNER. 5.05 CONTRACTOR and OWNER agree that OWNER, its employees, agents and officials should, to the extent permitted by law, be fully protected from any loss, injury, damage, claim, lawsuit, cost, expense, attorneys' fees, litigation costs, defense costs, court costs or any other costs arising out of or in any way related to the performance of this Agreement. Accordingly, the provisions of this indemnity are intended by the parties to be interpreted and construed to provide the fullest protection possible under the law to OWNER. CONTRACTOR acknowledges that OWNER would not enter into this Agreement in the absence of the commitment of CONTRACTOR to indemnify and protect OWNER as set forth here. Page 3 of 8 5.05.1 To the full extent permitted by law, CONTRACTOR shall defend, indemnify and hold harmless OWNER, its employees, agents and officials, from any liability, claims, suits, actions, arbitration proceedings, administrative proceedings, regulatory proceedings, losses, expenses or costs of any kind, whether actual, alleged or threatened, actual attorneys' fees incurred by owner, court costs, interest, defense costs, including expert witness fees and any other costs or expenses of any kind whatsoever without restriction or limitation incurred in relation to, as a consequence of or arising out of or in any way attributable actually, allegedly or impliedly, in whole or in part to the performance of this Agreement. CONTRACTOR's obligation to defend, indemnify and hold harmless shall include any and all claims, suits and proceedings in which CONTRACTOR (and/or CONTRACTOR's agents and/or employees) is alleged to be an employee of OWNER. All obligations under this provision are to be paid by CONTRACTOR as they are incurred by OWNER. 5.05.2 Without affecting the rights of OWNER under any provision of this Agreement or this Section, CONTRACTOR shall not be required to indemnify and hold harmless OWNER as set forth above for liability attributable to the sole fault of OWNER, provided such sole fault is determined by agreement between the parties or the findings of a court of competent jurisdiction. This exception will apply only in instances where OWNER is shown to have been solely at fault and not in instances where CONTRACTOR is solely or partially at fault or in instances where OWNER's fault accounts for only a percentage of the liability involved. In those instances, the obligation of CONTRACTOR will be all- inclusive and OWNER will be indemnified for all liability incurred, even though a percentage of liability is attributable to conduct of OWNER. CONTRACTOR acknowledges that its obligation pursuant to this Section extends to liability attributable to OWNER, if that liability is less than the sole fault of OWNER. CONTRACTOR has no obligation under this Agreement for liability proven in a court of competent jurisdiction or by written agreement between the parties to be the sole fault of OWNER. 5.06 In the event that OWNER requests that specific employees or agents of CONTRACTOR supervise or otherwise perform the services specified in each Task Order, CONTRACTOR shall ensure that such individual (or individuals) shall be appointed and assigned the responsibility of performing the services. 5.07 In the event CONTRACTOR is required to prepare plans, drawings, specifications and/or estimates, the same shall be furnished in conformance with local, state and federal laws, rules and regulations. Page 4 of 8 5.08 CONTRACTOR shall be solely responsible for obtaining all permits, licenses and approvals necessary or applicable to the performance of services under this Agreement, unless otherwise expressly provided for in any Task Order issued pursuant to this Agreement. In the event OWNER is required to obtain an approval or permit from another governmental entity, CONTRACTOR shall provide all necessary supporting documents to be filed with such entity. 5.09 CONTRACTOR shall be solely responsible for obtaining Employment Eligibility Verification information from CONTRACTOR's employees, in compliance with the Immigration Reform and Control Act of 1986, Pub. L. 99 -603 (8 U.S.C. 1324a), and shall ensure that CONTRACTOR's employees are eligible to work in the United States. 5.10 Drug-free Workplace Certification. By signing this Agreement, the CONTRACTOR hereby certifies under penalty of perjury under the laws of the State of California that the CONTRACTOR will comply with the requirements of the Drug -Free Workplace Act of 1990 (Government Code, Section 8350 et seq.) and will provide a drug -free workplace. 6. Obligations of Owner. 6.01 OWNER shall do the following in a manner so as not to unreasonably hinder the performance of services by CONTRACTOR: a. Provide information, requirements and criteria regarding OWNER's project; b. Furnish all existing studies, reports and other available data and items pertinent to each Task Order that are in OWNER's possession; C. Designate a person to act as a liaison between CONTRACTOR and the City Council of OWNER. 7. Additional Services Changes and Deletions. 7.01 During the term of this Agreement, the City Council of OWNER may, from time to time, and without affecting the validity of this Agreement or any Task Order issued thereunder, order changes, deletions and additional services by the issuance of written change orders authorized and approved by the City Council of OWNER. 7.02 In the event CONTRACTOR performs additional or different services than those described in any Task Order or authorized change order without the prior written approval of the City Council of OWNER, CONTRACTOR shall not be compensated for such services. 7.03 CONTRACTOR shall promptly advise OWNER as soon as reasonably practicable upon gaining knowledge of a condition, event or accumulation of events which Page 5 of 8 may affect the scope and/or cost of services to be provided pursuant to this Agreement. All proposed changes, modifications, deletions and/or requests for additional services shall be reduced to writing for review and approval by the City Council of OWNER. 7.04 In the event that OWNER orders services deleted or reduced, compensation shall likewise be deleted or reduced by a fair and reasonable amount and CONTRACTOR shall only be compensated for services actually performed. In the event additional services are properly authorized, payment for the same shall be made as provided in Section 4 above. Termination of Agreement. 8.01 In the event the time specified for completion of an assigned task in a Task Order exceeds the term of this Agreement, the term of this Agreement shall be automatically extended for such additional time as is necessary to complete such Task Order, and thereupon this Agreement shall automatically terminate without further notice. 8.02 Notwithstanding any other provision of this Agreement, OWNER, at its sole option, may terminate this Agreement at any time by giving 10 days' written notice to CONTRACTOR, whether or not a Task Order has been issued to CONTRACTOR. 8.03 In the event of termination, the payment of monies due CONTRACTOR for work performed prior to the effective date of such termination shall be paid within 45 business days after receipt of an invoice as provided in this Agreement. Upon payment for such services, CONTRACTOR agrees to promptly provide and deliver to OWNER all original documents, reports, studies, plans, specifications and the like which are in the possession or control of CONTRACTOR and pertain to OWNER. 9. Status of Contractor. 9.01 CONTRACTOR shall perform the services assigned by OWNER in CONTRACTOR's own way as an independent contractor, and in pursuit of CONTRACTOR's independent calling, and not as an employee of OWNER. CONTRACTOR shall be under the control of OWNER only as to the result to be accomplished and the personnel assigned to perform services. However, CONTRACTOR shall regularly confer with OWNER's City Council as provided for in this Agreement. 9.02 CONTRACTOR hereby specifically represents and warrants to OWNER that the services to be rendered pursuant to this Agreement shall be performed in accordance with the standards customarily applicable to an experienced and competent professional rendering the same or similar services. Further, CONTRACTOR represents and warrants that the individual signing this Agreement on behalf of CONTRACTOR has the full authority to bind CONTRACTOR to this Agreement. 10. Ownership of Documents; Audit. Page 6 of 8 10.01 All draft and final reports, plans, drawings, studies, maps, photographs, specifications, data, notes, manuals, warranties and all other documents of any kind or nature prepared, developed or obtained by CONTRACTOR in connection with the performance of services assigned to it by OWNER shall become the sole property of OWNER, and CONTRACTOR shall promptly deliver all such materials to OWNER. At the OWNER's sole discretion, CONTRACTOR may be permitted to retain original documents, and furnish reproductions. If OWNER uses such documents for any purpose other than for which they were prepared without CONTRACTOM prior written approval, OWNER hereby waives any claims against CONTRACTOR and will hold CONTRACTOR harmless from any claim or liability for injury or loss arising from OWNER's unauthorized use. 10.02 Subject to applicable federal and state laws, rules and regulations, OWNER shall hold all intellectual property rights to any materials developed pursuant to this Agreement. CONTRACTOR shall not use for purposes other than the performance of this Agreement, nor shall CONTRACTOR release, reproduce, distribute, publish, adapt for future use or any other purposes, or otherwise use, any data or other materials first produced in the performance of this Agreement, nor authorize others to do so, without the prior written consent of OWNER. 10.03 CONTRACTOR shall retain and maintain, for a period not less than four years following termination of this Agreement, all time records, accounting records and vouchers and all other records with respect to all matters concerning services performed, compensation paid and expenses reimbursed. At any time during normal business hours and as often as OWNER may deem necessary, CONTRACTOR shall make available to OWNER's agents for examination all of such records and shall permit OWNEM agents to audit, examine and reproduce such records. 11. Miscellaneous Provisions. 11.01 This Agreement supersedes any and all previous agreements, either oral or written, between the parties hereto with respect to the rendering of services by CONTRACTOR for OWNER and contains all of the covenants and agreements between the parties with respect to the rendering of such services in any manner whatsoever. Any modification of this Agreement will be effective only if it is in writing signed by both parties. 11.02 CONTRACTOR shall not assignor otherwise transfer any rights or interest in this Agreement without the prior written consent of OWNER. Unless specifically stated to the contrary in any written consent to an assignment, no assignment will release or discharge the assignor from any duty or responsibility under this Agreement. 11.03 CONTRACTOR shall comply with all applicable local, state and federal laws, rules, regulations, entitlements and/or permits applicable to, or governing the services authorized hereunder. Page 7 of 8 11.04 If required by law, CONTRACTOR shall file Conflict of Interest Statements with OWNER. 11.05 Any dispute which may arise by and between the OWNER and the CONTRACTOR, including the CONTRACTOR's subcontractors, laborers, and suppliers, shall be submitted to binding arbitration. Arbitration shall be conducted by the Judicial Arbitration and Mediation Services, Inc./Endispute, in accordance with its construction industry rules in effect at the time of the commencement of the arbitration proceeding, and as set forth in this Paragraph. Arbitration shall be conducted before a panel of three arbitrators, unless the PARTIES agree in writing to submit the matter before a single arbitrator. The arbitrators must decide each and every dispute in accordance with the laws of the State of California, and all other applicable laws. The arbitrators' decision and award are subject to judicial review for errors of fact or law in accordance with Section 1296 of the Code of Civil Procedure, by a Superior Court of competent venue and jurisdiction. Discovery may be conducted in the arbitration proceeding pursuant to Section 1283.05 of the Code of Civil Procedure. Unless the PARTIES stipulate to the contrary, prior to the appointment of the arbitrators, all disputes shall first be submitted to non - binding mediation, conducted by either the American Arbitration Association or Judicial Arbitration and Mediation Services, Inc./Endispute, in accordance with their respective rules and procedures for such mediation. In any arbitration or litigation arising out of this Agreement, or the performance of any obligation under this Agreement, the arbitrators or the court in such arbitration or litigation shall award costs and expenses of arbitration or litigation, including mediation and arbitration fees and expenses, expert witness fees and attorneys' fees, to the prevailing PARTY. IN WITNESS WHEREOF, the parties hereby have made and executed this Agreement as of the day and year first above - written. OWNER: CITY OF BEAUMONT CONTRACTOR: HARMSWORTH ASSOCIATES -� f - y�J�� /'L►v B By Y ayo , City ouncil Rodney Hdrmsworth Page 8 of 8 CONSULTING FEE SCHEDULE JULY 11, 2008 TO JUNE 309 2009 Labor Category Hourly Rates Principal $ 140.00 Vice-principal $ 100.00 Sr. Biologist $ 80.00 Project Biologist $ 68.00 Assistant Biologist $ 58.00 29 Vacaville, Irvine, California 92602 — (714) 389 -9527 — Cell (714) 2874986 — pgalvin9 @cox.net 3/4/09 CITY OF BEAUMONT INDEPENDENT CONTRACTOR'S TASK ORDER Biological Reporting Services — Heartland Mitigation/Potrero Boulevard TASK ORDER NO.: One CONTRACTOR: Name: Address: Telephone: Fax: E -mail: Fed. Tax Id. HARMSWORTH ASSOCIATES 29 Vacaville Irvine, California 92602 714-389-9527 714 - 287 -4986 pgalvin9 @cox.net 330065210 THIS TASK ORDER is issued pursuant to that certain Agreement for Services by Independent Contractor between the CITY OF BEAUMONT ( "OWNER ") and HARMSWORTH ASSOCIATES ( "CONTRACTOR ") dated May 5, 2009 (the "AGREEMENT"). 1. Task to be Performed. CONTRACTOR shall provide all labor, materials and equipment to perform the following tasks: a. Provide biological reporting services as described in the Proposal dated March 24, 2009, attached hereto as part of Exhibit A. 2. Time of Performance. Time is of the essence. Therefore, CONTRACTOR shall begin work within 20 days of the date this Task Order is signed by the OWNER and shall complete performance of such services by or before December 31, 2015. 3. Liaison of OWNER. Mr. Deepak Moorjani, P.E., Public Works Director shall serve as liaison between OWNER and CONTRACTOR. 4. Staff Assignments. CONTRACTOR will assign the following personnel to perform the services required by this Task Order: Paul Galvin 5. Deliverables. CONTRACTOR shall deliver to OWNER not later than the date or dates indicated for each task as set forth on Exhibit A: Pagel of 3 6. Compensation. For all services rendered by CONTRACTOR pursuant to this Task Order, CONTRACTOR shall receive a total not -to- exceed sum of $105,786.00 based on time and materials charged in accordance with the Hourly Rate Schedule attached hereto as part of Exhibit A. 7. Reimbursable Expenses. In addition to the compensation provided for in Paragraph 6 above, CONTRACTOR (choose and check one:) _ shall L4 shall not /be entitled to reimbursement for expenses. If authorized by this Task Order, reimbursable expenses shall be limited to: 8. Miscellaneous Matters. The following additional matters are made a part of this Task Order: CONTRACTOR shall coordinate and provide ample notice of pending activities to all responsible regulatory agencies as set forth in the regulatory permits associated with the project and subject property. IN WITNESS WHEREOF, the parties have executed this Task Order on the date indicated below. Dated: '�S-- 1 4 '©1 Dated: ///-,p - /./0,- CITY OF BEAMONT l � By Mayor, City Uouilcil CONTRACTOR: HARMSWORTH ASSOCIATES By odney H�=worth -Damn 7 n -VZ HARMSWORTH ASSOCIATES Environmental Consultants March 24, 2009 Alan C. Kapanicas, City Manager City of Beaumont 550 E 6" Street Beaumont, CA 92223 Dear Mr. Kapanicas: Re: Heartland Mitigation Monitoring Program Harmsworth Associates is pleased to submit this proposal and cost to conduct the mitigation monitoring program for the heartland Project as per the City /Suncal MOU and the project HMMP. We will conduct the following tasks; Task 1: Current status 14WA will review the bid documents being prepared for contractors and provide input as required. As necessary, HWA will provide or review the seed mix and planting plan for contractors and provide input on planting and work schedules. HWA will assess the current status of the site; document the location, extent and type of weed species present. A status report of the site and the mitigation schedule will be prepared and submitted to CDFG. Task 2: Monitor site preparation and weeding HWA will monitor the initial weeding program, will identify and mark the location of weeds for contractor removal and will assist the contractor with identification of weeds and native plant species to be avoided. HWA will monitor site -prep and installation of the 2 -acre planting area, including installation of the water -line. HWA will provide CDFG with an as -built report within 6 -weeks after completion of planting at 2 -acre site Task 3: Planting of spineflower seeds The salvaged spineflower seeds will be planted at an appropriate location within the 18- acre mitigation area Task 4: Annual monitoring and reporting Site monitoring and reporting to CDFG will be conducted annually for up to 5 years. Site monitoring will include monitoring of the annual weed control program, regular site monitoring as per the HMMP and an annual detailed mitigation monitoring program to be conducted in spring, as per the HMMP. Reporting includes an annual report to CDFG by November each year, as per the HMMP. 29 Vacaville, Irvine, California 92602 — (714) 389 -9527 — Cell (714) 2874986 — pgalvin9 @cox.net Costs for Task 4 are per year and can be stopped any year as requested by the city, if the site meets it's performance standards early, another entity takes over the monitoring and reporting tasks or for any other reason. First year costs include time for establishing a comparative on -site database, as per the HMMP. Monitoring of weeding is anticipated to decrease over time as the weed control program eradicates on -site weeds, and this is reflected in the reduced costs during years 4 and 5. COST PROPOSAL P643 Mit Mon 23- Mar -09 Task 1• Current status Personnel Job Classification Hours Rate Cost Hannsworth, R Principal 1 $140.00 $140.00 Galvin, P Vice Principal 30 $100.00 $3,000.00 Lippincott, M Senior Biologist 8 $78.00 $624.00 Expenses $150.00 Subtotal $3,914.00 Task 2• Monitor site preparati on and weeding Personnel Job Classification Hours Rate Cost Harmsworth, R Principal 1 $140.00 $140.00 Galvin, P Vice Principal 45 $100.00 $4,500.00 Lippincott, M Senior Biologist 60 $78.00 $4,680.00 Expenses $500.00 Subtotal $9,820.00 Task 3• Planting of s ineflower seeds Personnel Job Classification Hours Rate Cost Harmsworth, R Principal 1 $140.00 $140.00 Galvin, P Vice Principal 16 $100.00 $1,600.00 Lippincott, M Senior Biologist 24 $78.00 $1,872.00 Expenses $120.00 Subtotal $3,732.00 Task 4- Annual monitoring and reporting Personnel Job Classification Hours Rate J Cost Harcnsworth, R Principal 7 $140.00 $980.00 Galvin, P Vice Principal 55 $100.00 $5,500.00 Lippincott, M Senior Biologist 150 $78.00 $11,700.00 Expenses $1,500.00 Subtotal 2010 $19,680.00 29 Vacaville, Irvine, California 92602 — (714) 389 -9527 — Cell (714) 2874986 — pgalvin9 @cox.net Task 4 Subtotal 2011 $18,120.00 Task 4 Subtotal 2012 $18,120.00 Task 4 Subtotal 2013 $16,200.00 Task 4 Subtotal 2014 $16,200.00 Task 4 total, through 2014 $88,320.00 TOTAL TASKS 14, through 2014 $105,786.00 Time for management, meetings and co- ordination is included in each task. We can undertake this work on authorization on a T/M not -to- exceed cost of $105,786; and can proceed upon your written approval. Thank you for the opportunity to propose on this project. If you require additional information or if you have any questions please contact me at (714) 389 -9527. Sincerely, HARMSWORTH ASSOCIATES Paul Galvin, M.S. Vice President P643 Heartland Nfit Mon 23March09 29 Vacaville, Leine, California 92602 — (714) 389 -9527 — Cell (714) 2874986 — pgalvin9 @coz.net Exhibit A Proposal and Hourly Rate Schedule p7rta Z �f Z CONSULTING FEE SCHEDULE JULY 1, 2008 TO JUNE 30, 2009 Labor Category Hourly Rates Principal $ 140.00 Vice-principal $ 100.00 Sr. Biologist $ 80.00 Project Biologist $ 70.00 Assistant Biologist $ 60.00 29 Vacaville, Irvine, California 92602 — (714) 389 -9527 — Cell (714) 2874986 — pga1vin9 @cos.net 3/4/09 CITY OF BEAUMONT INDEPENDENT CONTRACTOR'S TASK ORDER Cooper's Creek Biological Study TASK ORDER NO.: Two CONTRACTOR: Name: Address: Telephone: Fax: E -mail: Fed. Tax Id. HARMSWORTH ASSOCIATES 29 Vacaville Irvine, California 92602 714- 389 -9527 714 - 287 -4986 pgalvin9 @cox.net 330065210 THIS TASK ORDER is issued pursuant to that certain Agreement for Services by Independent Contractor between the CITY OF BEAUMONT ( "OWNER ") and HARMSWORTH ASSOCIATES ( "CONTRACTOR ") dated May 5, 2009 (the "AGREEMENT "). 1. Task to be Performed. CONTRACTOR shall provide all labor, materials and equipment to perform the following tasks: a. Provide biological reporting services as described in the Proposal dated April 22, 2009, attached hereto as part of Exhibit A. 2. Time of Performance. Time is of the essence. Therefore, CONTRACTOR shall begin work within 20 days of the date this Task Order is signed by the OWNER and shall complete performance of such services by or before December 31, 2009. 3. Liaison of OWNER. Mr. Deepak Moor ani, P.E., Public Works Director shall serve as liaison between OWNER and CONTRACTOR. 4. Staff Assignments. CONTRACTOR will assign the following personnel to perform the services required by this Task Order: Paul Galvin 5. Deliverables. CONTRACTOR shall deliver to OWNER not later than the date or dates indicated for each task as set forth on Exhibit A: Pagel of 3 6. Compensation. For all services rendered by CONTRACTOR pursuant to this Task Order, CONTRACTOR shall receive a total not -to- exceed sum of $42,700.00 based on time and materials charged in accordance with the Hourly Rate Schedule attached hereto as part of Exhibit A. 7. Reimbursable Expenses. In addition to the compensation provided for in Paragraph 6 above, CONTRACTOR (choose and check one:) _ shall/ 4 shall not /be entitled to reimbursement for expenses. If authorized by this Task Order, reimbursable expenses shall be limited to: 8. Miscellaneous Matters. The following additional matters are made a part of this Task Order: CONTRACTOR shall coordinate and provide ample notice of pending activities to all responsible regulatory agencies as set forth in the regulatory permits associated with the project and subject property. IN WITNESS WHEREOF, the parties have executed this Task Order on the date indicated below. CITY OF BEAMONT Dated: S-14 ^ BY or, City Co ncil CONTRACTOR: HARMSWORTH ASSOCIATES Dated: 2 C I BY Rodney H sworth 139ryL 7 r%P2 Exhibit A Proposal and Hourly Rate Schedule HARMSWORTH ASSOCIATES Environmental Consultants April 22, 2009 Alan C. Kapanicas, City Manager City of Beaumont 550 E 6°i Street Beaumont, CA 92223 Re: Cooper's Creek Biological Studies Dear Mr. Kapanicas, Harmsworth Associates is pleased to provide you with this proposal and cost estimate to conduct biological studies and prepare a report on Cooper's Creek in relation to the proposed reduction of water to Cooper's Creek, as discussed at our April 1St meeting. The purpose of the report is to provide the biological support for the CEQA document required for the proposed project. We will assess the current and historic biology of the creek, evaluate habitat quality, biological value and the presence of special status plant and wildlife species; and assess potential impacts to these resources with the proposed reduction in water. A goal of the studies is to determine the quantity of water required to maintain the biological value of Cooper's Creek. Specific tasks are as follows. Task 1: Review existing data We will review and quantify existing biological data for Cooper's Creek, including a review of the CNDDB. We will review data collected in 2003 when daily water entry to the system was 1.8 mgd and use this as a baseline to compare with the current situation. Task 2: Vegetation and delineation studies We will conduct a generalized delineation of the creek system, documenting creek width, depth, location of pools, vegetation type and width of riparian vegetation. This will include establishing baseline stations compatible with the 2003 data to quantify current and future water depth, width and vegetation width at specific points. All locations will be photodocumented. A special status plant study will also be conducted throughout the entire creek. Task 3: Least Bell's vireo and willow flycatcher surveys We will conduct focused surveys for least Bell's vireo and willow flycatcher. All areas of the creek will be surveyed 3 -times. Protocol surveys for vireo require an 8 -time survey, however for the purposes of this project a 3 -time survey should be sufficient to document the location of any birds present. General wildlife and bird surveys will be conducted concurrent with these focused surveys. 29 Vacaville, Irvine, California 92602 — (714) 389 -9527 — Cell (714) 2874986 — pgalvin9 @cox net Task 4: Fish and aquatic wildlife surveys We will conduct surveys for fish and other aquatic wildlife along the creek, focusing on identified pools and deep water areas. Task 5: Data analysis, report, management and meetings We will analyze the results of the field visits and build on the review of existing data to create vegetation and special status plant and wildlife species maps. The report will document existing conditions, conditions in 2003 when daily water entry to the system was 1.8 mgd and analyze potential changes to the system under different flow amounts. A goal of the studies is to determine the quantity of water required to maintain the biological value of Cooper's Creek. COST PROPOSAL P655 Cooper's Creek Permits 7- Apr -09 Task 1 • Review existing data Personnel Job Classification Hours Rate Cost Galvin, P Vice Principal 35 $100.00 $3,500.00 Lippincott, M Senior Biologist 10 $80.00 $800.00 Expenses $250.00 Subtotal $4,550.00 Task 2• Vegetation and delineation studies Personnel Job Classification Hours Rate Cost Galvin, P Vice Principal 25 $100.00 $2,500.00 Lippincott, M Senior Biologist 40 $80.00 $3,200.00 Expenses $700.00 Subtotal $6,400.00 Task Least Bell's vireo and willow flycatcher survevs Least Job Classification Hours Rate Cost Galvin, P Vice Principal 96 $100.00 $9,600.00 Expenses Senior Biologist 50 $80.00 $700.00 Subtotal $10,300.00 Task 4• Fish and aquatic wildlife surveys Personnel Job Classification Hours Rate Cost Galvin, P Vice Principal 50 $100.00 $5,000.00 Karpman, B Senior Biologist 50 $80.00 $4,000.00 Expenses $700.00 Subtotal $9,700.00 29 Vacaville, Irvine, California 92602 — (714) 389 -9527 — Cell (714) 287 -4986 — pgalvin9 @cox.net man* and mpPfina% aSK J: 117AW 'anal 3i3, Personnel - Job Classification Hours Rate Cost Harmsworth, R Principal 10 $140.00 1 $1,400.00 Galvin, P Vice Principal 100 $100.00 $10,000.00 Expenses $350.00 Subtotal $11,750.00 TOTAL TASKS 1 -5 $42,700.00 We will require Urban Logic Group to provide hard copies of maps /aerial photographs for us to use and mark up in the field and for Urban Logic Group to prepare the final maps for inclusion in the report. HWA will work with Wildermuth staff using their water level, flow rate and modeling data during our analysis. We can conduct this work at a not -to- exceed cost of $42,700 and bill on a T/M basis at the provided rates and can proceed upon your authorization. Time for meetings, management and expenses are included. If you require additional information or if you have any questions please contact me at (714) 389 -9527. Yours sincerely, Harmsworth Associates Paul Galvin, M.S. Vice President 29 Vacaville, Irvine, California 92602 — (714) 389 -9527 — Cell (714) 2874986 — pgalvin9 @cox.net CITY OF BEAUMONT PROJECT PROGRESS REPORT COOPER'S CREEK BIOLOGY REPORT Fund Project Name: Cooper's Creek Biology Report Source: Sewer Enterprise Contract May 5, 2009 Contractors: Harmsworth Associates Date: Const. Budget: N/A Subcontractors: See approved CIP Contractor List A &E Budget: $42,7.00 Project Start Date: March 2009 Report Period: May 2009 Work Completed During Report Period: Prepared proposal for services. Problems or Delays During Report Period: No problems or delays. Change Orders: No change orders. Recommendation(s) for City Council Action: Prepare biology report and provide support as required. Repor proved by `'�� r / � l Mayors Signatur Date of City Council Approval STAFF REPORT Agenda Item 3 TO: Mayor and Council Members FROM: Public Works Department DATE: May 5, 2009 SUBJECT: Agreement and Task Order for Biological Consulting Services Background and Analysis: The proposed Task Order No. 2 would authorize Harmsworth Associates to prepare a biological report for Cooper's Creek. The report is needed to establish recycled water discharge requirements to maintain habitat values in the creek. Harmsworth Associates is most qualified to prepare the report based on the extensive work completed by the firm which served as the basis for establishment of the Cooper's Creek Special Connectivity Reserve. The cost of the services will be billed on a time and material basis and will not exceed $42, 700.00. Funding for the project will be from the sewer enterprise fund. The master agreement with Harmsworth was approved with Task Order No. 1 which authorized biological services for the Heartland MOU on April 7, 2009. Recommendation: Staff recommends APPROVAL of the Agreement, Task Order and Project Report, and AUTHORIZATION of the Mayor to execute the Agreement, Task Order and Project Progress Report subject to the authority of the City Attorney to make non - substantive changes. CITY City UM HARMSWORTH ASSOCIATES Environmental Consultants April 28th, 2009 City of Beaumont Attn: Ms. Shelby Hanvey 550 E. 6' St Beaumont, CA 92223 Dear Ms. Hanvey Please find enclosed the contracts for Heartland mitigation and Coopers Creek projects. I have instructed my insurance company to issue a certificate of insurance and waiver of subrogation to the City of Beaumont. Thank you for this opportunity. Harmsworth Associates Rodney V. Harmsworth Ph.D. President 19 Golf Ridge Drive, Dove Canyon, CA 92679 (949) 858 -1553 FAX (949) 589 -2784 e -mail: rod949@cox.net t. //.11 1 —0 DATE (MM /DD/YYYY CERTIFICATE OF LIABILITY INSURANCE OHARMS82 02/10/11 (OC)Heffernan Prof. Practices 1855 W. Katella Ave. #255 Orange CA 92867 Phone:714- 997 -8100 Fax:714- 460 -9935 INSURED Harmsworth Associates 19 Golf Ridge Dr. Dove Canyon, CA 92679 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES_ BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURER A: Hartford Casualty Insurance Co 29424 INSURER B: Property & Casualty Insurance LIMITS INSURER C. Sentinel Insurance Co, Limited LIABILITY INSURER D: Lloyds of London INSURER E: $1,000,000 PREMISES (Ea occurence) t.V V Crwl7GJ 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TYPE OF INSURANCE POLICY NUMBER DATECMM /DD/YYYY DATE MM/DD� LIMITS ATTN: SHELBY HANVEY 550 E. 8TH ST. AUTHORIZ SENTATIVE LIABILITY .J EACH OCCURRENCE $1,000,000 PREMISES (Ea occurence) $300,000 7GENERAL COMMERCIAL GENERAL LIABILITY CLAIMS MADE Fx] OCCUR 72SBAAH7853 02/13/11 02/13/12 MED EXP (Any one person) $10,000 PERSONAL BADVINJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG s2,000,000 P PRO- X PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $1,000,000 ANY AUTO B ALL OWNED AUTOS SCHEDULED AUTOS 72UECAH8139 02/13/11 02/13/12 BODILY INJURY (Per person) $ X X HIRED AUTOS BODILY INJURY (Per accident) $ X NON -OWNED AUTOS PROPERTY DAMAGE rPer accident) $ — GARAGE LIABILITY — AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ ANY AUTO N/A $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE N/A $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION OTH- X TORY LI MITS ER C AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTivED OFFIC ER/MEMBER EXCLUDED? L—1 (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below 72WBCPT7871 02/13/11 02/13/12 E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1,000,10 0 OTHER D PROFESSIONAL W15KQ2110501 02/13/11 02/13/12 PER CLAIM $1,000,000 LIABILITY AGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS *10 DAYS NOTICE FOR NON - PAYMENT OF PREMIUM. PROJECTS AS ON FILE WITH THE INSURED INCLUDING BUT NOT LIMITED TO AGREEMENT FOR BIOLOGICAL REPORTING SERVICES. CITY OF BEAUMONT IS NAMED AS ADDITIONAL INSURED ON GENERAL LIABILITY POLICY & A WAIVER OF SUBROGATION APPLIES TO THE GENERAL, AUTO & WORK COMP POLICIES -SEE ATTACHED ENDORSEMENTS. VCr� I IrIV/9 1 � 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL MMMAMA" MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, CITY OF BEAUMONT ATTN: SHELBY HANVEY 550 E. 8TH ST. AUTHORIZ SENTATIVE BEAUMONT, CA 92223 .J ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009101) Policy No.: 72SBAAH7853 Harmsworth Associates THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM C. Who Is an Insured In the BUSINESS LIA131LITY COVERAGE FORM Is amended to inciude as an Insured the person or organization shown In the Declarations but only with respect to liability arising out of the operations of the named Insured. Form SS 04 49 05 93 Printed in U.S.A. (NS) For losses covered under the BUSINESS LIABILITY COVERAGE of this policy this Insurance Is primary to other valid and collectible Insurance which is available to the person or organization shown in the Declarations as an Additional Insured. Copyright, Hartford Fire Insurance Company, 1993 Harmaworth & Associatep Policy #72SBAAH7853, t (6) When You. Are Added As An Additional Insured' To Other tnsurance That Is other lnsurande available to you covering. liability for damages arising out of the premises or operations, or products and completed operations, for which you have been added as an additional Insured by that insurance; or • • . ► )LESS LIABILITY COVERAGE FORM When this insurance Is excess over other insurance, we will pay ,.only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amoitnt'that all such other 1nsUrance would pay for the loss in the absence of this insurance; and (2) The total of ,all deductible 'and• self - insured; amounts under all that- other insurance. (7) 'When You • Add . Others As An ' 'Insured We will share the remaining lass, if any,'with Additional To This any ether insurance that IS not described in Insurance this Excess Insurance provision'and was not That is other Insurance available to an bought specifically to apply in excess of the add'itronai insured. Limits. ..'of Insurance* shown in the However, the following • ' Declarations of this Coverage Part , ,provisions apply ,to other insurance available to C. ' Method Of Sharing any person or organization who IS an if. . all •the other Insurance. permits ' insured under this Coverage contribution bq equal shares, we will follow Part: Part: this method- also.. Under this approach, (a) Primary' Insurance . When each Insurer contributes equal amounts Required By Contract until it• has• paid its, applicable limit of This insurance is primary If you Insurance or-none of the loss remains, have agreed In a written contract, whichever comes first. l written agreement or permit that. If-any ofthe other Insurance does not permit this Insurance be primary, If other contribution by .equgi shares, we will Insurance Is also primary, we will contribute by limits: Under this method, each share with all that other insurance insurer's share Is based on the ratio of its by the method, described In c, applic&fe limit of insurance to the total below. applicable limits of insurance.of all Insurers. (b) Primary. And Non - Contributory 8. Transfer Of Rights. Of. Recovery Against To ' Other Insurance When Others To Us Required By Contract a. Transfer Of Rights O.f Recovery If you have agreed in a written contract; written agreement. or if the Insured has rights to recover all or perrNt that., this Insurance is 'primary 'nbn• part of any • payment, including Supplementary Payments, we have made and contributory with, under this Coverage Part, those rights are the additional • Insureds own, Insurance, this Insurance is transferred to us. The insured must do primary and• we .will •not seek nothing after loss to impair them. At our request, the insured will bring "suit' or omm contribution •from that ocher transfer those rights to us, and help us Insurance. enforce them.. This condition does not Paragraphs (a) and (b) do.not apply to apply to Medical Expenses Coverage. i other Insurance.to which the additional 'has b. Waiver Of.'Rlghts bf Recovery (Waiver Insured been added as an i� additional lnsunW. ` Of Subrogation)• When this insurance is excess, we will If the insured 'has, waived any rights of • have no duty under this Coverage Part to recovery against- any person, or organization for alt or part of any payment, defend the insured against any "suit" if any ;other. insurer fias a duty to defend the Including Supplementary Payments, we insured against that. "suit.'- If no other •have made under this Coverage Part, we Insurer defends, we will undertake to do also waive that right, provided the insured . so, but we will be entitled to the insured's waived their rights of recovery against rights against all (hose other insurers. such person'or organization €n a contract, agreement or peimit that was executed prior to the Injury or damage. Hartnsworth Associates Policy #72UECAH8139 COMMERCIAL AUTOMOBILE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM To the extent that the provisions of this endorsement provide broader benefits to the "insured" than other provisions of the Coverage Form, the provisions of this endorsement apply. 1. BROAD FORM INSURED 13. Employees as Insureds A. Subsidiaries and Newly Acquired or Formed Organizations The Named Insured shown in the Declare- tons Is amended to Include: (1) Any legally Incorporated subsidiary in which you own more than 50% of the voting stock on the effective date of the Coverage Form. However, the Named Insured does not include any subsidiary that is an "insured" under any other automobile policy or would be an "insured" under such a policy but for its termination or the exhaustion of its Limit of Insurance. (2) Any organization that is acquired or formed by you and over which you maintain majority ownership. However, the Named Insured does not include any newly formed or acquired organization: (a) That is a partnership, joint venture or limited liability company (b) That is an "insured" under any other policy, (c) That has exhausted its Limit of Insurance under any other policy, or (d) 180 days or more after Its acquisition or formation by you, unless you have given us notice of the acquisition or formation. Coverage does not apply to "bodily injury" or "property damage" that results from an "accident" that occurred before you formed or acquired the organization. Paragraph A.I. - WHO IS AN INSURED - of SECTION li - LIABILITY COVERAGE is amended to add: d. Any "employee" of yours while using a covered "auto" you don't own, hire or borrow In your business or your personal affairs. C. Lessors as Insureds Paragraph A.I. - WHO IS AN INSURED - of Section 11 - Liability Coverage Is amended to add: e. The lessor of a covered `auto' while the "auto" is leased to you under a written agreement If: (1) The agreement requires you to provide direct primary Insurance for the lessor and (2) The "auto" is leased without a driver. Such a leased "auto" will be considered a covered "auto" you own and not a covered "auto" you hire. 2. AUTOS RENTED BY EMPLOYEES Any "auto" hired or rented by your "employee" on your behalf and at your direction will be considered an "auto" you hire. The O'T'HER INSURANCE Condition Is amended by adding the following: If. an "employee's" personal insurance also applies on an excess basis to a covered "auto" hired or rented by your "employee" on your behalf and at your direction, this Insurance will be primary to the "employee's' personal insurance. Form HA 89 16 03 02 Page 1 of 3 ® 2001, The Hartford (includes copydghted material of iSO Properties, Inc„ with Its permission.) 3. AMENDED FELLOW EMPLOYEE EXCLUSION 6. LEASE GAP COVERAGE EXCLUSION 5. - FELLOW EMPLOYEE - of SECTION Il - LIABILITY COVERAGE does not apply If you have workers' compensation insurance in -force covering all of your "employees ". Coverage Is excess over any other collectible Insurance. 4. HIRED AUTO PHYSICAL DAMAGE COVERAGE If hired "autos" are covered "autos" for Liability Coverage and if Comprehensive, Specified Causes of Loss, or Collision coverages are provided under this Coverage Form for any "auto" you own, then the Physical Damage Coverages provided are extended to "autos" you hire or borrow, subject to the following limit. The most we will pay for "loss" to any hired "auto" Is: (1) $50,000; (2) The actual cash value of the damaged or stolen property at the time of the "loss% or (3) The cost of repairing or replacing the damaged or stolen property, whichever Is smallest, minus a deductible. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. No deductible applies to "loss" caused by fire or lightning. Hired Auto Physical Damage coverage Is excess over any other collectible insurance. Subject to the above limit, deductible and excess provisions, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. We will also cover loss of use of the hired "auto" if it results from an "accident", you are legally liable and the lessor Incurs an actual financial loss, subject to a maximum of $1000 per " accidant". This extension of coverage does not apply to any "auto" you hire or borrow from any of your "employees ", partners (if you are a partnership), members (if you are a limited liability company), or members of their households. 5. PHYSICAL DAMAGE - ADDITIONAL TEMPORARY TRANSPORTATION EXPENSE COVERAGE Paragraph A.4.a. of SECTION III - PHYSICAL DAMAGE COVERAGE is amended to provided a limit of $50 per day and a maximum limit of $1,000. Form HA 99 16 03 02 Under SECTION III - PHYSICAL DAMAGE COVERAGE, If a long -term leased "auto" Is a covered "auto" and the lessor is named in the policy as a Loss Payee, we will pay In the event of a total "loss" your additional legal obligation to the lessor for any difference between the actual cash value of the "auto" at the time of the "loss" and the "outstanding balance" of the lease. "Outstanding balance" means the amount you owe on the lease at the time of "loss' less any amounts representing taxes; overdue payments; penalties, interest or charges resulting from overdue payments, additional mileage charges; excess wear and tear charges; tease termination fees. 7. AIRBAG COVERAGE Under Paragraph B. EXCLUSIONS - of SECTION iII - PHYSICAL DAMAGE COVERAGE, the following Is added: The exclusion relating to mechanical breakdown does not apply to the accidental discharge of an airbag. 8. SOUND RECEIVING AND TRANSMITTING EQUIPMENT - BROADENED COVERAGE Paragraphs BA.c. & d. - EXCLUSIONS - of SECTION III - PHYSICAL DAMAGE COVERAGE do not apply to equipment designed solely for receiving or transmitting sound and accessories uscd with such equipment, provided such equipment is permanently installed in the covered "auto" at the time of the "loss" or such equipment Is removable from a housing unit which is permanently installed in the covered "auto" at the time of the "loss ", and such equipment is designed to be solely operated by use of the power from the "auto's" electrical system, In or upon the covered "auto ". 9. EXTRA EXPENSE - BROADENED COVERAGE Under Paragraph A. - COVERAGE - of SECTION III - PHYSICAL DAMAGE COVERAGE, we will pay for the expense of returning a stolen covered "auto" to you. 1 D. GLASS REPAIR - WAIVER OF DEDUCTIBLE Under Paragraph D. - DEDUCTIBLE - of SECTION III - PHYSICAL DAMAGE COVERAGE, the following Is added. No deductible applies to glass damage If the glass is repaired rather than replaced. Page 2 of 3 11. TWO OR MORE DEDUCTIBLES Under Paragraph D. - DEDUCTIBLE - of SECTION III - PHYSICAL_ DAMAGE COVERAGE, the following Is added: If another Hartford Financial Services Group, Inc. company policy or coverage form that Is not an automobile policy or coverage form applies to the same "accident ", the following applies: (1) If the deductible under this Business Auto Coverage Form is the smaller (or smallest) deductible, it will be waived; (2) if the deductible under this Business Auto Coverage Form is not the smaller (or smallest) deductible, it will be reduced by the amount of the smaller (or smallest) deductible. 12. AMENDED DUTIES iN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS The requirement in LOSS CONDITIONS 2.a. - DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS - of SECTION IV - BUSINESS AUTO CONDITIONS that you must notify us of an "accident" applies only when the "accident" Is known to: (1) You, if you are an Individual; (2) A partner, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer or Insurance manager, if you are a corporation. 13. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS If you unintentionally fail to disclose any hazards existing at the Inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. Form HA 9916 03 02 14. HIRED AUTO - COVERAGE TERRITORY Paragraph 9. of GENERAL CONDITIONS 7. - POLICY PERIOD, COVERAGE TERRITORY - of SECTION IV - BUSINESS AUTO CONDITIONS Is replaced by the following; e. For short -term hired "autos ", the coverage territory with respect to Liability Coverage Is anywhere in the world provided that If the "Insured's" responsibility to pay damages for "bodily Injury" or "property damage" is determined In a "suit," the "suit" is brought in the United States of America, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. 15. WAIVER OF SUBROGATION TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US - of SECTION IV - 13USINESS AUTO CONDITIONS is amended by adding the following: We waive any right of recovery we may have against any parson or organization with whom you have a written contract that requires such waiver because of payments we make for damages under this Coverage Form. 16. RESULTANT MENTAL ANGUISH COVERAGE The definition of "bodily Injury" in SECTION V- DEFINITiONS is replaced by the following: 'Bodily injury" means bodily injury, sickness or disease sustained by any person. Including mental anguish or death resulting from any of these. 17. EXTENDED CANCELLATION CONDITION Paragraph 2. of the COMMON POLICY CONDITIONS - CANCELLATION - applies except as follows: If we cancel for any reason other than nonpayment of premium, we will mall or deliver to the first Named insured written notice of cancellation at least 60 days before the effective date of cancellation. Page 3 of 3 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA OD r- k, co ° Policy Number: 72 WBC PT7871 Endorsement Number: Effective Date: 02 / 13 / 10 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: HARMSWORTH ASSOCIATES 0 19 GOLF RIDGE DR co TRABUCO CANYON, CA 92679 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not o enforce our right against the person or organization named in the Schedule. (This agreement applies only to the W extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Tee 5 % of the California workers' compensation The additional premium for this endorsement shall be premium otherwise due on such remuneration. SCHEDULE e Person or Organization Job Description Any person or organization with whom projects as on t� you agree in writing to waive your file with the right to recover against them. You insured must agree to this waiver prior to the date of loss. I� tip r� i� r� Countersigned by AIINA Author ed Representative Form WC 04 03 06 (1) Printed in U.S.A. Policy Expiration Date: 02/13/11 Process Date: 11/16/09 Minutes Beaumont City Council Beaumont Redevelopment Agency Beaumont Financing Authority Beaumont Utility Authority 550 E. fig' Street, Beaumont, California City Council Workshop (4:00 p.m.) Closed Session (5:00 p.m.) Regular Session •) 2009 Tuesday, to an item on this agenda submitted to the CityO dog" Std during normal business hourrscket Materials related in the C;�y Clerk s office at 55 are available for public inspection Rion of the agenda where the citY Council can review documents _DB SHQP SESSION (This is the Portion agendas) and receive �rificabon on item to be heard on current or future place: Civic Center, Room 5 Workshop begin at 4:00 p -m- Mayor Fox, Council Member Berg, Council Member DeForge, Council Member Roll Call: Gall were present. Mayor Pro Tern Dressel was excused, Budget Bus Tour items included in the workshop session are for discussion purposes only. No action by the city council is taken at This portion of the agenda is to give input and receive clarification for items on the scheduled agenda or this time. T po for future agenda's. CLOSES SESSION No Action Taken Session began at 5:00 p.m. Place: Civic Center Conference Room Closed Council Member Council Member Berg, Council Member DeForge, Roll C811: P.m- Mayor went Mayor Pro Tem Dressel was excused. we're Pursuant to Government Code Section 54957.6, Conference with Labor Negotiator - City a. picas Negotiator as Personnel Director Alan Kapa Negotiator Employee Organizations and Staffing b• pursuant to Government Code Section 54956.8 Conference with Real Property e9 property Generally Located at Govemment Code Section 54956.8 — 0 Street & Beau LitigationnuConference C. Pursuant to Government Code Section 54956 -9(a) —Case No ED CV 03 -01461 RT SGLx with Legal Counsel — Existing Litigation(Govemment Code 54956.9) 1. Outdoor Media Group, Inc. vs. City of Beaumont Z. Peters vs. City — Case No. RIC 467388 of Beaumont —Case No. 3. Beaumont Citizens for Responsible Growth vs. City RIC518058 4. Cherry Valley Acres and Neighbors vs Sunny Cal - Case RIC 4809 REGULAR SESSION In at 6:04 p.m. Place: Civic Center, Room 5 Regular Session to beg Council Member DeForge, Mayor Fox, Mayor Pro Tern Dressel, Council Member Berg, Roll CaH: resent. Council Member Gall `"e Council Member DeForge invocation: Council member DeForge Pledge of Allegiance: Proclamation - National Day of prayer - May 7th Presentation: 1) an Donors 2) proclamation - Donate Life Month - organ Proclamation - Relay of Life Department 3) 3 recognition presentations by the Police 3) Adjustments to Agenda: none agenda of this meeting may wishing to address the City Counul on any matter not on the age a may � so at a is to gear public comments- Anyone wishkrg to speak on an item a it to � � Clerk at the ORAL AND �yRi'1'fEN COMMUNICATIONS: the agenda is t � Speak Form' and t� do so now. The oral communications portion s) wishing to speak must fit1 out hree (3) inute limit on public comment$- Them wr{I be There 15 the Yrne the Council Considers that item. Pe�O^( Tire foms apa available on the table at the back of the room. beginning of the meeting- to another person. no sharing or passing is Creek m Bolo Court (County Road) and Coope rlancy Hall - Comments regarding council will present COUNCIL REPORTS (This is the portion of the agenda where the city updates on city actions taken, committee assignments, and training and travel) a) Mayor Fox - b) Mayor pro Tern Dressel C) Council Member Berg d) Council Member DeForge e) Council Member Gall 2. CITY MANAGER REPORTS a. Community Information Update 1) Mobile Community Substation 2) Senior Center Update 3) Road Closure Update 4) sustainability update Local Project Update 1) Community b Recreation Center Update 2) Stewart Park ReStroornfSnack Bar Renovation C. Calendar of Events of Each Month - Story Time Cafe �) Second and Third Wednesday Four Season Lodge 2) May 7, 2009 -State of the City at g May 15, 2009 -COP Camp Out - Chili's - MDA Fund Raiser May 16, 2009 - Ms. Beaumont Queen's Pageant 5} May 30 2009 - Cherry Festival Car Show greezin through Beaumont 7) June 4-7F"2009 6) May - Cherry Festival , opening June 13, 2009 - community Recreation Center Grand Ope g} Concerts in the Park Air Supply a) July 4.2009' b) July 8, 2009 — Pat Genstar Disney's High School Musical C) Jury 22.2009 "' d} July 29- 2009 — KC in a Sun ine Band e} August 5, 2009 - d. Financial Update 1) Quarterly Financial Update 2) sales Tax Update e What's That and Rumor Control Manager) f Report on Oral and Written Communications (City 3, CONSENT CALENDAR a, Approval of all Ordinances and Resolutions to be read by title only and publish by summary. 21, 2009. b Approval of the Minutes of the City Council Meeting April C. Approval of the Warrant List for May 5, 2009. d. Authorization to Accept Open Space Lots for Tract 32020, Lots 11 J, K (Located in the South -side of Cougar Way at Palm Avenue) within Ryland Homes, Canyon Ridge subdivision. e. Approval of Agreementand 9 Task second reading YConsulting title only An Ordinance of the f. Adoption of Ordinance City Council of the City of Beaumont, California Adding Chapter 15.44 of the Beaumont Municipal Code Entitled "Building Occupancy Placards" Adoption of Ordinance No. 950 at its second reading —"An Ordinance of the City Council g of the City of Beaumont, California Amending Section 8.32.495D of the Beaumont Municipal Code regarding Appeals to the City Council. h. Adoption of Ordinance No. 951 at its second a .62 to0itle 5 of the the Beaumon�uncil of the City of Beaumont, California, Adding Chapter Municipal Code to prohibit the Establishment of Medical Marijuana Dispe nsaries in the City of Beaumont. i. Approval to Waive Curb, Gutter, and Sidewalk Requirement for 904 Magnolia Avenue and to Collect an In -Lieu Fee for its installation 1 Continuation of Community Facilities District Nod. 2019 a SP00 p ment Area 17B and 8D Public Hearing to the regular meeting of May Recommendation: Approval of the Consent Calendar as presented. Pull Item 3.h for Request to Speak. Seconded by council Member Dressel to approve the Motion by Council Member DeForge, Consent Calendar with the exclusion of item 3.h. Vote: 5/0 Marla Green — Opposed to item 3.h, Ordinance no. 951 Motion by Council Member DeForge, Seconded by Council Member Berg to approve item 3.h, Ordinance No. 951 at its second reading. Vote: 4/1 (Council Member Gall voted no) 4. ACTION ITEMS /PUBLIC HEARING /REQUESTS a, Report on Implementedon of Downtown Plan Elements Recommendation: Review and provide staff with speck direction Staff report was given by Ernest Egger, Director of Planning. of the City Council Meeting at 7:19 p.m. City r ___,„........N HARMASS-01 HBCTO2 Ar REY CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 1/17/2014 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(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). CONT PRODUCER License#0564249 NAMEACT Heffernan Insurance Brokers ta/c°.No,Ext):1 (714)361-7700 (A/C,No): 1 (714)3614701 6 Hutton Centre Drive,Suite 500 E-MAIL Santa Ana,CA 92707 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Valley Forge Insurance Company 20508 INSURED INSURER B:Twin City Fire Insurance Company 29459 - Harmsworth Associates INSURER C:Continental Casualty Company 20443 19 Golf Ridge Drive INSURER D: Dove Canyon,CA 92679 INSURER E: INSURER F: — COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTRINSR WVD POLICY NUMBER JMM/DD/YYYY►_(MM/DD/YYYYL LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X X 4031374684 2/13/2014 2/13/2015 DAMAGE TO RENTED PREMISES(Ea occurrence) $ 300 000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X_ LOC $ _ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ A ANY AUTO 4031374684 2/13/2014 2/13/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS BODILY INJURY(Per accident) $ AUTOS NON OWNED PROPERTY DAMAGE $ X HIRED AUTOS AUTOS (Per accident) $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE CUP5095861565 2/13/2014 2/13/2015 AGGREGATE $ 1,000,000 X DED RETENTION$ 10,000 _ $ WORKERS COMPENSATION X C STATU- 0TH- AND EMPLOYERS'LIABILITY TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N X 72WBCPT7871 2/13/2014 2/13/2015 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $ 1,000,000 C PROFESSIONAL EEH288366721 2/13/2014 2/13/2016 PER CLAIM 1,000,000 C LIABILITY EEH288366721 2/13/2014 2/13/2016 AGGREGATE 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) PROJECTS AS ON FILE WITH THE INSURED INCLUDING BUT NOT LIMITED TO AGREEMENT FOR BIOLOGICAL REPORTING SERVICES.CITY OF BEAUMONT IS NAMED AS ADDITIONAL INSURED ON GENERAL LIABILITY POLICY&A WAIVER OF SUBROGATION APPLIES TO THE GENERAL LIABILITY AND WORK COMP POLICIES-SEE ATTACHED ENDORSEMENTS.THIS CERTIFICATE REPLACES AND SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF BEAUMONT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CTN:SHELBHAT ACCORDANCE WITH THE POLICY PROVISIONS. 550 E.8TH ST. BEAUMONT,CA 92223 AUTHORIZED REPRESENTATIVE fit C/–_. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD • SB-146968-A CNA Policy No. 4031374684 (Ed. 01/06) IMPORTANT:THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY TO THE ADDITIONAL INSURED IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH C., OF THIS ENDORSEMENT FOR THESE DUTIES. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT WITH PRODUCTS-COMPLETED OPERATIONS COVERAGE BLANKET WAIVER OF SUBROGATION Architects, Engineers and Surveyors This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERS COMMON POLICY CONDITIONS A. WHO IS AN INSURED (Section C.) of the 4. The insurance provided to the additional insured Businessowners Liability Coverage Form Is amended does not apply to "bodily injury," "property to include as an insured any person or organization damage,""personal and advertising injury"arising whom you are required to add as an additional insured out of an architect's, engineer's, or surveyor's on this policy under a written contract or written rendering of or failure to render any professional agreement; but the written contract or written services including: agreement must be: a. The preparing, approving,or falling to prepare 1. Currently in effect or becoming effective during the or approve maps, shop drawings, opinions, term of this policy;and reports, surveys, field orders, change orders or drawings and specifications by any 2. Executed prior to the "bodily injury," "property architect, engineer or surveyor performing damage,"or"personal and advertising injury." services on a project of which you serve as B. The insurance provided to the additional insured is construction manager;or limited as follows: b. inspection, supervision, quality control, 1. That person or organization is an additional engineering or architectural services done by insured solely for liability due to your negligence you on a project of which you serve as specifically resulting from "your work" for the construction manager. additional insured which is the subject of the 5. This insurance does not apply to "bodily injury," written contract or written agreement. No "property damage," or "personal and advertising coverage applies to liability resulting from the sole injury"arising out of: negligence of the additional insured. a. The construction or demolition work while you 2. The Limits of Insurance applicable to the are acting as a construction or demolition additional Insured are those specified in the contractor. This exclusion does not apply to written contract or written agreement or in the work done for or by you at your premises. Declarations of this policy, whichever is less. These Limits of Insurance are inclusive of,and not C. BUSINESSOWNERS GENERAL LIABILITY in addition to,the Limits of Insurance shown in the CONDITIONS—Duties In The Event of Occurrence, Declarations. Offense, Claim or Suit (Section E.2.) of the a provided to the additional insured Businessowners Liability Coverage Form is amended 3. The coverage to add the following: within this endorsement and section titled LIABILITY AND MEDICAL EXPENSE An additional insured under this endorsement will as DEFINITIONS — "Insured Contract" (Section soon as practicable: F.9.)within the Businessowners Liability Coverage 1. Give written notice of an occurrence or an offense Form,does not apply to"bodily injury"or"property to us which may result in a claim or "suit" under damage" arising out of the "products-completed this insurance; operations hazard" unless required by the written contract or written agreement. SB-146968-A Page 1 of 2 (Ed.01/06) SB-146968-A (Ed.01/06) 2. Tender the defense and indemnity of any claim or against that "suit" If no other insurer defends;we "suit" to us for a loss we cover under this will undertake to do so, but we will be entitled to Coverage Part; the additional insured's rights against all those 3. Tender the defense and indemnity of any claim or other insurers. "suit" to any other insurer which also has When this insurance is excess over other insurance for a loss we cover under this Coverage insurance, we will pay only our share of the Part;and amount of the loss, if any, that exceeds the sum 4. Agree to make available any other insurance of: which the additional insured has for a loss we (a) The total amount that all such other Insurance cover under this Coverage Part. would pay for the loss in the absence of this We have no duty to defend or indemnify an additional insurance;and insured under this endorsement until we receive (b) The total of all deductible and self-insured written notice of a claim or "suit" from the additional amounts under all that other insurance. insured. We will share the remaining loss, if any, with any D. OTHER INSURANCE (Section H. 2. & 3.) of the other insurance that is not described in this Businessowners Common Policy Conditions are Excess Insurance provision and was not bought deleted and replaced with the following: specifically to apply in excess of the Limits of Insurance shown in the Declarations of this 2. This insurance is excess over any other insurance Coverage Part. naming the additional insured as an insured whether primary, excess, contingent or on any E. TRANSFER OF RIGHTS OF RECOVERY AGAINST other basis unless a written contract or written OTHERS TO US (Section K.2.) of the agreement specifically requires that this insurance Businessowners Common Policy Conditions is deleted be either primary or primary and noncontributing and replaced with the following: to the additional insured's own coverage. This 2. We waive any right of recovery we may have insurance is excess over any other insurance to against any person or organization against whom you which the additional Insured has been added as have agreed to waive such right of recovery in a an additional Insured by endorsement. written contract or agreement because of payments 3. When this insurance is excess, we will have no we make for injury or damage arising out of your duty under Coverages A or B to defend the ongoing operations or "your work" done under a additional insured against any "suit" if any other contract with that person or organization and included insurer has a duty to defend the additional insured within the"products-completed operations hazard," N V I I SB-146968-A Page 2 of 2 (Ed.01/06) P i •. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA c '-' Policy Number: 72 WBC PT7871 Endorsement Number: Effective Date: 02/13/2013 Effective hour is the same as stated on the Information Page of the policy. Q Named Insured and Address: RODNEY HARMSWORTH ASSOCIATES INC 0 19 GOLF RIDGE DR TRABUCO CANYON, CA 92679 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not o enforce our right against the person or organization named in the Schedule. (This agreement applies only to the s' extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in W the work described in the Schedule. The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description ANY PERSON OR ORGANIZATIONM▪ EE BLANKET WAIVER ® FROM WHOM YOU ARE REQUIRED BY EMI WRITTEN CONTRACT OR AGREEMENT mit man TO OBTAIN THIS - WAIVER OF RIGHTS FROM US MEM IMM Countersigned by WorgYYram Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: Policy Expiration Date: 02/13/2014