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05-0906_CAMP FIRE USA ORANGE COUNTY COUNCIL_Agreement AGREEMENT FOR AFTERSCHOOL RECREATION PROGRAM BETWEEN CITY OF SAN JUAN CAPISTRANO AND CAMP FIRE USA ORANGE COUNTY COUNCIL THIS AGREEMENT is made on the 6h day of September 2005, by and between the CITY OF SAN JUAN CAPISTRANO, hereinafter called "City," and CAMP FIRE USA ORANGE COUNTY COUNCIL, hereinafter called "Contractor". WITNESSETH WHEREAS, the City requires services for providing afterschool recreation programs for elementary age children at Ambuehl Elementary and San Juan Elementary schools within the City of San Juan Capistrano, NOW, THEREFORE, City and Contractor mutually agree as follows: SECTION 1. Scope of Work. The Contractor shall provide a quality afterschool program for boys and girls in grades K-5, a comprehensive program which is to include, but is not limited to, the following: • The program is to be held Monday-Friday, immediately after school for a minimum of two hours each day; hours of operation to be modified to minimum day and holiday and school schedules. • Provide alternative program activities during inclement weather. • Program components to include recreational games, nutritional life skills, theater, music, dance, cooking, arts & crafts, special events, tutoring, science and nature. Enrichment programs such as safety, health and nutrition,family responsibility, peer relationships, child care training,tobacco use prevention, understanding literacy and community projects. • Advertise the program activities through media releases and the distribution of flyers throughout the schools. SD • Provide a monthly calendar of daily and special activities to participants. • Keep records of daily attendance for each site. • All participants need to have a release of liability/waiver form on file. These forms are to state that the City, Contractor, and Capistrano Unified School District are indemnified and held harmless from liability/claims/damages resulting from participation. • Contractor to provide and fund transportation to and from local attractions and events. City vehicles can be used upon availability, pending City approval and Contractor's drivers meet City criteria for driving a City vehicle. SECTION 2. Equipment and Supplies. Contractor to purchase and supply all equipment and supplies needed to conduct afterschool programs. All equipment and supplies must be in good operable and safe condition. SECTION 3. Accident/incident Reports. Contractor shall report to the City any accident or incident requiring emergency response during the program. Official reports must be completed and submitted to the City within twenty-four(24) hours of the occurrence, Monday through Friday, and the following Monday if occurrence is Friday night through Sunday. SECTION 4. Evaluation Reports. Contractor shall provide City with monthly reports, which are due to the City by the fifth (5"')working day of the following month. Reports should include, but are not limited to, attendance records, monthly calendar of events, special activities and accomplishments. Contractor to provide an end of the year evaluation due by July 30, 2006, to include measurable outcomes of program. SECTION 5. Site Visits. The City shall have the right to visit a program site at any time during the term of this Agreement. City shall not hinder the normal operation of program services. SECTION 6. Inspection of Records. City may review and inspect Contractor's accounting records related to the Agreement. Page 2 SECTION 7. Facility Use. Contractor agrees that no recreational or community services programs may be offered under this Agreement which disrupt the educational program of any facility. The City will assist the Contractor with securing the Capistrano Unified School District facilities for program sites. The Contractor will be responsible for the daily operations of utilizing the school district facilities in regards to opening and securing facilities and keeping the area of program site free of trash and debris. The City will not charge Contractor for use of City buildings managed by the Community Services Department used during regular business hours. Use of City buildings before/after hours will be subject to charges for set-ups,take-down,and City staff supervision of site. SECTION 8. Desianated Representatives. City and Contractor shall each designate one (1) person to be responsible for the terms and conditions of this Agreement. The Contractor or his/her designee will attend staff, community, Commission, or City Council meetings as requested by the City. SECTION 9. Staff/Child Ratio. There shall be an adult-child ratio of 1:20. Compliance with this ratio shall be determined based on actual attendance. SECTION 10. Independent Contractor. Contractor shall be deemed at all times as an independent contractor, not an employee of the City. SECTION 11. Employees/Subcontractors. A listing of employees and/or subcontractors must be submitted to City.City must be notified immediately in writing of any changes of subcontractors or employees. SECTION 12. Employee Trainina/Background Checks/Physical. All employees of Contractor will be required to have a background check through references, past employment history, and fingerprinting. Employees and volunteers of Contractor will comply with Orange County Health Department requirements regarding health testing and immunizations. Contractor will provide the City with clearance documentation within 48 hours of employee start date. City reserves the right to reject the services of any employee of Contractor who fails the background check or pre-employment physical. Page 3 Contractor is to provide ongoing training and a minimum of quarterly training sessions regarding recreational programs and youth development. All employees are required to have first aid and CPR training. SECTION 13. Payment Schedule. Contractor shall maintain sufficient accounting records, time cards, and other documentation as deemed necessary in order to adequately document costs for the provisions of services under this Agreement. Contractor shall invoice City on a monthly basis for services rendered, which would be $5,040.00 per month, not to exceed $50,400.00 annually. City shall pay the amount due to Contractor per the City's payment schedule. (September 2005-June 2006) Each participant will pay to the Contractor$2 per day to participate in the afterschool program. Scholarships will be available through Contractor and/or City for children who cannot afford to pay $2 per day. No child will be turned away from program participation due to ability not to pay. The payment of $2 per day per participant will enable the Contractor to fund for additional staff and supplies to accommodate an unlimited number of participants. SECTION 14. Supplemental Funding. In addition to funding received from the City under the terms of this Agreement, Contractor agrees to fund additional expenses for specialized instruction costs and an expanded enrichment program, which supplement the basic program offerings. SECTION 15. Retention of Funds. City may withhold payment to Contractor to compensate City for any loss, cost, liability or damage suffered by City due to default of Contractor in the performance of services required. SECTION 16. Refunds. In the event Contractor collects membership or program fees from participants, it shall be the responsibility of Contractor to refund such fees for services not rendered.The City is entitled to collect damages due to default of Contractor in the performance of services required. SECTION 17. Term of Agreement. For a period of ten (10) months, beginning September 2005 through June 2006. City reserves the right to terminate all services of Contractor at any time upon sixty (60) days written notice, or immediately upon breach of the Agreement. Page 4 SECTION 18. Insurance and Indemnification. Contractor shall submit to the City: • A certificate of general liability insurance naming the City and Capistrano Unified School District as additional insured in the amount of$1,000,000 per occurrence; • A liability endorsement form with reference to the above-listed liability insurance; • Proof of Workers' Compensation insurance for all employees; • Comprehensive automobile liability coverage for owned, hired and non- owned vehicles in the amount of $1,000,000 package coverage including bodily injury, property damage and uninsured motorist. Contractor shall indemnify, defend, and hold harmless the City and its officers and employees against all liabilities or claims of liability or loss (including reasonable attorney's fees, related costs and expenses) because of death, personal injury or property damage arising or resulting from the fault or negligence of Contractor in its operations under this Agreement. SECTION 19. Notice. All notices shall be personally delivered or mailed to the below listed addresses, or to such other addresses as may be designated by written notice. These addresses shall be used for delivery of service of process: To City: Attn: Community Services Director City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 To Contractor: Attn: Shaun McBride, Executive Director Camp Fire USA Orange County Council 14742 Plaza Drive, Suite 205 Tustin, CA 92780 Page 5 0 SECTION 20. Conflict of Interest. Contractor must certify that to the best of its knowledge, no City employee or office of any public agency interest has any pecuniary interest in Contractor's business and that no person associated with Contractor has any interest that would conflict in any manner with the performance of duties specified as a part of this project. Contractor represents that it presently has no interest and shall not acquire any interest, direct or indirect,which could conflict in any manner or degree with the faithful performance of this project. IN WITNESS WHEREOF, the parties have executed this Agreement the day and year first hereinabove written. CITY OF SAN JUAN CAPISTRANO By Wyat art, Mayo CAMP FIRE USA ORANGE COUNTY COUNCIL By l X &� Shan McBride, Executive Director ATTEST: 7 R. Monahan, City Clerk APPROVED AS TO FORM: John R. Jhaw, City Attorney Page 6 CAMy Documents\City Council Meefings\City Cound]\\greements\Campfireagrmnt0506.doc 0 0 CITY CLERK'S DEPARTMENT-ACTION REMINDER TO: Linda Evans, Community Services Manager FROM Christy Swanson, Secretary DATE: June 1, 2006 SITUATION: At their meeting on September 6, 2005, the City Council of the City of San Juan Capistrano approved a Personal Services Agreement with Camp Fire USA to provide after school recreation programs. ACTION REQUESTED: Said Agreement states services shall be completed by June 30, 2006. Please notify this office if agreement has been extended or completed. ACTION TO BE TAKEN: ,n� t$ �-ow G• � ao o G. DATE WHEN NEXT ACTION (S) SHOULD BE TAKEN: -410 SIGNATURE OF OFFICIAL TAKING ACTION: i.�e- DATE SIGNED: ***FOR CITY CLERK'S DEPARTMENT USE ONLY*** Tickler Date: 06/01/06 Deadline Date: 06/30/06 (600.301camp fire) i4 • 9/6/2005 D14 AGENDA REPORT TO: Dave Adams, City Manager FROM: Karen Crocker, Community Services Director SUBJECT: Consideration of Agreement for Afterschool Recreation Programs (Camp Fire USA Orange County Council) RECOMMENDATION: By motion, approve the agreement with Camp Fire USA Orange County Council in an amount not to exceed $50,400 to provide afterschool recreation programs for the period of September 2005 through June 2006. SITUATION: A. Summary & Recommendation Staff is recommending that the City of San Juan Capistrano continue to contract with Camp Fire USA Orange County Council for afterschool program services for the period of September 2005 through June 2006. The Camp Fire USA Orange County Council has provided successful afterschool recreation programs in San Juan Capistrano since 1997. Through this agreement they will continue to provide a two-hour afterschool program at Ambuehl & San Juan Elementary schools. Activities will include arts & crafts, cooking, games, science&nature, music,theater,tutoring, &special events. Enrichment programs will also consist of safety, health & nutrition, family responsibility, peer relationships, child care training, tobacco use prevention, literacy & community projects. The afterschool programs at each site will be called the "Rising Stars." The Camp Fire USA Orange County Council will also modify their program hours to accommodate minimum-day schedules at each school site. Anticipated attendance at Ambuehl Elementary is 75-100 per day & San Juan Elementary is 50 per day. B. Backaround The City of San Juan Capistrano has been contracting with Camp Fire USA Orange County Council since the 1997-98 school year. The Camp Fire USA Orange County Council has been providing afterschool programs for elementary age children at Ambuehl & San Juan Elementary schools. There has been a significant increase in participation at both school sites since its inception in 1997. Agenda Report Page 2 September 6, 2005 COMMISSION/BOARD REVIEW, RECOMMENDATION: This item was presented to the Parks, Recreation and Equestrian Commission at their meeting on August 15, 2005. The Commission voted to forward to City Council a recommendation of approval for this agreement. FINANCIAL CONSIDERATIONS: The Community Services Department currently has $50,400 approved in the FY 2005- 2006 General Fund budget for this afterschool contract program. NOTIFICATION: Ms. Shaun McBride, Executive Director* Ms. Silvia Pule, Principal* Camp Fire USA Orange County Council San Juan Elementary Ms. Karen Jennings, Program Coordinator* Ms. Shell Tamaki, Principal* Camp Fire USA Orange County Council Ambuehl Elementary School *Agenda Report Included RECOMMENDATION: By motion, approve the agreement with Camp Fire USA Orange County Council in an amount not to exceed$50,400 to provide afterschool recreation programs for the period of September 2005 through June 2006. Respectfully submitted, Prepared by, �j C� aA4-n O c� Karen Crocker Linda Evans Community Services Director Community Services Manager KC:LE:de Attachments: 1. Location Map 2. Agreement for afterschool recreation program between the City of San Juan Capistrano & Camp Fire USA Orange County Council VIA Q •� r I TJ / o ' N / s �GNYn • FYY19H7i'6114��,! x s v .• J i '. i ': ..ate !!!H!!!•!ll,,,l�if••„' . X75\ -�Y pYU GlG.• •.•,•••••• .00 I!Ilr1! z •I fie 16 f♦ •` � yti AGREEMENT FOR AFTERSCHOOL RECREATION PROGRAM BETWEEN CITY OF SAN JUAN CAPISTRANO AND CAMP FIRE USA ORANGE COUNTY COUNCIL THIS AGREEMENT is made on the 6"'day of September 2005, by and between the CITY OF SAN JUAN CAPISTRANO, hereinafter called "City," and CAMP FIRE USA ORANGE COUNTY COUNCIL, hereinafter called "Contractor". WITNESSETH WHEREAS, the City requires services for providing afterschool recreation programs for elementary age children at Ambuehl Elementary and San Juan Elementary schools within the City of San Juan Capistrano, NOW, THEREFORE, City and Contractor mutually agree as follows: SECTION 1. Scope of Work. The Contractor shall provide a quality afterschool program for boys and girls in grades K-5, a comprehensive program which is to include, but is not limited to, the following: The program is to be held Monday-Friday, immediately after school for a minimum of two hours each day; hours of operation to be modified to mini ,.um day and holiday and school schedules. Provide alternative program activities during inclement weather. Program components to include recreational games, nutritional life skills, theater, music, dance, cooking, arts & crafts, special events, tutoring, science and nature. Enrichment programs such as safety, health and nutrition,family responsibility,peer relationships, child care training,tobacco use prevention, understanding literacy and community projects. Advertise the program activities through media releases and the distribution of flyers throughout the schools. ATTACHMENT 2 • Provide a monthly calendar of daily and special activities to participants. • Keep records of daily attendance for each site. • All participants need to have a release of liability/waiver form on file. These forms are to state that the City, Contractor, and Capistrano Unified School District are indemnified and held harmless from liability/claims/damages resulting from participation. • Contractor to provide and fund transportation to and from local attractions and events. City vehicles can be used upon availability, pending City approval and Contractor's drivers meet City criteria for driving a City vehicle. SECTION 2. Equipment and Supplies. Contractor to purchase and supply all equipment and supplies needed to conduct afterschool programs. All equipment and supplies must be in good operable and safe condition. SECTION 3. Accident/incident Reports. Contractor shall report to the City any accident or incident requiring emergency response during the program. Official reports must be completed and submitted to the City within twenty-four(24) hours of the occurrence, Monday through Friday, and the following Monday if occurrence is Friday night through Sunday. SECTION 4. Evaluation Reports. Contractor shall provide City with monthly reports, which are due to the City by the fifth (5'h)working day of the following month. Reports should include, but are not limited to, attendance records, monthly calendar of events, special activities and accomplishments. Contractor to provide an end of the year evaluation due by July 30, 2006, to include measurable outcomes of program_ SECTION 5. Site Visits. The City shall have the right to visit a program site at any time during the term of this Agreement. City shall not hinder the normal operation of program services. SECTION 6. Inspection of Records. City may review and inspect Contractor's accounting records related to—the Agreement. Page 2 SECTION 7. Facility Use. Contractor agrees that no recreational or community services programs may be offered under this Agreement which disrupt the educational program of any facility. The City will assist the Contractorwith securing the Capistrano Unified School District facilities for program sites. The Contractorwill be responsible forthe daily operations of utilizing the school district facilities in regards to opening and securing facilities and keeping the area of program site free of trash and debris. The City will not charge Contractor for use of City buildings managed by the Community Services Department used during regular business hours. Use of City buildings before/after hours will be subject to charges for set-ups,take-down,and City staff supervision of site. SECTION 8. Designated Representatives. City and Contractor shall each designate one (1) person to be responsible for the terms and conditions of this Agreement. The Contractor or his/her designee will attend staff, community, Commission, or City Council meetings as requested by the City. SECTION 9. Staff/Child Ratio. There shall be an adult-child ratio of 1:20. Compliance with this ratio shall be determined based on actual attendance. SECTION 10. Independent Contractor. Contractor shall be deemed at all times as an independent contractor, not an employee of the City. SECTION 11. Employees/Subcontractors. A listing of employees and/or subcontractors must be submitted to City. City must be notified immediately in writing of any changes of subcontractors or employees. SECTION 12. Employee Training/Background Checks/Physical. All employees of Contractor will be required to have a background check through references, past employment history, and fingerprinting. Employees and volunteers of Contractor will comply with Orange County Health Department requirements regarding health testing and immunizations. Contractor will provide the City with clearance documentation within 48 hours of employee start date. City reserves the right to reject the services of any employee of Contractor who fails- the background check or pre-employment physical. Page 3 r Contractor is to provide ongoing training and a minimum of quarterly training sessions regarding recreational programs and youth development. All employees are required to have first aid and CPR training. SECTION 13. Payment Schedule. Contractor shall maintain sufficient accounting records, time cards, and other documentation as deemed necessary in order to adequately document costs for the provisions of services under this Agreement. Contractor shall invoice City on a monthly basis for services rendered, which would be $5,040.00 per month, not to exceed $50,400.00 annually. City shall pay the amount due to Contractor per the City's payment schedule. (September 2005-June 2006) Each participant will pay to the Contractor$2 per dayto participate in the afterschool program. Scholarships will be available through Contractor and/or City for children who cannot afford to pay $2 per day. No child will be turned away from program participation due to ability not to pay. The payment of $2 per day per participant will enable the Contractor to fund for additional staff and supplies to accommodate an unlimited number of participants. SECTION 14. Supplemental Funding. In addition to funding received from the City under the terms of this Agreement, Contractor agrees to fund additional expenses for specialized instruction costs and an expanded enrichment program, which supplement the basic program offerings. SECTION 15. Retention of Funds. City may withhold payment to Contractor to compensate City for any loss, cost, liability or damage suffered by City due to default of Contractor in the performance of services required. SECTION 16. Refunds. In the event Conuactor collects membership or program fees from participants, it shall be the responsibility of Contractor to refund such fees for services not rendered.The City is entitled to collect damages due to default of Contractor in the performance of services required. SECTION 17. Term of Agreement For a period of ten (10) months, beginning September 2005 through June 2006. City reserves the right to terminate all services of Contractor at any time upon sixty (60� days written notice, or immediately upon breach of the Agreement. Page 4 • SECTION 18. Insurance and Indemnification. Contractor shall submit to the City: • A certificate of general liability insurance naming the City and Capistrano Unified School District as additional insured in the amount of$1,000,000 per occurrence; • A liability endorsement form with reference to the above-listed liability insurance; • Proof of Workers' Compensation insurance for all employees; • Comprehensive automobile liability coverage for owned, hired and non- owned vehicles in the amount of $1,000,000 package coverage including bodily injury, property damage and uninsured motorist. Contractor shall indemnify, defend, and hold harmless the City and its officers and employees against all liabilities or claims of liability or loss (including reasonable attorney's fees, related costs and expenses) because of death, personal injury or property damage arising or resulting from the fault or negligence of Contractor in its operations under this Agreement. SECTION 19. Notice. All notices shall be personally delivered or mailed to the below listed addresses, or to such other addresses as may be designated by written notice. These addresses shall be used for delivery of service of process: To City: Attn: Community Services Director City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 To Contractor: Attn: Shaun McBride, Exer,itive Director Camp Fire USA Orange Guunty Council 14742 Plaza Drive, Suite 205 Tustin, CA 92780 Page 5 SECTION 20. Conflict of Interest. Contractor must certify that to the best of its knowledge, no City employee or office of any public agency interest has any pecuniary interest in Contractor's business and that no person associated with Contractor has any interest that would conflict in any manner with the performance of duties specified as a part of this project. Contractor represents that it presently has no interest and shall not acquire any interest,direct or indirect,which could conflict in any manner or degree with the faithful performance of this project. IN WITNESS WHEREOF, the parties have executed this Agreement the day and year first hereinabove written. CITY OF SAN JUAN CAPISTRANO By Wyatt Hart, Mayor CAMP FIRE USA ORANGE COUNTY COUNCIL By ZcL:�t7 Shaun McBride, Executive Director ATTEST: Margaret R. Monahan, City Clerk APPROVED AS TO FORM: John R. Straw, City orney Page 6 CAMy Docvments\Ci ly Council MeelingslCity CoundlxAgreements\Campfireagrmnt0506.d 32400 PASEO ADE"NTO �' MEMBERS OF THE CITY COUNCIL SAN JUAN CAPISTRANO,CA 9267$ (949)493-1171 SAM ALLEVATO (949)493-1053 FAXIat ORPORR Eo DIANE BATHGATE VVV ESTI1961 MATT HART wivic.sanjuancapistrano.org 1976 JOE SOTO DAVID M.SWERDLIN NOTIFICATION OF MEETING OF POTENTIAL INTEREST OF THE SAN JUAN CAPISTRANO CITY COUNCIL The City Council of San Juan Capistrano will meet at 7:00 p.m. on September 6, 2005 in the City Council Chamber in City Hall, to consider: "Consideration of Agreement for Afterschool Recreation Programs (Camp Fire USA Orange Council)" — Item No. D14. If you have specific thoughts or concerns regarding this item, you are encouraged to participate in this decision making process. You can communicate with the City Council through correspondence addressed to the Council and/or by attending the meeting and speaking to the Council during the public meeting. Correspondence related to this item must be received at the City Clerk's office by 12:00 p.m. on Tuesday, September 6, 2005 to allow time for the Council to consider its content. If you would like to speak at the meeting, please complete a yellow "Request to Speak" form found inside the entrance to the Council Chamber. This form is turned in at the staff table, just in front of the Council dais. You will be called to speak by the Mayor when the item is considered. You have received this notice at the request of the City staff member Linda Evans, Community Services Manager. You may contact that staff member at (949) 443-6390 with any questions. The agenda, including agenda reports, is available to you on our web site: www.sanivancapistrano.org. If you would like to subscribe to receive a notice when agendas are posted to the web site, please make that request by sending an e-mail to: council-agendas&sanivancapistrano.org. Meg Monahan, CMC City Clerk cc: Shaun McBridge, Camp Fire USA Orange Council*; Karen Jennings, Camp Fire USA Orange County Council*; Silvia Pule, San Juan Elementary*; Shele amok, Ambuehl Elementary School*; Karen Crocker, Community Services Director; Linda Evans, Community Services Manager * Received staff report San Juan Capistrano: Preserving the Past to Enhance the Future ��� Pnnletl on receded oa0er 32400 PASEO ADELANTO �� 6 MEMBERS OF THE CITY COUNCIL SAN JUAN CAPISTRANO,CA 92675SAM SAM ALLEVATO (949)493-1171 %✓f' %(S o m[1opv6OA1pitA DIANE BATHG ATE(949)493-1053 ATT ART wx + sanjuaapistrano.nrg 1776JOE SOTO DAVID M.SWERDLIN September 7, 2005 , NOTIFICATION OF ACTION BY THE CITY COUNCIL OF SAN JUAN CAPISTRANO On September 6, 2005 the City Council of San Juan Capistrano met regarding: "Consideration of Agreement for Afterschool Recreation Programs (Camp Fire USA Orange Council)" Item No. D14. The following action was taken at the meeting: Agreement with Camp Fire USA Orange County Council, in an amount not to exceed $50,400, to provide after school recreation programs for the period of September 2005 through June 2006, approved. If you have any questions regarding this action, please contact Linda Evans, Community Services Manager at 443-6390 for more detailed information. Thank you, Mi�rtiz� Deputy City Clerk Cc: Shaun McBridge, Camp Fire USA Orange Council*; Karen Jennings, Camp Fire USA Orange County Council*; Silvia Pule, San Juan Elementary*; Shele amok, Ambi Elementary School*; Karen Crocker, Community Services Director; Linda Evans, Community Services Manager San Juan Capistrano: Preserving the Past to Enhance the Future 6> Printed on recvcled Paver 10/18/2005 11:51 7148380 CAMP FIRE USA PAGE 01/03 04 Camp Fire USA Md&TumnmwW loaders. Orange County Council 14742 Plaza Drive , Suite 205 Tustin , CA 92780 Phone 714 . 838 . 9991 Fax 714 . 838 . 0567 FACSIMILE TRANSMITTAL SHEET ATTN: L, EVANS FROM; MAY DEOL, DIRECTOR OF PROGRAMS & OPERATIONS (EXT. 31) COMPAI ITY OF SAN JUAN CAP. DATE: 10/18/05 FAX NUI t: 949-661-6660 NO. OF PAGES (INCLUDING COVER): 3 NUMBEI 39-443-6390 RE: INSURANCE PAPERWORK ❑U T 13 FOR REVIEW ❑PLEASE COMMENT ❑PLEASE REPLY ❑ PLEASE RECYCLE Hi Lin+ Here'z ; correct paperwork — I'm also sending copies via mail today. Sony all of the confusion - anything that you can do to expedite paym( A the invoices is appreciated! Taker Nav W.9'RE ABOUT rx,E FasrrIVE1 10/18/2005 11:51 714838*7 CAMP FIRE USA*C PAGE 02/03 ACORD„ RTIFICAI a OF LIABILITY INSURANCE 06/09/"E/20o PRODUCER (949)70' 0 FAX (949)709-1656 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Comprehen5 i ve ance Sere i Ces ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 22342 Avenida 'sa HOLDER.THIS CERTIFICATE DOES NOT AEIBND,EX7EN0 OR TER THE POVERAGE AFFORDED 9Y THE P L Suite 200 RSM, CA 92688 INSURERS AFFORDING COVERAGE NAIC 0 EIEUam Camp F I R Orange County Council IISURERA; MARKEL INSURANCE COMPANY 14742 P I II -f ve, Ste 205 INSURER a: Tustin, C 180 NSURERc: MSURER 0: _ INSURER E THE POLICIES OF IN! :E LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INmcAT*v.NOTWITHSTANDING ANY REOUIREMENT, JR OONDMO14 OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TH16 CERTIFICATE MAY 56 ISSUED OR MAY MAIZE It ICE AFFORDIID BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGA TS SHOYN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE, ONCE POLICY WIESER WRs GENERAL UAE 8502CY243262-3 07/12/2005 07/12/2006 EACHOccuwEwe s 11000100 X1 COUMEW.. ERALLIASILM DWASE TDFR,ENWf 100 00 CUMe O OCCUR MED I W(AMY I $ 5,00c A PERSONALAADV MWURY s 110001 GENERAL MORWATE s 3,000, ASM.AGGREG rAPPURGPSR: PRODUCTS.COMPWP AGO F 3,000,00 x I POLICY F LDC AUTOYCSILEI. 1002CY243263-3 07/12/2005 07/12/2006 COMINED SINGLE IEAIT s ANY AUrO 1.DOO,0 ScNEomi I fP ui s A X HIREDAN BODILY INJURY s X Nowoym S IPPrwmtlPnl) 'RCPERTlyDAMAGE s GARAGe LML91I AUTO ONLY-EAACCIDENT S OTHER TRAIN PNY AVTO SA ACC $ ' AUTO ONLY: AGO S ERCEESAAISRI SIMR EACH OCCURRENCE s OCCUR OWNS MADE A04REGATE S s DEDUCTS S . RFTRNT101 S WORKERS COMPENS. W WC A - OTN MPIDYERP LIAR" EL EACH ACCIDENT S ANY PROPRIETCRTP� RECUTNE OFFICERIMEMEEa EY R YN,60bibP Md. E.L.DISEASE-EA EMPLOYEE S E PROVISIONS; E.L.DISEASE-POLICY UMR S L ABUSE 8502CY243262-3 07/12/2005 07/12/2006 $1.000,000 PER PERSON A7 $1,000.000 PER OCCURRENCE $1,000,000 PER AGGREGATE R IFI TATE HOLE NAMEa Akrl TW I ONA��1 NSURE P A 026 EXCEPT 10 DAYS ION-PAYMENT fl�aiTF.RISA QI CANCELLATION SHOULD ANY OF ME ABOVE DEECRNEO FOLIOIEs PE TAM'L_BEFORE WE E.VIRATWN GATE iNEaEOP,THE MSIWIG EItIRiFR RRLLENOEAVOR To MAIL CITY OF S/ W CAPISTRANO A3O oAyr. RNOMETOTEDERrmuYeHOLDERNAMMTOTMtWt.' ATTN: DAWN INDERI , DEPLITY CITY CLERK WrEALURETOMAIL SUCH NOT"AWALL"POOR.gwuGATE:NORUAELm 32400 PASV, SANTO OPANYKMWMTIEmsVMKrMAGgIntMMP MW'kTMM SAN JUANC 4TANO, CA 92675 AvnwRao aRPREaENTAmME �y Richard Eynon, CIC/KRISTY a, � z ACORD 26(2001/08) WORD CORPORATION 1986 10/18/2005 11:51 7148380 67 CAMP FIRE USAW PAGE 03/03 CA T. "NDORSBMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION Ti dor=ncnt modifics insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE NA f Persnu or Organization: CI r SAN JUAN CAPISTRANO �H (try aPfears above, information required to complete this endorsement will be shi a the Declarations as applicable to this endorsement. W: ; AN INSURED Section ) orli tion shown in the Schedule as an insured that onlye as an insured the person or om rur operations or premises owned by or rented to you. pact to liability arising Nei 1 INSURED: Camp Fire USA-Orange County Council PO a NUMBER: 8502CV243262-3 EX. ►TION DATE: 07/12/2006 CG . ORTHOLDER COPY SP STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 09-08-2005 GROUP: POLICY NUMBER: 1703497-2005 CERTIFICATE ID: 32 CERTIFICATE EXPIRES:07-01-2006 07-01-2005/07-01-2006 CITY OF SAN JUAN CAPISTRANO SP ATTN: DAMN SCNANDERI, DEPUTY CITY CLERK 32400 PASEO ADELANTO SAN JUAN CAPISTRANO CA 92675 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms- exclusions, and conditions, of such policy. 1 - c . AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. EMPLOYER CAMP FIRE BOYS & GIRLS CLUB SP 14742 PLAZA DR STE 205 TUSTIN CA 92780 (B18,SGI IREV.2-05) PRINTED : 09-09-2005 AcoRgR, CERTIFICATE OF INSURANCE 7ECATE( D/YV) 0MM6-21-2/D005 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS Markel Insurance Company NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, P.O. Box 3870 EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Glen Allen, VA 23058-3870 COMPANIES AFFORDING COVERAGE COMPANY CODE SUBCODELETTER A MARKEL INSURANCE COMPANY COMPANY D INSURED LETTER B z' Camp Fire USA Orange County Council COMPANY C D= 14742 Plaza Dr. #205 LETTER Tustin, CA 92680 COMPANY D C-)C-) t LETTER r_ COMPANY rn LETTER E �� v THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NMAED ABeVE 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 0 POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER LIMITS TR DATE IMM/OD/YYI DATE IMM/Dp/YVI GENERAL LIABILITY GENERAL AGGREGATE $ 3,000,000 A COMMERCIAL GENERAL LIABILITY X PRODUCTS-COMP/OPS AGGREGATE $ 1,000,000 CLAIMS MADE EKI OCCUR. 8502CY243262-3 07-12-2005 07-12-2006 PERSONAL&ADVERTISING INJURY 5 1,000,000 OWNERS&CONTRACTOR'S PROT. EACH OCCURRENCE 9 1,000,000 FIRE DAMAGE IAny one fire) $ 100,000 MEDICAL EXPENSE IAny one person) $ 5,000 AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT 3 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per Person) 5 HIRED AUTOS BODILY INJURY 3 NON-OWNED AUTOS (Per accident) GARAGE LIABILITY PROPERTY DAMAGE $ EXCESS LIABILITY EACH OCCURRENCE 5 UMBRELLA FORM AGGREGATE S OTHER THAN UMBRELLA FORM i- ' 777777 WORKER'S COMPENSATION STATUTORY LIMITS AND EACH ACCIDENT 9 DISEASE-POLICY LIMIT 8 EMPLOYERS'LIABILITY DISEASE-EACH EMPLOYEE $ A OTHER Property 8502CY243262-3 07-12-2005 07-12-2006 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS Certificate holder is included as additional insured for operations conducted by the named insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO City of San Juan Capistrano MAIL in DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION 32400 Paso A Delanto OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR San Juan Capistrano,CA 92675 REPRESENTATIVES, AUTHORIZED REPRESENTATIVE Bruce A. Kay ABU ACORD 25-517/90) Icl ACORD CORPORATION 1990 32400 PASEO ADELANTO .� A MEMBERS OF THE CITY COUNCIL SAN JUAN CAPISTRANO,CA 92675 (949)493 1171 - SAM ALLEVATO ` IDORPHOUB DIANE BATHGATE (949)4931053 FAX • ISIRRISNO 1161 VVYwww.sanptoncapisnrano.org 1776 JOEA OTOTT RT • • DAVID M.SWERDLIN September 7, 2005 Camp Fire USA Orange County Council 14742 Plaza Drive, Suite 205 �� ` C0 Tustin, CA 92780 Attention: Shaun McBride, Executive Director Dear Mr. McBride: An agreement for after school recreation program was approved by the City Council on September 6, 2005. It is in the process of being executed. It will be issued upon receipt of required documentation related to contract terms under Section 14. Insurance. Insurance evidence may be faxed to (949) 493-1053 — ATTENTION CITY CLERK -- followed by original signed documents. I have enclosed a copy of the agreement terms for your reference in supplying this documentation. If you have questions specific to the contact, please contact the project manager, Brian Perry, Senior Civil Engineer (949) 443-6353. Please call Mitzi Ortiz, Deputy City Clerk (949) 443-6310 if you have questions regarding the forms of insurance needed. Thank you, Me Mon a7CMC Cit Clerk cc: Linda Evans, Community Services Manager Karen Crocker, Community Services Director San Juan Capistrano: Preserving the Past to Enhance the Future SECTION 18. Insurance and Indemnification. Contractor shall submit to the City: • A certificate of general liability insurance naming the City and Capistrano Unified School District as additional insured in the amount of$1,000,000 per occurrence; • A liability endorsement form with reference to the above-listed liability insurance; • Proof of Workers' Compensation insurance for all employees; • Comprehensive automobile liability coverage for owned, hired and non- owned vehicles in the amount of $1,000,000 package coverage including bodily injury, property damage and uninsured motorist. Contractor shall indemnify, defend, and hold harmless the City and its officers and employees against all liabilities or claims of liability or loss (including reasonable attorney's fees, related costs and expenses) because of death, personal injury or property damage arising or resulting from the fault or negligence of Contractor in its operations under this Agreement. SECTION 19. Notice. All notices shall be personally delivered or mailed to the below listed addresses, or to such other addresses as may be designated by written notice. These addresses shall be used for delivery of service of process: To City: Attn: Community Services Director City of San Juan Capistrano 32400 Paseo Adelanto San Juan Capistrano, CA 92675 To Contractor: Attn: Shaun McBride, Executive Director Camp Fire USA Orange County Council 14742 Plaza Drive, Suite 205 Tustin, CA 92780 Page 5 32400 PASEO ADELANTOv , MEMBERS OF THE CITY COUNCIL SAN JUAN CAPISTRANO,CA 92675 �� I� (949)4931171 /,fes DIANESAM BEVATO (949)4931053 FAX (,/ mfOAvaeelEo DIANE HATHOATE fSie176 1 (9s) JOES HART wwwsanjuancapistrano.org 177g � �oEsoro ��. • DAVID M.SWERDLIN October 19, 2005 Camp Fire USA Orange County Council 14742 Plaza Drive, Suite 205 Tustin, CA 92780 Attention: Shaun McBride, Executive Director Dear Mr. McBride: A fully executed, original Personal Services Agreement related to providing after school programs is enclosed for your records. Thank you for forwarding documentation confirming current compliance with the terms of insurance under your agreement with the city. Please keep in mind that should this documentation lapse, all work under this agreement must stop and all payments will be withheld until we receive proper evidence of insurance. You may proceed with work under this agreement in coordination with the project manager, Linda Evans, Community Services Manager (949) 443-6390. Thank you, Meg M aha , CMC City erk cc: Linda ans, Community Services Manager Kare rocker, Community Services Director San Juan Capistrano: Preserving the Past to Enhance the Future ^) Printed on movicled Paper