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
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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
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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:
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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.
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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