HomeMy WebLinkAbout13-39 Resolution No. 13-39
RESOLUTION
AUTHORIZING EXECUTION OF A SERVICE AGREEMENT WITH
DIXON DANCE ACADEMY, INC. FOR DANCE INSTRUCTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF ELGIN,ILLINOIS,that
pursuant to Elgin Municipal Code Section 5.02.020B(9) the City Council hereby finds that an
exception to the requirements of the procurement ordinance is necessary and in the best interest of
the city; and
BE IT FURTHER RESOLVED BY THE CITY COUNCIL OF THE CITY OF ELGIN,
ILLINOIS, that Sean R. Stegall, City Manager, and Kimberly A. Dewis, City Clerk, be and are
hereby authorized and directed to execute a service agreement on behalf of the City of Elgin with the
Dixon Dance Academy,Inc.to provide dance instruction at The Centre for the year 2013,a copy of
which is attached hereto and made a part hereof by reference.
s/David J. Kaptain
David J. Kaptain, Mayor
Presented: March 6, 2013
Adopted: March 6, 2013
Omnibus Vote: Yeas: 7 Nays: 0
Attest:
s/Kimberly Dewis
Kimberly Dewis, City Clerk
SERVICE AGREEMENT
THIS AGREEMENT is made and entered into this 6th day
of March 2013, by and between the CITY OF ELGIN,
Illinois, a municipal corporation (hereinafter referred to
as the "City") , and Dixon Dance Academy,Inc. a corporation
organized and existing under the laws of the State of
Illinois (hereinafter referred to as the "Service
Provider") .
WHEREAS, the City has determined that it would serve a
beneficial public purpose to enter into an agreement with
the Service Provider for the Service Provider to provide
certain contract services as described in this agreement on
behalf of the City and the City' s Parks and Recreation
Department; and
WHEREAS, the Service Provider represents that it has
the necessary expertise and experience to furnish the
Subject Services upon the terms and conditions set forth in
this agreement .
NOW, THEREFORE, in consideration of the mutual
promises and covenants contained herein, the sufficiency of
which is hereby acknowledged, the parties hereto hereby
agree as follows :
1 . The Service Provider shall provide all of the
services as described in Exhibit A, attached hereto and
made a part hereof by this reference (such services are
hereinafter referred to as the "Subject Services") . Unless
otherwise specified in Exhibit A, the Service Provider
shall provide the Subject Services at such dates and times
as are determined and approved by the City' s Early
Childhood Supervisor and/or Recreation and Facilities
Superintendent .
2 . The Service Provider shall also perform the
Subject Services according to the Activity Plan which is
attached hereto and made a part hereof as Exhibit B. The
Service Provider represents and warrants that the Service
Provider has the skills and knowledge necessary to conduct
the Subject Services provided for in Exhibit A and in the
Activity Plan set forth in Exhibit B. It is agreed and
understood that the City is relying on such representations
and it is further agreed and understood that the Subject
Services set forth in Exhibit A and the activity plan set
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iJ
forth in Exhibit B are integral parts of this agreement and
not be modified, amended or altered except by a written
amendment to this agreement agreed to and executed by both
parties hereto.
3 . The Service Provider shall perform the Subject
Services at the location specified in Exhibit A. In
connection with the Subject Services to be performed on
other than City properties, the Service Provider warrants
and agrees to maintain all facilities and equipment used in
the performing of the Subject Services in a clean, sanitary
and safe condition and free from defects of every kind
whatsoever. Service Provider agrees and warrants that the
Service Provider will periodically inspect all of such
facilities and equipment for such purposes . Service
Provider also warrants that the Service Provider and the
Service Provider' s facilities and equipment used in the
performing of the Subject Services are not now, nor shall
be during the term of this agreement in violation of any
health, building, fire or zoning code or regulation or
other applicable requirements of law. In connection with
the Subject Services on properties owned or controlled by
the City, Service Provider agrees and warrants to use, and
to cause persons participating in the Subject Services to
use, through proper supervision and control, all facilities
with due care, and to report all defects in or damage to
any such facilities, and the cause thereof, if known,
immediately to the City' s Recreation and Facilities
Superintendent .
4 . The Service Provider shall complete, maintain and
submit to the Recreation and Facilities Superintendent of
the City, or her designee, . any and all records, reports and
forms relating to the Subject Services and this agreement
as requested by the City.
5 . The City shall pay the Service Provider for the
Subject Services under this agreement the amount of 65% of
the listed Resident Class fees per person for all classes
provided by the Service Provider. Notwithstanding anything
to the contrary in this agreement, the total monies to be
paid by the City to the Service Provider pursuant to this
agreement shall not exceed the total amount of $20, 000 . The
City shall make payments to the Service Provider based upon
actual progress of the Subject Services within sixty (60)
days after the receipt and approval of an invoice . Said
periodic payments shall not be made until the services for
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which payment is sought are completed and accepted by the
City. The Service Provider shall submit invoices in a
format approved by the City. Progress reports will be
included with all payment requests . The Service Provider
shall maintain records showing actual time devoted and
costs incurred. The Service Provider shall permit the
authorized representative of the City to inspect and audit
all data and records of the Service Provider for work done
under this agreement . The Service Provider shall make these
records available at reasonable times during the agreement
period, and for a year after the completion of the Subject
Services to be performed pursuant to this agreement .
6 . Service Provider agrees and warrants that the
Service Provider has procured all licenses, permits or like
permission required by law to conduct or engage in the
Subject Services provided for in this agreement, and that
the Service Provider will procure all additional licenses,
permits or like permission hereinafter required by law
during the term of this agreement, and that the Service
Provider will keep same in full force and effect during the
term of this agreement . Service Provider shall perform the
Subject Services with due care and in compliance with all
applicable legal requirements .
7 . The enrollment of students or participants for
the Subject Services to be conducted pursuant to this
agreement is the sole responsibility and right of the City.
Service Provider shall not disseminate information to the
public concerning the Subject Services to be conducted
pursuant to this agreement or independently advertise or
solicit students or participants for the Subject Services
to be conducted hereunder except with the prior written
consent of the City' s Recreation and Facilities
Superintendent . Service Provider shall not represent any
activity in which the Service Provider is engaged,
including but not limited to the activity which is the
subject of this agreement, as having been approved or
otherwise use the City' s name in a testimonial manner
without the prior written permission of the City' s
Recreation and Facilities Superintendent . The Service
Provider shall not solicit or encourage students or
participants enrolled by the City in the Subject Services
to enroll or participate in competing or similar services
which are not sponsored by the City.
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8 . Notwithstanding any other provision hereof, the
City may terminate this agreement at any time upon written
notice to the Service Provider. In the event this
agreement is so terminated, the Service Provider shall be
paid for services actually performed.
9 . This agreement shall become effective as of the
date the Service Provider is given a notice to proceed by
the City, and unless terminated for cause or pursuant to
paragraph 8 , shall be deemed concluded on the date the City
determines that all of the Service Provider' s work under
this agreement is completed. A determination of completion
shall not constitute a waiver of any rights or claims which
the City may have or thereafter acquire with respect to any
term or provision of the agreement .
10 . This agreement shall not be construed so as to
create a partnership, joint venture, employment or other
agency relationship between the parties hereto. Service
Provider understands and agrees that the relationship of
the Service Provider to the City arising out of this
agreement shall be that of an independent contractor. It
is expressly agreed and understood that the Service
Provider and the Service Provider' s officers, employees and
agents are not employees of the City and are not entitled
to any benefits or insurance provided to employees of the
City. City shall not be entitled to direct Service Provider
as to the means or methodology of performance of this
agreement by the Service Provider.
11 . If either party violates or breaches any term of
this agreement, such violation or breach shall be deemed to
constitute a default, and the other party has the right to
seek administrative, contractual or legal remedies as may
be suitable to the violation or breach.
12 . To the fullest extent permitted by law, Service
Provider agrees to indemnify, defend and hold harmless the
City, its officers, employees, agents, boards and
commissions from and against any and all claims, suits,
judgments, costs, attorney' s fees, damages or other relief,
including but not limited to worker' s compensation claims,
in any way resulting from or arising out of negligent
actions or omissions of the Service Provider in connection
herewith, including negligence or omissions or agents of
the Service Provider arising out of the performance of this
agreement . In the event of any action against the City,
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its officers, employees, agents, boards or commissions
covered by the foregoing duty to indemnify, defend and hold
harmless, such action shall be defended by legal counsel of
the City' s choosing. The provisions of this paragraph
shall survive any termination of this agreement .
13 . No official, director, officer, agent or
employee of the City shall be charged personally or held
contractually liable under any term or provision of this
Agreement or because of their execution, approval or
attempted execution of this Agreement .
14 . The Service Provider shall provide, pay for and
maintain in effect, during the term of this agreement, a
policy of comprehensive general liability insurance,
written in occurrence form, with limits of at least
$1, 000, 000 per occurrence for bodily injury and $1, 000, 000
per occurrence for property damage . The Service Provider
shall deliver to the City a certificate of insurance naming
the City as an additional insured. The policy shall not be
modified or terminated without ten (10) days prior written
notice to the City. The certificate of insurance shall
include_ the contractual obligation assumed by the Service
Provider under Paragraph 12 hereof . This insurance shall
apply as primary insurance with respect to any other
insurance or self-insurance programs afforded to the City.
There shall be no endorsement or modification of this
insurance to make it excess over other available insurance;
alternatively, if the insurance states that it is excess or
pro rate, it shall be endorsed to be primary with respect
to the City. The Service Provider shall also provide, pay
for and maintain in effect during the term of this
agreement worker' s compensation insurance in amounts
required under the laws of the State of Illinois .
15 . In all hiring or employment made possible or
resulting from this Agreement, there shall be no
discrimination against any employee or applicant for
employment because of sex, age, race, color, creed,
national origin, marital status, of the presence of any
sensory, mental or physical handicap, unless based upon a
bona fide occupational qualification, and this requirement
shall apply to, but not be limited to, the following:
employment advertising, layoff or termination, rates of pay
or other forms of compensation and selection for training,
including apprenticeship.
16 . No person shall be denied or subjected to
discrimination in receipt of the benefit of any services or
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activities made possible by or resulting from this
Agreement on the grounds of sex, race, color, creed,
national origin, age except minimum age and retirement
provisions, marital status or the presence of any sensory,
mental or physical handicap. Any violation of this
provision shall be considered a violation of a material
provision of this Agreement and shall be grounds for
cancellation, termination or suspension, in whole or in
part, of the Agreement by the City.
17 . The parties intend and agreed that, if any
paragraph, sub-paragraph, phrase, clause or other provision
of this Agreement, or any portion thereof, shall be held to
be void or otherwise unenforceable, all other portions of
this Agreement shall remain in full force and effect .
18 . This Agreement and its exhibits constitutes the
entire Agreement of the parties on the subject matter
hereof and may not be changed, modified, discharged or
extended except by written amendment duly executed by the
parties . Each party agrees that no representations or
warranties shall be binding upon the other party unless
expressed in writing herein or in a duly executed amendment
hereof .
19 . This Agreement shall be deemed to have been made
in, and shall be construed in accordance with the laws of
the State of Illinois . Venue for the resolution of any
disputes or the enforcement of any rights pursuant to this
agreement shall be in the Circuit Court of Kane County,
Illinois . With the sole exception of an action to recover
any money to which it may be entitled pursuant to the
specific provisions of this Agreement, and notwithstanding
anything else to the contrary in this agreement, no action
shall be commenced by the Service Provider against the City
for monetary damages . In the event any legal action is
brought by the City for the enforcement of any of the
obligations of the Service Provider in this agreement and
the City is the prevailing party in such action, the City
shall also be entitled to recover from Service Provider 90
per annum interest and attorney' s fees at the rate of $300
per hour, which Service Provider hereby agrees constitutes
a reasonable rate .
20 . The Service Provider certifies hereby that it is
not barred from bidding on a public contact as a result of
a violation of 720 ILCS 5/33E et seq. or any similar state
or federal statute regarding bid rigging.
21 . As a condition of this contract, the Service
Provider shall have written sexual harassment policies that
include, at a minimum, the following information:
A. the illegality of sexual harassment;
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B. the definition of sexual harassment under state
law;
C. a description of sexual harassment, utilizing
examples;
D. the vendor' s internal complaint process
including penalties;
E. the legal recourse, investigative and complaint
process available through the Illinois
Department of Human Rights, and the Illinois
Human Rights Commission;
F. directions on how to contact the department and
commission;
G. protection against retaliation as provided by
Section 6-101 of the Human Rights Act .
A copy of the policies must be provided to the
Department of Human Rights upon request 775 ILLS 5/2-105 .
22 . As a further condition of this agreement, the
Service Provider shall submit to and pass a drug test and
criminal history background check. The requirements
necessary to constitute "passing" shall be at City' s sole
discretion. Service Provider warrants and represents, and
understands and agrees, that as a term and condition of
this agreement that Service Provider is not and has not
within the past thirty (30) days, and shall not during the
term of this agreement, use or used any illegal drug or
unexplained legal drug; nor has Service Provider been
convicted of any crime of which Service Provider has failed
to provide written notice to City. In the event that
Service Provider is determined to have violated this or any
other provisions of this agreement, Service Provider shall
be deemed to be in breach of this agreement, and may be
terminated by City immediately without penalty to City.
23 . All notices, reports and documents required under
this Agreement shall be in writing and shall be mailed by
First Class Mail, postage prepaid, addressed as follows :
As to the City: As to Service Provider:
Dixon Dance Academy
777 S . 8th Street
City of Elgin West Dundee, IL 60118
150 Dexter Court Attn: Cathy Dixon
Attn: Janice Monell
24 . This agreement is and shall be deemed to
construe to be a joint and collective work product of the
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City and the Service Provider and, as such, this agreement
shall not be construed against the other party, as the
otherwise purported drafter of same, by any court of
competent jurisdiction in order to resolve any
inconsistency, ambiguity, vagueness or conflict, if any, of
the terms and provisions contained herein.
25 . This agreement shall be binding on the parties
hereto and their respective successors and permitted
assigns . This agreement and the obligations herein may not
be assigned by the Service Provider without the express
written consent of the City which consent may be withheld
at the sole discretion of the City.
26 . Notwithstanding any other provision of this
agreement it is expressly agreed and understood that in
connection with the performance of this agreement that the
Service Provider shall comply with all applicable Federal,
State, City and other requirements of law, including, but
not limited to, any applicable requirements regarding
prevailing wages, minimum wage, workplace safety and legal
status of employees . Without limiting the foregoing,
Service Provider hereby certifies, represents and warrants
to the City that all Service Provider' s employees and/or
agents who will be providing products and/or services with
respect to this agreement shall be legal residents of the
United States . Service Provider shall also at its expense
secure all permits and licenses, pay all charges and fees
and give all notices necessary and incident to the due and
lawful prosecution of the work, and/or the products and/or
services to be provided for in this agreement . The City
shall have the right to audit any records in the possession
or control of the Service Provider to determine Service
Provider' s compliance with the provisions of this section.
In the event the City proceeds with such an audit the
Service Provider shall make available to the City the
Service Provider' s relevant records at no cost to the City.
Service Provider shall pay any and all costs associated
with any such audit .
IN WITNESS WHEREOF, the undersigned have entered into
executed this agreement on the date and year first written
above .
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CITY OF ELGIN, a municipal (SERVICE PROVIDER)
Corporation
By By
Sean R. Stegall
City Manager
Attest :
-i�/�" 6 jzz
City Clerk
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EXHIBIT A
DESCRIPTION OF SERVICES TO BE PROVIDED BY SERVICE PROVIDER:
1) Provide instructors and instruction for adult and youth dance
classes in the areas of -
Creative Dance, Small Fry Combo, Hip Hop, Ballet, Jazz, Tap.
2) Work cooperatively with the Program Supervisor in management
of participants and instructors.
. 3) Provide 1-2 staff to assist photographers on picture day.
4) Arrange Dress Rehearsal schedule and Dance Recital Performance
schedule.
5) Choreograph, direct and manage the Dance Recital performance
and rehearsal .
6) Design Recital Program.
7) Manage, direct and oversee the Dress Rehearsal and Recital
operation.
8) Measure participants; collect fees, select, and order recital
costumes.
DESCRIPTION OF SERVICES TO BE PROVIDED BY CITY OF ELGIN:
1) Program space for dance programs.
2) Registration, fee collection, refund services and class list
maintenance.
3) Print and reproduction of Dance Recital Program.
4) Contracting of a photographer and videographer for student and
group photos and recital performances.
5) Program space for picture day and recital program design.
6) Use of Hemmens Cultural Center for Dress Rehearsal and Recital
performances.
7) Any revenue collected through recital ticket sales from the
Dance Recital shall be used to:
a. Reimburse Hemmens Cultural Center for any staff,
equipment and box office fees and costs.
b. Reimburse the City of Elgin for staff used for Will Call,
Ushers and program printing.
c. Reimburse Dixon Dance Academy for documented expenses
incurred that was the direct result of the Dress
Rehearsal and Recital performances.
d. Any remaining revenue that may exist after expenses have
been paid shall be kept by City of Elgin as program
revenue.
DATES AND TIMES OF SERVICES :
January - December 2013
Dance Recital June 20, 2013 .
LOCATION OF SERVICES :
The Centre of Elgin
100 Symphony Way
Elgin, IL 60120
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EXHIBIT B
ACTIVITY PLAN
CREATIVE DANCE 1
A. Hello Circle(5 min)
Attendance&wait for"late comers"
Make eye contact and say each child's name
Student should stand up and curtsey(emphasize as respect for teacher and fellow students)
Hand out coloring sheets and/or monthly newsletter
September- "Female Dance Apparel"
"1sl Position"
"2nd Position"
October- "3rd Position"
"4th Position"
"5l Position"
November- "All 5 positions"
"Curtsey"
"Flex/Point"
December-NO HOMEWORK
January-"Recital"
February-"Passe"
March-"First Arabesque"
April-"Practice and You'll Know Your Dance"
"Smile"
"Applause"
May- "Makeup"
"Stage.,
B. Warm Up(5-10 minutes)
Group Exercise-students should move simultaneously
Should consists of -Isolations
Rhythm patterns(stomping/clapping)
Stretching
5 positions
Plie/Releve
Arabesque
Pique/Passe
Have one song the same from week to week to allow for familiarity(Change song monthly)
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CREATIVE DANCE 2
A- Hello Circle-(5 minutes)
Attendance and wait for late comers
Make eye contact and say each child's name
Student should stand up and curtsey(emphasize as respect for teacher
and fellow students)
Hand out coloring sheets.and/or monthly newsletter
September—"Female Dance Apparel
"1s`position"
"2"d position"
October—"3'd position"
"4"'position"
"5"'position"
November—"All 5 positions"
"Curtsey"
"Flex/Point"
December—"Pile"
"Releve"
January—"Recital"
"5 positions with poem_"
"Flexibility Exercises"
February—"Tendu"
"Passe"
March—"Arabesque"
"Grande Jets"
April—"Practice and You'll Know You're.Dance"
"Smile"
"Applause"
May—"Make-Up"
"Stage"
"5 positions quiz"
B. Warn-Up(5-10 minutes)
Group exercise--Students should move simultaneously.
Should consist of--Isolations
Rhythm patterns(stomping/clapping)
Stretching
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CREATIVE DANCE 3
A. Hello Circle(S min)
Attendance&wait for"late comers"
Make eye contact and say each child's name
Student should stand up and curtsey(emphasize as respect for teacher and fellow students)
Hand out monthly newsletter.
B. Barre Work(20 minutes)
September
S positions(all at one time)
Introduction to Ballet Barre
How to Stand
Jewelry Analogies-Crown,Earrings,Necklace
Fingertips only
Face Barre when turning
Dressing like a ballerina
Plie/Eleve
Tendu
Rond de Jambe
October
Plie/Releve
Tendu
Degage
November
Plie/Grande Plie
Tendu
Stretching
December
Review Everything
January Review Everything
February
Plie/Grande Plie
Tendu
Degage
March
Plie/Grande Plie
Tendu
Degage
April Plie/Grande Plie
Tendu
Stretching
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Academy Service Agreement A.Docx
SMALL FRY COMBO 1
A. Hello Circle(5 min)
Attendance&wait for"late comers'
Make eye contact and say each child's name
Student should stand up and curtsey(emphasize as respect for teacher and fellow students)
Hand out monthly newsletter.
B. Barre Work(20 minutes)
September
5 positions(all at one time)
Introduction to Ballet Barre
How to Stand
Jewelry Analogies-Crown,Earrings,Necklace
Fingertips only
Face Barre when turning
Dressing like a ballerina
Plie/Eleve
Tendu
Rond de Jambe
October
Plie/Releve
Tendu
Degage
November
Plie/Grande Plie
Tendu
Stretching
December
Review Everything
January Review Everything
February
Plie/Grande Plie
Tendu
Degage
March
Plie/Grande Plie
Tendu
Degage
April Plie/Grande Plie
Tendu
Stretching
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SMALL FRY COMBO 2
A. Hello Circle(5 minutes)
Attendance and wait for late comers
Make eye contact and say each child's name
Student should stand up and curtsey(emphasize as respect for teacher
and fellow students)
Hand out monthly newsletter
B. Barre Work(20 minutes)
September-18`week
5 positions(all at one time)
Introduction to Ballet Barre
How to Stand
Jewelry Analogies-Crown,Earrings,
Necklace
Fingertips only
Face Barre when turning
Dressing like a ballerina
Plie/Eleva Releve/Cambre/Sous Sous
Tendu en croix(from I")
Rond de Jambe(en dehors and en dedans)
October—Demi Plie/Grande Plie/Sous Sous
Tendu en croix(from 5"')
Degage en croix(from 1")
November—Plie/Grande Plie/Sous Sous
Battement Tendu en croix(from V)
Stretching
December—Review Everything
January—Review Everything
February—Plie/Grande Pile
Battement Tendu en croix(from 5`")
Rond de Jambe a terre/Petite Rond de Jambe en fair
March—Plie/Grande Pile
Battement Tendu en croix(from 5`"—add arms)
Degage(from 5'")
April—Plie/Grande Plie
Sattement Tendu en croix(from 5"'—with arms)/Pique
Stretching
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t }gam - -
4 �
{ x,
.Hop 1
1 Y
N �_el.^fIIEtE
1 Y ltendance and wait for late comers
iElalte eFe contact and say,each child's name
dlc f monthly. newsletter
F
rtz Cardio-i0 minutes(different speeds)
Arms=use weights
..'].:..Grapevine mlksistep touch
Isolations-head,shoulder, ribs;hips
�rrerrhiag. .
Spinal stretches
Roll downs with plie
Side stretches
Flat back stretches
Lunges
., Both sides
Center
Straight-legged
Flex foot
Floor
151 position .
Straddle
Ankles/feet—point,flex and rolling
Abdominals
The I(IQs .
Roll ups
Upper,Lower,obliques
Increase amount as semester moves on
C Progressions(20 minutes)
*EVERY CLASS**
Body Rotls(RW gi t;teft and center/Reverse)
Add manipulations
Turning(1/4;'72,full rotations)
Both directions
Isolations across the floor
Head,shviYiders,ribs,hips
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Academy Service Agreement A.Docx
01/31/2013 06:15 18474266241 STATE FARM PAGE 01/01
CERTIFICATE OF INSURANCE
This certifies that ® STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
❑ STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario
❑ STATE FARM FLORIDA INSURANCE COMPANY,Winter Haven, Florida
❑ STATE FARM LLOYDS, Dallas,Texas
insures the following policyholder for the coverages indicated below,
Name of policyholder DIXON, CATHLEEN DBA DIXON DANCE ACADEMY
Address of policyholder 777 S 8TFi ST WEST DUNDES IL 60118-2108
Location of operations Same
Description of operations Dance instruction
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is
subject to all the terms exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims.
POLICY PERIOD LIMITS OF LIA131LITY
POLICY NUMBER TYPE OF INSURANCE Effective Date ; Expiration Date (at beginning of policy period)
93-QF-7122-6 Comprehensive 01/09/1.3 01/09/14 BODILY INJURY AND
Business Liability PROPERTY DAMAGE
This insurance includes: ® Products Completed Operations
® Contractual Liability
❑ Underground Hazard Coverage Each Occurrence $1,000,000
® Personal Injury
❑Advertising Injury General Aggregate $2,000,000
❑ Explosion Hazard Coverage
❑ Collapse Hazard Coverage Products—Completed $2,000,000
❑ Operations Aggregate
POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE
EXCESS LIABILITY Effective Date 1 Expiration Date (Combined Single Limit)
❑ Umbrella 0 Each Occurrence S
❑Other Aggregate $
Part 1 STATUTORY
j Part z BODILY INJURY
93-S3-L720-8 Workers'Compensation 10/18/12 10/18/13
and Employers Liability Each Accident $ 100,000
Disease Each Employee $ 100,000
Disease-Policy Limit $ 500,000
POLICY PERIOD LIMITS OF LIABILITY
POLICY NUMBER TYPE OF INSURANCE Effective Date ; Expiration Date (at beginning of policy period)
:
THE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
Listed as additional insured. If any of the described policies are canceled before
Its expiration date, State Farm will try to mail a written
notice to the certificate holder 3o days before
cancellation. If however, we fail to mail such notice,
Name and Address of Certificate Holder no obligation or liability will be imposed on State
Farm or its agents or representatives
The City Of Elgin
150 dexter ct
elgin ii, 60120 Signature of Authorized Representative
Agent/Sta£L 02/01/2013
Title Date
Agent's Code Stamp
AFO Code 6090
55 8-894 a,l 04.1999 Printed in U.S.A.