HomeMy WebLinkAbout09-0101 Morgan ( 1/06/04 )
SERVICE AGREEMENT
THIS AGREEMENT is made and entered into this 01 day of
January, 2009, by and between the CITY OF ELGIN, Illinois,
a municipal corporation (hereinafter referred to as the
"City") , and Kellie Morgan, 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 on the dates and times as described in Exhibit A
attached hereto and made a part hereof (such services are
hereinafter referred to as the "Subject Services") .
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
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 reimburse the Service Provider for
the Subject Services under this agreement the amount of
-
$28 . 50 per class and 65% of fees for pre-registered
istered fitness
classes . 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 $10, 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 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 ress 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 engaged,
which the Service Provider is en aged,
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.
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 and reimbursable
expenses actually incurred prior to termination, except
that reimbursement shall not exceed the total amount set
forth under paragraph 5 above.
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.
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,
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 thirty (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
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 the monies
the City has agreed to pay pursuant to the preceding
paragraph 5 hereof, 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 reasonable
interest and reasonable attorney' s fees .
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;
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 ILCS 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:
City of Elgin Kellie Morgan
150 Dexter Court 3028 Cookson Ave.
Elgin, IL 60120-5555 Elgin, IL 60123
Attention: Health/Fitness Supervisor
24 . This agreement is and shall be deemed to construe to
be a joint and collective work product of the 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.
IN WITNESS WHEREOF, the undersigned have entered into
executed this agreement on the date and year first written
above.
CITY OF ELGIN, a municipal (SERVICE PROVIDER)
corporation
r
�By / By
Director of Parks and ecreation el ie Morgan
Attest :
City Clerk
F:\Legal Dept\Agreement\PSA-DRAFT FORM-CENTRE INSTRUCTORS-MRG.doc
EXHIBIT A
DESCRIPTION OF SERVICES TO BE PROVIDED BY SERVICE PROVIDER:
1) Instruct group fitness classes .
DATES AND TIMES OF SERVICES:
January 1, 2009 - , December 31, 2009
Classes will occur during normal business hours of
operation, which are Monday - Friday 5 : 30am - 10 : 00pm;
Saturday 7 : 00am - 6: 00pm and Sunday 8 : 00am - 6: 00pm.
Schedule will be determined by Health/Fitness Supervisor.
LOCATION OF SERVICES:
All services will be rendered in The Centre, 100 Symphony
Way. Elgin, IL 60120
EXHIBIT B
ACTIVITY PLAN TO BE PROVIDED
Group Fitness classes taught will include any one or more
of the following exercise components : warm-up, aerobic
activity, anaerobic activity, cool down, stretching.
EXHIBIT B
ACTIVITY PLAN TO BE PROVIDED
Group Fitness classes taught will include any one or more
of the following exercise components : warm-up, aerobic
activity, anaerobic activity, cool down, stretching.
Initial the additional services listed below that are to be
provided by service provider:
• Arrive to class 10 minutes early to set up
and prepare for class activities and
instruction.
16-N\ • Communicate substitute instructors to Fitness
Supervisor prior to substitution taking place.
Avoid repeated absenteeism and class
substitution. Repeated absenteeism may result
in class cancellation or class reassignment to
another instructor.
W,IY1 • Maintain appropriate class participation
numbers, or class may be subject to
cancellation.
�M • Provide invoices according to the accounts
payable schedule. Providing invoices according
to schedule assists in expediting payout in a
timely manner.
v.---N\ • Maintain a current CPR/AED & appropriate job
specific certifications that are required to
teach Group Fitness classes . Provide copies of
all certifications to the Fitness Supervisor.
V'1A. • Maintain a current Certificate of Liability
insurance listing the City of Elgin as
additional insured. Provide an updated copy to
the Fitness Supervisor prior to the expiration
of the current insurance certificate on file .
1/41/A • Report any damaged equipment or hazardous
conditions in Group Fitness studios to the
Fitness Supervisor in a timely manner.
141 • Any additional services or job specific
requirements as assigned by the Fitness
Supervisor.
Sign & Date :
Name : Date : wieg
2009 Accounts Payable Schedule--Fitness
Paperwork to Purchasing By Payout Date
December 3, 2008 December 19, 2008
December 17, 2008 January 2, 2009
December 30, 2008 January 16, 2009
January 14, 2009 January 30, 2009
January 28, 2009 February 13, 2009
February 11 , 2009 _February 27, 2009
February 25, 2009 March 13, 2009
March 11 , 2009 March 27, 2009
March 25, 2009 April 10, 2009
'April 8, 2009 I 'April 24, 2009
April 22, 2009 May 8, 2009
May 6, 2009 May 22, 2009
May 20, 2009 June 5, 2009
June 3, 2008 June 19, 2009
June 17, 2009 July 3, 2009
July 1 , 2009 July 17, 2009
July 15, 2009 July 31 , 2009
July 29, 2009 August 14, 2009
August 12, 2009 August 28, 2009 -
August 26, 2009 September 11 , 2009
September 9, 2009 September 25, 2009
September 23, 2009 October 9, 2009
October 7, 2009 October 23, 2009
October 21 , 2009 November 6, 2009
November 4, 2009 November 20, 2009
November 18, 2009 December 4, 2009
December 2, 2009 December 18, 2009E _. .
December 16, 2009m.�_7_... . . __�,m.�... ..,...�..T�.��..._ January 1 , 2010
Date: 6/30/2008 Time: 2 :26 PM To : 8 918475317020 C.
M. Meiers Company Page: 001
ACORD.,,, CERTIFICATE OF LIABILITY INSURANCE 6/30/2008Y'
PRODUCER (818)224-6100 FAX: (818)224-6099 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
C. M. Meiers Company, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
21045 Califa St. #100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Woodland Hills CA 91367 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER-Markel Insurance Company
Kellie Morgan INSLIRERE
3028 Cookson Ave. INSURERC
INSURER D
Elgin IL 60123 INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY
REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR
INSR ADM_ POLICY TYPE OF INSURANCE POLICY NUMBER DATE(MMIDD/YYE POLICY
MM/DDYYY)N LIMITS
LT INSRD _ ( )
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
AGE TO
X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occuED ence) $ 100,000
A X CLAIMS MADE nOCCUR 3602HE314555-0 7/1/2008 7/1/2009 MEDEXP(Any one person) $ 5,000
X Professional Liab. PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 3,000,000
GEN'L AGGREGATE LIMIT APPLIES PEP PRODUCTS-COMP/OP AGO $ 1,000,000
POLICE
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea accident)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per person)
HIRED AUTOS BODILY INJURY
IJvN-OWNED AUTOS
(Per accident)
PROPERTY DAMAGE $
(Per acadent)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT
—1 ANY AUTO OTHER THAN EA ACC $
AUTO ONLY. AGO $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE
7 OCCUR n CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE $
RETENTION $ 6
WORKERS COMPENSATION AND WC
EMPLOYERS'LIABILITY TORS
IMITS E
ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $
OFFICER/MEMBER EXCLUDED? E L DISEASE-EA EMPLOYEE
If yes,describe under
SPECIAL PROVISIONS below FL DISEASE-POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Premium and fees are fully earned at inception. Policy does not provide Premises Liability. Certificate holder is
listed as an additional insured.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Elgin EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
150 Dexter Ct. 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
Elgin, IL 60120 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE /
Herbert Rothman/RETH •
ACORD 25(2001/08) ,c,ACORD CORPORATION 1988
INS025(0108)08a
Date: 6/30/2008 Time: 2 :26 PM To: @ 918475317020 C.
M. Meiers Company Page: 001
A RD„
CERTIFICATE OF LIABILITY INSURANCE 6DATE/30/2008Y)
PRODUCER (818)224-6100 FAX: (818)224-6099 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
C. M. Meiers Company, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
21045 Califa St. #100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Woodland Hills CA 91367 INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER, Markel Insurance Company
Kellie Morgan INSURER B
3028 Cookson Ave. INSURER
INSURER D
Elgin IL 60123 INSURERE
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY
REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,
THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION
LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DONY) DATE(MMJDD/YY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 100,000
A X CLAIMS MADE I X I OCCUR 3602HF314555-0 7/1/2008 7/1/2009 MEDEXP(Any one person) $ 5,000
X Professional Liab. PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 3,000,000
PLGATE LIMIT APPLIES PER PROW CIS-COMP/OP AG $ 1,000,000
EL- e I I EC LOC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO (Ea accdent) {
ALL OWNED AUTOS BODILY INJJRY
SCHEDULED AUTOS (Per person)-
f
_ HIRED AUTOS BODILY INJURY
NON-OY NED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accdent)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY' AGO
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE ,f.
7 OCCUR El CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE C
RETENTION $ f
WORKERS COMPENSATION AND WC STAT - OTH-
EMPLOYERS'LIABILITY TGRY I IMI S ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT
OFFICER/MEMBER EXCLUDED?
E L DISEASE-EA EMPLOYEE'f
If yes.describe under
SPECIAL PROVISIONS below E L DISEASE-POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
Premium and fees are fully earned at inception. Policy does not provide Premises Liability. Certificate holder is
listed as an additional insured.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
City of Elgin EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
150 Dexter Ct. 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
Elgin, IL 60120 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE .. _ .w,a
Herbert Rothman/BETH ':-::i.--z.,',,,-,-(-. -.,,re_fr,z-, .-,_..
ACORD 25(2001/08) c ACORD CORPORATION 1988
INS025;ou;.1 .; ,.).. I_