HomeMy WebLinkAboutC2007-037 - 3/6/2007 - NAAGREEMENT TO PROVIDE VIDEO SERVICES
STATE OF TEXAS §
COUl~iTY OF NUECES §
WHRREAS, the City of Corpus Christi (City) broadcasts its regular City
Council meeting over the governmental access channel; and
WHEREAS, the City also videotapes other programs and public service
announcements for broadcasting and training video for training; and
WHlREAS, the City needs an operator to provide videotape services for
the City Council meetings, programs, training videos, public service
announcements, and similar video presentations, and
WHEREAS, Richard DeLeon, Jr. doing business as RDL Productions
(Operator), is a skilled videotape operator and is willing to provide video
services to the City;
NOW, THEREFORE, in consideration of the mutual promises herein, the
parties agree as follo~~~s:
1. Term. The term of this Agreement is for twelve (12) months beginning
March l , 2007..
2. Rates. Operator will charge City the rates set out in Exhibit A, attached
and incorporated, for providing the video services set out in Exhibit A.
c)perator shall invoice the City monthly, setting out in detail all services
performed. the rate for those services, the time spent rendering the
services, rind the department for whom the services were rendered. The
2007-037
03106/07
Deleon, Jr., Richard
t'ity will pay within thirty (30) days of receipt of invoice and any required
<~locumentation New services and their rates may be added to Exhibit
a at anv time ~~ith the City Manager's or designee's (City Manager), and
t )perator's approval. The total contract limit will not exceed $25,000.
3 Re lar Council Meetings. Operator will be at City Hall on each Tuesday
City Council is scheduled to meet ~n sufficient time to verify that all
audio and video equipment is operable. If any equipment is
malfunctioning, Operator shall inform the City Secretary or his designee
(City Secretary), of the malfunction any associated costs, and with his
approval contact Time Warner, other appropriate parties, to fix the
malfunction. Operator is responsible for maintenance of all of City's
audio and video equipment in the City Council Chamber. If any costs
are incurred by Operator, City will reimburse Operator within thirty (30)
days of receipt of invoice and back up documentation of an expenditure
incurred by Operator tcj remedy any malfunction, or provide routine
maintenance.
Once Operator has verified that all audio and video equipment is
operable, Operator ma~~ leave City Hall and return by 9:00 a.m. that
same day
Regular City Council meetings begin at 10:00 a.m. on Tuesdays.
Ciry Council frequently does not schedule a Regular City Council
meeting on the first Tuesday of each month. City Secretary will provide
t )perator at_ least twenty-four (24) hours notice of change in the council
meeting start tame or c ancellation of regular City Council meetings.
Operator gill provide audio and video services during each regular
i:'ity Council meetings. Operator shall not leave until the City Council
meeting is adjourned and all equipment has been turned off.
4_ Special Crty Council Meetings. City Council occasionally has special
council meetings. The City Secretary will provide Operator at least
twenty-four X24) hours notice of any special City Council meeting.
If Operator has a conflict and cannot provide audio-video services,
hc~ shall inform. the City Secretar-tiT as soon as possible that the Operator
is not available.
If Operator is available, he shall be at City Hall in sufficient time to
~~erify that all audio and video equipment is operable and to correct any
rnalfunct.ions. A special Citti~ Council meeting does not include meetings
~:onducted immediately before, after or during the regularly scheduled
City Council meeting.
5. Bulletin Board. The Director of Public Information or designee (Director)
may contact. Operator about production and videotaping services for the
t'ity's Bulletin Board. Thf• Director and Operator will arrange a mutually
agreeable time frame for producing and taping the bulletin board, or the
Director may use other service providers.
h. Ownership. The City will own all tapes which Operator may tape and/or
edit. Operator has no = ownership interest in and may not make copies of
any video tapes he tapes and/or edits for the City.
7 Troubleshooting. The Director may contact Operator about
troubleshooting for user departments. Director and Operator will
arrange a mutually agreeable time frame for providing the
troubleshooting services, or the Director may use other service providers.
8 Illness. If Operator is ill and unable to provide the audio-video services
for a regularly scheduled City Council meeting, he will notify the City
Secretary or his designee no later than 8:30 a.m. on that Tuesday.
9. Termination. Either party may terminate this Agreement without cause
upon thirty (30) days v~~ritten notice to the other party. If Operator fails
to notify the City Secretar-~~ that he is unable to provide his services by
H:30 a.m. cm any regularly City Council meeting day, or fails to provide
his services until after City Council adjournment, the City Manager may
terminate upon two (2) working days notice.
10. Appropriation of Funds. All parties recognize that the continuation of
any contract after the close of any fiscal year of City, which fiscal year
ends on July 31 of each year, shall be subject to appropriations and
budget approval providing for covering such contract item as an
expenditure in said budget. City does not represent that the budget item
will be actually adopted, said determination being within the sole
discretion of the City Council at the time of adoption of such budget.
l l . Assignability. The Operator shall not assign, transfer, or delegate any of
his obligations or duties in this Agreement to any other person without
the prior written consent of the City, except for routine duties delegated
to field assistants and clerical helpers. The performance of this
Agreement by Operator is the essence of this Agreement and City's right
to withhold consent to such assignment shall be within the sole
discretion of the City on an~~ grounds whatsoever.
12. Ind~endent Contractor. Operator shall perform all professional services
as an independent contractor and shall furnish such services in its own
manner anal method, and under no circumstances or conditions shall an
agent, servant, or employee of the Operator be considered an employee of
h~~ City
1;3. Subcontractors. Operator may not use subcontractors in connection
titirith the work performed under this Agreement.
14. Venue and Applicable Law. This Agreement shall be subject to all
Federal, State and local laws. All duties of the parties shall be performed
rn the City of Corpus Christi, Texas. The applicable law for any legal
disputes arising out of this Agreement shall be the law of Texas and such
ti~rum and venue for such disputes shall be the appropriate district,
ounty, or justice court in and for Nueces County, Texas.
1~. Waiver. No waiver of an_y breach of any term, or condition of this
Agreement, shall be construed to waive any subsequent breach of the
same.
1 b. Disclosure of Interests. Operator further agrees, in compliance with City
of Corpus Christi Ordinance No. 1'7112, to complete, as part of this
Contract, the Disclosure of Interest form provided to Operator.
17. INL"1~MNIFICATION. Operator must indemnify and hold City, its
officers, employees or agents ("Indemnitees") harmless of, from, and
against all claims, demands, actions, damages, losses, costs,
liabilities, expenses, including attorneys fees, and judgments
recovered from or asserted against Indemnitees on account of injury
or damage to person or property to the extent any such damage or
injury is caused by an act or omission, negligence or misconduct on
the part of Operator, or any of its agents, servants, contractors, or
employees in performance of this Agreement.
l~. Insurance. Operator agrees to provide insurance in accordance with the
attached exhibit. In lieu of worker's compensation, Consultant has
executed ?:he attached Release and Covenant not to sue.
19. No Waiver._No waiver of any covenant or condition, or the breach of any
covenant. or condition of this Agreement, constitutes a waiver of any
subsequent: breach of the covenant or condition of the Agreement.
20. Amendments or Modifications. No amendments or modifications to this
Agreement mad be made, nor any provision waived, unless in writing
~;igned by <i person dult~ authorized to sign agreements on behalf of each
z~arty.
21. Captions. The captions in this Agreement are for convenience only and
are not a part. of this Agreement. ?`he captions do not in any way limit or
<~rzlplify the terms and i~rovisions of this Agreement.
22. Notice. Notice will be provided by certified mail, hand-delivered, or via
facsimile as set out below
IF TO THE CITY: IF TO OPERATOR:
Citti- Secretary' Richard DeLeon Jr. ~~'~`
City of Corpus Christ, ~ ,~Zt~ ~1t~E~'~-~~'~~ 92
P.O. Box 9277 Corpus Christi, TX 7841$
Carpus Christi, TX 78469-9'? 7 7 (361) ~~z7 ~y 2 ' 2q~1 ~
Fax No~ : (361) 880-3 ] 13
Change off' address may be effectuated by sending notice of the new
address in the manner set oL~t above.
SIGNED this ~~~' _ da~• of ____ 1y~~~c_~t-t , 20Ct`i .
ATTICST:
--
Armando Chapa
City Secretary
OPERATOR:
_,
11A F ~ f „
Richard DeLeon, Jr.
Operator
G or .Noe
rty Manager
APPROVED as to legal form ___~_i-o ~~-~ c_~. *-
MARY KAY FISCHER, CITY ATTORNEY
'' ~ -, ~,
20 ~ ~~
EXHIBIT A
Initial Administrative expenses payment .....................$ 997.00
?. Fee for ensuring all Council Chambers audio-video equipment is
operable and videotaping each regular scheduled and special city
council meeting:
a) In its entirety .. ........... ........................... $350.00
3. Fee for providing video services under Section 5 of the contract.
a) Fee per hour .,. .......................................... $65.00
4. Fee for providing troubleshooting services under Section 7 of the
contract.
a) Fee per hour ... ............................................. $20.00
(In quarter hour increments for calls requiring site visits)
.ATTACHMENT
INSURANCE REQUIREMENTS
i. Operator's Liability Insurance
~. Operator must not commence ~~ork under this agreement until. all insurance required herein has
been obtained and such insurancc has been approved by the City. The Operator must not allow any
subcontractor to commence work until all similar insurance required of the subcontractor has been
obtained.
B. Operator must furnish to the ('ity'S Risk Manager two (2) copies of Certificates of Insurance,
showing the following minimum coverage b_y insurance company(s) acceptable to the City's Risk
:Manager. The City must be named as an additional insured for the General liability policy and a
blanket. waiver oI~ subrogation is required on all the General Liability and Workers Compensation
policie~~.
TYPE OF INSURANCE MINIMUM INSURANCE COVERAGE
30-Day written notice of cancellation, material Bodily Injury and Property Damage
chaage, noH-renewal or terndnation is required on Per occurrence /aggregate
all certificates
COMMERCIAL GENERAL I,IABILCI Y including: $500,000 COMBINED SINGLE LIMIT
1, t'ommerc~al Form
?. Premises Operations
Products.' Completed Operations Hazard
4. ('ontractual Liability ~
~. Independent Contractors
~,. Personalln~arv
Applicable if employs any person other than himself,/
herself WHICH COMPLIES WITH THE TEXAS
WORKERS' COMPE'JSA110I~ WORKERS' COMPENSATION ACT AND
PARAGRAPH II OF THIS EXHIBIT
EMPLOI'ERS L[ABIL1"L~. 500.000.-'500,000/500,000
('. In the event of accidents of any kind, the Operator must furnish the Risk Manager with copies of
all reports of such accidents within te.n (10) days of accident.
lI. ADDITIONAL REQUIREMENTS
~. When employing person other than himself/ herself, Operator must obtain workers' compensation
coverage through a licensed insurance company obtained in accordance with Texas law. The
contract for coverage must be written on a policy with endorsements approved by the Texas
Department of Insurance. The coverage provided must be in amounts sufficient to assure that all
workers' compensation obligations incurred by the Operator will be promptly met.
B. Certificate of Insurance.
* fhe Cite of Corpus Christi must be named as an additional insured on the General
liability co~era~e and .; blanket waiver of subrogation is required for all applicable
policies.
* If your ;nsurance company uses the standard ACORD form, the cancellation clause
(bottom :-fight) must be amended by adding the wording "changed or" between "be" and
"canceled"', and deleting the words, '`endeavor to", and deleting the wording after "left".
In the aLernati. e, a cope of the endorsement evidencing that the policy(s) was endorsed
with the required cancellation provisions will be accepted,
* The name of the project must be listed under "Description of Operations"
* At a minimum, a 30-day written notice of cancellation, material change, non-renewal or
termination is required.
('. ]f the Certificate of lnsurance does not show on its face the existence of the coverage required by
items l.B (l ~)-(6), an authorized representative of the insurance company must include a letter
sped tically stating whether items 1. B. (1)-(6) are included or excluded.
CITY OF CORPGS CHRISTI
DISCLOSL',RE OF INTEREST
i`ity ot~ C`orpus Christi Ordinance 171 12. a, amended, requires al] ppersons or firms seeking to do business with the
City to provide the following information. Eery question must be answered. If the question is not applicable,
ans~~er with "N.y". See reverse side for definitions.
t`OMPANYNAME : ~h-.\~L ~4~SL~s `, sS~ti_-' ~
_- _ __ _-
~ . _ __.
STREET: _~ ~ C b }~~ ~1~~,-~`-~- - - -- CI'I l": ~~St~_~~ ; ~ ~~tZ i5"Tl ZIP: ~ ~~
FIRM ISM 1 _ Corp~.~ration ( ) _. Partnership ( ) 3. Sole Owner
~. association ( ) Other ( )
DISCLOSURE QUESTIONS
If additional space is necessary, please use the reverse side of this page or attach separate sheet.
i . State the names of each "employee" of the City of Corpus Christi having an "ownership interest" constituting
3°%~ or more of the ownership in the above named "firm."
Name Job Title and City Department (if known)
~,
State the names of each "`official" of the City of Corpus Christi having an "ownership interest" constituting 3%
or more of the ownership in the above named "firm."
Name ~, `~ Title
~. State t names ~eac~i ~oar~c mem~r ` o~ the City off`-Corpus C`~iristi avmg an "owners tp mterest'
constituting i% or more of the ownership in the above named "firm."
Name Board, Commission, or Committee
~_ State the names oi~ each employee or officer of a "consultant" for the City of Corpus Christi who worked on any
matter related to the subject of this contract and has an "ownership interest" constituting 3% or more of the
ownership in the above named "firm."
Consultant
CERTIFICATE
1 certify that all information
lr~owingly withheld disclosure t
submitted to the City of Corpus C
('ertifying Person: ~ ~, ~'~iv~
_~~
Signature of ('ertifying Person:
provided is true and correct as of the date of this statement, that I have not
~f any information requested: and that supplemental statements will be promptly
`hristi, Texas a~ changes occur.
r
~ ~ lti ~ - _ _ ~ Title: .~'!~~ 1L
6i nn[ ~ ~
~ x.~ ~y,~ = --~~- -Date: _ 3 ~ D-l
DEFINITIONS
a. "Board member. ' ,1 n~~ember «t any board. commission, or committee appointed by the City
t'ounc;i of the CEt-~ of Corpus Chnst~. ~fexas.
h "Employee.~~ .any person employed by the City of Corpus Christi, Texas either on a full or part-
time basis, but not as an independent contractor
c. "Finn. ' Any crrtity operated for economic gain, whether professional, industrial or commercial, and
whether established to produce or deal with a product or service, including but not limited to, entities
operated in the Corm of sole proprietorship, as self-employed person, partnership, corporation, joint
stock company_ mint venture, receivership or mist. and entities which for purposes of taxation are
treatzd as non-protit organizations
d. "Official." I~he Mayor, members of~ the C~tv Council, City Manager, Deputy City Manager,
Assistant City Managers. Department and Division Heads, and Municipal Court Judges of the City of
Corpus Christz, Texas.
e. "Ownership Interest" [.,egal or equitable interest, whether actually or constructively held, in a
firm. ~neluding when >uch interest is held through an agent, trust, estate, or holding entity.
Constructively held refers to Moldings or control established through voting trusts, proxies, or
special terms of venture or partnership agreements.
t: "Consultant." Any person or firn1. such as engineers and architects, hired by the City of Corpus
t'hristi for the purpose of professional consultation and recommendation.
REL LASE OF 1 IAt;[t.tTY A?~1) CQVENANT NOT TO SUE
THE STATE OF -TEXAS
COUNTY" OF NL~EC'ES
KNOW ALL BY THESE PRESENTS:
This Release of Liability and Covenant Not to Sue (hereinafter "Release") is made by and
between and the City of Corpus Christi. Nueces County, Texas, and Richard DeLeon, Jr. doing
business as RDL Productions executed on this the ~;~'}l. ` day of March, 2007, and is entered into
for the purpose of releasing the Cite of Corpus Christi, its officers, employees, representatives,
agents and contractors (herein collectively referred to as "City") from any and all liability
whatsoever arising out of, caused b~•, or in any way connected with, either proximately or
remotely, wholly or in part, participation by Richard DeLeon, Jr. doing business as RDL
Productions in providing professional services to review City's deferred compensation plans,
which is the subject of the attached contractual agreement ("Agreement") between Richard
DeLeon. Jr. and the City.
1~ Richard DeLeon. Jr. in exchange for City allowing me to forego the condition of
providing a Worker's Compensation insurance policy as a requirement of the Agreement, do
hereby voluntarily enter into the following covenants:
1 I acknowledge that I, individually, employ no other workers than myself. I covenant that I
will not enter into an employer-employee relationship with any individual or individuals during
the term of the Agreement. I acknowledge that the capacity in which I will be participating in
the Agreement is that of an independent contractor and not as an employee or agent of the City.
1 further understand that, as an independent contractor, I will receive no worker's compensation
benefits. health benetts, disability henetits, or other insurance benefits which might be available
to full time employees of City and that, as an independent contractor, I am fully responsible for
incurring the cost of and paying for and medical services that I may require during the term of
the Agreement.
?. 1 understand that 1 will participate in this Agreement at my own risk and hereby release,
waive, and in all ways relinquish any and all present or future claims against City which I, my
heirs, successors, assigns. or any other person or entity (collectively, hereinafter "I"), may
assert, hay e, or acquire as a result oi~ any injury, death. damage, or loss whatsoever to myself or
my property resulting from, arising out of, or connected with my participation in the Agreement
between myself and the City.
;. I hereby so release, waive, and relinquish all such claims, and further covenant not to sue City
for any such claim, regardless of whether same may arise from any negligence or gross
negligence ofCitti,
~. I understand that there may be risks involved in participating in the Agreement. I assume all
such risks. and will rely solely on myself and not the City in determining what those risks are.
I acknowledge that my sen~ices under the Agreement may occur on real property located in
the Cit}~ of Corpus Christi. Nueces County, Texas. It is my intention to completely absolve the
City of all potential liability caused bv, arising out of, or incident to my performance of services
on City real proper? y
(~. I agree that this Release shall apply to all activities during or connected in any way with my
participation in the Agreement and my performance thereunder.
7 I agree that this Release. shall be governed by and enforceable under the laws of the State of
Texas. Venue shall lie in Nueces County, Texas, where this Release was executed.
8 I hereby acknowledge that I have carefully read the foregoing Release of Liability and
Covenant Not to Sue, and intending to be legally bound, accept each of its terms.
EXECt`TED IN DLPLIC.ATE, each of which shall be considered an original, on this
the_~l,''~` - daY c+f --_ c~~ 4' _ --~ X007.
I ,~
j ~(~ {k ` '
jLiv7 1 ~.~t '~.~C ~ ~~ ~.J~i\
Richard DeLeon, .Ir.
Address- ._'1S~ _~-~J4,_~~_~u- , ~~<_ __ ___ _ -
__
Date: 3
STATE OF . '~ ti
COiJN~I~Y OF -_ ~j_~ ~~- ~ ----_
Before me, 4~ ~. '~Yr ~,~ ~',, k 4 ~ :,,: _, 'c, on this day personally
appeared Richard DeLeon, Jr. known to me to be the person whose name is subscribed to the
foregoing instrument and acknowledged to me that he executed the same for the pu ose and
consideration therein expressed. Given under my hand and seal of office this (~~ day of
March, ?U07.
~~_
Notary Public, State of Texas
~o,~'~ ~ MARIA Y JUAREZ
Commission expires: Notary ?umic
~' ~ ~'~ STATE OF TEXAS
z'~,,~,. My Comm. Exp. 10-25-2009
CIIenHF: 8314 RDLPROD
AC10RI~n CERTIFICATE OF LIABILITY INSURANCE o~;2z,o;°"""'
PRDCI~IOI:R THIS CERTIFICATE IS ISSUED A A MATTER OF INFORMATION
HRH of Corpue Chris#i ONLY AND CONFERS NO RIGHTS UPON 7HE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AME~1D, EXTEND OR
X733 So, Padre Island Drive ALTER THE COVERAGE AFFORDED EY THE POLICIES BELOII~.
P. ~. Dox 8341
Corpus Chris#i, TX X8468 INa~1RERS AFFORDIl~C COVERAGE NAIL #
INSIf REIN INSURER A: cot#sdai$ Insurance CQn1p ~~~~~
RDL Praductions; Richard DeLeon dha, INSURER B.
756 Angelwing Dr II~SU~ER c:
Corpus ChrIS#i, TX 78414 INSURER D:
INSURER E:
COVERAGEa
THE POLICIES 01= INSURANCE LISTEp BE~O1N HAVE BEEN ISSUED TO THE INSUREp NAMED ABOVE f+OR THE POLICY PERIOp INDICATEp. NOT1N ITHSTANpING
TERM Old CONpIT10N OF ANY CONTRACT OR OTHER DOCUMENT VIIITH RESPECT TO WHICH TWIS CERTIFICATE MAY BE ISSUED OR
ANY REQUIREMENT
,
YHE INSURANCE AFFaRDEp BY THE POLICES DESCRIBED HEREIN IS SUBJECT `I"0 ALL THE TERMS, E~LCLUSIaNS AND CONDITIONS OF SUCH
MAY PERTAIN
,
POLICIES. AGGREGATE L1M1~'S SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS,
PGI.ICY EFFECTIVE POLICY E][PIRATIQN I
IM#T5
LTR NSR TYPE DF #NSURAHCE POLICY NUMBER I]ATE MM1DDfYY aATE MM11?D .
~ GENERAL LIABILITY CL~36OT14 43f2~lO7 ~~{21lOS EAGl~ OCCURRENCE ~'~ 4aD DOD
DAMAGt= TO RENTEQ $~ DD ~aO
~ COMMERCIAL Gt=I~iERAL LIABILITY P E n e
CLAIMS MAI}E ~ OCCUR MED E}(P {Any one person} ;~~ ODD
PERBONAL & ADV INJURY Excluded
GENERAI. AGGREGATE ~~ DOD O4O
GEN'L AGGREGATE LIMIT APPLIES PEI: PRODUCTS - COMPfOP AGG ~~ DOD 444
POLICY J~CT LOC
AUTOMOBILE LIABILITY D } ING#.E LIMIT
B ~
{~ a
c ~e
ANY AUTO
AI.L OWNED AUTOS BODILY INJURY ~
{Per person}
SCHEf}Uk.ED AUT05
H{RED Al]T05 BODILY INJURY ~
{Per acadeN}
NOh!-OWNED AUTOS
PROPERTY DAMAGE ~
{Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIQENT $
ANY AUTO OTHER THAN P~4 ACC $
AUTO ONLY: AGG ~
EXCI*SSNMBRELLA t_IAGILITY EACH OCCURRENCl: ~
OCCUR ~ CLAIMS MADt= AGGREGATE ~
~
DEDUCTIBLE
RETENTION $
1NC TATU- OTH- ~
WORKERS cOMPENSATIaN ANa
EMPLaYERS' LIABILITY E.L. EACH ACOIDI=NT $
ANY PROPRIETDRIPARTNERfEXECUTIVE
OtiFICERFMEMBER F~(CI.~IDED?
E,L. DISEASE - EA EMPLOYEE $
If yes, describe ender E.L, pISEASE - POLICY LIM17 $
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPEDATION3 f LOCATtQNS f VEHICLES f EXCLUSIONS AaaED BY ENaaRSEMENT f SPEO#AL PROVISIONS
Cer#ificate Holder 1s irlar~ed As Additinnaf Insured
CERTIFICATE HOLDER
City of Carpus Christi
p+D Box 977
Corpus Christi, T!( 78469
Attn: M Juarez
ACORD 25 ~Z00~f08~ 1 of ~ #3GG13
CA~ICELLf~T1~N
SHOULa ANY OF THE ABOVE aEBCRIBI=a EaLIC#ES BE CANCELLED BEFORE THE E7(I~#RAT1aN
DATE THEREOF, THE ISSUING INSURER VY1LL ENDEAVOR Ta MAIL ~ aAYB WRITTEN
NOTICE TOTHE CI=RTIF#CATE HOLDER NAMEa 70 THE LEFT, BUT FAILURE TO DO Sa BHALL
IMROSE Ra agLIGATtaN aR LlA13ILtTY Of AIVY KItVD llPO>-i THE INSURED, ITS AGENTS aR
REPRESENTATNES.
AUTHORI~Ea REPRESENTATIVE
RR~ o ACORD CORPORATION 1988
ff r
:7
lM P~~TA~IT
if the certificate holder is an AD~ITI~NAL INURE, the policy~ies~ must be endorsed. A statement
on this certificate does not canter rights to the certificate holder in lieu of such endorsement~s~F
if UBR~~ATI~N I vVAIVEa, subject to the terms and conditions of the policy, certain policies may
require an endorsementF A statement on this certificate does not confer rights to the certificate
balder in lieu of such endorsements}.
i~IaCLAIME
The erkificate of Insurance on the reverse side of this farm does not constitute a contract between
the issuing insurers}, authorized representative ar producer, and the certificate holder, nor does it
affirmatively yr negatively amend, extend ar alter the coverage afforded by the policies listed thereon.
ACDRD 25-5 ~~0~1l~8~ ~ of 2 #3B~~