HomeMy WebLinkAboutStaff Report 3.B 06/06/2005Crry OF PETALumA, CALIF®RNu &B
AGENDA BILL June 6, 2005
Agenda Title: Meeting Date:
Resolution Approving the Award of the Sonoma -Marin Fair Law June 6, 2005
Enforcement Services Contract on June 22 through June 26, 2005 to
the Petaluma Police Department. Meeting Time: ® 3:00 PM
❑ 7:00 PM
Cateeory (check one): ® Consent Calendar ❑ Public Hearing ❑ New Business
❑ Unfinished Business ❑ Presentation
Denartment: Director: Contact Person: Phone Number:
Police Deparhnent Steven Ho d Sgt. Tim Lyons 7784596
Chief of Pwe
Cost of Pronosal: I Account Number:
$34,998.17 (Contract Overtime) 4080-51240
Amount Budgeted: Name of Fund:
$0 Overtime Contract
Attachments to Agenda Packet Item:
A. Petaluma PD 2005 Estimated Budget
B. Sonoma -Mann Fair Standard Contract
Summary Statement:
The Petaluma Police Department was awarded the Sonoma -Marin Fair Law Enforcement Services
Contract. The contract provides for reimbursement of costs in the amount of $34,998.17. The Fair Board
requires a City Council resolution to complete the contract. It is recommended the Council adopt the
resolution.
Recommended Citv Council Action/Suggested Motion:
Approval of Resolution
Reviewed by Admin. Svcs. Dir:
Pate: S'/Z� �v�
Todav's Date:
May 20, 2005
Reviewed by City Attornev:
Date:
Anoroved bv Citv Manager:
Jj Date:
Revision # and Date Revised: File Code:
CITY OF PETALUMA, CALIFORNIA
JUNE 6, 2005
AGENDA REPORT
FOR
Resolution Approving the Award of the Sonoma -Marin Fair Law Enforcement Service
Contract on June 22 through June 26, 2005 to the Petaluma Police Department.
1. ExECUTIVE SUMMARY:
The Petaluma Police Department was awarded the Sonoma -Marin Fair Law Enforcement Services
Contract. The contract provides for reimbursement of costs in the amount of $34,998.17. The Fair
Board requires a City Council resolution to complete the contract. It is recommended the Council adopt
the resolution.
2. BACKGROUND:
The annual Sonoma -Marin Fair is considered one of the major events taking place in the Bay Area this
week, and is the largest event to take place in Petaluma. The 2005 event will be the 66th amoral. The
fair runs for 5 days. The fair takes place on the Sonoma -Marin Fairgrounds, a 54 acre facility. Recent
Fair attendance figures have been relatively steady, with approx. 61,000 attendees each year.
The primary entertainment venue is the Budweiser Gardemvay Stage, featuring premier entertainers
every evening of the fair. Smaller, auxiliary stages are spread through out the grounds and provide a
wide variety of entertainment. The fair hosts a major carnival, and features a variety of foods, alcoholic
beverages, commercial products, competitions open to the public and livestock displays. There is a
Destruction Derbys on the last day of the Fair.
The Sonoma -Marin fair attracts a large number of people to a relatively small area. It is necessary to
provide high visible law enforcement presence to prevent criminal behavior and apprehend violators.
Four years ago the Petaluma Police Department was awarded the contract. The contract was again
awarded to us this year without a bid process. The Petaluma Police Department received several
compliments on the service we provided.
Sworn Officer Duties: Officers will be assigned to teanis with a minimum of two officers per
team. Officers will conduct high profile patrols of the fairgrounds area. Most of the patrols will be on
foot, however up to four officers may use bikes each day. Officers will be primarily responsible for
preserving the peace and safety for fair attendees. This may include patrolling the entrance gates,
racetrack grandstands, music stages, livestock areas, carnival and areas where alcohol is sold.
3. ALTERNATIVES:
Not approve resolution.
4. FINANCIAL IMPACTS:
The contract awarded will have a cost to the City of Petaluma, which will be reimbursed by the Sonoma -
Marin Fair. All personnel working the fair will be working on an overtime basis. The contract includes
compensation for supervisor overtime, pre -fair organizational efforts, meetings, officer overtime,
dispatcher overtime, orientation for officers and dispatchers, financial processing time and a cost per
police vehicle, per hour. See attached estimated budget proposal.
Col
CONCLUSION:
In order for the Sonoma -Marin Fair Law Enforcement Services Contract to be completed a Resolution
approving the awarding of the contract must be come from the City Council.
6. OUTCOMES OR PERFORMANCE MEASUREMENTS THAT WILL IDENTIFY SUCCESS OR CONIPLETION:
Review of contract and operational costs after the completion of the fair. Input from Sonoma -Marin
Fair on our performance.
RECOMMENDATION:
Approval of a Resolution supporting the awarding of the contract to the Petaluma Police Department.
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PETALUMA POLICE DEPARTMENT
2005 ESTIMATED BUDGET
ESTIMATED PERSONNEL COSTS
Sgt. hours at the Fair 40 hours
Sgt. hours of preparation 40 hours
TOTALS 80 hours @ $ 61.33 per hour = $ 4,906.40
Officers hours at the Fair 424 hours
Officer orientation 20 hours
TOTALS 444 hrs @ $ 51.62 per hour = $ 22,919.28
Dispatcher hours at the Fair 40 hours
Dispatch orientation 3 hours
TOTALS 43 hours @ $39.94 per hour = $1,717.42
TOTAL PERSONNEL COSTS $ 29,543.31
ADMIN/FINANCE PROCESSING $293.32
TOTAL ESTIMATED VEHICLE COSTS
150 hours @ $ 2.75 per mile = $ 412.50
TOTAL HOURS TO BE PAID BY KIWANIS CLUB
80 Hours @ $ 51.62 per hour = $4,129.60
TOTAL HOURS TO BE PAID BY GLAD ENTERPRISES
12 Hours @ $ 51.62 per hour = $ 619.44
TOTAL ESTIMATED COSTS OF PERSONNEL & VEHICLE $ 34,998.17
Page 1
rQ)
STATE OF CALIFORNIA
STANDARD AGREEMENT
STD 213 (Rev 06/03)
AGREEMENTNUMBER FEDERAL IDm
S05-21 1 94-6000392
Phone Number
707-778-4332; Tim: 778-4596
This Agreement is entered into between the State Agency and the Contractor named below:
STATE AGENCY'S NAME
4TH District Agricultural Association; Sonoma -Marin Fair
CONTRACTOR'S NAME
City of Petaluma Police Department
2. The term of this June 22, 2005 through June 26, 2005
Agreement is:
3. The maximum amount $ 35,000.00
of this Agreement is:
4. The parties agree to comply with the terms and conditions of the following exhibits which are by this reference made a
part of the Agreement.
Exhibit A — Scope of Work 2 page(s)
Payment Provisions
Exhibit B — Budget Detail 1 page(s)
Exhibit C* — General Terms and Conditions 2 page(s)
Check mark one item below as Exhibit D:
Exhibit - D Special Terms and Conditions (Attached hereto as part of this agreement) page(s)
❑ Exhibit - D* Special Terms and Conditions
Exhibit E— Additional Provisions 2 page(s)
Exhibit E, Insurance Requirements
Exhibit E1, Workers Compensation
Items shown with an Asterisk (*), are hereby incorporated by reference and made part of this agreement as if attached hereto.
These documents can be viewed at www.ols.dgs.ca.gov/Standard+Language
IN WITNESS WHEREOF, this Agreement has been executed by the parties hereto.
CONTRACTOR
CONTRACTOR'S NAME (if other than an Individual, state whether a corporation, partnership, etc.)
City of Petaluma — Police Department
BY (Authorized Signature) DATE SIGNED(Do net ppe)
.e� �f' �� 5-23.0s,
PRINTED NAME AND TITLE OF (PERSON SIGNING
S.I-('-oo chte-
ADDRESS
969 Petaluma B►d. N.
Petaluma, CA 94952
STATE OF CALIFORNIA
AGENCYNAME
4`t' District Agricultural Association
BY (Authorized Signature)
X
PRINTED NAME AND TITLE OF PERSON SIGNING
Tawny Tesconi
ADDRESS
175 Fairgrounds Drive
Petaluma, CA 94952
DATE SIGNED(Do no( qpe)
California Department of General
Services Use Only
® Exempt per. 3955.1
r�
Exhibit "A"
Scope of Work
S05-21
CONTRACTOR AGREES:
In accordance with laws that allow Contractor to provide law enforcement services in addition to the levels of protection usually and
customarily provided, Contractor agrees:
To famish the State, Sonoma -Marin Fair, located in Petaluma, California with the services of such law enforcement personnel under
the command of the Petaluma Police Department as may be necessary to provide for the safety of the public and protection of the
facilities of the 4" District Agricultural Association from June 22, 2005 to June 26, 2005 on the fairgrounds (Payran Street and
Fairgrounds Drive). Contractor must provide proof of insurance per Exhibit "E".
To pay the contractor a sum not to exceed thirty-five thousand and no cents (35,000.00) for additional security services during Fair.
Services rendered pursuant to this agreement represent an estimate of need and are based upon past experience for
the Sonoma -Marin Fair event. Contractor shall endeavor to mitigate costs to the State by sending assigned security
personnel home early should circumstances and events dictate less security requirements. Conversely, contractor
reserves the authority to add additional security personnel should circumstances dictate such need.
Contractor must have approval of Fair Management before adding additional security personnel.
Services provided under this agreement are limited to the normal operating hours of the fair. Such hours are
defined as beginning each day of the fair, starting June 22, 2005 at approximately 12:00 noon and ending each day
at approximately 1:00 A.M., through June 26, 20045
APPROVAL REFLECTED BY ORIGINAL SIGNATURES (NO STAMPED SIGNATURES):
4TH DISTRICT AGRICULTURAL ASSOCIATION
BY:
Tawny Tesconi, CEO
Date
APPROVED AS TO FORM:
OFFICE OF CITY COUNSEL
BY:
Date
ATTEST:
Print Name: City Cleric
Date
CITY OF PETALUMA
Fra
David Glass, Mayor
Date
PETALUMA POLICE DEPARTMENT
APPROVET RECOMMENDED
BY:
Chief Steve Hood
Date
5.23 05
Fl
STANDARD AGREEMENT S05-21
4TH DAA AND CITY OF PETALUMA
ESTIMATED PERSONNEL COSTS
Sgt hours at the Fair
Sgt hours of preparation
TOTALS
Officer hours at the Fair
Officer orientation
TOTALS
Dispatcher hours at Fair
Dispatcher orientation
TOTALS
ESTIMATED BUDGET
80 hours x $64.34 per hour = $5;147.20
431 hours x $52. per hour = $22,442.17
43 h urs x $42.86 per hour = $1,842.98
i%
TOTAL PERSONNEL COSTS $29,432.35
TOTAL ESTIMATED VEHI � LE COSTS 150 x $2.75 per mile = $412.50
TOTAL ESTIMATED URS TO BE PAID BY ICIWANIS CLUB
80 hours @ $52.07 $4,165.60
TOTAL ESTIMAT D HOURS TO BE PAID BY GLAD ENTERPRISES
12 hours @ $52.07 $ 624.84
TOTAL ESTIMATED COSTS OF PERSONNEL & VEHICLES $34,635.29
r -7l
GTC 304
EXHIBIT C
GENERAL TERMS AND CONDITIONS
1. APPROVAL: This Agreement is of no force or effect until signed by both parties and
approved by the Department of General Services, if required. Contractor may not commence
performance until such approval has been obtained.
2. AMENDMENT: No amendment or variation of the terms of this Agreement shall be valid
unless made in writing, signed by the parties and approved as required. No oral understanding or
Agreement not incorporated in the Agreement is binding. on any of the parties.
3. ASSIGNMENT: This Agreement is not assignable by the Contractor, either in whole or in
part, without the consent of the State in the form of a formal written amendment.
4. AUDIT: Contractor agrees that the awarding department, the Department of General Services,
the Bureau of State Audits, or their designated representative shall have the right to review and
to copy any records and supporting documentation pertaining to the performance of this
Agreement. Contractor agrees to maintain such records for possible audit for a minimum of three
(3) years after final payment, unless a longer period of records retention is stipulated. Contractor
agrees to allow the auditor(s) access to such records during normal business hours and to allow
interviews of any employees who might reasonably have information related to such records.
Further, Contractor agrees to include a similar right of the State to audit records and interview
staff in any subcontract related to performance of this Agreement. (GC 8546.7, PCC 10115 et
seq., CCR Title 2, Section 1896).
5. INDEMNIFICATION: Contractor agrees to indemnify, defend and save harmless the State, its
officers, agents and employees from any and all claims and losses accruing or resulting to any
and all contractors, subcontractors, suppliers, laborers, and any other person, firm or corporation
furnishing or supplying work services, materials, or supplies in connection with the performance
of this Agreement, and from any and all claims and losses accruing or resulting to any person,
firm or corporation who may be injured or damaged by Contractor in the performance of this
Agreement.
6. DISPUTES: Contractor shall continue with the responsibilities under this Agreement during
any dispute.
7. TERMINATION FOR CAUSE: The State may terminate this Agreement and be relieved of
any payments should the Contractor fail to perform the requirements of this Agreement at the
time and in the manner herein provided. In the event of such termination the State may proceed
with the work in any manner deemed proper by the State. All costs to the State shall be deducted
from any sum due the Contractor under this Agreement and the balance, if any, shall be paid to
the Contractor upon demand.
S. INDEPENDENT CONTRACTOR: Contractor, and the agents and employees of Contractor,
in the performance of this Agreement, shall act in an independent capacity and not as officers or
employees or agents of the State.
9. RIT`r� CERTIFICATION: The Contractor shall certify in writin _ a y of
(� perjury, the minimum, ' exact, percentage of rec omen, both post consumer waste
j11 and secondary waste as defined m ontcact Code, Sections 12161 and 12200, in
CJS materials, goods, or supplie e or products usetii erformance of this Agreement,
regardless of whe ie product meets the required recycled produc tage as defined in
the Pub ' ontract Code, Sections 12161 and 12200. Contractor may certify that duct
sins zero recycled content. (PCC 10233, 10308.5, 10354)
10. NON-DISCRIMINATION CLAUSE: During the performance of this Agreement, Contractor
and its subcontractors shall not unlawfully discriminate, harass, or allow harassment against any
employee or applicant for employment because of sex, race, color, ancestry, religious creed,
national origin, physical disability (including HIV and AIDS), mental disability, medical
condition (cancer), age (over 40), marital status, and denial of family care leave. Contractor and
subcontractors shall insure that the evaluation and treatment of their employees and applicants
for employment are free from such discrimination and harassment. Contractor and subcontractors
shall comply with the provisions of the Fair Employment and Housing Act (Government Code
Section 12990 (a -f) et seq.) and the applicable regulations promulgated thereunder (California
Code of Regulations, Title 2, Section 7285 et seq.). The applicable regulations of the Fair
Employment and Housing Commission implementing Government Code Section 12990 (a -l), set
forth in Chapter 5 of Division 4 of Title 2 of the California Code of Regulations, are incorporated
into this Agreement by reference and made a part hereof as if set forth in full. Contractor and its
subcontractors shall give written notice of their obligations under this clause to labor
organizations with which they have a collective bargaining or other Agreement.
Contractor shall include the nondiscrimination and compliance provisions of this clause in all
subcontracts to perform work under the Agreement.
11. CERTIFICATION CLAUSES: The CONTRACTOR CERTIFICATION CLAUSES
contained in the document CCC 304 are hereby incorporated by reference and made a part of this
Agreement by this reference as if attached hereto.
12. TIMELINESS: Time is of the essence in this Agreement.
13. COMPENSATION: The consideration to be paid Contractor, as provided herein, shall be in
compensation for all of Contractor's expenses incurred in the performance hereof, including
travel, per diem, and taxes, unless otherwise expressly so provided.
14. GOVERNING LAW: This contract is governed by and shall be interpreted in accordance
with the laws of the State of California.
U�ANTITRUST CLAIMS: The Contractor by signing this agreement hereby certifies it t if
these ervices or goods are obtained by means of a competitive bid, the Contractor sl comply
with th requirements of the Government Codes Sections set out below.
a. The G emment Code Chapter on Antitrust claims contains the following d tuitions:
1). "Public rchase" means a purchase by means of competitive bids of go s, services, or
materials by t . State or any of its political subdivisions or public agent' on whose behalf the
Attorney Genera ay bring an action pursuant to subdivision (c) of S tion 16750 of the
Business and Profe 'ons Code.
2). "Public purchasing ody" means the State or the subdivision r agency making a public
purchase. Government C e Section 4550.
b. In submitting a bid to a pub'pubX purcha;
accepted, it will assign to the purlkasing
action it may have under Section 4 o tht
Cartwright Act (Chapter 2 (commencin
Business and Professions Code), arising
bidder for sale to the purchasing body pi
become effective at the time the purch ys
Government Code Section 4552. 7
ing b' body, theder offers and agrees that if the bid is
body all rig s, title, and interest in and to all causes of
Clayton ct (15 U.S.C. Sec. 15) or under the
with S tion 16700) of Part2 of Division 7 of the
Fr urchases of goods, materials, or services by the
r to the bid. Such assignment shall be made and
final payment to the bidder.
c. If an awarding body or pubf purchasing body receiv either through judgment or
settlement, a monetary reco ry for a cause of action assign under this chapter, the assignor
shall be entitled to receiv reimbursement for actual legal cost "ncurred and may, upon demand,
recover from the publi ody any portion of the recovery, includr treble damages, attributable
to overcharges that ere paid by the assignor but were not paid by t public body as part of the
bid price, less th expenses incurred in obtaining that portion of the ret very. Government Code
Section 4553.
d. Upon #mand in writing by the assignor, the assignee shall, within one year\(a)e
deman , reassign the cause of action assigned under this part if the assignor hay
hav een injured by the violation of law for which the cause of action arose anignee
h not been injured thereby, or (b) the assignee declines to file a court action fof
ction. See Government Code Section 4554.
16\CHILD SUPPORT COMPLIANCE ACT: "For any Agreement in excess of $1 0, the
contrac knowledges in accordance with, that:
a). The contractor recogm e importance of child and fa support obligations and shall
fully comply with all applicable s and federal law ating to child and family support
enforcement, including, but not limited to, '
or
of information and compliance with
earnings assignment orders, as provide Chapte commencing with section 5200) of Part 5
of Division 9 of the Family Cod ; d
b) The contractor, e best of its knowledge is fully complying wr ie earnings assignment
orders of all oyees and is providing the names of all new employees e New Hire
Regis atutaned by the California Employment Development Department."
l-�
E
17. UNENFORCEABLE PROVISION: In the event that any provision of this Agreement is
unenforceable or held to be unenforceable, then the parties agree that all other provisions of this
Agreement have force and effect and shall not be affected thereby.
I& UNION ACTIVITIES For all contracts, except fixed price contracts of $50,000 or
acknowledges that:
By signing this eer
Code Section 1664
a) Contractor will not
Contractor hereby acknowledges the
;h Section 16649 to this agreement a
on a state service contract, incih<
b) No state funds received under
organizing.
c) Contractor will not, for any bt
hold meetings with employees
promote or deter union or rzir
or deter union
a public works
)licab' ' of Government
fees to the following:
employees performing work
used to assist, promote or deter union
15ss-6ondheked under this agreement, use any state property to
ipervisors, if -thekurpose of such meetings is to assist,
unless the state pr4pqrty is equally available to the general
public for holding m ngs.
d) If Contractor ' urs costs, or makes expenditures to assist, pr
Contractor ' I maintain records sufficient to show that no reimbur
been ght for these costs, and that Contractor shall provide those
erat upon request.
S:\ADMIN\homepage gtc 304 kay.doc
2,
or deter union organizing,
lent from state funds has
ords to the Attorney
California Fair Services Authority
INSURANCE REQUIREMENTS
1. Evidence of Coveraec
Exhibit "E"
The contractor/renter shall provide a signed original evidence of coverage for the term of the agreement protecting the legal
liability of the State of California, District Agricultural Associations, County Fairs, Counties in which County Fairs are located,
Citrus Fruit Fairs, or California Exposition and State Fair, their directors, officers, agents, servants, and employees, from
occurrences related to operations under the contract. This may be provided by:
A. Insurance Certificate -The contractor/renter provides the fair with a signed original certificate of insurance (the ACORD
form is acceptable), lawfully transacted, which sets forth the following:
List as the Additional Insured: "That the State of California, the District Agricultural Association, County Fair, the
County in which the County Fair is located, Citrus Fruit Fair, or California Exposition and State Fair, their
directors, officers, agents, servants, and employees are made additional insured, but only insofar as the operations
under this contract are concerned."
2. Dates: The dates of inception and expiration of the insurance. For individual events, the specific event dates
must be listed, along with all set-up and tear down dates.
Coverages:
a. General Liability - Commercial General Liability coverage, on an occurrence basis, at least as broad as the
current Insurance Service Office (ISO) policy fomt #CG 0001. Limits shall be not less than $5,000,000 combined
single limits per occurrence for Fairtime Carnival Rides; $3,000,000 combined single limits per occurrence for
Motorized Events All Types; $3,000,000 combined single limits per occurrence for Rodeo Events All Types with a
paid gate and any Rough Stock events;$2,000,000 combined single limits per occurrence for Rodeo Events All
Types without a paid gate and with any Rough Stock events; $1,000,000 combined single limits per occurrence
for Rodeo Events All Types without any Rough Stock Events; $2,000,000 combined single limits per occurrence
for Interim Carnival Rides, Concerts with over 5,000 attendees, Raves All Types, Mechanical Bulls, Extreme
Attractions All Types, Orbitrons, and Simulators; $1,000,000 for all other contracts for which liability insurance
(and liquor liability, if applicable) is required.
b. Automobile Liabilitv - Commercial Automobile Liability coverage, on a per accident basis, at least as broad as
the current ISO policy form # CA 0001, Symbol # 1 (Any Auto) with limits of not less than $1,000,000 combined
single limits per accident for contracts involving use of contractor vehicles (autos, trucks or other licensed vehicles)
on fairgrounds.
c. Workers' Compensation - Workers' Compensation coverage shall be maintained whenever contractor/renter has
employees, as required by law.
d. Medical Maloractice —Medical Malpractice coverage with limits ofnot less than $1,000,000 per occurrence shall
be maintained for contracts involving medical services.
e. Liauor Liabilitv — Liquor Liability coverage with limits of not less than $1,000,000 per occurrence should be
maintained for contracts involving the sale of alcoholic beverages.
4. Cancellation Notice: A statement by the insurance company that it will not cancel or reduce the limits or coverages
of said policy or policies without giving 30 days prior written notice to the named certificate holder.
5. Certificate Holder:
For Individual Events Only - Fair, along with fair's address, is listed as the certificate holder.
For Master Insurance Certificates Only - California Fair Services Authority, Attn: Risk Management, 1776
Tribute Road, Suite 100, Sacramento, CA 95815 is listed as the certificate holder.
-1-
6. Insurance Comoanv: The company providing insurance coverage must be acceptable to the California Department
ofinsurance.
OR
B. CFSA Snecial Events Program - The contractor/renter obtains liability protection through the California Fair Services
Authority (CFSA) Special Events Program, when applicable.
OR
C. Master Certificates -A current master certificate of insurance for the contractor/renter has been approved by and is on file
with California Fair Services Authority (CFSA).
OR
D. Self -Insurance - The contractor/renter is self-insured and California Fair Services Authority (CFSA) has approved
acceptable evidence of self-insurance.
II. General Provisions
A. Maintenance of Coverage The contractor/renter agrees that the commercial general liability (and automobile liability,
workers' compensation, medical malpractice and/or liquor liability, ifapplicable) insurance coverage herein provided for
shall be in effect at all times during the term of this contract. In the event said insurance coverage expires at any time or
tunes prior to or during the term of this contract, contractor/renter agrees to provide the fair, prior to said expiration date,
a new certificate of insurance evidencing insurance coverage as provided for herein for not less than the remainder of the
term of the contract, or for a period of not less than one (1) year. New certificates of insurance are subject to the approval
of Califomia Fair Services Authority, and contractor/renter agrees that no work or services shall be performed prior to
the giving of such approval. In the event the contractor/renter fails to keep in effect at all times insurance coverage as
herein provided, the fair may, in addition to any other remedies it may have, take any ofthe following actions: (1) declare
a material breach by contractor/renter and terminate this contract; (2) withhold all payments due to contractor/renter until
notice is received that such insurance coverage is in effect; and (3) obtain such insurance coverage and deduct premiums
for same from any sums due or which become due to contractor/renter under the terms of this contract -
B. Primary Coverage — The contractor/renter's insurance coverage shall be primary and any separate coverage or
protection available to the fair or any other additional insured shall be secondary.
C. Contractor's Resnonsibilitv — Nothing herein shall be construed as limiting in any way the extent to which
contractor/renter may be held responsible for damages resulting from contractor/renter's operations, acts, omissions or
negligence. Insurance coverage obtained in the minimum amounts specified above shall hot relieve contractor/renter of
liability in excess of such minimum coverage, nor shall it preclude the fair from taking other actions available to it under
contract documents or by law, including, but not limited to, actions pursuant to contractor/renter's indemnity obligations -
D. Certified Conies of Policies — Upon request by fair, contractor/renter shall immediately furnish a complete copy of any
policy required hereunder, with said copy certified by the underwriter to be a true and correct copy of the original policy.
HI. Participant Waivers
For hazardous participant events, the contractor/renter agrees to obtain a properly executed Release and Waiver of Liability
Agreement (CFSA Form "Release. Lib") from each participant prior to his/her participation in the events sponsored by
contractor/renter. Hazardous participant events include but are not limited to any event within the following broad categories:
Athletic Team Events; Equestrian -related Events; Motorized Events; Rodeo Events; and Wheeled Events, including bicycle,
skates, skateboard, or scooter. Contact California Fair Services Authority at (916) 921-2213 for further information.
S:tAccounting\S'MStA-[w_Req-EXHIBfr E
Revised 10/1103
SONOMA-MARIN FAIR
FOURTH DISTRICT AGRICULTURAL ASSOCIATION
175 FAIRGROUNDS DRIVE
PETALUMA, CA 94952
PHONE: (707) 283-3247 FAX 283-3250
EXHIBIT "EV
ALL CONTRACTORS WORKING FOR THE FOURTH DISTRICT AGRICULTURAL ASSOCIATION, SONOMA-
MARIN FAIR, COVERED BY WORKERS' COMPENSATION, ARE REQUESTED TO SUBMIT A CERTIFICATE OF
WORKER'S COMPENSATION INSURANCE TO THE FAIR ADMINISTRATION OFFICE ALONG WITH THE
ENCLOSED STANDARD AGREEMENT.
PL ASE CHECK THE APPROPRIATE LINE:
I HAVE WORKERS' COMPENSATION INSURANCE. I HAVE ENCLOSED A COPY
OR WILL REQUEST ONE BE SENT TO THE FAIR.
I HEREBY CERTIFY THAT 1 AM AN INDEPENDENT CONTRACTOR AND HAVE NO
PAID OR VOLUNTEER EMPLOYEES AND THEREFORE, WORKERS'
COMPENSATION INSURANCE WHICH IS REQUIRED FOR EACH CONTRACT AS
STATED IN ITEM #18 ON STD SCTC, (STANDARD CONTRACT TERMS AND
CONDITIONS), DOES NOT APPLY TO ME.
I AM AWARE THAT THIS STATEMENT IS FOR THE INTERNAL USE OF CFSA AND THE SONOMA
MARIN FAIR AND DOES NOT ALTER THE WORKERS' COMPENSATION REQUIREMENTS IN THE
LABOR CODE OF THE STATE OF CALIFORNIA DEFINING "EMPLOYEES".
Petaluma Police Department
NAME ON STANDARD AGREEMENT
1. V"- — /�t,or-� S-1-Ky os—
IGNATURE — Prik Name DATE
9