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HomeMy WebLinkAboutResolution 2008-045 funding for perimeter bicycling tour of the tucson mountainsMARANA RESOLUTION N0.2008-45 RELATING TO COMMUNITY DEVELOPMENT; GRANTING IN-KIND SERVICES PAID THROUGH DISCRETIONARY FUNDING TO THE PERIMETER BICYCLING ASSOCIATION OF AMERICA, INC., AN ARIZONA 541(C)(3)NQN-PROFIT ORGANIZATION, TO SUPPORT THE TOUR OF THE TUCSON MOUNTAINS BICYCLING EVENT TO BE HELD APRIL 27, 2008 IN THE TOWN OF MARANA. WHEREAS, the Town of Marana has established a discretionary fund to support local non-profit organizations forwarding the priorities set by Mayor and Council; and WHEREAS, Mayor and Council recognizes the need to promote programs that encourage positive activities for Marana's youth and families and a sustainable environment; and WHEREAS, Perimeter Bicycling Association of America, Inc., acommunity-based non- profit organization, is providing programming to promote the youth and families, physical fitness, and a clean environment; and WHEREAS, on April 27, 2008, the Tour of the Tucson Mountains will start and finish in Marana, providing positive activities for youth and families and drawing participants from around the United States to Marana; and WHEREAS, Mayor and Council find that providing in-kind services through its discretionary fund in the amount up to $7,000 is in best interest of the citizens of Marana. NOW, THEREFORE, BE IT RESOLVED BY THE MAYOR AND COUNCIL OF THE TOWN OF MARANA, ARIZONA, to provide Perimeter Bicycling Association of America, Inc. public safety and traffic control support for the Tour of the Tucson Mountains bicycling event held Apri127, 2008. PASSED AND ADOPTED BY THE MAYOR AND CO CIL OF THE TOWN OF MARANA, ARIZONA, this 18th day of March, 2008. `1~~~,`pF° ~-,~~,'' Ma or Ed Honea ~ F~ ~ ~~R~ Tf ~®,,• y ... _ - ,o ~ c~1 ~~ v° s r F7L~iL"~ ~ "~ ® I !~ ATTEST: '®~- ,y~~~iuo~e-o~``~ ~•` /~ ~i.~/.Z. 1g .o'~` Town Clerk APPROV A TO FORM: ~~;t f~ c Cass` y, Town ,9Ctto ey DISCRETIONARY FUNDING AGREEMENT PERIMETER BICYCLING ASSOCIATION OF AMERICA, INC. THIS DISCRETIONARY FUNDING AGREEMENT (this "Agreement") is entered into by and between the TOWN OF MARANA, an Arizona municipal corporation (the "Town") and the Perimeter Bicycling Association of America, Inc., an Arizona 501 (c) 3 non-profit corporation (the "Agency"). The Town and the Agency are sometimes referred to collec- tively as the "Parties," either of which is sometimes individually referred to as a "Party." RECITALS A. The Agency provides benefits to the Town and its residents by promoting posi- tive activities for youth and their families and economic development in the Marana area. B. The Agency has filed an application with the Town for discretionary funding to provide general support. C. The Town has reviewed the Agency's application and has determined that the heritage and general welfare of the citizens of Marana will be substantially advanced by authorizing the funding under the terms and conditions and for the purposes as set forth in this Agreement. D. The Parties acknowledge that tracking Town in-kind services and Agency out- puts and outcomes resulting from the Town funding is prudent practice to assure that public funds are appropriately used and that the public receives the anticipated benefits of the funding. AGREEMENT Now, THEREFORE, based on the foregoing recitals, which are incorporated here by reference, the Parties agree as follows: 1. Funding. The Town hereby commits in-kind services including public safety and traffic control support through discretionary funding from the Town's Fiscal year 2007-08 budget to the Agency to fund general assistance. 2. Outputs and/or Outcomes. On Apri127, 2008, the Agency hereby agrees to pro- vide the following outputs and/or outcomes with the Town general assistance funding provided under this agreement: 2.1. At least 1,200 Bicyclist will take part in the Tour of the Tucson Mountains on Apri127, 2008 2.2. More than 300 volunteers will provide community service in support of the event. 2.3. At least 100 participants will take part in the "Kids and Family Fun Ride" coinciding with the event. Perimeter Bicycling Contract Documents 2008 - i - 2.4. As a result of the public safety and traffic control support the number of vehicle bicycle accidents will be minimized. 3. Final Report. Within 30 days after the event on April 27, 2008 the Agency shall complete and submit a report to the Town in substantially the form attached as Exhibit A, showing the Agency's progress toward the outputs and/or outcomes set forth in para- graph 2 above. 4. Required Insurance. Before receiving any payment under this Agreement, the Agency shall provide insurance certifications evidencing the following coverages for at least the term of this Agreement: 4.1. $1,000,000 per occurrence general liability coverage with the Town listed as additional insured. 4.2. $1,000,000 per occurrence automobile liability coverage with the Town listed as additional insured (if the Agency has vehicles). 4.3. $1,000,000 per occurrence directors and officers coverage with the Town listed as additional insured. 4.4. State of Arizona minimum workers' compensation coverage (if the Agency has paid staff). 5. Corporate Documents. Before receiving initial payment under this Agreement, the Agency shall provide copies of the following Agency documentation, including any and all amendments: 5.1. Articles of incorporation. 5.2. Current bylaws. 5.3. List of current members of the Board of Directors, including their af- filiations. 5.4. Current fiscal year's budget approved by the Board of Directors. 5.5. Internal Revenue Service designation letter. 6. Amendments to Insurance and Documentation. True and accurate copies of any amendments during the term of this Agreement to coverages or terms of insurance re- quired by paragraph 4 above or to the Agency's corporate documentation listed in para- graph 5 above shall be provided to the Town as soon as practicable after approval, but in any event not later than one calendar week after they become effective. Amendments that reduce the insurance coverages below the minimums set forth in paragraph 4 above or that in the Town's reasonable opinion materially affect the Agency's ability to deliver the outputs and/or outcomes set forth in paragraph 2 above constitute default for which the Town may withhold payment until the Agency restores the minimum insurance cover- ages or restores the Agency's ability to deliver the outputs and/or outcomes. 7. Default and Dispute Resolution. If either Party defaults (the "Defaulting Party") with respect to any of that Party's obligations under this Agreement, the other Party (the "Non-Defaulting Party") shall be entitled to give written notice in the manner prescribed in paragraph 8 to the Defaulting Party, stating the nature of the default claimed Perimeter Bicycling Contract Documents 2008 - 2 - and demanding that the default be corrected. The Defaulting Party shall then have twenty days from the date of the notice within which to cure the default. If any default is not cured within twenty days, then the Non-Defaulting Party shall be the Town, its officers, employees, and agents from and against any and all claims relating to the Agency's ac- tivities, including but not limited to those funded in whole or in part by this Agreement. 8. Manner of Serving. All notices, filings, consents, approvals and other commu- nications provided for in or given in connection with this Agreement shall be validly given, filed, made, transmitted or served if in writing and delivered personally or sent by registered or certified United States mail, postage prepaid, to (or to such other addresses as any Party may from time to time designate in writing and deliver in a like manner): To the Town: TOWN OF MARANA Town Manager 11555 West Civic Center Drive, Building A3 Marana, Arizona 85653 With a copy to: TOWN OF MARANA Town Attorney 11555 West Civic Center Drive Building A3 Marana, Arizona 85653 To the Agency: Perimeter Bicycling Association of America, Inc. Marketing Director 2609 East Broadway Boulevard Tucson, Arizona 85716 9. Term. The term of this Agreement shall begin on the effective date and, unless sooner terminated by the mutual consent of the Parties, shall automatically terminate and shall thereafter be void for all purposes on July 1, 2008. 10. Waiver. No delay in exercising any right or remedy shall constitute a waiver of that right or remedy, and no waiver by the Town or the Agency of the breach of any term of this Agreement shall be construed as a waiver of any preceding or succeeding breach of the same or any other term of this Agreement. 11. Attorney's Fees. If any Party brings a lawsuit against any other Party to en- force any of the terms of this Agreement, or by reason of any breach or default of this Agreement, the prevailing Party shall be paid all reasonable costs and reasonable attor- neys' fees by the other Party, in an amount determined by the court and not by the jury. Nothing in the use of the word "lawsuit" in the preceding sentence shall constitute a waiver, requiring disputes to be resolved by binding arbitration. 12. Counterparts. This Agreement may be executed in two or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. The signature pages from one or more counterparts may be re- Perimeter Bicycling Contract Documents 2008 - 3 - moved from the counterparts and the signature pages all attached to a single instrument so that the signatures of all Parties may be physically attached to a single document. 13. Headings. The descriptive headings of this Agreement are inserted to assist in understanding the meaning and construction of this Agreement. 14. Recitals. The Recitals set forth at the beginning of this Agreement are hereby acknowledged, confirmed to be accurate and incorporated here. 15. Exhibits. Any exhibit attached to this Agreement shall be deemed to have been incorporated in this Agreement by reference with the same force and effect as if fully set forth in the body of this Agreement. 16. Time Essence. Time is of the essence for purposes of this Agreement. 17. No Assig~unent. The Agency's obligations under this Agreement may not be assigned without the written consent of the Town Manager or his designee. 18. No Partnership and Third Parties. It is not intended by this Agreement to, and nothing contained in this Agreement shall, create any partnership, joint venture or other arrangement between the Agency and the Town. No term or provision of this Agreement is intended to, or shall be for the benefit of any person, firm, organization or corporation not a party to this Agreement, and no such other person, firm, organization or corporation shall have any right or cause of action under this Agreement. 19. Other Instruments. Each Party shall, promptly upon the request of the other, have acknowledged and delivered to the other any and all further instruments and assur- ances reasonably request or appropriate to evidence or give effect to the provisions of this Agreement. 20. Imposition of Duty by Law. This Agreement does not relieve any Party of any obligation or responsibility imposed upon it bylaw. 21. Entire Agreement. This Agreement constitutes the entire agreement between the Parties pertaining to the subject matter of this Agreement. All prior and contempora- neous agreements, representation and understanding of the Parties, oral or written, are hereby superseded and merged in this Agreement. 22. Amendments to Agreement. No change or addition shall be made to this Agreement except by a written amendment executed by the Parties. The Parties agree to cooperate and in good faith pursue any amendments to this Agreement that are reasona- blynecessary to accomplish the goals expressed by this Agreement. 23. Good Standing; Authority. The Agency represents and warrants to the Town that it is duly formed and validly existing under the laws of the State of Arizona. The Town represents and warrants to the Agency that it is an Arizona municipal corporation with authority to enter into this Agreement under applicable state laws. Each Party repre- sents and warrants that the individual executing this Agreement on its behalf is author- ized and empowered to bind the Party on whose behalf each such individual is signing. 24. Severability. If any provision of this Agreement is declared void or unen- forceable, it shall be severed from the remainder of this Agreement, which shall other- wise remain in full force and effect. Perimeter Bicycling Contract Documents 2008 - a - 25. Governing Law. This Agreement is entered into in Arizona and shall be con- strued and interpreted under the laws of Arizona, and the Parties agree that any litigation or arbitration shall take place in Pima County, Arizona. Nothing in the use of the word "litigation" in the preceding sentence shall constitute a waiver, requiring disputes to be resolved by binding arbitration. 26. Interpretation. This Agreement has been negotiated by the Town and the Agency, and no Party shall be deemed to have drafted this Agreement for purposes of construing any portion of this Agreement for or against any Party. 27. Force Ma~el ure. If any Party is unable to perform under this Agreement by rea- son of "force majeure," then the failure to perform shall not constitute a default under this Agreement as long as the non-performing Party uses its best effort to remedy with all rea- sonable speed the event or condition causing the non-performance and performance can be restored within a reasonable amount of time. "Force majeure" means any condition or event not reasonably within the control of a Party, including without limitation, "acts of God," strikes, lock-outs, or other disturbances of employer/employee relations; acts of public enemies; orders or restraints of any kind of government of the United States or any state thereof or any of their departments, agencies, or officials, or of any civil or military authority; insurrection; civil disturbances; riots; epidemics; landslides; lightning; earth- quakes; subsidence; fires; hurricanes; storms; droughts; floods; arrests, restraints of gov- ernment and of people; explosions; and partial or entire failure of utilities. 28. Conflict of Interest. This Agreement is subject to A.R.S. § 38-511, which pro- vides for cancellation of contracts by government entities in certain instances involving conflicts of interest. 29. Effective Date; Term. This Agreement is effective on the date of the last Party's signature below and shall automatically terminate and shall thereafter be void for all purposes on July 1, 2008, unless sooner terminated by the mutual consent of the Par- ties. Perimeter Bicycling Contract Documents 2008 - 5 - IN wtTrrESS wxEREOF, the Parties have executed this agreement as of the date set forth below their respective signatures. The Town: The Agency: The Town of Marana, Perimeter Bicycling Association of America, Inc. an Arizona municipal corporation an Arizona 501 (c) 3non-profit corporation ~- By: ~'l~~C)~ac By: // , ~ Ed Honea; Mayor Printed: 1~ V15~ Wl1~r-ec~ Its: 2ve~1~~~meu+ l~IV~L~O~ Date: °~" 7-~ Date: ;w, ATTEST: Jo yn C. Br son, Town Clerk PR~V~L~ AS TO FORM: ran Cassidy,'F~wn Attorney ExxIBITs A. Final report form B. Required documents form Perimeter Bicycling Contract Documents 2008 - 5 - ~ o °D ~ ~ °o ~ ~ N c~ ~ o c C N y,.. 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PROJECT: Tour of the Tucson Mountains Bicycling Event 2008 RE6?UIRED DOCUMENTATION Outside agencies receiving funding from the Town of Marana are to provide corporate documents and insurance certifications to the Town on an annual basis. ...~ ~ .. ~~ General Liability with Town Additionally-insured Minimum $i,ooo,ooo F- ,~~ , ~{ ~ i j~~ Automobile Liability with Town Additionally-insured Minimum $1,000,000 ~~ ~ , ~-~ ~ i ~ (~ ~) Directors and Officers Minimum $1,000,000 _ ~ ~~ P ~.~ ~ ~_(' ~ ~ ~ ~ ~ ~,, Workers Compensation •~~•~ ~ ~• Articles of Incorporation Received 02/2007 Current/Updated Bylaws Received 02/2007 Board Approved BUdget'(Currenfi FY) r Board of Directors List (Including Affiliation) IRS Designation Letter Received 02/2007 The Town of Marana has documentation that the above coverages are in effect. Signed: ~' Organization re resen ative Date Signed: ~ C~ ~ ~~ " ~ ,- Town of Marana Managers Office Date FAILURE TO SUBMIT THESE DOCUMENTS MAY DELAY THE PROCESSING OF PAYMENT REQUESTS. 03/2620013 14:04 00000000000 FRAZIER INSURANCE PAGE 32/44 m ;" ~ < , v PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMTIdN ONLY pt~l3 $BRVICE CALL: ANd CONFERS NO RIGHTS UPON THE CERTIFICATE HOLdER, Frazier Insurance Agency, InC. THIS CERTIFICATE dOES NCIT AMENI], EXTQND CR ALTER THE P O Box 1250 COVERAGE AFFOi~DED BY THE POLICIES BELOW. . . Midlothian, VA. 23113 COMPANIES AFFORpING COVERAGE PH ($p4) 754-7510 FX (804} 754-7613 E M i1 I ~ COMPANY Capitol Specially Insurance Carparatian - Fraziert a a?Frazlerlnsursnce.com A INSURED Sports and ReCreati4n Arovidrsrs Assn. Risk Management, Inc, COMPANY StarNel Insurance Compan I~erimeter Bicycling Assaclatian of America y B , InG. COMPANY 2609 E. Broadway Boulevard 0 TUCSOn, AZ 85716 C~ttificate; A~6D$S COMPANY p t THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW WAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICAT(_D, NoTWITwsrANDINa ANY REQUIREMENT, TERM OR CONDITION of ANY CONTRACT OR O'YWE=R DQCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THG INSURANCE AFFORDED BY THE POLICIES DESCRIBE;p HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND coNDmoNS OF SUCH POLICIES LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POLICY NUINBER dPn7E MluroeDrrv o MM 1~.4TtoN LIMITS A GENERAL LIABILITY GENERAL AOCaREGA'tE $ 2 000 000.00 X COMMERCIAL GENERAL LIn81L1TY RRboucrs-cpMPlpP AC~O $ 2,OOb,000.00 CLAIMS AMUE ~ OCCUR OW ' ' C$Q~y217968 V 001108 Q4101109 PERSONAI, R qpV INJURY $ 1,000~DQD_{J~ NER S & CONTRliCTDR S PROT INCLUDES ATHLErIC 1 x:01 AM EACH bCCURRENCE $ 1,000 oop,oD X PARTIGIPAN79 -.- FIRE onMgpE (Any one nre) $ 100,000.00 AUTOMOBILE LIABILITY ' MEN EXP (a,y one porson) $ 5,000.00 ANY AUTO cOMBINEO SINGLE LIMYr $ 1,000,000.00 AI L OWNED AUtbS A . SCHEDULEpAUTOS B~jp.f1D$ 114/01/09 BODILY INduRY (Pt,rpF>r+on) $ H1REb AUTOS CSOOx'I7968 ' ' X 12:0 1 AM X NON.OWNEDAI170S gDDILY IN.IURY (Pm:ktldant> ~ RRbFERTY OAMAt`i!; $ GAR AGE LIABILITY nuTD oNLY t:q ACCI ANY AUTO . DENT $ OTHER THAN AUTD ONtr. - EA CH nCCIDENT $ EXCE gS LIABILITY AGGREGATE EACH OCCURRENCE $ UMBRELLA FQRM 04 $ 1,000 000.00 A OTHER THAN UMBREL CS00217970 04/01/0$ /01/09 12 119 AA A{~C~REGArE $ 1,000,000.00 X LA FORM : fi $ WORKER'S COMREN3AT(ON AND EMPLOY@RS'LIA91Ln'Y WC BTATU OTh- TORY LIMRE ~ ~ EL EncH ACCIDENT P~~ ~ ~ rNK ..._. (NCL EL OISEABE - 4>DLICY LInn1T $ ,C~ nkE: EXCL EL DIBEA3E - EA EMPLpYEE $ OTHER B Accident /Medical PAI V00211970-001 04,101/0$ 04/01/09 , L'""t~ Ap&d. ~ zs,ooo.oo ~ 2 500 00 i2Yp,l AM d®ducEible; , . $ 100,00 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS PQLICY DEDUCTIBLE: $0.00 PER CLAIM. 1498 ISO OCCURRENCE FORM (11-88) AND COMPANY'S SPECIFIC FORM, Event pate; April z7, 2008 Certificate Noldler is An Additional Insured, I9ut Only As Respects The Operations Qf Thle Named Insured. ~1~~~f~I~ry ~,''~1~~;~1~'~ '+:"~~1'~~d,~ t llfd~llt(rt i1il+ ,#!y~"~'' 'r` ~'.~. u'I~~ + j~ il! (U `~t1 ,' '+' `+~ K,° t 1 , SHOULD ANY QF THE ABOVE DESCRIBED PQLICIES BE CANCELLED Town of Marana BEFORE THE pXplRq'rION DATE TWEREOF, Tk#E ISSUING COMPANY WILL Attn: Jim DeGraad ENOEAVDR TO MAIL 30 dAY3 1NRrrTEN NOTICE TO THQ CERTIFICATE 11555 Civic Center Drive HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SWALL IMPOSE NO OBLIGATIQN QR LABILITY OF ANY KIND UPON THE Marana, AZ 85653 coMPAnrr ITS A4ENTS OR REPRESENTATIVES. AUTHQRI~ED REPRESENTATIVE ~~ , ~,4~ ~1 ' t." ~ ~~ ~~- .W ~ f t . ~ i "~ . ~ ~ .i , ~ ' ..r 1__ _.,_.- ..-._2 _._ i.. ... ~ i I ~~i28~2~08 15 c q3 !-IAL.+JC1R50h1 I NSURANCE a 7451992 ~ NO . F32f NIJN lE'ft.(I~{ IT pR.U~'TIU.~Y,~ LrA.~~iL~ FtJ~I X `: ~S IS A.. C~.,AZNL4- MA~I7E ~'4LIC~`. ' ~t.EAS~ ~~ ~~ ~~LI X C,ARE~Ufi.,:l~~ Nl+w ~ -~~~11~lTEL15TAT~~S' LI,A~IL T ~ .-- Re~newa~oiNumb~x 1N~URANCE ~IiAPAN. ~ oaoos~ wAYiV6, Pf~NN~YLVANrA i c~~roll~xL No. NZ7-U~462187 ' PoucY pecLar~a'noNS ~ ~ ' I ' .,~ ~ ITEM I. PAR ~ NT ORCsANICi4TION ANt3 Pf~INCIPAL~ADDRESS Peri Ater Blc;~~clii~~~ A~~Qiatlan of Amert~~! ~ ~ 2609 ; . Btgacl~nray~ ~ -~ Tucson, AZ $(17141 ~ I ,ITEM II. P0I.1~Y PERIt~D: ~MM/PI7IYYYY), ~ 12:0~4IAM STANDARD TIME ATYt:;tUf~ FR(~IUI 6I22'r;20tty ~"O X1/22/2008 N~AiI.;1dG ADD~~SS SHO~M~I ABCI~VE G~061 'I~IIS POLICY CONSISTS OF 'tT~ Ft)T,LO'WI;`IG COVERA,(3E PAttTS POIi. WHICl~ LII~~'S OF L]AHII,I'I'~' ARE INI7IC':A D. I - i Cav~rage l~sit~ti A,. ; Nun Profit Directors ~nd~ Qfficers I..iability !~ ITEM Ill. ~.IMil'S OF t_L=ti[311_t'IrY: $1,008,000`; EACH CLAIM i Not Covs+ted FIpUCiARY LIABILITY LIMIT. ~ $1,Og8,000 1N THE AGGREGATE r .ITEM !V. RETENTION: ~ ~ $680 EACH I;LA6M :ITEM V. PREMIUM: $840 ' ~avr;:ra~~w P~Irfi B. ~mplayment Pf~acfiices Liability ITEM iil. LIMA'S OF LIJ~BILI`'fY:~ $1,080,QOt3 EACH.+~IAIM ~ ' $1,Op8,OD0. ~IN THE AG~REGATE I ~' ITEM IV. RETENTION: ~ ~ ~ $600 !EACH.+;LA1M + ITEM V. PREMIUM: $220. ;~ NOTIGE: DEFIrNSE GO:@. f3 ,3N~ALL BE APPLlEa AGAINSfi THI~ FIETENTION. ,. . ITEM Vl. CAVerage, Form(s)/I. ~,3rt(:s} end ~Endbrsement{s) made apart of tnfs policy at time of issue; IVPPIA (Q9-f35) Applitatibn DO-Z73 (D4-Oi:) FL.StAr Ekdusl4n ~ UO-l0U (p4--00) Coverage Pc'~rt A DC1-~79 (05.0:0 ~roed Firm Prot. end Cov. Amend. ~ndt. ao-ioi (oq-on) coverage Part ~ use=~xaa (aa-coo) anl~.y.>~~cet ' ~7C1-2Ui {OS-94) ACCredikatieY~/CerC.,~~tancl. K;~tting Eridt i ~ Agent: ALL RiSK,3 OF TIME SbUTHwEST, LTD. [1o~7'y bate Issued: PJ2pJ~Or11' EY i ~~~~ ~~ r~an~~,~rar ya~~c P.O. Box 33049 Phoenix, AZ 85067-3049, 602.831-2800 POLICY PAYROLL REPORT PERIN~TER BICYCLING ASSOCIATION OF 2609E BROADWAY BLVD TUCSON AZ 85716 Doc Type: Report ID: Policy Number: Date Issued: Due Date: Policy Status: Report Period: FSPYRL 8735137 282765 04/07/2008 05/05/2008 Active 01 /01 /2008 -04/01 /2008 * * IMPORTANT NOTICE To avoid cancellation this payroll report and premium payment must be received by the due date. Reports received after the due date may result in the assignment of a higher premium deposit in the future. Please notify SCF of Arizona of any changes to your business operations immediately. Premium Work Classification Class Rate Period Loc Description Code Gross Payroll Per 5100 Premium 01/01/2008 - 04/012008 2 SECURITY ENFCMENT OR 7720 3.52 PRTCTION-CNTRCT SALESPERSONS OR 8742 0.37 COLLECTORS -OUTSIDE CLERICAL OFFICE EMPLOYEES- 8810 0.24 N.O.C. Total Payroll /Premium Calculate the premium by applying the factor times the previous results Factor Deviated Premium Multiply by 0.9000 Premium Period Subtotal Total Modified Premium Foreign Terrorism Total Payroll Multiply by 0.0002 Subtotal (Add Total Modified Premium to Terrorism Surcharge) DTEC Surcharge Total Payroll MuRiply by 0.00003 Enter Total Premium Due THE UNDERSN3NED HEREBY CERTIFIES THAT THE PAYROLL REPORTED IS CORRECT AS TO WORK CLASS CODE AND AMOUNTS FOR THE PERIOD STATED DATE SIGNATURE TITLE 13003 0411912005 CARRIER CODE 19909 Doc Type: POLEND POLICY ENDORSEMENT ~ Please attach this endorsement to your policy s >. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. ~( ~..~ ~a~4.1~1~ ~1~~ y'r (IF'~~/~ If you have any questions, please contact your local SCF Ariwna office. EFI~EC:TIVG 12:01 AM MO DAY YEAR AMENDINCIPOLICYNUMBER MO DAY YEAR AUTHORIZED REPRESENTATIVE 01 01 2008 282765 03 31 2008 Counter signed at Phoenix,-Ariwna PERIMETER BICYCLING A830CIATION OF AMERI 2609 E BROADWAY BLVD TUC30N AZ 85716 Schedule - AZ 0.0030 -Rate per $100 of Estimated Payroll Estimated Payroll $447,763.00 Estimated DTEC Premium $13.00 ($447,763.00 /100) x 0.0030 = $13.00 DOMESTIC TERRORISM, EARTHQUAKES, AND CATASTROPHIC INDUSTRIAL ACCIDENTS PREMIUM ENDORSEMENT This endorsement is notification that your insurance carrier is charging premium to cover the losses that may occur in the event of domestic terrorism, earthquakes, and/or a catastrophic industrial accident. Your policy provides coverage for workers compensation losses caused by acts of domestic terrorism, earthquakes, and/or catastrophic industrial accident including workers compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, or regulations. The premium charge provides funding for the risk of earthquakes, catastrophic industrial accidents, and acts of domestic terrorism. It does not provide funding for acts of foreign terrorism as that term is defined in the Foreign Terrorism Premium Endorsement (WC 00 04 22), attached to this policy. For purposes of this endorsement, the following definitions apply: Domestic Terrorism -All acts of terrorism, certified (as defined in the Terrorism Risk Insurance Act of 2002), or non-certified, that are outside the scope of the Foreign Terrorism Premium Endorsement (WC 00 04 22), and where aggregate workers compensation losses are in excess of $50 million. Earthquake -The shaking and vibration at the surface of the earth resulting from underground movement along a fault plane or from volcanic activity where aggregate workers compensation losses from the single event are in excess of $50 million. • Catastrophic Industrial Accident -Any single event resulting in aggregate workers compensation losses in excess of $50 million. 61-462C 01101f2008 p Copyright 2007 National Council on Compensation Insurance, Inc. All Rights Reserved. WC OO O4 21 B ~~, . EFI~IiC'1'IVE 12.01 AM i MO ~- DAY ~ YEAR CARRIER CODE 19909 Doc Type: POLEND POLICY ENDORSEMENT Please attach this endorsement to your policy This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. [f you have any questions, please contact your local SCF Arizona office. AMENDING POLICY NUMBER MO DAY YEAR AUTHORIZED REPRESENTATIVE 01 01 2008 282765 31 2008 at PERIMETER BICYCLING ASSOCIATION OF AMERI 2609E BROADWAY BLVD TUCSON AZ 85716 TERRORISM RISK INSURANCE PROGRAM REAUTHORIZATION ACT ENDORSEMENT This endorsement addresses the requirements of the Terrorism Risk Insurance Act of 2002 as amended and extended by the Terrorism Risk Insurance Program Reauthorization Act of 2007. Definitions: The definitions provided in this endorsement are based on and have the same meaning as the definitions in the Act. If words or phrases not defined in this endorsement are defined in the Act, the definitions in the Act will apply. "AcY' means the Terrorism Risk Insurance Act of 2002, which took effect on November 26, 2002, and any amendments thereto resulting from the Terrorism Risk Insurance Program Reauthorization Act of 2007. "Act of Terrorism" means any act that is certified by the Secretary of the Treasury, in concurrence with the Secretary of State, and the Attorney General of the United States as meeting all of the following requirements: a. The act is an act of terrorism. b. The act is violent or dangerous to human life, property or infrastructure. c. The act resulted in damage within the United States, or outside of the United States in the case of the premises of United States missions or certain air carriers or vessels. d. The act has been committed by an individual or individuals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. "Insured Loss" means any loss resulting from an act of terrorism (including an act of war, in the case of workers compensation) that is covered by primary or excess property and casualty insurance issued by an insurer if the loss occurs in the United States or at the premises of United States missions or to certain air carriers or vessels. st-assn o~rovsoos ©Copyright 2007 National Council on Compensation Insurance, Inc. All Rights Reserved. WIC OO O1 13A ~h~ CARRIER CODE 19909 Doc Type: POLEND POLICY ENDORSEMENT w ''~'~~, Please attach this endorsement to your policy . This endorsement changes the policy to which it is attached and is elFective on the date issued unless otherwise stated. aeo..e~. If you have any questions, please contact your local SCF Arizona office. EFFliC9'IVE I?:01 AM MO DAY YEAR AMENDING POLICYNUMHER MO DAY YEAR AUTHORIZED REPRESENTATIVE 01 01 2008 282765 03 31 2008 n Counter signed at Phoenix, Arimna "Insurer deductible" means, for the period beginning on January 1, 2008, and ending on December 31, 2014, an amount equal to 20% of our direct earned premiums, over the calendar year immediately preceding the applicable Program Year. "Program Year" refers to each calendar year between January 1, 2008 and December 31, 2014, as applicable. Limitation of Liability The Act limits our liability to you under this policy. If aggregate Insured Losses exceed $100,000,000,000 in a Program Year and if we have met our Insurer Deductible, we are not liable for the payment of any portion of the amount of Insured Losses that exceeds $100,000,000,000; and for aggregate Insured Losses up to $100,000,000,000, we will pay only a pro rata share of such Insured Losses as determined by the Secretary of the Treasury. Policyholder Disclosure Notice 1. Insured Losses would be partially reimbursed by the United States Govemment. If the aggregate industry Insured Losses exceeds $100,000,000 in a Program Year, the United States Govemment would pay 85% of our Insured Losses that exceed our Insurer Deductible. 2. Notwithstanding item 1 above, the United States Govemment will not make any payment under the Act for any portion of Insured Losses that exceeds $100,000,000,000. 3. The premiums charged for the coverage for Insured Losses under this policy are included in the amounts shown in Item 4 of the Information Page or in the Schedules in the Domestic Terrorism, Earthquakes, and Catastrophic Industrial Accidents Premium Endorsement (WC 00 04 21 B) and the Foreign Terrorism Premium Endorsement (WC 00 04 22), attached to this policy. st-assn ovotrzoos ©Copyright 2007 National CounGl on Compensation Insurance, Inc. All Rights Reserved. 1MC 00 01 13A CARRIER CODE 19909 Doc Type: POLEND j~'~ POLICY ENDORSEMENT ~ '"~, ~ Please attach this endorsement to your policy tfa ~ ~ This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. ,g ~ < If you have any questions, please contact your local SCF Arizona office. Eb'FEC'I'IVE 12:01 AM ~ MO ~ DAY ~ YEAR AMENDING POLICY NUMBER MO DAY YEAR I AUTHURIZEDREPRESENTATIVE 01 01 2008 282765 03 Counter si¢ned al PERIN]ETER BICYCLING ASSOCIATION OF AI~RI 2609E BROADWAY HLVD TvcsoN Az e5716 Schedule - AZ 0.0200 -Rate per $100 of Estimated Payroll Estimated Payroll $447,763.00 Estimated Foreign Terrorism Premium $90.00 ($447,763.00 /100) x 0.0200 = $90.00 FOREIGN TERRORISM PREMIUM ENDORSEMENT This endorsement is notification that your insurance carrier is charging premium for losses that may occur in the event of an act of foreign terrorism. Your policy provides coverage for workers compensation losses caused by acts of foreign terrorism, including workers compensation benefit obligations dictated by state law. Coverage for such losses is still subject to all terms, definitions, exclusions, and conditions in your policy, and any applicable federal and/or state laws, rules, oi- regulations. For purposes of this endorsement, an "act of foreign terrorism" is defined as: a. Any act that is violent or dangerous to human life, property or infrastructure; and b. The act has been committed by an individual or individuals acting on behalf of any foreign person or foreign interest, as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of the United States Government by coercion. The premium charge for the coverage your policy provides for workers compensation losses caused by an act of foreign terrorism is shown in Item 4 of the Information Page or in the Schedule below. WC 00 04 22 st-as~sof~ovzoos ®2005 National Council on Compensation Insurance, Inc O O M~ 0 0 O O O of O~ LL~ O O O O N O W O O O O M O~ M N I~ O O O O M LL~ ~ n n O N a~ O n 0 0 0 d' M M O N ~ N~ O 1~ O O M O N n O N m O M 7 0 0 0 N cp O O f~ V M O ~ ~ N m~ f~ r O~ M~ O V ~fJ N M N a M (O N M W M ~ O ~O f~ n O 0 M ~ ~ ~ N W N m ~O ~ O ~[J ~~ O M O O O O M itJ 0 0 0 0 0 0 to t0 O O O m O f~ M N ~ N M O O O O W i~ O i0 O W ~ O O N O O ~ M O M N 7 t~ N C O ~fl O N t~ ~ ~ W O M N O 1~ O~ O O f~ O I~ O O O M tP M N O N V O of (O i0 to M a r O ~ W~ M m ~ 1~ O a ~ 0) OJ M M M n N O ~ O O N W N V~ ~ N N W O ~f'J W o~ Z ~ f~ ~ ~ N N N ~ ` M O ~ O V W O~~ O~~ O O O O O O~ O V O ~O O O M O M N N ~ (O M (D O N I~ W O ~~ O O N O V t0 f~ O O O W O M i~ W M O O O O r O O O 47 ~O O O O O ~O f~ W O O M O 7 ~ V V~ N ~ I~ 7 ~O a a O 7 i1J N ~O O ~ cD I~ M 7 n O N W n V O 1~ n O 7 ~ W U W OJ m 0) I~ ~ r n O O N N ~ V 7 7 M ~-- M O M V 0 0 0 0 O m 0 0 B O O l0 O O O LL) O O O O O N ~ O m V N O O N ~O O a 7 0 0 1~ r O V N N O O m M O O M O m N M 0 0 O O m V O~ M O M O N 0 0 7 O o7 N cp (O O f~ N i0 O M ~ O N N 1~ O p_ O W N (O (D .- N N M M E N o~ V (D I~ ~ '7 N M M N N ~~ ~ O N a N 0 0 0 0 O O ~O O O ~[J (O N 0 0 0 LL~ ~ O ~O O O O O (p O N ~ O N N N O O W i~ V N W O O N t~ O W E ~O O N O M oco~o~nM~ooui iri ro~o ocD~oarno~ ro O ~ M N (O W M 7~ O) m N N r~ N ~O t~ l0 V' N 1~ W [O (p .- (O ~O N f~ ~ O ~ N Q ~ V M N ~ ~[ V V t0 0 0 N~ 47 O O ~O O V O t~ 0 0 0 0 0 0 0 0 0 0 O O M O c0 O) N N W W 1~ O O~ ~ to O O O O n O ~ i0 B O O W U M O ~ N a N ~O 0 0 0 d' O N_ V O O O I~ O m ~ (D O O O Z O (D W O N d' N N ~O ~- O 7 M W W N M M V _ O N N ~ O .-- O ~ M N V I~ ~ r ~ ~ m a O M .-- V (O ~ M N ~ O U N M W Q O= "' 0 0 0 0 0 0 0 0 i0 m V LL'J 0 0 0 0 ~~ O O O O O M z~ ~, oo~oovooornrnronoooo~o~n ~n ~noo n O ~ of O W O O O W M ~_ O O O O (O m O O O O_ O V N O O N '- ~~ O W m O O~ m N LL) O O N M Q~ ~ O (O M (O N O N (O N M (D 7 p m p ~ ~i ri cD ~ N ~ vii ~ m ,~ _ ~ o ~ ~ P Qz.- ~om z ~ °o -O~ 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