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Home My WebLink About2011-013 RESOLUTION NO. 2011-13 1 2 3 4 5 6 7 8 9 10 11 12 RESOLUTION OF THE MAYOR AND COMMON COUNCIL AUTHORIZING TH EXECUTION OF AN AGREEMENT BETWEEN THE CITY OF SAN BERNARDIN AND THE SAN BERNARDINO BLACK CULTURE FOUNDATION FOR FINANCIA ASSISTANCE FROM THE 2010/2011 CIVIC AND PROMOTION FUND. BE IT RESOLVED BY THE MAYOR AND COMMON COUNCIL OF TH CITY OF SAN BERNARDINO AS FOLLOWS: SECTION 1. The City Manager of the City of San Bernardino is hereby authorized and directed to execute on behalf of said City an Agreement with the San Bernardino Black Culture Foundation for financial assistance from the Civic and Promotion Fund for FY 2010/2011, a copy of which is attached hereto, marked Exhibit A, and incorporated herein by reference as fully as though set forth at length. SECTION 2. The authorization to execute the above referenced agreement is 13 rescinded if the parties to the agreement fail to execute it within sixty (60) days of the adoption 14 of this resolution. 15 III 16 17 18 19 20 21 22 23 24 25 26 27 28 III III III III III III III III III 2011-13 RESOLUTION OF THE MAYOR AND COMMON COUNCIL AUTHORIZING TilE EXECUTION OF AN AGREEMENT BETWEEN THE CITY OF SAN BERNARDINO AND THE SAN BERNARDINO BLACK CULTURE FOUNDATION FOR FINANCIAL ASSISTANCE FROM THE 2010/2011 CIVIC AND PROMOTION FUND. I HEREBY CERTIFY that the foregoing resolution was duly adopted by the Mayor and Common Council of the City of San Bernardino at a joint regular meeting thereof, held on the 24th day of January ,2011, by the following vote to-wit: Council Members: AYES NAYS ABSTAIN ABSENT MARQUEZ x DESJARDINS x BRINKER x SHORETT x KELLEY x x JOHNSON MCCAMMACK x ~~ il.~ Rac el G. Clark, CIty Clerk The foregoing resolution is hereby approved this d4 "f"~ day of January ,2011 Approved as to form: JAMES F. PENMAN, City Attorney /2 "f~~'!........ '- 2 2011-13 Exhibit A AGREEMENT Civic and Promotional Funding Agreement This AGREEMENT is entered into between the CITY OF SAN BERNARDINO, a municipal corporation, hereby referred to as "City" and the SAN BERNARDINO BLACK CULTURE FOUNDATION, INC., a non-profit organization, hereby referred to as "Organization." The parties agree to as follows: 1. Recitals. A. Organization has requested financial assistance from City for the Fiscal Year 2010/11, in order to assist in defraying the expense of events related to their 2011 Black History Week celebration, as outlined in their Request for Funding to the Mayor and Common Council, a copy of which is attached hereto and marked as Attachment A. The terms of the request are incorporated herein by reference and shall govern the uses of the funds provided herein. The financial assistance provided for in this agreement is made on a one-time basis, and receipt of said funds shall not imply a continuing obligation of the City beyond the terms of this agreement. B. The expenditure is for a valid municipal public purpose, to wit: for the conduct of events related to their 2011 Black History Week celebration and Black History Parade scheduled for February 5, 2011. 2. Payment. Upon presentation of a claim to the City's Finance Director, City shall pay the total sum of$5,000 to Organization from the FY 2010/11 Civic and Promotion Fund. 3. Use of Funds. The funds paid to Organization shall be used solely for the purposes set forth in Paragraph 1 above. No deviation from these provisions shall be made without the express approval of the City of San Bernardino. Any unexpended funds shall be returned to the City by Organization. 1 2011-13 AGREEMENT BETWEEN CITY OF SAN BERNARDINO AND BLACK CUL TURE FOUNDATION FOR FINANCIAL ASSISTANCE FROM FY 2009/2010 CIVIC AND PROMOTION FUND. 4. Accountability. Financial records shall be maintained in accordance with generally accepted accounting principles by Organization in such manner as to permit City to easily trace the expenditure of the funds. All books and records of Organization are to be kept open for inspection at any time during the business day by the City or its officers or agents. Failure to submit the financial records in accordance with this section will result in the Organization reimbursing the City in the full amount received by Organization. At the conclusion of the program, Organization shall present the City Manager or his designee a written accounting of all expenditures and revenues connected with said event. Organization will further supply City with any and all receipts relating to accounting of expenditures if so requested by City. If Organization does not submit an accounting of expenditures and revenues which City deems appropriate, such failure will result in the Organization reimbursing the City in the full amount received by Organization. 5. Hold Harmless. Organization covenants and agrees to defend, (if requested by City), indemnify, and hold harmless the City, its departments, agencies, boards, commissions, elected officials, officers, attorneys, employees and agents from all liabilities and charges, expenses (including counsel fees), suits, or losses, however occurring, or damages arising or growing out of the use or receipt of the funds paid hereunder and all operations under this Agreement. Payments hereunder are made with the understanding that the City is not involved in the performance of services or other activities of Organization. The costs, salary and expenses of the City Attorney and members of his office in enforcing this Agreement on behalf of the City shall be considered as "counsel fees" for the purposes of this paragraph. 2 2011-13 AGREEMENT BETWEEN CITY OF SAN BERNARDINO AND BLACK CUL TURE FOUNDATION FOR FINANCIAL ASSISTANCE FROM FY 2009/2010 CIVIC AND PROMOTION FUND. 6. Insurance. While not restricting or limiting the foregoing, during the term of this agreement, Organization shall maintain in effect policies of comprehensive public, general and automobile liability insurance, in the amount of $1 ,000,000, per occurrence combined single limit, naming the City of San Bernardino, its officers, employees and agents, as additionally insured. Said coverage shall require ten (10) day written notice to the City if insurance is terminated or materially altered. 7. Termination. City shall have the right to terminate this agreement by mailing a ten-day written notice to Organization and this agreement shall terminate ten days after the mailing of such notice. In the event this agreement is terminated for reasons of improper use of funds or use of funds for any purpose other than those authorized, any unexpended portion of the funds provided by City shall be returned to City. In addition, Organization shall reimburse to City any funds expended which were used for any purpose other than those authorized under this agreement. 8. Authorization to Execute. Organization hereby covenants that it has taken all actions necessary to make the adherence to the obligations imposed by this agreement a binding obligation of the organization. 9. Notices. All notices herein required shall be in writing and delivered in person or Sent by certified mail, postage prepaid, addressed as follows: As to City: City of San Bernardino 300 North "D" Street San Bernardino, CA 92418 Attn: City Manager, 6th Floor As to Organization: Black Culture Foundation P.O. Box 7288 San Bernardino, CA 92411 Attn: Margaret Hill, President 3 2011-13 . . AGREEMENT BETWEEN CITY OF SAN BERNARDINO AND BLACK CULTURE FOUNDATION FOR FINANCIAL ASSISTANCE FROM FY 2009/2010 CIVIC AND PROMOTION FUND. 10. Entire Agreement. This agreement and any documents or instruments attached hereto or referred to herein integrate all terms and conditions mentioned herein or incidental hereto, and supersede all negotiations and prior writing in respect to the subject matter hereof. In the event of conflict between the terms, conditions or provisions of this agreement, and any such document or instrument, the terms and conditions of this agreement shall prevail. In witness whereof, the parties hereto have executed this agreement on the day and date first above shown. CITY OF SAN BERNARDINO By. Date: Charles McNeely, City Manager SAN BERNARDINO BLACK CULTURE FOUNDATION By. Date: Joann Roberts, President ATTEST: By: City Clerk Approved as to form: James F. Penman City Attorney By: 4 2011-13 AGREEMENT Civic and Promotional Funding Agreement This AGREEMENT is entered into between the CITY OF SAN BERNARDINO, a municipal corporation, hereby referred to as "City" and the SAN BERNARDINO BLACK CULTURE FOUNDATION, INC., a non-profit organization, hereby referred to as "Organization." The parties agree to as follows: 1. Recitals. A. Organization has requested financial assistance from City for the Fiscal Year 2010/11, in order to assist in defraying the expense of events related to their 2011 Black History Week celebration, as outlined in their Request for Funding to the Mayor and Common Council, a copy of which is attached hereto and marked as Attachment A. The terms of the request are incorporated herein by reference and shall govern the uses of the funds provided herein. The financial assistance provided for in this agreement is made on a one-time basis, and receipt of said funds shall not imply a continuing obligation of the City beyond the terms of this agreement. B. The expenditure is for a valid municipal public purpose, to wit: for the conduct of events related to their 2011 Black History Week celebration and Black History Parade scheduled for February 5, 2011. 2. Payment. Upon presentation of a claim to the City's Finance Director, City shall pay the total sum of$5,000 to Organization from the FY 2010/11 Civic and Promotion Fund. 3. Use of Funds. The funds paid to Organization shall be used solely for the purposes set forth in Paragraph 1 above. No deviation from these provisions shall be made without the express written 1 2011-13 AGREEMENT BETWEEN CITY OF SAN BERNARDINO AND BLACK CUL TURE FOUNDATION FOR FINANCIAL ASSISTANCE FROM FY 2010/2011 CIVIC AND PROMOTION FUND. approval of the City of San Bernardino. Any unexpended funds shall be returned to the City by Organization. 4. Accountability. Financial records shall be maintained in accordance with generally accepted accounting principles by Organization in such manner as to permit City to easily trace the expenditure of the funds. All books and records of Organization are to be kept open for inspection at any time during the business day by the City or its officers or agents. Failure to submit the financial records in accordance with this section will result in the Organization reimbursing the City in the full amount received by Organization. At the conclusion of the program, Organization shall present the City Manager or his designee a written accounting of all expenditures and revenues connected with said event. Organization will further supply City with any and all receipts relating to accounting of expenditures if so requested by City. If Organization does not submit an accounting of expenditures and revenues which City deems appropriate, such failure will result in the Organization reimbursing the City in the full amount received by Organization. 5. Hold Harmless. Organization covenants and agrees to defend, indemnify, and hold harmless the City, its departments, agencies, boards, commissions, elected officials, officers, attorneys, employees and agents from all liabilities and charges, expenses (including attorney fees), suits, or losses, however occurring, or damages arising or growing out of the use or receipt of the funds paid hereunder and all operations under this Agreement. Payments hereunder are made with the understanding that the City is not involved in the performance of services or other activities of Organization. The costs, salary and expenses of the City Attorney and members of his office in enforcing this Agreement on behalf of the City shall be considered as "attorney fees" for the purposes of this paragraph. 2 2011-13 AGREEMENT BETWEEN CITY OF SAN BERNARDINO AND BLACK CUL TURE FOUNDATION FOR FINANCIAL ASSISTANCE FROM FY 2010/2011 CIVIC AND PROMOTION FUND. 6. Insurance. While not restricting or limiting the foregoing, during the term of this agreement, Organization shall maintain in effect policies of comprehensive public, general and automobile liability insurance, in the amount of $1 ,000,000, per occurrence combined single limit, naming the City of San Bernardino, its officers, employees and agents, as additionally insured. Said coverage shall require ten (10) day written notice to the City if insurance is terminated or materially altered. 7. Termination. City shall have the right to terminate this agreement by mailing a ten-day written notice to Organization and this agreement shall terminate ten days after the mailing of such notice. In the event this agreement is terminated for reasons of improper use of funds or use of funds for any purpose other than those authorized, any unexpended portion of the funds provided by City shall be returned to City. In addition, Organization shall reimburse to City any funds expended which were used for any purpose other than those authorized under this agreement. 8. Authorization to Execute. Organization hereby covenants that it has taken all actions necessary to make the adherence to the obligations imposed by this agreement a binding obligation ofthe organization. 9. Notices. All notices herein required shall be in writing and delivered in person or sent by certified mail, postage prepaid, addressed as follows: As to City: City of San Bernardino 300 North "D" Street San Bernardino, CA 92418 As to Organization: Black Culture Foundation P.O. Box 7288 San Bernardino, CA 92411 3 2011-13 AGREEMENT BETWEEN CITY OF SAN BERNARDINO AND BLACK CUL TURE FOUNDATION FOR FINANCIAL ASSISTANCE FROM FY 2010/2011 CIVIC AND PROMOTION FUND. Attn: City Manager, 6th Floor Attn: Margaret Hill, President 10. Entire Agreement. This agreement and any documents or instruments attached hereto or referred to herein integrate all terms and conditions mentioned herein or incidental hereto, and supersede all negotiations and prior writing in respect to the subject matter hereof. In the event of conflict between the terms, conditions or provisions of this agreement, and any such document or instrument, the terms and conditions of this agreement shall prevail. In witness whereof, the parties hereto have executed this agreement on the day and date first above shown. By Date: /) zj D 1/11 ATTEST: By. DzLn / II Date:~ By:a~b.~ - City Clerk Approved as to form: James F. Penman City Attorney By: . . ((3,/)/..._--..., 4 EXECUTIVE COMMITTEE Joann Roberts President Genevieve G. Echols 1st Vice President Taylor Avery 2nd Vice President Charles Burris Treasurer Evelyn Gonzalez Secretary ADVISORS W Robert Fawke Margaret B. Hill Joseph Smith Jr. Frank Washington 11/ Ida N. Roberson (Emeritus Advisor) SAN~MANUEL BAND OF rf~f M1SSIQN lNDIANS SPONSORS Community Hospital of San Bernardino San Bernardino City Unified School DistrIct Edison International The Gas Company 2011-13 San Bernardino Black Culture Foundation P. O. Box 7288 San Bernardino, CA 92411-0288 Tax LD. No. 95-3674139 December 6, 2010 Mayor and Common Council City of San Bernardino 300 North 0 Street San Bernardino, Ca. 92418 Re: 2011 Black History Parade - Theme ("Building Bridges, Between Cultures and Generation ") The 42nd Annual Black History Parade will be held at 1 0:00a.m., Saturday, February 05, 2011. The parade is to starl at Eight and E Streets, proceed south and end at Second and E Streets. As a non-profit organization, we request financial assistance from the City to defray the cost of the parade and its other activities, as ref/ected in the attached budget. Request a waiver of fees and support services, closing of streets, and barricades along the parade route. Additionally, we request the loan and delivery of the foJ/owing: a. one large stage to be placed in front of the Carousel Mall along with forly chairs which will be used to seat our special guest. b. Use of Courl Street Square and Public restrooms in the Lobby of City Hall. c. Bleachers from the City of San Bernardino and crews to transport the bleachers. A Hold Harmless Agreement has been prepered and a map of the parade route is attached. We have obtained sufficient insurance to cover all events and a copy of the Certificate of Insurance is attached. Should you require additional information, please contact Ms. Genevieve Echols at (909) 874-3763. Thank you for considering our request and we hope to hear from you soon. Sincerely: /:/ "f /1 ul-~-::"'~/j, -'- '/ LfJU/U{r"I frLtt1/(.:;)--> f / fi Joann Roberls, President JRleg Enc/ 2011-13 HOLD HARMLESS AND INDEMNIFICATION LicenseeIPermittee shall protect, defend,indemnity and hold the City and its elective and appointive boards, commissions, officers, agents, employees and servants free and harmless from any and all losses, claims, liens, demands and causes of action of every kind and character including, but not limited to, the amounts of judgments, penalties, interests, court costs, legal fees, and all other expenses incurred by the City arising in favor of any party, including claims, liens, debts, personal injuries, including employees of the City, death or damages to property (including property of the City) and without limitation by enumeration, all other claims or demands of every character occurring or in any ways incident to, in connection with or arising directly or indirectly out of this agreement. Licensee/Permittee shall investigate, handle, respond to, provide defense for and defend any such claims, demand, or suit at the sole expense of the Licensee/Permittee. LicenseeIPermittee shall also bear all other costs and expenses related thereto, even if the claim or claims alleged are groundless, false or fraudulent. This provision is not intended to create any cause of action in favor of any third party against Licensee/Permittee or the City or to enlarge in any way the Licensee/Permittee's liability but is intended solely to provide for indemnification of the City from liability for damage or injuries to third persons or property arising from Licensee/Permittee's performance hereunder. /)"f Iv JIb I DATED San Bernardino Black Culture Foundation, Inc Licensee/Perm~ . l:/./' .1J;."i -.. Ir.:-.ry'''// / :,~~ BY: 'if....IAc/'. I (,A.....L L'~;'- _ Title: J Joann Roberts ,President Attach a certified coy of documentation, which will authorize Applicant to contract on behalf of corporation/business). 2011-13 SAN BERNARDINO REQUEST FOR CIVIC AND PROMOTION FUNDING (PART I) Name of Organization SAN BERNARDINO BLACK CULTURE FOUNDATION, INC. Address POST o F FI C E BOX 7288 - SAN BERNARDINO, CA. 92411 Contact Person Phone Fax GENEVIEVE ECHOLS (909) 874-3763 WK 991-9530 CELL (909) 874-7286 FAX Designation of 5-1 c (3) non-profit status of Organization (Attached: Yes-x- No - Date of Event Location Estimated No. of Attendees FEBRUARY 5, 2011 EIGHTH AND "E" STREETS 3.000 Purpose of Funding 2011 BLACK HISTORY MONTH ACTIVITIES CONSISTING OF: MISS BLACK SAN BERNARDINO PAGEANT, CROWING OF THE SENIOR KING AND QUEEN. ANNUAL PARADE, EXPO, Al\fARDS BANQUET AND GOSPEL PROGRAM. PROPO~ED CURRENT BUDGET A. REVENUES: (List all anticipated revenues other than City of San Bernardino) .. AMOUNT TOTAL Sponsorships i~c:()() ReQistrations -() Promotions, concessions, souvenirs, oroQram sales -::0- Donations (Sr.J.l()T.A'RSHT"P~"\ i?ooo In Kind Services (Other than City Services) 2000 i"pA'RAnF V":H 1 I."R~ r.H A NN"RT "\ Total Dollar Amount ReQuested of City 5000 A. TOTAL PROPOSED REVENUES 1'7 C;()(\ 2011-13 2011 REQUEST FOR CIVIC AND PROMOTION FUNDING REQUEST FOR FEE WAIVERS (PART III) NAME OF ORGANIZATION: SAN BERNARDINO BLACK CULTURE FOUNDATION, INC. (List all City services for which you are requesting fee waivers) C. Fee Waivers AMOUNT Police ' 1 R I. '::U~ su~ Security Traffic Control Other Fire Site Inspections Crowd Control Facilities Sound System Civic Center Use Permit Public Services Refuse Bins Street Sweepinq qhQ QQ Development Services Planninq TUP Buildinq , 'RNGINEF.RINQ 2 422.03 Other (Explain) "P A 'R v <:: ^ I\T T\ t1 1':' r t1 1;' ^ 'l' T /l 1\1 ? h?A on r"TBl'l' ~ '~1<'I<,'I' <::/lTTt.P1;' 17':; 00 Total Amount of Fee Waivers (In-Kind Services) 24 O~2 77 For Office Use Only: Departmental Costs In: Police Fire Public Services Public Works Development Services Facilities Previous Year's Accounting Reviewed: Admin: Finance 2011-13 2011 REQUEST FOR CIVIC AND PROMOTION FUNDING PROPOSED CURRENT BUDGET (PART II) MUST 5t! SUB[I1ITTED TO CITY MA~GER'S (lFF1Cfi $O!lA YS PRIOR TO EVEIfT FOR WH/9JO FUNVING IS ~l/f(;1Tf'P. NO f,XCEPr/ON& NAME OF ORGANIZATION: ~ A N B~R NARDTNO BLA r.~ ClJLT1)R E FOlJNDA TTON. INC. B. EXPENDITURES: (Include aU known direct expenses connected with event) EXPENSES AMOUNT TOTAL Personnel/Salaries (} Permits Fire Business License ABC .- Other r;.t; Insurance I 1/.7 City of San Bernardino (attached Yes x No ) '. Park Damaqe Bond 1 , R .....~ Park Clean Un Deoosit/Damaqe Bond I Security S.B.P.D. 7'J ~ Private Security - Other <::r.(,TT'RT"T'Y VVN'rTI\l'r- 7?~ AdvertisinQ Radio ,Newspaper OJ:: .--.- Banners Flyers ~C;() ~- Other - Entertainment Music 775 Sound System 300 Other 550 ,.- Promotional Items Trophies "<;7 Ribbons and/or Plaaues () T-Shirts ~,1 I. ,__~'_m~' Other 121?_._. --~. Sanitation Portable Restrooms - Public Services 225 ~cial Events I Banquets Facilities 69/19 Parade Other - Parks Recreation B. TOTAL PROPOSED EXPENDITURES ** (SEE ATTACHED) 16632 Summary: A Total Revenues B. Total Expenditures C. Total Fee Waivers- (from Part III) $ 17500 $ 16632 $ 2~~j-@- D. Total Amount Requested $. 5000 2011-13 zen J. ~- C'J 'T.l t:J -- tr.l tr.l tI:l l"d !"l" t1 r1" r1" l'i 0 t1 t1 (l) l-' (D l'O l'O ~ (t) (1) l"l" l"l" r1' C (I) - 9th street Div 1 0 'i:$ 8th Street rd" ., IU Cf.l t1 niu '=t -rt' sturges '5- . @ Auditorium II) l'O tn- rt" 7th street n;u .Ii lJpolice :+station Victoria CI1 6th street Public , Library 5th street 4th street -- >Col Carousel Mall 'i ;::: (tic" t>> 'S. -Court street t:l Court street 0 I.Q Square 1-'- ~ 2nd street ro Ii - t'ara ae 1:1;nas UJ 0> .- l-' Rlalto Arrowhead Credit . , Um.on Park 280 South E street ~.,_.--." -~ <---- 1 illl ACORD ~- 2011-13 I CERTIFICATE OF LIABILITY INSURANCE PRODUCER ECHOLS INSURANCE AGENCY - 0622474 219 S ORANGE AVENUE RIAL TO, CA. 92376 (909) 874-3763 -- INSURED SAN BERNARDINO BLACK CULTURE FOUNDATION, INC PO BOX 7288 SAN BERNARDINO, CA. 92411 INSURERS AFFORDING COVERAGE INSURER A: US LIABILITY ~<<_.<<<-- .<<<<< ---- ~~~<- INSURER C: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWlTHSTANDING 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. INS~ AD~~ POLICY NUMBER P~Al.{~~:~~8~~ POUC~~piAATi~N LIMITS LTR INSR TYPE OF INSURANCE DATE MMIDDIYY GENERAL LIABILITY NBP1550384 01/30/11 01/30/12 EACH OCCURRENCE $ 1,000,000 A X ~~'"u~~u~'~ ~~~~~'Es YE~~~~ncel $ 100.000 I CLAIMS MADE 0 OCCU: I I I MED EXP (Anyone person) $ PERSONAL & ADV INJURY $ I I GENERAL AGGREGATE $ 2,000,000 I -<- Grl'LAGGREGATE LIMIT APPLIES PER: I PRODUCTS-COM~OPAGG $ -X POLICY n jr~T n LOC I $ AUTOM081LE LIASILITY COMBINED SINGLE LIMIT $ i j ANY AUTO (Ea accident) 1--<--<-<'-<--- < ALL OWNED AUTOS ! BODILY INJURY i $ SCHEDULED AUTOS (Per person) -....- ---- -".,... ..._m.. . .,_m_g' i HIRED AUTOS ! BODILY INJURY $ NON-OWNED AUTOS I (Per accident) - ---' - PROPERTY DAMAGE $ (Per aecidant) I~RAGE L1A8ILITY AUTO ONLY -EAACCIOENT $ : EA ACC $ l--i ANY AUTO OTHER THAN ! i AUTO ONLY: AGG l $ pESSJUM8RELLA LIA81LITY I EACH OCCURRENCE $ OCCUR 0 CLAIMS MADE i -- I AGGREGATE $ I $ I I R DEDUCTIBLE I $ I -..- RETENTION $ $ WORKERS COMPENSATION AND I T"&? LfM-W-s I I OJ.H. ER! <<-- EMPLOYERS' LIABILITY EL EACH ACCI~~NT I $ I ANY PROPRIETOR/PARTNERIEXECUTIVE m<_________ OFFICER/MEMBER EXCLUDED? ! U-;SEASE - EA EMPLOYE~-;- If yes, dascrlbe under ! I -<--<-- SPECIAL PROVISIONS balow ! EL DISEASE - POLICY LIMIT $ OTHER I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT' SPECIAL PROVISIONS ANNUAL BLACK HISTORY MONTH ACTIVITIES; PARADE & EXPO TO BE HELD ON SATURDAY; FEBRUARY 5, 2011. CARRIER TO ISSUE ENDORSEMENT NAMING CERTIFICATE HOLDER AS AN ADDITIONAL INSURED AS THEIR INTEREST MAY APPEAR CERTIFICATE HOLDER CANCELLATION CITY OF SAN BERNARDINO 300 NORTH "0" STREET SAN BERNARDINO, CA. I ACORD 25 (2001/08)