18-001 Mami Weber Ct"("Y AF
No._
F1'2018-20
COJPERTINO
RECREATION SERVICES AGREEMENT
1. Parties. This contract is made and entered into as of 7/1/2018 ("Effective Date"), by and
between the City of Cupertino, a municipal corporation("City"), and with MAMI WEBER,
LOS ALTOS, CA 94027 ("Contractor"), a CALIFORNIA SOLE PROPRIETORSHIP for ADULT
ART CLASSES.
2. Services. Contractor agrees to provide the Services included in the Scope of Work and
in accordance with the Schedule of Performance attached in Exhibit A.
3. Term. This contract begins on the Effective Date and ends on 6/30/2020 ("Contract
Time"),unless extended or terminated as provided herein. Time is of the essence and Contractor must
have sufficient time, resources, and qualified staff to deliver the Services as required. Contractor must
promptly notify City of any acival or potential delays to afford the Parties adequate opportunity to
address or mitigate such delays.
4. Cornpensation. City will pay Contractor for satisfactory performance of the Services an
amount that will based upon actual costs but that will be capped so as not to exceed$12,000("Contract
Price"),based upon the Scope of Services,budget,performance schedule, and rates included in Exhibit
A. The maximum compensation includes alI costs, expenses and reirnbursements and will rernain in
place even if Contractor's actual costs exceed the capped amount. Contractor must submit invoices and
the inforrnation required in Exhibit A in order to receive payment. City will cornpensate Contractor
within 30 days after approval of written invoices.
Invoices are subject to review and audit by City during regular business hours upon 24-hours'
notice. Contractor must maintain complete and accurate records of payrolls, expenditures,
disbursements and otller cost items charged to City or establishing the basis for an invoice, for a
minirnum of four (4) years from the date of final payment.
5. Independent Contractor.Contractor is an independent Contractor and not an ernployee,
partner, or joint venture of City. Contractor is solely responsible for the means and methods of
performing the Services and for the persons hired to work under this Agreement.No civil service status
or other right of ernployment will be acquired by virtue of Contractor's performance of the Services.
Contractor is not entitled to City's health benefits, worker's compensation or any other benefit.
Contractor must have the sl<ills and qualifications to perform the Services in a competent and
professional manner. Contractor will supply all tools, materials and equipment required to perform
the Services under this Contract. Contractor is responsible for obtaining permits and licenses required
by law and must obtain a City business license.
Recreation Services Ag�eemer�t/Rev. 3-27-2018
Page 1 of 6
6. Proprietary/Confidential Info�mation. To the extent Contractor inay have access to
private or confidential inforination owned or controlled by the City, Contractor agrees to treat it
confidential and use it solely to perform this Agreeinent. Contractor must exercise the same standard
of care to protect City information as a reasonably prudent Contractor would use to protect its own
proprietary data.
7. Ownership of Materials. To the extent Contractor prepares written inaterial, drawings
or data in connection with this contract, City will have the property rights to those materials and all
copyrights, if any, to such worl<product will constitute City property.
8. Records. Contractor must maultain complete,accurate, and detailed accounting records
relating to its performance u1 accordance with generally accepted accounting principles and
procedures. The records must include detailed inforination about Contractor's services, benchrnarks,
deliverables and costs/fees,and must be made reasonably available to City.The records and supporting
documents must be kept separate from other files and maintained for four years from the date of City's
final payment,
9. Assignrnent. This Contract is not assignable. Contractor may not substitute another or
transfer any rights or obligations under this Contract without prior written approval of Cify.Only those
persons whose names are included in Exhibit A may perform the Services.
10. Publicity and Signs. Any publicity generated by Contractor related to this contract or
the Services during the Contract Time and for one year thereafter must reference City contributions.
The words "City of Cupertino" shall be displayed in all pieces of publicity, including flyers, press
releases, posters, brochures, public service announcements, interviews and newspaper articles. No
signs may be posted, exhibited or displayed on or about City property, except signage required by law
or under this Agreement without prior written approval from City.
11. Indemnification. To the fullest exfent allowed by law and except for losses caused by
the sole negligence or willful misconduct of City personnel, Contractor agrees to indemnify, defend,
and hold harmless the City, its City Council, boards and commissions, officers, officials, employees,
agents, servants, volunteers and Contractors (collectively, "Indemnitees"), through legal counsel
acceptable to City, from and against any liability for dainages, claims, actions, causes of action,
demands, charges, losses, costs and expenses (including attorney fees, legal costs and expenses related
to litigation, arbitrations, administrative and regulatory proceedings), of every nature, arisu�g out of or
in any way related to Contractor's or Contractor's agents performance of this contract or the Services.
This includes but is not limited to Liability resulting in personal injury, death, property damage, or
econoinic losses. Contractor must pay any costs City may incur in enforcing this provision and must
accept a tender of defense upon receiving notice from City. Contractor's payments may be deducted or
offset to cover any money the City lost due to a claim or counterclaim arising out of this Contract.
12. Insuranee. Contractor shall comply with the insurance requirernents in Exhibit B. City
will not execute the Agreement until it has received and approved satisfactory certificates of insurance
and endorsements evidencing the type, amount, and dates of coverage. Alternatively, City in its sole
discretion may purchase insurance and deduct the costs from payments to Contractor, or terminate the
contract.
Recreation Services Agreeme�t/Rev. 3-27-2018
Page 2 of 6
13. Cornpliance with Laws and Other City Requirements.
Reqairernents for all Contracts. This contract is subject to local, state and federal laws and
regulations prohibiting discrimination,including Title VII of the Civil Rights Act of 1964,the California
Fair Einploylnent Practices Act,the Americans with Disabilities Act of 1990,and otlzer laws that pertain
to fair employment and anti-discrimination practices, Contractor must comply with labor laws
pertaining to prevailitlg wages, working hours, overtime, payroll records, and other requirements
imposed by t11e Department of Industrial Relations.If Contractor does not have employees,it must sign
the Affidavit of No Employees, attached as Exhibit C. Contractor is responsible for verifying
employment eligibility of employees pursuant to the Iminigration Reforin and Control Act of 1986.
Contractor must comply wit11 conflict of ulterest laws and regulations applicable to this Agreement and
avoid conflicts of interest. Contractor may be required to file a conflict of interest form for engaging in
governrnental decisions or serving in a staff capacity, and is hereby advised to review the requirements
of California Political Reform Act and the California Code of Regulations. Services may only be
perforrned by persons who are not employed by City and who do not have a contractual relationship
wit11 City other than this contract. Contractor agrees to abide by City policies and administrative rules
prohibiting gifts to City officials and employees.
Additional Requirernents for Services Provided to Minors: Contractor and its employees
who provide services under this Agreement must comply with these additional requirements:
A. Undergo fingerprinting and a criminal background checl< and verify all employees
providing services under this contract have met this requirement.
S. Complete a Tuberculosis screening test as required by law and as set forth in Exhibit D,
C. Coinply with the Mandatory Reporting under California Penal Code 11164-11174.3 and with
the protocols, reporting, and training required under California Health and Safety Code
Section 124235, AB2007, and other laws pertaining to concussion evaluation, removal from
play, and return to play protocols. (Refer to Center for Disease Control & Prevention,
1-�t;t�7s:j�ctir�,v�hr.:c:�cic;..�;c��r(hc;���_c�,tit,�_�7,!rr�_c�TeTx�h tm N�.
D. Submit required forms and acknowledgrnents included in Exhibit D, and ensure its each
participant is provided with a concussion information sheet, signs and returns the forins to
the City as required by Health and Safety Code Section 124235.
Require coaches and administrators to successfully complete the concussion and head injury
education at least once either online or in person, before supervising a participant.
Contractor shall offer training, educational inaterials, or both to each Contractor
administrator on a yearly basis. (Training resources are available at the Center for Disease
Control&Prevention (link cited above).
E. If providing instruction, Contractor must acknowledge and comply with all requirements
set forth in the Recreation&Community Services Instructor Manual.
Checic one (if applicable):
❑ This contract requires services for children.
Recreation Services Agreement/Rev. 3-27-2018
Page 3 of 6
� T11is contract currently does not require services for children. If u1 the future, services
for children are required, the contract will require a'written amendment' to include the
appropriate insurance coverages as required in'Exhibit B—Insurance Requirements for
Recreation Contracts', proof of finger printing and additional requirements under
Paragraph 13. The contract amendment will also require the approval of the Director of
Recreation and Community Services and City Attorney.
14. Coordination of Services. The Parties designate the following persons as Services
Coordinators with the responsibility to oversee the delivery of Services in accordance with the terms of
this Agreeinent. Contractor's designation and any substitution are subject to City approval.
For City: For Contractor:
Name: Daniel Mestizo Name: Marni Weber
Position: Recreation Coordinator Position: I�lstructor
Contact: d,a��i�.1�c�?�c��.i�cx�°�in.t�.E�.�� I 408-777-3134 Contact:
15. Abandonment. City may abandon or postpone the Activity or Prograin and will notify
Contractor as soon as possible. Contractor will be paid for satisfactory Services rendered through the
date of abandonment upon submission of final invoices approved by City.
16. Terrnination. City rnay terininate this contract for cause or without cause at any time
and will notify Contractor as soon as possible.Contractor will be paid for satisfactory services rendered
through the date of termination upon submission of final invoices approved by City.
17. Governing Law,Venue and Dispute Resolution. This contract is governed by the laws
of the State of California. Any legal actions or proceedings filed against City in connection with this
contract must comply with the governrnent claims filing requirements and rnust be filed with the
Superior Court for the County of Santa Clara, State of California. At City's request, Contractor is
required to continue to provide Services pending resolution of any dispute. If the Parties elect
arbitration, the arbitrator's award must be supported by law and substantial evidence and include
detailed written findulgs.of law and fact.
18. Attorney Fees. If City is required to pursue litigation,arbitration or other administrative
or regulatory proceeding to enforce its rights or the terms of this Agreement, the prevailing party will
be entitled to reasonable attorney fees and costs. This Section survives t11is Agreement.
19. Third Party Beneficiaries. There are no third partybeneficiaries under this Contract.
20. Waiver.Neither acceptance of Services nor payment thereof constitutes a waiver of any
contract provision. City waiver of a breach shall not constitute waiver of another term, provision,
covenant or condition, or a subsequent breach, whether of the same or a different character.
21. Entire Agreement. This Agreernent and all referenced Exhibits are hereby attached and
incorporated into the Agreement by this reference and represent the full and complete understanding
as to those matters contauled herein, and supersede any other contract or understailding, eitller oral or
Recreation Se�^vices Agreement/Rev. 3-27-2018
Page 4 of 6
written,between the Parties.T11is Agreeinent inay not be modified or amended except in writulg signed
by both Parties.If there is any inconsistency between the rnain contract and any attachments or e�iibits
thereto, the main contract shall prevail.
22. Inserted Provisions.Each provision or cl�use required by law or tllis contract is deemed
to be included and will be inferred herein, Eitller party may request an ainendment to cure any
inistaken insertion or omission of a required provision.
23. Headings. The l�eadings are for convenience only and are not a part of the contract or
ultended to affect, limit or amplify the terms or provisions of this Agreement.
24. Severability/Partial Invalidity. If any contract terrn or provision, or tlleir application to
a particular situation, is found by the court to be void, invalid, illegal or unenforceable, such term or
provision shall remain in force a�1d effect to the extent allowed by such ruling.All other contract terms
and provisions and their application to specific situations will remain m full force and effect.
25. Survival.All provisions which by their nature must continue after the Agreement ends,
including without limitation Indemnification, Insurance, Ownership of Maferials, Records, Governing
Law and Attorney Fees,will survive t11e expiration or terinination of this Agreement.
26. Notices.All notices and instruments pertaining to material provisions of this contract or
significant disputes which are required by law or under this contract to be in writing must be sent to
the persons listed below. The notices will be deemed effective on the date of personal delivery or the
date confirmed by a reputable overnight delivery service, on the fifth calendar day after deposit in the
United States Mail, postage prepaid, registered or certified, or the next business day following
electronic submission.
To City of Cupertino: To Contractor:
Office of the City Manager 1910 Noel Drive, Los Altos, CA 94024
10300 Torre Ave., Cupertino CA 95014 cc: Representative/Coordinator:
cc: Representative/Coordinator: Marni Weber
Daniel Mestizo Email:
Email: danielm@cupertino.org •
27. Validity of Contract. This contract is valid and enforceable only if it complies with the
provisions of Cupertino Municipal Code Chapters 3.22 and 3.23, is signed by the City Manager or
authorized designee, and is approved for form by the City Attorney's Office.
28. Execution. The person executing this contract on behalf of Contractor represents and
warrants that Contractor has full right, power, and authority to execute fhis contract and to carry out
all actions and services required. This contract constitutes a legally binding obligation of Contractor,
and may be executed in counterparts, each one of which is deemed an original and all of which, tal<en
together, constitute a single binding instrument.
Recreation Services Agreement/Rev. 3-27-2018
Page 5 of 6
IN WITNESS WHEREOF, the parties h�ve caused this contract to be executed.
CONTRACTOR CITY OF CUPERTINO
Maini Weber A Municipal Corporation
By� �� �2,.., By � -z`'e��
�,,J � � o , / ��,
Name/ /7_ ��,v„� �/� ,..PI�- Naine,�A'I!/1,��� I7��1��
Title ��,S��t.c�(31/' Title,��j�• ,'�/�CCs���'2.►�''
Date (7�< <f'/��� � Date � '�����
Tax I.D. No,: �..L�, �/l/—�
APPROVED AS TO FORM: ATTEST:
r� E'� �/.ZB�i�'
, � � �-.� �/�/��
� ��
R CIO . FIERRO GRACE SCHMIDT � , �, ��'
Cuper o Acting City Attorney City Clerk
ContractlEncumbered Amount:580-62-613 700-702
Account No.: $12,000
Recreation Services Agreement/Rev. 3-27-2018
Page 6 of 6
EXHIBIT A
SCOPE OF WORK, PERFORMANCE AND PAYMENT SCHEDULES
The CONTRACTOR will provide ADULT ART CLASSES in,but not lirnited to,the following:
WATERCOLOR, PAINTING, DRAWING, ART SKILLS, ART CLASSES
Location and Tirne of CONTRACTOR Services:
Refer to the Recreation Schedule dated SUMMER 2018 —FALL 2020 for agreed upon dates, tiines,
and class locations. The City, at its sole discretion, may change the agreed terms.
Cornpensation for CONTRACTOR Services:
Contractor shall be compensated for services performed pursuant to this Agreement. Compensation
shall consist of the following: 65% of resident fee based on final class rosters. The total cornpensation
to the Contractor shall not exceed$12,000.
Eligible Participant Minimum and Maximums for CONTRACTOR Services:
Minimum: 6
Maximum: 20
If less than the required minimum number of participants enroIl in and pay for a particular class as
identified in the schedule before the class is scheduled to start, the City may cancel the particular class
and/or terminate this Agreement without additional notice or payment to Contractor.
p
List of all Contractor Ernployees worl<ing for the City of Cupertino (if no Ernployees,identify
"self"):
--��-I-�
Performance of CONTRACTOR Services:
In t11e case Contractor unilaterally cancels performance of a class, camp, activity or service without
City approval, City reserves the right to immediately and without notice cancel the remainder of
programs/services offered and or performed by Contractor.
The Contractor shall follow all guidelines pertauzing to registration procedures as listed in the
quarterly recreation schedule. Participants rnay not take part in tlle program unless they are Iisted on
the class roster or can show proof of enrollment. All participants and volunteers need to complete the
City's Waiver of Liability forin prior to taking part in the prograrn. If applicable, contractors who are
responsible for supervising minors must remain with the class until a parent of legal guardian has
arrived and all minors are released to them.
In the event of an injury occurring to a participant, the Contractor will notify the City within 1 hour
and complete an Incident Report in the form approved by the City. The Incident Report must be
submitted to the City within 24 hours of the injury occurring.
EXHISIT C
AFFIDAVIT OF NO EMPLOYEES
State of California
County of Santa Clara
City of Cupertino
I, the undersigned, declare as follows:
I am an independent contractor and the owner of � t��v'; UV..Q ..�(�
I wish to enter into a services contract with the City of Cupertino. I am fully aware of the
provisions of section 3700 of the California Labor Code, which requires every employer to
provide Worl<ers' Compensation coverage for employees in accordance with the provisions
of that Code. I am also aware that I must provide proof of worl<ers' compensation insurance
to the City of Cupertino for any and all employees I may have, pursuant to Section 12 of the
City of Cupertino's contract.
I hereby certify that I do not have any employees nor will I have any employees worl<ing for
me or my business during the terrn of any service contract with the City of Cupertino. I am
not required to have Worl�ers' Compensation insurance.
I declare under penalty of perjury under the laws of the State of California that the foregoing
is true and correct.
Executed on this �day of�U j� , 2018, at� 1 i� C� California.
���Q� � �,�.� ��r
PRINT NAME
� ( .
SIGNATURE
EVANSTON INSURANCE COMPANY
CERTIFICATE NO.: 636505933264682775
CERTIFICATE OF INSURANCE
SPECIAL EVENT LIABILITY PROGRAM
PRODUCER PUBLIC ENTITY(ADDITIONAL INSURED)
Alliant Insurance Services,Inc.in conjunction with City of Cupertino
Apex I�lsurance Services
P.O.Box 6450
Newport Beach,CA 92658
License No:OC 36861
NAMED INSi]RED(EVENT HOLDER): EVENT INFORMATION:
Mami Weber TYPE: Arts And Crafts(Various)
DA�(s): o��osi2o�$-�z�s�i2o�a
Los Altos, CA 94024 LOl.1-1TI�1V. Qulnlan Community Cen[er,10185 North Stelling Road,Cupartino,CA 95014
*Liquor Liability Yes� No�
��*Liquor Liability after 12 am ends before 2 am ❑
This is to certify that the insurance policy listed below has been issued to the above insured named(event holder)for the policy
period indicated. The insui�ance described herein is subject to all the terms,exchisions and conditions of such policy(ies)unless
auiended as described in Special Conditions.
INSURANCE CA�2IER:Evanston Insurance Company
MASTER POLICY NUMB�R: SEP41026
MASTER POLICY DATES: EFFECTIVE: January 01,2018 EXPIRATION: January 01,2019
COMMERCIAL GENERAL LIABILITY General OCCiIRR�NCE FORM DEDUCTIBLE: NONE
Aggregate L'unit $2,000,000
Products&Completed Operations 1,000,000 SPECIAL CONDITIONS:
Peisonal&Advertising Injury 1,000,000 The following endorsements attached to
Each Occun-ence Limit 1,000,000 the Master Policy do not apply to this
Damage To Premises Rented To You(Any One Premises) 100,000 Certificate Of Insurance:
Medical Payments(Any One Person) 5,000 MEGL1643
Liquor Liability (If purchased) 1,000,000
Optioual Limits Purcliased
❑ $1,000,000/$3,000,000
❑ $2,000,000/$2,000,000
Property Damage(If purchased)
No Property Damage Coverage
The lnnits of insurance apply separately to each event insm-ed Uy this policy as if a separate policy aP insurauce has been issued for that eveut.
OTHER ADDITIONAL INSiJPZEDS
City of Cupertino, Its City Council, Boards and
Commissions, Officers, Officials, Employees,
Agents, Servants, Volunteers and Consultants
CANCELLATION: Should the above desciibed policy Ue cancelled Uefore the expiration date thereof,notice will be delivered in accordance with the policy
provisions.
fJ �"'�"`"`�_,sz�.
AUTHORIZED REPRESENTATIV�:
DATE IS SLJED: 01/03/2018
POLICY NUMBER: SEP41026 COMMERCIAL GENERAL LIABILITY
CG 20 26 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIOIVAL INSURED - DESIGNATED
PERSOIV OR ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):
City of Cupertino, Its City Council, Boards and Commissions, Officers,
Officials, Employees,Agents, Servants, Volunteers and Consultants
For Certificate No.: 636505933264682775
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section 11 — Who Is An Insured is amended to B. With respect to the insurance afforded to these
include as an additional insured the person(s) or additional insureds, the following is added to
organization(s) shown in the Schedule, but only Section III—Limits Of Insurance:
with respect to liability for "bodily injury", "property If coverage provided to the additional insured is
damage or personal and advertising injury required by a contract or agreement, the most we
caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the
omissions or the acts or omissions of those acting amount of insurance:
on your behalf:
1. In the performance of your ongoing operations;
1. Required by the contract or agreement; or
or 2. Available under the applicable Limits of
2. In connection with your premises owned by or
Insurance shown in the Declarations;
rented to you. whichever is less.
However: This endorsement shall not increase the
1. The insurance afforded to such additional applicable Limits of Insurance shown in the
insured only applies to the extent permitted by
Declarations.
law; and
2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.
CG 20 26 04 13 O Insurance Services Office, Inc., 2012 Page 1 of 1
Renewal auto policy declarations
�� Alistate�w�
Your policy effective date is March 5,2018 You're in good hands.
Page 1 of 4
Information as of January 11,2018
Total Amount Due forthe Policy Period
Please review your insured vehicles and verify their VINs are correct, �ummary
Vehiclescovered fdentificafionlVumber(VIN) Premium Named Insured(s)
489.00 Mailing address
California Fraud Assessment Fee 1J6 1970 Noel Dr
Total* $1,022.95 �Os Altos CA 94024-706U
.._.._._ . .,._.... ....... ........ ... . .._..._ ..... , ....... ... ... .......,.. ... ....._ �... ._..._
Policy number
*Your bil!wil!be mailed separafely.Before making a payment,piease re fer to your g14 9S3 281
latest bill,which includes paymenf opfions and instal/menf fee informafion.lf you do Your policy provided by
nof pay in full,you will be charged an installment fee(s). Allstate Northbrook Indemnity
See the Important payment and coverage information section for details about Company
installment fees. Policy period
Beginning March 5,2018 through
September 5,2078 at 12;01 a.m.
DISCOUI7�S (included in your total premium) standard time
Anti-theft $1.80 Good Driver(20%) $237.59 Your Allstate agency is
Multiple Policy $18.$0 Distinguished $200.65 Annie Pham
Driver 521 Gharcot Ave 109
- - ---- - - — __ _ __ ---- __ _ SanJoseCA95131
Total discounts $458.84 (408)248-5212
`. __ _ _ _ _____ _ __._ _ __ AnnieDang@allstate.com
Discounts per vehicle Some or all of the information on your
Policy Declarations is used in the rating
2�1n 7oy.Truek I�av4 ' ����-���' of your policy or it could affect your
Anti-theft $,86 Good Driver(20%) $115,34 eligibility for certain coverages.Please
Multiple Policy $9.11 Distinguished $95,34 notify us immediately ifyou believe that
Driver any information on your Policy
201Q Ta ata Prius �Z�g;�g: Declarations is incorrect.We will make
Anti-theft $.94 Good Driver(20/o) $122.25 Y �
o corrections once ou have notified us
Multiple Policy $9.69 Distinguished $105.31 and any resulting rate adjustments,will
Driver be made only for the current policy
period or for future policy periods.
Listed drivers on your policy Please also notify us immediatety if you
believe any coverages are not listed or
are inaccurately listed.
Mami Nishio
Excluded drivers from your policy
None
0
m
�
0
0
¢
U
�!��
Renewal auto policy declarations Page 2 of 4
Policy number: 914 953 287
Policy effective date: March 5,2018
Coverage detail for 20'IQ Toy. Truck Rav4
Coverage Limifs Deductible Premium
Automobile Liability Insurance Not applicable $310.03
:�•',� Bodily Injury $100,000 each person
$300,000 each occurrence
� Property Damage $100,000 each occurrence
wAuto Collision Insurance Actual cash value $1,000 $134.$2
Waiver of deductible applies
� Auto Comprehensive Insurance Actual cash value $1,000 $16.19
�' Rental Reimbursement Not purchased*
,,�,�L Towing and Labor Costs $100 each disablement Nat applicable $5.84
Uninsured Motorists Insurance for Bodily $100,000 each person Not applicable $65.31
Injury $300,000 each accident
�� Automobile Medical Payments Not purchased*
Coordinated Medical Protection Not purchased*
Lease/Loan Gap Not purchased*
Repair or Replacement Cost Option Not purchased*
� Sound System Not purchased*
Tape Not purchased*
Tatal premium far 2q10'foy.Truck Rau�: $532.`I9:
*This coverage can provide you wifh va(uable protection. To help you stay
current wifh your insurance needs,contact your Allstate agent to discuss
coverage options and other products and services that can help protect you.
VIN Rating information
Your premium is determined based on certain information,
including the following;
• This vehicle is driven 10-20 miles to worl</school,married
female licensed 25 years. m
�
0
Allstate uses mileage information as one factor to help determine your premium amount. �
Important Note:The annual mileage figure applicable to this vehicle for the expiring policy period was:22,500-22,999.The
annual mileage figure applicable to this vehicle for the current policy period is:22,500-22,999. �
�
If any of the information shown above is incorrect,missing or changes in the future,please contact your Allstate o
representative.Please keep in mind that a change in any of the information may result in an adjustment to your premium. Q
�
�
N
r
O
Q
M
m
0
M
O
O
O
�
O
O
O
Q
U
N
X
n
O
O M
O Q¢
O Q O
O'�Q
O�
ry�O
X
Renewal auto policy declarations
Policy number: 914 953 281 Page 3 of 4 �~ A I I state��
Policy effective date: March 5,2018
You're in good hands.
Coverage det�il for 2U'10 Toyota Prius
Coverage Limits Deductrble Premrum
Automobile Liability Insurance Not applicable $241.50
+� Bodily Injury $100,000 each person
$300,000 each occurrence
� Property Damage $100,000 each occurrence
� Auto Collision Insurance Actual cash value $1,000 $170.72
Waiver of deductible applies
� Auto Comprehensive Insurance Actual cash value $1,000 $17.80
� Rental Reimbursement Not purchased*
a� Towing and Labor Costs $100 each disablement Not applicable $5.84
Uninsured Motorists Insurance for Bodily $100,000 each person Not applicable $53.14
Injury $300,000 each accident
r� Automobile Medical Payments Not purchased*
Coordinated Medical Protection Not purchased*
Lease/Loan Gap Not purchased*
Repair or Replacement Cost Option Not purchased*
� Sound System Not purchased*
Tape Not purchased*
Tatal premium for 2q1p Toy�ta Prius $,�g9,{�p;:
*Thrs coverage can provide you with valua6le protection. To help you stay
current wifh your insurance needs,contact your Aflstate agenf to discuss
coverage options and other products and services that can he/p profecf you.
VIN Rating information
Your premium is determined based on certain information,
including the following;
� This vehicle is driven 3-9 miles to worl</schoal,married male
licensed 28 years,
Allstate uses mileage information as one factor to help determine your premium amount.
Important Note:The annual mileage figure applicable to this vehicle for the expiring policy period was:18,000-18,499.The
annual mileage figure applicable to this vehicle for the current policy period is:18,000-18,499.
If any of the information shown above is incorrect,missing or changes in the future,please contact your Allstate
representative.Please keep in mind that a change in any of the information may result in an adjustment to your premium.
Additional coverages
Coverage Limits
Automobile Death Indemnity Insurance Not purchased*
Automobile Disability Income Protection Not purchased* o
�
a
(continued) �
s
a
v
�