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HomeMy WebLinkAboutFAST CARRIER PICTURES 1V • AGREEMENT TERMINATION Please complete this form when the attached agreement is no longer in effect. Return form to the Sr_ Deputy Clerk of the Council (M-30), Call 647-5238 if you have any questions. ----------------�---„-- -----------------------,----- T`he agreement with </ I GLV / a` %�`� No. -pZ�04—W c' was completed on -0 q , and final payment has been made. Department: PO t ) ce. Signature: t BAm l Date: City of Santa Ana Revised 8-7-03 Clerk of the Council 0JISURANGt ud i 1LE A-2004-002 WORK 111M FnOCEED UNiP.. iMui-ANCE EXPIRES I _ 5 CLERK OF COUNCIL CONSULTANT AGREEMENT DAIS; i -,fib -04 C, �Q THIS AGREEMENT, made and entered into this It -1 day of AW 2004 by r �L and between FAST CARRIER PICTURES, a California "S" Corporation, REGEN TE, a California 501(c) 3 non-profit public benefit corporation (hereinafter "Consultants"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California (hereinafter "City"). RECITALS A. The City desires to retain a consultant having special skill and knowledge in the field of film production to develop and produce an edutainment video for Santa Ana's anti - drunk driving campaign. B. Consultant represents that Consultant is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in its field and that any services performed by Consultant under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES Consultant shall develop and produce an anti drunk -driving video as set forth in City's RFQ 03-077 and Consultant's Proposal, both incorporated in this Agreement by reference, and the Scope of Services attached hereto as Exhibit A. 2. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services, the milestone payments identified in Exhibit A. The total sum to be expended by City under this Agreement shall not exceed $75,000.00 during the term of this Agreement. b. Payment by City shall be made within thirty (30) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. TERM This Agreement shall commence on the date first written above and terminate on July 31, 2004, unless terminated earlier in accordance with Section 12, below. The term of this Agreement may be extended upon a writing executed by the Chief of Police and the City Attorney. 4. INDEPENDENT CONTRACTOR Consultant shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer-employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Consultant performs the services which are the subject matter of this Agreement; however, the services to be provided by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services. Consultant shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 5. INSURANCE Prior to undertaking performance of work under this Agreement, Consultant shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Consultant shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) and shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Consultant's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $2,000,000 per occurrence. Consultant shall supply City with a fully executed additional insured endorsement in substantially the form attached hereto as Exhibit B upon execution of this Agreement and shall be approved in form by the City Attorney. b. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the Labor Code, Consultant, if Consultant has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance. Prior to commencing the performance of the work under this Agreement, Consultant agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. C. The following requirements apply to the insurance to be provided by Consultant pursuant to this section: (i) Consultant shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. (ii) Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved in form by the City Attorney. (iii) Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. d. If Consultant fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the City with required proof that insurance has been procured and is in force and paid for, the City shall have the right, at the City's election, to forthwith terminate this Agreement. Such termination shall not effect Consultant's right to be paid for its time and materials expended prior to notification of termination. Consultant waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 6. INDEMNIFICATION Each party to this Agreement agrees to and shall indemnify and hold harmless the other party, its officers, agents, employees, consultants, special counsel, and representatives from liability (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including health, and claims for property damage, which may arise from the direct or indirect operations of the indemnifying party or its contractors, subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section 1 of this Agreement. 7. DELIVERY OF WORK PRODUCT Consultant shall deliver to City all work -product resulting from the services provided. Said work product shall be produced in the formats agreed by Consultant and City. Consultant agrees, for itself, its officers, employees, agents, contractors and volunteers that the City of Santa Ana shall be the sole and exclusive copyright holder of all creative material developed pursuant to this Agreement. Said copyright includes, but is not limited to, the final production, scripts, music, sound effects, graphics, dramatic presentations, titles and other creative elements developed for the production of this program. 8. CONFIDENTIALITY If either party to this Agreement receives from the other party, information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, the receiving party agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the receiving party disclosed in a publicly available source; (c) is in rightful possession of the receiving party without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the receiving party without reference to information disclosed by the other party. 9. CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 10. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by telefacsimile or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 facsimile (714) 647-6956 With courtesy copies to: and, Chief of Police City of Santa Ana 60 Civic Center Plaza (M-97) P.O. Box 1988 Santa Ana, California 92702 facsimile (714) 245-8007 City Attorney City of Santa Ana 20 Civic Center Plaza (M-29) P.O. Box 1988 Santa Ana, California 92702 facsimile (714) 647-6515 To Consultant: Fast Carrier Pictures 3535 Hayden Avenue Culver City, California 90232 Facsimile (310) 836-5012 Attn: Steven Jay Rubin Regenerate 2899 Agoura Road, #268 Westlake Village, California 91361 Facsimile (805) 371-4374 Attn: David L. Miller A party may change its address by giving notice in writing to the other party. Thereafter, any notice, tender, demand, delivery, or other communication shall be addressed and transmitted to the new address. If sent by mail, any notice, tender, demand, delivery, or other communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by telefacsimile, any notice, tender, demand, delivery, or other communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. IL EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Consultant. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Consultant nor the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein. 12. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Consultant, Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other consultants retained by City. 13. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for all services performed by Consultant prior to receipt of such notice of termination, subject to the following conditions: a. Asa condition of such payment, the Chief of Police may require Consultant to deliver to the City all work product completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 14. DISCRIMINATION Consultant shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 15. JURISDICTION —VENUE This Agreement and all questions relating to its validity, interpretation, performance, and enforcement shall be governed and construed in accordance with the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 16. PROFESSIONAL LICENSES Consultant shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in writing of her inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 17. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terns of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: C PATRICIA E. HEALY Clerk of the Council APPROVED AS TO FORM: ",v--- -� OSEPH W. FLETC14ER City Attorney CITY OF SANTA�N�A DAVID N. REAM City Manager FAST CARRIER PICT , S /._, ��t� IM/L' STEVEN JAY VINJ" President REGENERATE By youth > for youth DAVID L. MILL Executive Director EXHIBIT A SCOPE OF SERVICES CONSULTANT'S OBLIGATIONS Consultant shall assist the City in all aspects of production of a short "Don't Drink and Drive" Edutainment Video. Consultant's obligations shall include, but not be limited to, those items set forth in SCOPE OF WORK of City's Request for Qualifications. 2. TIMELINE AND PRODUCTION MILESTONES Consultant shall perform services and be compensated based on achieving milestones as follows: a. Commencement of preproduction activities, $25,000.00 including delivery of a Treatment upon which the final script will be based. At this time, Consultant will begin scriptwriting, casting, creating music or securing rights to existing music, booking crew and preparing final budget. b. Delivery of final script, including locations and actors, $30,000.00 production schedule and final budget. c. Wrap principal photography, commence post production $15,000.00 d. City approval of and delivery of video and copies as $ 5,000.00 Required in RFQ Consultant shall contribute in-kind production personnel, equipment, services, public relations and marketing, which match and/or exceed the total compensation of $75,000 which will be paid by City. CITY'S OBLIGATIONS City will provide all emergency service personnel, vehicles and support required in the production. City shall make available, as necessary, its own facilities for production purposes. City shall act as liaison with other Santa Ana and Orange County agencies involved in the production, including obtaining any required permits and/or licenses. City will assist in securing in-kind donations such as props, catering services, equipment and facility rental or use. EXHIBIT B ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company _St. Paul Surplus Lines Insurance Company & St. Paul Fire & Marine Insurance Company_ This endorsement modifies such insurance as is afforded by the provisions of Policy # TBD* relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective TBD* this endorsement form as a part of Policy# TBD*_ Issued to Fast Carrier/ Regenerate Named Insured ���r� fit ✓',r Countersigned by Authorized Representative . *The Effective Dates and Policy Numbers are pending purchase of attached quote. 46 t 3105535897 GMTV 219 P02 MAR 25 104 14:30 CERTIFICATE OF INSURANCE mm w PRODUCER THIS CERTIFICATE IB ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RI Supple -Merrill &Driscoll, Inc. HOLDER.UPON THE CCRTIrICATE THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALT THE COVERAGE AFFORDED BYICISSB 550 EI Dorado Street COMPANIES AFFORDING COVERAGE PSEadena, CA 91102 _ »�• Fw (626) 577 6656 (626) )859921 DOMAANv STS . St- Paul Surplus Lines Ins. Co. q . INSURED Fast Carrier/Regenerate CONPANV ATTN: Steve Rubin $535 Hayden Avenue COMPINY c Culver City, CA 90232 — CDMPANY POmN NP. F4 W. 1 ❑ COVERAGE$ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE RUN ISSUED TO THE INSURED NAMEDAWNE FOR THE POLICY PERIOD INDICATED, NOT WITH STANDINGANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIOH THIS CERTIFICATE MAY eE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SVWECT TOA" THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAV BEEN REDUCED BY PAID CW MS. OD LTR TYPE OF INSURANCE - P WNLWM POLICYEFFEGTVE mmwfflNDIYYY PDUCYEXMMTN)N OAT, IMIVDONYT UNITE °�E�L�NmDENER,N.AODREcnre X COMNERCML OENlRK LMSIIIry E004502860 04/24/04 05/04/04 $ 1000-000- 000 ,00 000 PRCDUCT9•C0MPMPACC S RK -0 S•rS� GNIMB MACE ER] OCCUR pEMONALIIDVIWIIRV 2 00 000 EACN OCCURRENCA S ARE DAMAW(ZY MM M)S 00000 MED E%P(A, ww pMOl� 6 . A OMOS"LMBIITY AMY AUro ED04502050 04/24/04 05/04/04 COMMNED &ISLE LMIIT 8 1,000,000 (P&N.) ° Included STS .. ALL OVARD AUTO, SCHEOULEDAUTOs AU12DAMADECTWLe aeDU X HIRED AuTca N OWNED AUroE 10% Or loss, Subject to $2,5DO min and $7.500 BODY INJURY , PMA46MM ° Included max PROPERTY Mxx prnum °126 000 MexASRPShIP M 500,000 DAMACE mus MIIRLRY EACNDCCURRENCE S •, _ AGOREGATS 3 UMGRELU POPN nTXER THAN VAERlLU FPRM $ . wORRaR eOMPENMnON Atm NPLnYERSUPaRATY Nd maPRlEroa E I,'`... EL N,CH ACCIOEM$ EL gIEASE. POLICY LIAR L PARR#RE%ECTrvE RCL OIMICEa ARE' Excl. EL DISEASE -EA EMPLOYEE Is STS OTNER Equipment, Props, Sets b WaMrobes E1304502860 04124104 05/04/04 COVERAGEpEDUCTISLE E 100,000 $ 1,500 ObORRnON OP OpaRATONEM1ACATbwaJYEHIDLa$nrceML ITeaE 'Split Dates apply to all comagea In the speci/ed CDvarue a Lacelhn. 'United States & Canatla Certificate holder Is named as an Additional Insured and I -OSS Payee BE their IntereStE may appear. PmdUDIOD: Santa Ana Edutainment VW All coverages expire at O9KnfIQATE N ... CANCELLATION- .. -.. aHOUL0ANYOFTIEAG0VR00eRMSDP000IESDE CANCML BEFOREYNE City Of Santa Ana S%PRATON MM THEREOF, RIE MOUND COMPANYYM.L ENCEAVOR TO MAK. 1 "VOMNNOTWEMTEGERWWATEHOWMNAMEDTOTHELNT. 20 Civic Center Plaza Santa Ana, CA 82701 GUT PAILURE TO MM *UQN NOTICE BNN.L IMPOSE NO MLN11TION M LMMIJTY OF ANY END UPON THE COMPANY, ITS AGENYI Oa RP ORMTAVWN, AURIRIMDREPR MTAM Rq„M N0. Fq Nq ._.. .... ... lTn.. 3v:"r ,-, ..�:., : .,, r Nun.•, I .�:.,w,. . , I .L.1 .. .'.. r.`i: "WA�i ;:'h: EXHIBIT B ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company _St. Paul Surplus Lines Insurance Company & St. Paul Fire & Marine Insurance Company_ This endorsement modifies such insurance as is afforded by the provisions of Policy # TBD* relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. I 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective TBD* this endorsement form as a part of Policy # TBD*_ Issued to Fast Carrier/ Regenerate Named Insured APPROVED AS TO I CORM Laura S a Jcxdy Assistant city Attorney, Countersigned by _ Authorized Representative . *The Effective Dates and //Policy Numbers are pending purchase of attached quote. j J. EXHIBIT B ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company _St. Paul Surplus Lines Insurance Company & St. Paul Fire & Marine Insurance Company_ This endorsement modifies such insurance as is afforded by the provisions of Policy # TBD* relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. I 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective TBD* this endorsement form as a part of Policy # TBD*_ Issued to Fast Carrier/ Regenerate Named Insured APPROVED AS TO I CORM Laura S a Jcxdy Assistant city Attorney, Countersigned by _ Authorized Representative . *The Effective Dates and //Policy Numbers are pending purchase of attached quote. j Supple -Merrill & Driscoll, Inc. 550 EI Dorado Street • Pasadena, CA 91102 (626) 795-9921 a Fax: (626) 577-6656 a Email: david@productioninsurance.com Short Term Production Quote ouoteNumber: 22808 Quote Date: 1/8/2004 Client Details Nanre Fast Carrier/Regenerate Phone (310) 836-5018 Contact Steve Rubin Fax (310) 836-5012 Aadreee 3535 Hayden Avenue Deter Phone Stunts, Pyrotechnics, Aircrafts, Boats, City, state, zip Culver City, CA 90232 Email Address steve@fastcarrier.com Production Details Production Title Santa Ana Edutainment Video Coverage Territory USA and Canada Production Type Educational & Training Film Prlorclelms None Gross Production Coat 75,000 Major Exclusions Stunts, Pyrotechnics, Aircrafts, Boats, Workers Comp Payroll $11,250 (State: CA) Animals, Cast Coverage, Weather, Fight Payroll Calculated as 15% of Gross Production Cost Extra Expense Scenes, Equipment in Unattended Excluded Vehicles, Owned Equipment, Blanks, Squibs, Guns Premium and Coverage Summary Coverages Limit Coverage Description Deductible Premium Property 100,000 Rented Equipment, Props, Sets & Wardrobes 1,500 $300.00 Excluded Negative Film or Videotape Excluded Faulty Stock, Camera & Processing Excluded Extra Expense Excluded Third Party Property Damage State Mandated Taxes 9.68 General Liability 2,000,000 General Aggregate None 1,075.00 2,000,000 Each Occurrence Included Certificates/Blanket Additional Insureds Included City / Other Special Certificates 150.00 State Mandated Taxes 39.51 Umbrella Excluded Per Occurrence / Aggregate Automobile 1,000,000 Hired/Non-Owned Liability 300.00 500,000 Hired/Non-Owned Physical Damage -Aggregate 10% loss/$2,500 min 350.00 125,000 Hired/Non-Owned Physical Damage -Per Vehicle 10% loss/$2,500 min State Mandated Taxes 20.96 Workers' Compensation 1,000,000 Limits None 962.75 State Mandated Taxes 26.00 Sub -Total 3,233.90 Coverage Dates #Days Policy Fee 225.00 Property 03/29/04 - 04/08/04 10 Broker Fee 150.00 General Liability 03/29/04 - 04/08/04 10 Convenience Fee 0.00 Automobile 03/29/04 - 04/08/04 10 Total $3,608.90 Workers' Com ensation 03/29/04 06/27/04 90 P - 'AII coverages expire at 12:01 a in. Staneam Time. See attached page for Coverage Explanations. Sample policy available online at www.shorttermproductions.com `t'Coverage will not be bound until receipt of full payment and company approval. Coverage cannot be cancelled nor amended once bound License #: 0517777 Supple -Merrill & Driscoll, Inc. 550 EI Dorado Street • Pasadena, CA 91102 (626) 795-9921 • Fax: (626) 577-6656 • Email: david@productioninsurance.com Credit Card Authorization Production Company Quote Number Card Holder Name Type: (Visa/Mastercard/ Amex/Dismver) Card Number Expiration Date Billing Zip Code Billing Address Signature Fast Carrier/Regenerate 22808 Premium 3,233.90 Policy Fee 225.00 Broker Fee 150.00 Convenience Fee (0.0%) 0,00 Total charge 3,608.90 Cardholder acknowledges receipt of goods and/or services in the amount of the total shown hereon and agrees to perform the obligations set forth in the Cardholder's agreement with the Issuer. By signing this form I understand and agree that coverage cannot be cancelled nor changed once my credit card has been charged. In addition, I agree that there are no refunds nor charge -backs allowed after my credit card has been charged. All credit card charges are processed through Burbank Insurance Agency. Accordingly, I understand my credit statement will show Burbank Insurance Date For Internal Use Only Approval Number All credit card charges are processed through Burbank Insurance Agency. Accordingly, I understand my credit statement will show Burbank Insurance Agency as the vendor. )�W� See attached page for Coverage Explanations. Sample policy available online at www.shorttermproductions.com Coverage will not be bound until receipt of full payment and company approval. Coverage cannot be cancelled nor amended once bound License #: 0517777 Coverage Definitions These definitions are for your information only and are not intended to replace any of the language of the actual policy form. Please seethe policy contract for terms, conditions, and exclusions. In addition, all coverages below may not have been purchased. See quote sheet for the coverages you selected. ipment, Props, Sets and Wardrobe What is covered? Camera, sound, lighting and miscellaneous rented equipment. Owned equipment is not covered. Props, sets, and wardrobe are covered. How much should I The insurable value should be the total value of your rented equipment, props, sets, and insure for? wardrobe from all vendors. If coverage is required for owned items, the total value should be Coverage Term? increased for the value of the owned items and declared to the insurance broker. Can the deductible No. The deductible is based on the total limit of equipment, props, sets, and wardrobe. be changed? Are "Loss Payees" Equipment insurance includes your vendors being provided with certificates of insurance naming included? them as loss payee in the event of a loss. Unlimited certificates can be issued. Negative Film or Videotape & Faulty Stock, Camera & Processing Mat is covered? Damage or destruction of raw film or tape stock, exposed film or videotape, faulty stock, faulty cameras or lenses. How much should I The coverage limit is the declared budget of the production, up to a maximum coverage limit of insure for? $25,000. Coverage Term? Coverage is valid for 4 months from the policy inception date. Extra Expense Met is covered? Extra expense reimburses the insured for the out-of-pocket expenses in the event of the interruption, postponement or cancellation of the declared production, as a result of loss, damage or destruction of property or facilities contracted for use by the insured. Third Party Property Damage Mat is covered? Covers damages to locations while it is in the care, custody and control of the insured (i.e. damage to a house that you are shooting in). General Liability Mat is covered? Covers the insured for losses due to bodily injury or property damage caused by the insured's employees or agents. Locations will require general liability for 1,000,000. The aggregate is the total liability limit. The occurrence is the limit per claim. Are "additional With blanket additional insureds, your vendors and locations will be provided with certificates of insureds"included? insurance naming them as additional insureds in the event of a loss. Unlimited certificates can be issued. City and other The City of LA, other cities, and entities may require "special wording" on their certificates or have special certificates a special form they require be completed. Film permit offices will require this. Automobile (Hired & Non -Owned) What is covered? Vehicles rented for the production. Liability covers injury to third parties or damage to their property. Physical damage provides coverage for damage to the vehicles. Umbrella What is covered? This provides excess liability over the general liability, automobile (if purchased) and employers liability (if purchased) subject to a $10,000 deductible and can be obtained in increments of 1,000,000. Workers' Compensation What is covered? Injury to your compensated and non -compensated employees and volunteers. Who is not covered? For corporations, partnership, LLC's and other legal entities, officers are excluded from coverage. For individuals and dba's, the owners are excluded from coverage. This is a general summary of available coverages and it Is not intended to give complete policy information. All coverages and exclusions are found in the policies. Please contact your broker for a copy of the policy.