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SPECIAL OLYMPICS
V !/bac e _S&71 0,7 e 5 uS D /riot)ee net J 1:1A. 40 • TROLLEY RENTAL CONTRACT This Agreement is made on this date of 1 IJ. � 2011 between The Parks and Recreation Department of the City ofJeffersonville "Vendor") and 5-f G'/y h/ /C� As follows: CONTRACT TIME Vendor contracts to rent}23 passenger vehicle from(time) • '; y}P on(date) 2- '11)until(time) /'d+' 3' P1VI�on(date) `a - {fc'- )qthe"Contract T' }+PICK UP ADDRESS: ( Time"). DROP OFF ADDRESS: �,/ *PROVIDE ROUTE MAP:YES NO IF DR/I i`� att-gsn:15 ��`��'� VEHICLE DESCRIPTION If only one trolley is requested,driver will utilize ready vehicle. No. 19 Trolley 1998 Chance AH-28 No. 11 Trolley 1998 Chance AH-28 CONTRACT PRICE The Customer agrees to pay$150 per hour(minimum 2 hrs)per vehicle for the services to be rendered for the contract time. To hold the reservation,$300 deposit(or preferably full amount)&completed contract is required. The Customer agrees to pay$150 per hour per vehicle for each additioivl hour or part thereof after e contract time.Total contract hours 6 X$150.00= j /-I\[�� Pk_ WARRANTY Vendor warrants that the vehicle has undergone regular maintenance and is in good,clean condition. The foregoing warranty does not warrant that the vehicle will be free from unforeseen mechanical defects. ASSUMPTION OF RISK BY CUSTOMER Vendor does not guarantee the safety or assume any responsibility for any personal articles or items lost,stolen,damaged or left in the vehicle. Vendor is not responsible for delays in the vehicle's departure and arrival caused by weather,road conditions,hazards,accidents or other unforeseen events, including acts of God or War. RULES&SPECIAL CONDITIONS There shall not be more than 23 persons provided transport or shelter in the vehicle at any one time. *If requested by Vendor,Customer agrees to provide a specific route(s)of transportation and stop(s). There shall not be any possession or consumption of alcoholic beverages, illegal drugs or use of tobacco products on the vehicle. There shall not be any unruly behavior by passengers,nor any conduct causing,or in the driver's opinion likely to cause,damage to the vehicle. Passengers shall not engage conduct that will interfere with,or in the driver's opinion,likely to interfere with,safe operation of the vehicle. Vendor reserves the right to expel any passengers)from the vehicle and/or terminate this contract if,in the opinion of the driver,a violation of the above stated conditions has occurred.In the event of such an early termination,there will be a forfeiture of all paid deposits and fees for service. Tipping of the driver is not allowed. DAMAGE Customer agrees to pay for any and all damage and any cleaning to the vehicle which results or is required due to the conduct of any person in the vehicle.Specifically,such damage includes, but is not limited to,burns,spillage,vomiting, broken glassware,scratches,stains and broken windows,seats and mirrors. HOLD HARMLESS Customer agrees to indemnify and hold harmless the driver and Vendor for any and all negligence or gross negligence of the conduct of any passenger.Moreover,Customer agrees that it shall instruct its insurance carrier to affix the City of Jeffersonville,its entities,assigns,employees and all other individuals associated therewith,as"also insured"for the amount of$1,000,000 for the purpose of A providing the City with liability coverage for any and all claims that may or may not be made related to this contract and subject Event related to the Vehicle's use. BREACH OF CONTRACT AND ATTORNEY FEES If the customer shall breach this contract,the Vendor shall be entitled to terminate service under this agreement immediately and be entitled to his attorney's fees,the costs of collection and costs incurred in any lawsuits arising out of or in connection with said breach. SEVERABILITY If any provisions of this contract are deemed void or unenforceable,the remaining provisions shall remain in full force and effect. JURISDICTION The parties agree that all the terms and conditions stated herein shall be construed under the laws of the State of Indiana and any action or proceeding brought in connection with or arising out of this contract shall be within the jurisdiction of Clark County, Indiana. Vendor Signature ti ` ' �— (signature after finalized) Printed Name Paul Northam, Parks 8t Recreation Director Date • - rf,. ) Customer Signature iesipent- Printed Name e1 t-1,th` 'ark Date 1/7-51/1 Customer contact number 3/ 3 2--e3 /75 33d, 706 Deposit/Total Paid: 1J A Date Receipt# AC RO p® CO CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DD/YYVY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.ITHIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s). PRODUCER CONTACT American Specialty Insurance&Risk Services,Inc. PHONE (A/C.No,Ext): 260 969-5203FAx 260-969-4729 E-MAIL 1(A/C,No); 7609 W.Jefferson Blvd.,Suite 100 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL* Fort Wayne IN 46804 INSURED INSURER A: Philadelphia Indemnity Insurance Company 18058 Special Olympics,Inc. INSURER B: INSURER C: 1133 19th Street NW INSURER D: —' Washington INSURER E: DC 20036 INSURER F: COVERAGES CERTIFICATE NUMBER: 1001631580 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEOD ABOVE N BOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERGENERALLIABILITY (MM/DD/YYYy) (MM/DD/Y CLAIMS-MADE I X I OCCUR PREMISES EACH OCCURRENCE $ 1,000,000 DAMAGE O(Ea occu RENTED $ 1,000,000 A Y PI IPK1921784 MED EXP(Any one person) _ $ Excluded 12/31/2018 12/31/2019 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: 7 POLICY I I ,,,vg I I LOC GENERAL AGGREGATE $ 5,000,000 XI OTHER: OTHER PRODUCTS-COMP/OP AGG $ 1,000,000 AUTOMOBILE LIABIUTY $ COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) OWNED BODILY INJURY(Per person) $ A AUTOS ONLY AtC�HOESULED PHPK1921784 12/31/2018 12/31/2019 BODILY INJURY(Per accident) $ X HIRED vNON-OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Per accident) $ UMBRELLA UAB NON-OWNED/HIRED AUTO $ 1,000,000 OCCUR EXCESS UAB EACH OCCURRENCE $ CLAIMS-MADE DED RETENTION$ AGGREGATE $ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY ERH ANYPROPRIETOPJPARTNER/EXECUTIVE Y/N I STATUTE I OFFICER/MEMBER EXCLUDED? I I N/A E.L.EACH ACCIDENT $ In(Mandatory INH) _ If yes,des ne under E.L.DISEASE-EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H mom space is required) -Coverage applies to the following:SPECIAL OLYMPICS INDIANA,6200 TECHNOLOGY CENTER DRIVE,SUITE 105, INDIANAPOLIS, IN 46278. -Named Insured(cont'd):All Special Olympics Accredited U.S. Programs CERTIFICATE HOLDER CANCELLATION City of Jeffersonville,its entities,assigns,employees and all other individuals associated therewith SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 500 Quartermaster Ct. AUTHORIZED REPRESENTATIVE Jeffersonville IN 47130 D.A..e.A p r---* -,.v-4" ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: LOC#: '4 O ADDITIONA AGENCY L REMARKS SCHEDULE Page 1 of NAMED INSURED American Specialty Insurance&Risk Services,Inc. Special Olympics, Inc. POLICY NUMBER 1133 19th Street NW PHPK1921784 1 CARRIER NAIC CODE Washington,DC 20036 Philadelphia Indemnity Insurance Company 18058 EFFECTIVE DATE: 12/31/2018 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE-Certificate#1001631580 -The Hired Auto Physical Damage limit contains a$1,000 collision deductible and a$100 other than collision deductible(for commercially rented vehicles only). Nonowned and Hired Auto(NOHA)liability is excess of any valid and collectible insurance. -Coverage for property you rent or occupy;property loaned to you and property in the care,custody,or control of the Insured,$100,000 limit subject to a $2,500 deductible per loss,excluding watercraft,aircraft,and autos. -The Certificateholder is only an Additional Insured with respect to liability caused by the negligence of the Named Insured as per Form PI-AM-002-Additional Insured-Certificateholders,as respects to the SPECIAL OLYMPICS INDIANA,TROLLEY FOR BORDEN PLUNGE on February 16,2019. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD