HomeMy WebLinkAboutEMBASSY CONSULTING SERVICES, LLCGL, AL&,W WC N-2018-192
INSURANCE NOT ON FILE
WORK MAY NOT PROCEED
CLERK OF COUNCIL
DATE: OAT 2 1 203PGREEMENT TO PROVIDE LEADERSHIP
O: SAPD ( /) AND TRAINING SERVICES
FisC�HIS AGREEMENT is made and entered into on this 3rd day of October, 2018 by and between
Embassy Consulting Services, LLC, a California limited liability company ("Consultant'), 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 ("City").
RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
providing leadership and supervisory training workshops for the Santa Ana Police
Department (the "Department').
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:
SCOPE OF SERVICES
Consultant shall perform during the term of this Agreement, the tasks and obligations
including all labor, materials, tools, equipment, and incidental customary work required to fully
and adequately complete the services described and set forth in -Exhibit A, attached hereto and
incorporated by reference.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services for
City, the rates and charges identified in Exhibit A. The total amount to be expended
under the term of this Agreement shall not exceed $6,375.
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.
3. TERM
This Agreement shall commence on the date first written above for a one (1) year period,
unless terminated earlier in accordance with Section 15, below.
Page 1 of 8
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. OWNERSHIP OF MATERIALS
This Agreement creates a non-exclusive and perpetual license for City to copy, use,
modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property
embodied in plans, specifications, studies, drawings, estimates, and other documents or works of
authorship fixed in any tangible medium of expression, including but not limited to, physical
drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or
caused to be prepared by Consultant under this Agreement ("Documents & Data"). Consultant
shall require all subcontractors to agree in writing that City is granted a non-exclusive and
perpetual license for any Documents & Data the subcontractor prepares under this Agreement.
Consultant represents and warrants that Consultant has the legal right to license any and all
Documents & Data. Consultant makes no such representation and warranty in regard to
Documents & Data which were provided to Consultant by the City. City shall not be limited in
any way in its use of the Documents and Data at any time, provided that any such use not within
the purposes intended by this Agreement shall be at City's sole risk.
6. 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 $1,000,000 per occurrence, with $2,000,000 in the
aggregate. Such insurance shall (a) name the City, its officers, employees, agents,
and representatives as additional insured(s); (b) be primary and not contributory
with respect to insurance or self-insurance programs maintained by the City; and
(c) contain standard separation of insureds provisions.
Page 2 of 8
b. Business automobile liability insurance, or equivalent form, with a combined single
limit of not less than $1,000,000 per occurrence. Such insurance shall include
coverage for owned, hired and non -owned automobiles.
C. Worker's Compensation Insurance. In accordance with the provisions of Section
3700 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.
d. 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 by the City.
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.
iv. Where the amounts or coverage provided by the certificates of insurance
provides coverage greater than those listed by this Agreement, the amounts
provided by the certificates of insurance shall be incorporated by reference
into the Agreement.
V. Consultant shall supply City with a fully executed additional insured
endorsement.
e. I£ 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 affect
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.
INDEMNIFICATION
Consultant agrees to defend, and shall indemnify and hold harmless the City, its officers,
agents, employees, contractors, 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 death, and claims for property damage, which may arise from the
negligent operations of the Consultant, its subcontractors, agents, employees, or other persons
acting on its behalf which relates to the services described in section 1 of this Agreement; and (2)
from any claim that personal injury, damages, just compensation, restitution, judicial or equitable
relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and
hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial
Page 3 of 8
or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in
this Section or by reason of the terms of, or effects, arising from this Agreement. The Consultant
further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including
fees and costs for special counsel to be selected by the City, regarding any action by a third party
challenging the validity of this Agreement, or asserting that personal injury, damages, just
compensation, restitution, judicial or equitable relief due to personal or property rights arises by
reason of the terms of, or effects arising from this Agreement. City may make all reasonable
decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing,
to the extent Consultant's services are subject to Civil Code Section 2782.8, the above indemnity
shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of,
pertain to, or relate to the negligence, recklessness, or willful misconduct of the Consultant.
8. INTELLECTUAL PROPERTY INDEMNIFICATION
Consultant shall defend and indemnify the City, its officers, agents, representatives, and
employees against any and all liability, including costs, for infringement of any United States'
letters patent, trademark, or copyright infringement, including costs, contained in the work product
or documents provided by Consultant to the City pursuant to this Agreement.
Consultant shall keep records and invoices in connection with the work to be performed
under this Agreement. Consultant shall maintain complete and accurate records with respect to
the costs incurred under this Agreement and any services, expenditures, and disbursements
charged to the City for a minimum period of three (3) years, or for any longer period required by
law, from the date of final payment to Consultant under this Agreement. All such records and
invoices shall be clearly identifiable. Consultant shall allow a representative of the City to
examine, audit, and make transcripts or copies of such records and any other documents created
pursuant to this Agreement during regular business hours. Consultant shall allow inspection of all
work, data, documents, proceedings, and activities related to this Agreement for a period of three
(3) years from the date of final payment to Consultant under this Agreement.
10. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Consultant 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
Consultant disclosed in a publicly available source; (e) is in rightful possession of the Consultant
without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e)
Page 4 of 8
is independently developed by the Consultant without reference to information disclosed by the
City.
11. 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.
12. 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.
13. 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 or 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 is not embodied herein.
14. 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.
15. 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. As a condition of such payment, the Executive Director may require Consultant to
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deliver to the City all work product(s) 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.
16. WAIVER
No waiver of breach, failure of any condition, or any right or remedy contained in or
granted by the provisions of this Agreement shall be effective unless it is in writing and signed by
the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or
remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not
similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies.
17. JURISDICTION - VENUE
This Agreement has been executed and delivered in the State of California and the validity,
interpretation, performance, and enforcement of any of the clauses of this Agreement shall be
determined and governed by 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.
18. 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 its inability to obtain or maintain such permits, licenses, approvals, waivers, and
exemptions. Said inability shall be cause for termination of this Agreement.
19. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature herein below has the
power, authority and right to bind their respective parties to each of the terms 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.
20. 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
Page 6 of 8
first class or certified mail, postage prepaid, or sent by fax 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
Fax: 714- 647-6956
With courtesy copies to:
Chief of Police
City of Santa Ana
20 Civic Center Plaza (M-97)
P.O. Box 1988
Santa Ana, California 92702
Fax: 714-245-8007
To Consultant:
Josef Levy, President
Embassy Consulting Services, LLC
11278 Los Alamitos Blvd. #232
Los Alamitos, CA 90720
A party may change its address by giving notice in writing to the other party. Thereafter,
any communication shall be addressed and transmitted to the new address. If sent by mail,
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 fax, 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.
[signature page to follow]
Page 7 of 8
N-2018-192
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first
above written.
ATTEST:
izar
Council
APPROVED AS TO FOAM:
SONIA R. CARVALHO
City Attorney
Tamara Bogosian
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
avid—Vaten to
Chief of Police
CITY OF SANTA ANA
r6mgr'�-
Raut Godinex IT
City Manager
CONSULTANT:
gev
nt
Page 8 of 8
EXHIBIT A
SCOPE OF SERVICES
EXHIBIT A
N-2018-192
EMBASSY CONSULTING SERVICES, LLC
1 1278 Los ALAMITOS BLVD. #232
Los ALAMITOS. CA 90720
1 i
I
�1 ,J
a,
EMWAssYCONSULTING SEgVICE4
CREATING SAFE COMMUNITIES
AGREEMENT TO PERFORM CONSULTING SERVICES FOR
This Program Agreement is entered into by and between Contractor, Embassy Consulting Services, LLC
and the Client, Santa Ana Police Department and is subject to the terms and conditions specified below.
SCOPE OF WORK
Embassy Consulting Services, LLC will provide Santa Ana Police Department with the following:
Month I.-
8-hour training block covering the following topics:
• Leadership
o Ethical Leadership
o Situational Leadership
• Ethical decision making
Total Fee - $2,550.00
Month 2:
4-hour training block covering the following topics:
• Supervisory pitfalls
• Effective communication
Total Fee - $1,275,00
Pragrm Ayevvent far S ajil aAnn Police Department
Month 3:
4-hour training block covering the following topics:
• Employee conflict resolution
• Creating cohesion within a team
Total Fee - $1,275.00
Month 10:
(In-house Instructors/Possibly with inclusion of Embassy Consulting)
4-hour training block. This will consist of a training program wrap-up. It will serve as an opportunity
to pose questions and have a facilitated discussion regarding the topics addressed and real -world
incidents that may have arisen during the training program.
Total Fee - $1,275.00
DATE OF PROGRAM DELIVERY
Embassy Consulting Services, LLC will deliver these trainings on:
■ Dates and times to be decided on by both parties
CONTRACTOR RESPONSIBILITIES
Embassy Consulting Services, LLC will provide one trained facilitator to provide the services outlined in
this agreement.
CLIENT RESPONSIBILITIES
• Santa Ana Police Department will provide a location and training room that can comfortably allow
appropriate teaching/seating configurations.
■ Santa Ana Police Department will notify Embassy Consulting Services, LLC immediately of any
changes (dates, scheduling, participant attendance, etc.).
■ Santa Ana Police Department will be responsible forLCD projector/screen, and making any
handouts that will be provided to the participants during the program by Embassy Consulting
Services, LLC.
Pingwn Agreement for S'aataAna Police Department
A Rpm CERTIFICATE OF LIABILITY INSURANCE
° (..-.o
19
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
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(ies) must 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 lieu of such endorsement(s).
PRODUCER
NAME: Lirette Garcia
SHED Insurance Services, Inc.
"Ea Ext: (562)439-9731 FAX WC. Na; 156a1439-4453
E-MAI lg
SS: azcia@hmbd. Does,ADDRE
3633 East Broadway, Suite 200
AFFORDING COVERAGE
NAIC p
--INSURER(S)
INSURERA: Scottsdale Insurance Company
41297
Long Beach CA 90803-6035
INSURED
INSURERB:SiSCOX Insurance Company
10200
INSURER C:
Embassy Consulting Services, LLC
4221 Avenida Madrid
INSURER°:
INSURER E
INSURER F:
Cypress CA 90630
COVERAGES CERTIFICATE NUMBER:IM-le GL L PL REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 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
LTR
rypE OF INSURANCE
ADDL
SD
SUER
WVD
POUCYNUMBER
POLICYEFF
MMMR
POUCYEXP
MMMDIYYYY
LIMITS
X
COMMERCIAL GENERALLUU$IUDY
EACH OCCURRENCE
$ 1,000,000
A
CLAIMS -MADE OCCUR
PREMISES Ea occu�eno9
S 50,000
MED EXP (Arty one pemonl
$ 5,000
CPS3083862
10/7/2019
10/7/2019
PERSONAL BADV INJURY
S 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERALAGGREGATE
S 2,000,000
X POLICY ECTT LOC.
PRODUCTS-COMPIOP AGO
$ 1,000,000
$
OTHER'
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY (Par accident)
$
NON -OWNED
HIREDAUTCS AUTOS
PROPERTY DAMAGE
Per aaatlent
$
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
$
AGGREGATE
S
EXCESS DAB
CLAIMS -MADE
OED I I RETENTION $
$
WORKERS COMPENSATION
PER OTH-
ANDEMPLOYERS 'LIASIUW YIN
STATUTE Eft
E.L. EACH ACCIDENT
$
ANYPROPRIETORIPARTNERIEXECUTIVE
OFFICERIMEMBER EXCLUDED? ❑
NIA
E.L. DISEASE -EAEMPLOVEE
$
(Mandatory in NHl
If yea, deacnoe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -POLICY LIMIT
$
B
Profesaional Liability
MPL169985718
9/20/2010
9/20/2019
$1.000.1)(1) Each Claim
Claima-Made Form
Ratro Date: 3/25/16
$1,000,000 Aggregate
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addiflonal Remarks Schedule, may be Atached if more space is manned)
General liability includes blanket additional insureds when required by written contract, agreement or
permit per attached endorsement - GLS-150s (7-06). City of Santa Ana, its officers, Employees, agents,
End representatives.
CERTIFICATE HOLDER CANCELLATION
I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Santa Ana Illl THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
20 Civic Center Plaza ACCORDANCE WITH THE POUCY PROVISIONS.
Santa Ana, CA 92701
AUTHORIZED REPRESENTATIVE
Semaan/GOWENS -
n 19RA_9n1A annpn r.ORPORATUIN All rinhlc r c.—.H
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
INS025 pot wi)
/JOCi�t� Co/v/=OP�hs T4 ffl�/��Fh4�/ L%��#2ffF
A SCOTTSDALE INSURANCE COMPANY"
ENDORSEMENT
NO.
ATTACHED TO AND
ENDORSEMENT EFFECTIVE DATE
FORMING A PART OF
POLICY NUMBER
(12:01 A.M. STANDARD TIME)
NAMED INSURED
AGENT NO.
CPS3083862
10/07/2018
Embassy Consulting Services, LLC
04040
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BLANKET ADDITIONAL INSURED ENDORSEMENT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
With respect to this endorsement, SECTION II - WHO IS
AN INSURED is amended to include as an additional in-
sured any person or organization whom you are required
to add as an additional insured on this policy under a writ-
ten contract, written agreement or written permit which
must be:
a. Currently in effect or becoming effective during
the term of the policy; and
b. Executed prior to the "bodily injury," "property
damage," or "personal and advertising injury."
The insurance provided to these additional insureds is lim-
ited as follows:
1. That person or organization is an additional in-
sured only with respect to liability for "bodily
injury," "property damage" or "personal and adver-
tising injury" caused, in whole or in part, by:
a. Your acts or omissions; or
b. The acts or omissions of those acting on your
behalf.
A person's or organization's status as an additional
insured under this endorsement ends when
your operations for that additional insured are
completed.
2. With respect to the insurance afforded to these ad-
ditional insureds, the following exclusions are
added to item 2. Exclusions of SECTION I -
COVERAGES:
This insurance does not apply to "bodily injury,"
"property damage" or "personal and advertising in-
jury" occurring after:
a. All work, including materials, parts or equip-
ment furnished in connection with such work,
on the project (other than service, mainte-
nance or repairs) to be performed by or on be-
half of the additional insured(s) at the location
of the covered operations has been com-
pleted; or
b. That portion of "your work" out of which the in-
jury or damage arises has been put to its in-
tended use by any person or organization
other than another contractor or subcontractor
engaged in performing operations for a princi-
pal as a part of the same project.
3. The limits of insurance applicable to the additional
insured are those specified in the written contract,
written agreement or written permit or in the Decla-
rations for this policy, whichever is less. These lim-
its of insurance are inclusive of, and not in addition
to, the Limits of Insurance shown in the Declara-
tions for this policy.
4. Coverage is not provided for "bodily injury," "prop-
erty damage," or "personal and advertising injury"
arising out of the sole negligence of the additional
insured.
5. The insurance provided to the additional insured
does not apply to "bodily injury," "property dam-
age," or "personal and advertising injury" arising
out of an architect's, engineer's or surveyor's ren-
dering of or failure to render any professional serv-
ices including:
Includes copyrighted material of ISO Properties, Inc., with its permission.
Copyright, ISO Properties, Inc., 2004
GLS-150s (7-06) Pagel of 2
INSURED
a. The preparing, approving or failing to prepare
or approve maps, shop drawings, opinions, re-
ports, surveys, field orders, change orders or
drawings and specifications; and
b. Supervisory, inspection, architectural or engi-
neering activities.
6. Any coverage provided hereunder will be excess
over any other valid and collectible insurance avail-
able to the additional insured whether primary, ex-
cess, contingent or on any other basis unless a
written contract specifically requires that this insur-
ance be primary.
When this insurance is excess, we will have no du-
ty under SECTION I - COVERAGES to defend the
additional insured against any "suit" if any other in-
surer has a duty to defend the additional insured
against that "suit" If no other insurer defends, we
will undertake to do so, but we will be entitled to
the additional insured's rights against all those oth-
er insurers.
AUTHORIZED REPRESENTATIVE DATE
Includes copyrighted material of ISO Properties, Inc., with its permission.
Copyright, ISO Properties, Inc., 2004
GLS-150s (7-06) Page 2 of 2
t),(64 mi
WORKERS' COMPENSATION DECLARATION
I Josef Levy, President hereby affirm under penalty of perjury, the
(Name/Tide)
following declaration:
Embassy Consulting Services, LLC
I certify on behalf of that during the term of my
Leadership and r8 ininCO1"°anY Name)
contract for P 9 services with the City of Santa Ana, I will
not employ any person in any manner so as to become subject to the workers
compensation laws of California, and agree that if I should become subject to the
workers' compensation provisions of Section 3700 of the Labor Code, l shall forthwith
comply with those provisions and provide proof of workers' compensation coverage.
DATE: 10/24/2018
a Josef Levy
Name:
Title President
Telephone:
562-577-5874
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS
UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN
ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR
IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES.
ACSC 10/24/2018 12:04:23 PM PAGE 2/007 Fax Server
Automobile Club of Southern California
P.O. Sax 25001, Santa Ana CA 92722.5001
AAA.com
(877)422-2100
August 5, 2018
LEVY, JOSEF AND GAMSOA-LEVY, LYSA
4221 AVENIDA MADRID
CYPRESS CA 90630.3405
MODIFIED AUTO INSURANCE RENEWAL
Policy Number: CAA 073298668
Thank you for your membership with the Auto Club and for your continued business. A ohange was
recently made to your policy that modifies your upcoming renewal. Please replace the renewal
declarations previously sent to you with the enclosed updated renewal declarations.
This change may have also affected the amount of your Policyholder Savings Dividend since
dividend amounts are calculated using your current policy premium. Now that your polloy has been
revised, your Policyholder Savings Dlvldend amount Is $456. This amount has already been
applied to your renewal premium and may or may not be different from the amount originally
Indicated on your renewal offer. Please refer to the reverse of this letter for your most current
Policyholder Savings Dividend Statement.
Please note that any additional premium or premium credit resulting from the recent change to your
policy (Including any adjustment to your Policyholder Savings Dlvldend amount) will be evenly
distributed among the remaining premium payment installments. If you have already paid your
premium in full you will either:
be billed separately for any additional premium, or
receive a refund check for any credit due.
ff you have not yet paid your renewal premium, please pay at least the minimum amount
shown an your previous billing statement.
If you have any questions, please contact a Policy Service Representative at 1-877.422.2100,
weekdays from 7:00 a.m. to 9:00 p.m. or Saturday from a:00 a.m. to 5:00 p.m. We appreciate your
business and are pleased to continue assisting you with your Insurance needs.
Sincerely,
e 4. /
Katrina Bradley
Vice President
Member Service Center
Call (577) 422-2100 Click AAA.com/myeocount to access your Visitor call your local Auto Club branch
pollcy and pay your bill online AAA.com/branches
E�3'di9" InaLm.,ve provided to quaMad Auto Club members by the lntI &change of the Autamab6a Club.
��OC /C c% ('4!✓�/Jf�� Tel �f"��/'��1 E�iLJir L��" `� - �f 1 yY�
ACSC 10/24/2018 12:04:23 PM PAGE 3/007 Fax Server
AUTO POLICY NUMBER: CAA 073208088
POLICYHOLDER SAVINGS DIVIDEND STATEMENT
We are pleased to announce that our auto poIIoyhclders wlII once agal n receive money back through
the payment of a POLICYHOLDER SAVINGS DIVIDEND.
While auto dividends are not guaranteed, qualifying auto policyholders have received a Policyholder
Savings Dividend in each year since 1990 and now you have the opportunity to get money backjust for
insuring your car with us.
For years our auto policyholders have enjoyed the benefit of quality Insurance, caring customer service,
great discounts and also the opportunity to receive money back through a Policyholder Savings
Dividend. Not all Insurance companies can say that. Giving money back to our auto policyholders
through dividends Is another way we're always with you.
The amount of the Policyholder Savings Dividend that you will receive upon completion of your current
policy period is displayed below, Your dividend amount is based on your current policy premium. Since
dividends are paid at the end of your current policy term, the good news is we have applied your
dividend to your renewal premium to reduce your premium balance and your minimum due. This
means less money coming out of your pocket to renew your policy.
roue
I
YOUR POLICYHOLDER SAVINGS DIVIDEND THIS YEAR SAYINCIS
Policyholder Savings Dividend Amount: $486
Dividend applied to renewal premium for auto policy period: 06.23.18 to 08.23.19
YOUR POLICYHOLDER SAVINGS DIVIDEND HISTORY
Total savings received from dividends within the last five years: $1,591
Call (877) 422-2100 I Click AAA.com/myaccount to aoceasyour Visitor call your local Auto Club bremoh
policy and pay your bill online AAA.com/branches
Insurance provided b quaMW Auto Club members by the inferinsurence Exchenpe or the Automabffe Club.
ACSC
10/24/2018 12:04:23 PM PAGE 4/007 Fax Server
E]
Interinsurance Exchange of the Automobile Club
Automobile Insurance Policy Coverages and Limits
Modified Renewal Declarations
We are pleased to offer you a renewal for your automobile insurance policy. To renew your policy, send at least the minimum payment on or
before the due date Insurance is in effect only for the vehicles, coverages, and limits of liabilityshown on this declarations page and as Bet forth
In the Insurance pollcy and endorsements. These declaratlans, together with the contract and the endorsements In sffaot complete your policy If
any change to your policy or to the Informatlon we have on flle results Ina premlum decrease during the pollcy perlod, the Interinsurance
Exchange reserves the right to apply any refund due to your outstanding balance.
LEVY, JOSEF AND (3AMBOA-LEVY, LYSA
4221 AVENIDA MADRID
CYPRESS CA 90530-3405
YeMIOLee
POLICY EFFECTIVE DATE:
POLICY EXPIRATION DATE;
TIME)
08.23.18 ' 2:01 A, M
08.23.12 '2:01 A
VEH.
NO.YEAR
MAKE MODEL
IDENTIFICATION
NUMBER
VEHICLE
USE
GARAGE
ZIP CODE
ANNUAL••
MILES
VERIFIED
MILEAGE
SALVAGE
4
2011
MAZD 3170JRING
JM18LIVF08100105S
PLEASURE
9083C
17,501 • 20,000
VERIFIED
NO
7
2007
HOND CIVIC HYBRID
JHVFA38237600428$
COMMUTE
9003C
4,5C1. 5,500
VERIFIED
NO
8
2000
LEX5 RX 330
JTJOA31 Ue50053482
COMMUTE
9053C
10,001 • 12,500
VERIFIED
NO
COVERAGES AND LIMITS ANNUAL PREMIUMS
Coverage In not In anecl unless a premlum or the word "Included" Is shown.
COVERAGES
LIMITS OF LIABILITY
Vehicle 4
Vehicle 7
Vehicle a Vehicle Vehicle
Lladlflty
Bodily Injury
$1,000,000 ✓9aoh person/ $1,000,000%soh occurrence
i $ 354
$ Al
I $ 333 1 1
Property Damage
81,000,000 obac7 occurrence
$ 226
$ 598
$ 228
Medical
$
$is
$18
s18
PhyslaefDamage(Actuwouhvousunosoomentlnalled,lIdodiadble)
Vehlcle 4
Vehicle 7
VaNds a VePocle VeNcle
Comp'e ahrelve
ACV
ACV
ACV
'Lou Deductible)
$500
9500
$500 I
Colllelon
ACV
No Coverage
ACV
(Leas Deductible)
S500
No Coverage
$500
Car Rental Expense
Bodily Injury- $100,000 aeon person! $300.000 each scoldait
UnlneLred a Underinsured Vehlcles
Unlreurad DeductlDlo Weyer
Unireured Cdlieion
PREMIUM DISCOUNTS
$50
sea
i
$53
$ 482
No Coverage'
I
8 30E
850
iNo Coverage:
$41
silo
$97
Sol
Included
:No Coverage!
Included
$ 1290
Tease refer to the erolosed document entitled "Premium Discounts Appled to Your Automobl',e Polley
• If at any time you choose to pay lase than the full balance outstanding,
finance charges of up to 1.6°% per month of the balance outstanding will apply
as explalned In your billing statements, which are part of these deelaratlane.
" To sea the annual mileage for your expiring pollcy, planes refer to the
"Notice of Annual Mileage" page contained In your renewal package.
$1821 8 1002
"No Coverage" Indlcates coverage not purchased.
Total Annual Premlum" $ 4003
(Includes all appllcabie dlscounls.)
Lass Pollcyholder Savings Dividend $ 468
Not Pramlum" 3637
PROCESS DATE 08.04.18 PLEASE ATTACH TO YOUR POLICY
���DC /Gr� IONFr�2�i_S' �� �t=E�1�✓� �i���1�Y�
(son REVERSE)
ACSC 10/24/2018 12:04:23 PM PAGE 5/007 Fax Server
Interinsurance Exchange of the Automobile Club
Automobile Insurance Policy Coverages and Limits
Modified Renewal Declarations (continued)
2 GAMBOALEVY, LYSA FEMALE MARRIED 1978
3 LEVY. NATHAN -IXCLUDID" MALE SINGLE 2015
4 LEVY, NOAH MALE SINGLE 2017
5 LEVY, ADAM J - EXCLUDED" MALE SINGLE 2010
" IMPORTANT: NO COVERAGE 18 PROVIDED BY THIS POLICY WHILE ANY VEHICLE 19 BEING OPERATED BY AN EXCLUDED DRIVER. PLEASE
READ THE"EXCLUSION OR DESIGNATED PERSON ENDORSEMENT' AOREEMENIT PREVIOUSLY RROVID[D TO YOU. IEndorsarnam No. 2184
DRIVING RECORD
DRIVER NUMBER OF TRAFFIC CONVICTICNB RATED
NUMBER PRINCIPALLY DRIVER STATUS VEHICLE
AT-FAULTACCIDENTe Mauna aaaxviaI Ma.inx I•nnv ni.".u"innie NUMBER
■NDORSWI EMS AND CERTIFICATES
NUMBER T TITLE
2011 MEMBERS AUTOMOBILE POLICY— POLICY NUMBER CHANGE
2052 LOSS PAYABLE - NOTICE TO LIENHOLDER
2161 ADDL INSURED NOTICE • DRIVER
2184 EXCLU&ION OF DESIGNATED PERSON
2296 SELECTION OF UMIUIM COVERAGE ENDORSEMENT
2387 AMENDATORY ENDORSEMENT
PRIMARY
PRIMARY
EXCLUDED
PRIMARY
EXCLUDED
SPICIALSQUIPMENT""
I SOUND NQUIPMENT""
VEH.
NO.
CAMPER!
VAN CONV.
rnREa
2.WAY TELE.
RADIO FHCNE
Maio
a 1211
4
7
8
'Cover"a le Indloated by a"YES" In the appropriate equipment
odumn. Owerape limitations appry unless camragewee
purchased spedfledlyfor cxtaln equipment,
ANY PHYSICAL DAMAGE LOSS MAY BE MADE PAYABLE TOYOUANDANY INTEREST LISTEDIROW:
LONG BEACH CITY EFOU
PO BOX 1787
LONG BEACH CA 80601
PERSON 048IONATID TO RECEIVE NONPAYMENT OF PREMIUM NOTION:
An Ind vidwel deafgnafed by a pallcyncdd@r M recelve nolks of Lpae, termtnegad
expiration, nonlerawal, or oance'Iallol or Hie Panay mr nonpaym m Of Omnum
doss not nays any dgrRa, whaMar as an addhldnsl Inaumd or alhahVMq to any
OanMMa under In* Panay, Other Mon Ina right to MONW Am".
WN =10 Click AAA,comlmyaeeount to access your pelley Information online, pay your bill or
print additional proof of insurance cards
a,(, 4-- %`fv
ACSC 10/24/2018 12:04:23 PM PAGE 6/007 Fax Server
Interinsurance Exchange of the Automobile Club
Premium Discounts Applied to Your Automobile Policy
Auto Policy Number: CAA 07328863B
The following automobile premium discounts are available from the Interinsurance Exchange. Ir you meet the discount
requirements, an "X" will appear in the box next to the discount name and you will receive a premium reduction on all
coverages that qualify for the discount,
®
MULTbFOLICY
HOMEOWNERS
®
MULTI-VIIIIIIHICLE
®
SELECT PROFESSIONALS 6 OROUPa
®
LOYALTY
❑
DRIVING COURSE
❑
MATURN DRIVIR
❑
aTUDENTAWAY
®
GOOD STUDINT
LEVY, NOAH
®
GOOD DRIVER
LEVY, JOSr7
®
VERIFlED MILEAGE
2011 MAZE) 31 TOURING
2005 LEXS Rx 330
OAMBOALEVY, LYBA
2007 HOND CIVIC HYBRID
If you need additional information about any of the above discounts, please refer to the Available Automobile Premium
Discounts Insert Included with your renewal offer (or the Insert provided with your application). If you have additional
questions about premium discounts or your auto policy, please call us at 1-877-422-2100.
sae
R. oa„
ACSC 10/24/2018 12:04:23 PM PAGE 7/007 Fax Server
0 Interinsurance Exchange of the Automobile Club
Policy Number CAA 073298668
NOTICE OF ANNUAL MILEAGE
Pursuant to seotlon 2632.6 (o) of the Cellfornla Insurance Cade of Regulatlons, we are provIdIng you with the annual
mileage figures for your vehlcle(s).
Vehlole
No.
Vehicle
Year
Vehicle
Make
Vehicle
Identification No.
Annual Miles
Expiring Policy
4
2011 MAID JM1 BL1 VF9B1901058
20,001 .26,000
7
2D07
HCND
JHMFA36237SO04283
001 • 1,600
B 2005
LEXS
J7JOA31U650053482
7.601 - 10.000
5217
Ed. 00.2008
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