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HomeMy WebLinkAboutSOLOMON, STEPHENINSURANCE. NOT ON FILE N-2019-049 1NORK MAY N PROCE.FD CLERK OF COUNCIL. DATE: ViM s s Z019 AGREEMENT WITH STEPHEN SOLOMON TO ®' 19;,N Vt PROVIDE ADMINISTRATIVE HEARING SERVICES StSS1Gw d'1+.r✓bo2a, THIS AGREEMENT is made and entered into on this 13Tn day of February, 2019 by and between Stephen H. Solomon, ("Contractor"), 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 Contractor having special skill and knowledge in the field of arbitration and mediation to provide professional administrative hearing services. B. Contractor represents that he is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Contractor represents that he is knowledgeable in its field and that any services performed by Contractor 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 Contractor will provide professional Administrative Hearing services for the City of Santa Ana Community Preservation Department and Public Works Department, as set forth in Exhibit A, attached hereto and incorporated herein by this reference. Such hearings may include Vehicle Abatement, Administrative Citation Appeals, and Alternative Public Nuisance Abatement. Administrative Hearing officer services may be utilized by other agencies with the City of Santa Ana. 2. COMPENSATION a, City agrees to pay, and Contractor 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 during the term of this Agreement shall not exceed $20,000. b. The parties agree that services were provided by the Contractor after the expiration of Agreement 9N-2014-130 and the commencement of this Agreement. City agrees to pay Contractor for services rendered during the period between August 25, 2018 until the commencement date for this Agreement. Copies of outstanding invoices provided by the Contractor are attached as Exhibit B to this Agreement. Contractor shall have 90 days from the commencement date to provide the City with any remaining outstanding invoices for services rendered by the Contractor during the gap in Agreements between the parties. Any outstanding invoices received by the City for work performed during the gap in services from the Contractor, after this 90 day period, will not be paid. Page i of 8 c. Payment by City shall be made within forty-five (45) 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 and continue for a two (2) year term until February 12, 2021, with the option for the City to grant a one (1) year renewal, exercisable by a writing executed by both parties, including the City Manager and the City Attorney, unless terminated earlier in accordance with Section 15, below. 4. INDEPENDENT CONTRACTOR Contractor 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 Contractor performs the services which are the subject matter of this Agreement; however, the services to be provided by Contractor shall be provided in a manner consistent with all applicable standards and regulations governing such services. Contractor 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 Contractor under this Agreement ("Documents & Data"). Contractor 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. Contractor represents and warrants that Contractor has the legal right to license any and all Documents & Data. Contractor makes no such representation and warranty in regard to Documents & Data which were provided to Contractor 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, Contractor shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Contractor shall maintain commercial general liability insurance naming the City, its officers, employees, agents, Page 2 of 8 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 Contractor'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. 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, Contractor, if Contractor 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, Contractor agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. d. If Contractor is or employs a licensed professional such as an architect or engineer: Professional liability (errors and omissions) insurance, with a combined single limit of not less than $1,000,000 per claim with $2,000,000 in the aggregate. e. The following requirements apply to the insurance to be provided by Contractor pursuant to this section: i. Contractor 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. Contractor shall supply City with a fully executed additional insured endorsement. If Contractor 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 Contractor's right to be paid for its time and materials expended prior to notification Page 3 of 8 of termination. Contractor 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 Contractor 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 Contractor, 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 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 Contractor 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 Contractor'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 Contractor. 8. INTELLECTUAL PROPERTY INDEMNIFICATION Contractor 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 Contractor to the City pursuant to this Agreement. 9. RECORDS Contractor shall keep records and invoices in connection with the work to be performed under this Agreement. Contractor 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 Contractor under this Agreement. All such records and invoices shall be clearly identifiable. Contractor 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. Contractor 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 Contractor under this Agreement. Page 4 of 8 10. CONFIDENTIALITY If Contractor receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Contractor 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 Contractor disclosed in a publicly available source; (c) is in rightful possession of the Contractor without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Contractor without reference to information disclosed by the City. 11. CONFLICT OF INTEREST CLAUSE Contractor 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. NON-DISCRIMINATION Contractor 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. Contractor 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 Contractor, 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 Contractor. 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 Contractor 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. Page 5 of 8 14. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Contractor, Contractor 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 Contractors retained by City. 15. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Contractor shall be entitled to receive and the City shall pay Contractor compensation for all services performed by Contractor 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 Contractor to 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 Contractor 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. 10NEW"AL WWI 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 Contractor 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. Contractor shall notify the City immediately and Page 6 of 8 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. 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 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: Executive Director, Planning and Building Agency City of Santa Ana 20 Civic Center Plaza (M-21) P.O. Box 1988 Santa Ana, California 92702 Fax:714-647-5897 To Contractor: Stephen H. Solomon 17853 Santiago Blvd. #107-188 Villa Park, CA 92861 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. 20. 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 Page 7 of 8 this Agreement, and shall indemnify City filly, including reasonable costs and attcxney'S foes, fur any injuricS or damages to City in the event that such authority or power is not, in filet, field by the signatory or is withdrawn. h. All Exhibits referenced herein and attached hereto shall lie incorporated as if fully set Furth in the body of this Agreement. IN WITNESS WHEREOF, the parties hereto have cxwRed this Agreement the date and year first above written. 4 VI �Y dONorma Mitre A\\ Acting Clerk of tire Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attonxcy Lisa Storck Assisttmt City Attorney RECOMMENDED FOR APPROVAL: Minh Thai Executive Director Planning and Building Agency C ITY OF SANTA ANA Steven M ntdwa Acting City Manager CONTRACTOR: Stephen H. Solomon Page 8 of 8 EXHIBIT A SCOPE OF SERVICES and COMPENSATION EXHIBIT A SCOPE OF SERVICES BACKGROUND In order to provide effective and expeditious hearings to individuals cited for violations of the Santa Ana Municipal Code (SAMC), the City would like to develop a list of Hearing Officers to conduct Administrative Hearings. The selected Hearing Officers will be assigned cases on a rotating, as -needed basis. The Hearing Officer will conduct Administrative Hearings for the City of Santa Ana. Primarily, the Hearing Officer will hear administrative citation appeals, alternative nuisance abatement proceedings and vehicle abatement proceedings associated with action of the City's Planning and Building agency. The Hearing Officer may also be asked to provide administrative hearings for other City Agencies (i.e. Public Works Agency). The Hearing Officer will be charged with making a just determination as to whether a municipal code was violated, whether the property owner is still in violation, and will also make determinations as to whether the process for the abatement of a nuisance, including inoperative vehicles, will move forward. Hearings will be held in accordance with the City of Santa Ana Municipal Code (Chapter 2 Sections 1-21 through 1-21.8, Chapter 16 Section 119, Chapter 17 Sections 17-108 and 135). GENERAL INFORMATION It is the intent of the City to establish a list of qualified Hearing Officers. The actual number of hearing officers utilized will depend on the total number of qualified candidates established by the proposal process, and the number of hearings required. A. When appropriate, the City will provide forms and information in its possession relevant to the conduct of a fair hearing, including, but not limited to, Notices of Violation, Administrative Citations, and Vehicle Abatement Notices. B. The Hearing Officer shall be responsible for the review of documents provided by the City prior to the hearing. C. All documents and other products used or developed during preparation for a hearing will become the property of the City. D. The Hearing Officer shall preside over the City's Administrative Hearings. The Hearing Officer will be required to independently evaluate the facts of each case and make a determination as to the merits of that case based upon the information presented at the hearing and the Santa Ana Municipal Code. The Hearing Officer must be experienced and knowledgeable in administrative hearing procedures. The Hearing Officer shall be responsive and maintain excellent working relationships with property owners, residents, business representatives, and City staff. The Hearing Officer's service will include preparation of finding of facts, hearing dispositions, billing statements, and other documents as necessary. JOB REQUIREMENTS FOR ADMINISTRATIVE HEARING OFFICERS The selected consultant shall meet the following expectations and/or provide the following services: A. The Hearing Officer must be independent and impartial. In this regard, a hearing officer may not: 1. Be an employee of the City of Santa Ana or any public agency that is involved in testifying at a hearing; 2. Be a member of any board or commission of the City of Santa Ana; 3. Have a personal or professional interest that would conflict with his/her objectivity in the hearing. B. All hearings will be conducted at Santa Ana City Hall, at dates and times to be determined by the City. C. A hearing officer must possess the necessary support and equipment to perform his/her duties as a hearing officer including telephone, computer, internet and e- mail access. D. A hearing officer must possess standards of neutrality and confidentiality. E. A hearing officer must organize and maintain individual case files along with detailed records of activity on each case, such as research, drafting of orders, decisions and correspondence. F. A hearing officer must comply with all legal and contractual timelines, including, but not limited to: 1. Rendering a final written decision, including findings of fact disposing of all issues raised by the parties in a hearing not later than 10-days after the date of the hearing; 2. Mailing the final written decision to the appellant, with a copy to the City, on the date the decision is rendered; 3. Returning individual case files to the City within 30-days of rendering a final decision. The files, which must be organized and maintained by the hearing officer are the property of the City and must be maintained in accordance with the Agency's record retention schedule. It is therefore imperative that the files are returned to the Agency within 30- days of the date of the final decision. 4. Upon notification that the agency has received a request for a document pursuant to the Public Information Act, the relevant document must be provided to the City immediately. G. The hearing officer shall prepare and submit to the Planning and Building Agency a standard invoice detailing the activities and expenses by case. Payment for services and reimbursement of expenses by the City to the hearing officer are further conditioned upon: 1. The reasonableness of the amount of time spent by the hearing officer - - on - the case(s) for which the hearing officer is seeking payment/reimbursement, 2. The hearing officer's timely submission of reasonable and acceptable documentation supporting all expenses being claimed by the hearing officer; and 3. The hearing officer's prompt return to the City of all file materials relating to closed cases; H. Providing hearing officer services to other clients is not barred so long as the hearing officer does not decline the request for hearing services more than two consecutive times; specifically, the hearing offer must: 1. Maintain the ability to respond to requests for hearings and prehearing motions within 24-hours; 2. Meet all applicable time lines; and 3. Demonstrate that such outside practice does not conflict with contractual work with the City of Santa Ana. 4. Comply with the decision format requirements set by the City pursuant to the rules governing a hearing officer's decision as per the SAMC (Chapter 2 Sections 1-21 through 1-21.8, Chapter 16 Section 119, Chapter 17 Sections 17-108 and 135). The decisions of the hearing officer must include formal findings of fact, and meet in all respects the minimum requirements applicable to the decisions of executive agencies conducting contested cases. 5. There is no guarantee as to the number of cases that will be assigned to a hearing officer. The City anticipates that it will establish a list of qualified hearing officers and assign hearings based on a rotation of names on the list. COMPENSATION The City agrees to pay and the applicant agrees to accept as total compensation for all services and costs, a rate of $100 per hour, to the nearest quarter hour, for all hearing officer services provided to the City. Said services include review of the materials provided by the City, holding of the hearing and providing findings and determination. The City will not pay costs associated with providing hearings including City validating parking receipts for the time that hearing officer is performing services for the City and travel time to and from the hearing site. EX$IBIT B OUTSTANDING INVOICES City of Santa Am PIannesg a BaLIding tl gency nqi-i; Max ToniaZerba P.O. Box 1980 Santa illy CA 92702 RE-: CERRMURIG Tita7nv ec tAia R!`rvAYSn{;:1ffi mi "f11Y1A FnnenY nn T[:v/3C41.+FT1 V •.ITif1 FlPgTiY16 ('.A4`i?C nri REVIEW MAMTG DISPO TOTAL TOTAL t CASE:: ,971DUSS TUVI£ THE PREPAPAT10I`1 TIME COST Please send as} meat Stove: Solomon 170053 Smtiago Blvd.0107-1300 +!iliaParlc CA 92051 urnuoJOS •H usyd7lS I d 609t-1Z6-bLL Date:, r i)- i V J1 t Below is the accoumtine of time scent on reviewing and hearing cases an CASEt< j REVIEW " ADDRESS _ 1 TIME REAM, G TIME DISPO PREPARATtO�I TOTAL TIME TOTAL COST c. 344 oW awoumt Sae: n---- Please send paymeirr Steve Solomon 17853 Santiago Blvd. 4107-198 Villa Park, CA 92851 ZA 6M_ I zFi-b 6L JOLU01ocq H UOLIdolS City of SMIta Ana 1'1aming &- Building A geacy 1Y-19 Ate: fouia Zerba P.O. Box 1988 San � rna. CA 92702 n; Fie,�7.�,?g'i�tpI+'�+'Il�IC+�€Y3ilLiLt-2�TC Below is the accattntina of time scent on roviewina and hea_dna cases on CASE P ADD.RrSS t2EVT6ii� TINE. AEARIN+G TIII -- 33° AISPO 1 PREPARATION TQTAL ME TOTAL COS 1 41-1 i7.274, W, I/Ai9i4, .23d k o4w¢ emount dtse. Please send payment: Reve Solomon 17053 ftitiago lv& #107-100 'Illla Park, CA 92061 I; tl 6994-tZ6-b1L u0u+010S .N LIOWBIS Digitally signed by Francine R. Francine R. Villareal Villareal ACOR" CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD/YYYY) �....� 02/04/21 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 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 lieu of such endorsement(s). PRODUCER CONTACT NAME: COMPLETE EQUITY MARKETS INC a/Co"N Ext: 847 541-0900 a/c No: 847 541-0444 A DRIESS: 1190 Flex Court INSURER(S) AFFORDING COVERAGE NAIC# Lake Zurich, IL 60047 INSURERA : Underwriters at Lloyd's London dba Complete Equity Markets Insurance Agency, Inc. INSURED INSURER B Stephen H. Solomon INSURER C INSURER D : 18861 Ridgewood Lane INSURER E : Villa Park, CA 92861 INSURER F : COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR TO RENTE DAMAGE SES (E. occurrDence)$ PREM 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ EXCLUDED A X 1500312 02/05/21 02/05/22 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $ 1,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Each Claim $1,000,000 A Professional Liability X 859995 06/01/20 06/01/21 Aggregate $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Subject to all policy terms, conditions, exclusions and endorsements of each respective policy. The City of Santa Ana, it's officers, employees, agents and representatives is an additional insured but only per the terms & conditions of the endorsement generated for each respective policy and subject to all policy terms, conditions, exclusions and endorsements. Primary/Non-Contributory, Waiver of Subrogation and 30 Day Notice of Cancellation applies to the General Liability policy. SURPLUS LINES NOTICE TO POLICYHOLDER - PLEASE SEE ATTACHED CERTIFICATE HOLDER CANCELLATION The City of Santa Ana Risk Management Division 20 Civic Center Plaza 4th Floor Santa Ana Ca 92701 ACORD 25 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD The ACORD name and logo are registered marks of ACORD cF RAManagmentUlMsian REVIEWED & APPROVED BY.- v --� Risk MManagement Analyst NOTICE: 1. THE INSURANCE POLICY THAT YOU HAVE PURCHASED IS BEING ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE STATE OF CALIFORNIA. THESE COMPANIES ARE CALLED "NONADMITTED" OR "SURPLUS LINE" INSURERS. 2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY REGULATION AND ENFORCEMENT THAT APPLY TO CALIFORNIA LICENSED INSURERS. 3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE, THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO MAKE PAYMENTS AS PROMISED. 4. THE INSURER SHOULD BE LICENSED EITHER AS A FOREIGN INSURER IN ANOTHER STATE IN THE UNITED STATES OR AS A NON -UNITED STATES (ALIEN) INSURER. YOU SHOULD ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER, OR "SURPLUS LINE" BROKER OR CONTACT THE CALIFORNIA DEPARTMENT OF INSURANCE AT THE FOLLOWING TOLL -FREE TELEPHONE NUMBER: 1-800-927-4357 OR INTERNET WEB SITE WWW.INSURANCE.CA.GOV. ASK WHETHER OR NOT THE INSURER IS LICENSED AS A FOREIGN OR NON -UNITED STATES (ALIEN) INSURER AND FOR ADDITIONAL INFORMATION ABOUT THE INSURER. YOU MAY ALSO CONTACT THE NAIC'S INTERNET WEB SITE AT WWW.NAIC.ORG. 5. FOREIGN INSURERS SHOULD BE LICENSED BY A STATE IN THE UNITED STATES AND YOU MAY CONTACT THAT STATE'S DEPARTMENT OF INSURANCE TO OBTAIN MORE INFORMATION ABOUT THAT INSURER. on FOR NON -UNITED STATES (ALIEN) INSURERS, THE INSURER SHOULD BE LICENSED BY A COUNTRY OUTSIDE OF THE UNITED STATES AND SHOULD BE ON THE NAIC'S INTERNATIONAL INSURERS DEPARTMENT (IID) LISTING OF APPROVED NONADMITTED NON -UNITED STATES INSURERS. ASK YOUR AGENT, BROKER OR "SURPLUS LINE" BROKER TO OBTAIN MORE INFORMATION ABOUT THAT INV TuEu cF RiskMmWmerdDMsian REVIEWED & APPROVED BY. v --� Risk janagement Analyst binders°138 m 7. CALIFORNIA MAINTAINS A LIST OF APPROVED SURPLUS LINE INSURERS. ASK YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST, OR VIEW THAT LIST AT THE INTERNET WEB SITE OF THE CALIFORNIA DEPARTMENT OF INSURANCE: WWW.INSURANCE.CA.GOV. 8. IF YOU, AS THE APPLICANT, REQUIRED THAT THE INSURANCE POLICY YOU HAVE PURCHASED BE BOUND IMMEDIATELY, EITHER BECAUSE EXISTING COVERAGE WAS GOING TO LAPSE WITHIN TWO BUSINESS DAYS OR BECAUSE YOU WERE REQUIRED TO HAVE COVERAGE WITHIN TWO BUSINESS DAYS, AND YOU DID NOT RECEIVE THIS DISCLOSURE FORM AND A REQUEST FOR YOUR SIGNATURE UNTIL AFTER COVERAGE BECAME EFFECTIVE, YOU HAVE THE RIGHT TO CANCEL THIS POLICY WITHIN FIVE DAYS OF RECEIVING THIS DISCLOSURE. IF YOU CANCEL COVERAGE, THE PREMIUM WILL BE PRORATED AND ANY BROKER'S FEE CHARGED FOR THIS INSURANCE WILL BE RETURNED TO YOU. LMA9098A 04 May 2017 D-2 (Effective January 1, 2017) Risk MmWmerdDMsiun REVIEWED & APPROVEDSY: --� RFsk Pjanagement Analyst SOLOMON AND ASSOCIATES HEARING OFFICERS January 26, 2021 City of Santa Ana Risk management Division 20 Civic Center Plaza, 4th Floor Santa Ana, CA 92702 Re: Auto Insurance Requirement Dear City of Santa Ana Risk management Division: I, _Stephen Salomon _ , have entered into an agreement with the City of Santa Ana. Throughout the course of this agreement, I attest to the following: As an independent contractor, I. will utilize my personal vehicle/non-company owned, borrowed, or rented/leased vehicle for transportation to and from work, and will carry my own automobile insurance. I, _Stephen Salomon attest that I possess the legal authority to enter into an agreement with the City of Santa Ana as well as the legal authority to attest to the statements above. If at any time, it is found that I am not adhering to any/all statements in this document and have not provided the minimum Auto liability insurance coverage of $1 million per occurrence, the contract will be considered null and void and I will be held fully liable for any and all damages. Sincerely, Stephen Solomon Solomon and Associates Hearing Officers (714) 345-9767 ssolomon408 @gmail.cam L-d Risk Mwmgemad Division REVIEWED & APPROVED BY. — Risk Management Analyst d6V Z L ` l Z Co qaj 01/20/2021 ¢ o.. Mendoza, CAVof Santa Ana� any #et me know. ew cF RAMwagementDMsian Jy/\'x REVIEWED & APPROVED BY.- V"° --� Risk Pjanagement Analyst CITY OF SANTA ANA RISK MANAGEMENT, 4 HUMAN RESOURCES Aftinaging f WORKERS' COMPENSATION DECLARATION _ I, s e, ,/ 6,,no,4/ hereby affirm under penalty of perjury, the (Name/Title) following declaration: certify on behalf of zTzflY" /I s'ol-amo4l _ that during the term (Consultant/Company Name) of my contract for wAz services with the City of Santa Ana, (Type(lf servi provided) 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, I shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately. Date: �, I Print Name: Print Title: Signature: Telephone: 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. 1: Risk Mgmtklnsurance Requirements ti WC Declaration 08152019 flRlsk Mwwg=w1 DMslon REVIEWED & NPROVED BY. i -.----� Risk ManagementAnalyV I CERTIFICATE OF LIABILITY INSURANCE I DATE JAIWD IY1'1'Y) Q4J9ER 8 THIS CERTIFICATE IS ISSUED AS A IVE.O OF INFORMATION AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THt CERTIFICATE ROES NOT TEOFINSURANCE AFFIRMATIVELY E NEGATIVELY AMCEND, C-.XTEND Ott ALTER. THE COVERJAGe FIPFORORO HY THE PULIGIE- BELOW. THIS CERTIFICATE OF INSURANCE DOTS NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPRRTANT: if the Cerliflcato holdor is an ADDITIONAL INSURED, the pOiley(IRS) must have ADDITIONAL INSURED provisions or be endorser If SUBROGATION IS WAIVED, subject to the terms and Cnndillons of the policy, certain poticles may require an endorsement A statement o this Certificate does notconfer rights to the certificate holder In Ilan of such endnrsement(s}. PRODUCER COMPLETE EQUITY MARKETS INC 1190 Flex Court Lake Zurich, IL 60047 Hhe Cmnplme F.4uitq MOrkeis m,UranCn Ayarry, Inr. INSURED Stephen H. Solomon INSURER A: INSUft4j6 j 18$61 RidgBUVood Lane I,rsnReRB � .�w -"""" VtllEtPark CA 92861 � -"""— INSURERP COVERAGF_S rconnrn rc u, ,. ft wWWVN NUMBER: THIS IS TO CERTIFY `MAT THE POLICIES OF INSURANCE USTEO BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE_ FOR THE POLICY PERIOI INDICATED, NO'TWTHSTANDING ANY REQUIREMENT, TERM OR CONDmON OF ANY CONTRACT OR OTHER CERTIFICATE MAY HE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY DOCUMENT WITH RESPECT TO WHICH TH]t THE POLICIES DESCRIBED EXCLUSIONS AND CONDITIONS OE SUCH POLICIES, LIMrIS SHOWN MAY HAVE BEEN HEREIN 15 SUBJECT TO ALL THE TERME REDUCED BY PAID INSn _�.___._._.._�_._..__ ..— ._r.—_—.__.___ �VN L UDR R TYPE GFINSURANCE POLICY NUMBBn CLAIMS. --.... _ ._...—�... O�CYLT E FF - POUCYMP CO"ERCLM. GENERAL LABILITY g,�i"r11 RlIM10DIYYYYII LIMITS CIAIMS.NADE E OCCUR EACH OCCURRENCE S '6AM"AZEYd Fl -- - 6'-' PREMISES�Ea vtturrenro)__ S I P_Sfa {Anq.mrt ,Lanonl_ is .__. ... PERSONAL b ADV INJURY S GENLAGGREGAYE WES PER: IT APPU �_ OTAPRU POLtOY JcCT El IAC aENERALAGGREGATE $ -' PROUD TS CCMPodPA6G $ O-HER: ----�_ , 8 AUrOM08LL.E LIABILITY -1 I COM9IHEU SIN LEL MIT ANYAUTO BODILYIHJURY(Pe'MMOe) 5 — _ — —!OWNED SCNECULPO AUTOS ONLY AUTOS ZIM NUTMS BOB-1YINJURY ON LY I � - tFROYeraERPYt[IIAMA'G'f' -� E UMBRELLA Me �BCCUR `EACIi UCCURRENCE 1 —_ ES EXCESS LIAe CLAIMS`E MAD E _ AGGREGATE. �_ ,y 0.I RETENTIONb `—.—"'..— ������I�0 �_�._..�_ I ' WORKERS COMPENSATION AND ETAPLQTER5 U0.91LIiV LIABILITY MFRLOYERO TIN 1 PER OTII-� T 1 $ ANY LA OFF9CERR.iL'hIBEREXdLL'UED'± ❑ NIA .ii....._I--_. E.L. E\CN ACCIDtayT` �$ (Mya�+ndatory to NHl — _---------. pf E.L,D)iSF�SE_EA EMPLDYEd,$_ nESGRIPTION CRERgT1CN5 imlaw I Professional Liability E.L. OISEgSE-PUUCY LIIr1;T Eac aim 000,000 X X ( 857634 881olmil D6totJ19 Aggregate $1,000,000 bE9CRtPTNJt1 OF DPERATION5ILOCA'r10N$ I V£RICLEa (ACaRP Yat, Addjpnnal nrnrarrs Scnadulo, miry be aMCheN R mom space is mnulretl] Subject to all policy terms, conditions, exclusions and endorsements. The City Of Santa Ana is listed as an Insured but only per the terms & Conditions of the endorsement generated and additional subject to all policy terms, Conditions, exclusions, and endorsements. CERTIFIGATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The City Of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Civic Center ACCORDANCE WnH THE POLICY PROVISIONS. 20 Civic Center Plaza Santa Ana CA 92701 AUTIfORSMD REPRESENTA71VF © 1988.2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2R76193) The ACORD name and logo are registered marks of ACORD t`d 688b-1Z6-17II uowClaSLid UeL{dOJS 1 4COR002 CERTIFICATE OF LIABILITY INSURANCE DA 61NM pDIY YY) 04130/18 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI CERTIFICATE. DOES NOT AFFIRMATIVELY OR NEGATIVELY AMGNO. ERTENO OR ALTER THE COVERAGE AFFC/RDED BY THE POLICIE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING 1NSURER(S), AUTHORIZE REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER IMPORTANT: If the cent MIO holder Is an ADDITIONAL INSURED, the pol1oy0BS) must have ADDITIONAL INSURED provisions or be endorse( If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement o this certificate does notconfer ri htsto the certificate holder in Ileu of such endorsement s). PRODUCM ------- NALE' COMPLETE EQUITY MARKETS INC "HD V 847 541-0900 FA 1190 Flex Court Ner (84�5a1-0444 Lake Zurich, IL60047 AooRF: Ube Cmnplet¢ Epuily Markets mswance Agenry, Inc.__. _... _ NraURER(GIAFFORDINGCOVERAGE - NAICN INsurtERA:.Und rwriters at Llgvd's London _ Ixsuaao Stephen H. Solomon i - — INaURDR C- WsURERD: 18861 Ridgewood Lane Villa Park CA 92861 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOI ---- ---- -- INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO-WHICH-RIII - CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, —THE—INSURANCE--AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERME - _ EXCLUSIONS A`1O CONDITIONS OF SUCH POLICIES. LIMBS SHOWN MAY RAVE BEEN REDUCED BY PAID CLAIMS. -- --- ITRR TYPE OF INSURgNCE MD 9UtlR — PODCYE,F PDLICYEIP PoUCY NUMBERMMDIWDDLIMITS COMMERt1,LL GENFRAI WIeILTr EACH OCCURRENCE I 'S CLAINSMADE OCCUR At E TE PREMSEa IE+om�negF.9.1._....' S Men EXP (Any.. pe.pnl 3 tlll — PERSCNAL 3ADV INJURY 5 GENt AGGREGATE UFAIT APPLIES PER GENERAL AGGREGATE 3 POLICY LOC PRODUYS-COMPIOPAG9 IS AUT .Y.OSILELIARIUTY COAezWm151 LEUMIT. 'S _ .. I MYAUTO BODILY INJURY IP, penonl E OWNED ILFD GODLY wTURYIPe+emvenq S 1 AIONLY I1T03 AUTOS HIREDM NOK�NED qOPERIY ruaAADE AUTOS ONLY gmOE ONCI mTOS I i S UMBRELLALIAS OCCUR EACH OCCURRENCE 'S EXCESSLIAR CLAIMS -MADE AGGREGATE S I DEO RIITENrCIN 3 $ WORKERS CDMIENN PER H ANDERILERsASILV YIN - PROPUIFJOFVI`ARRPCU.­ 1 OFVIC8RffiAEIJHER XCLUDED? NIA EL -EACH ACCIDENT f 3 IMAntlplory W NHi IfyyeGzz tlesums urger EL OISFASE_Fn EWWyE -- S DESCRIPRON' or OPERATIONSWOb I �E.L DISEASE -POLICY UMIT _ 3 Professional Liability ac aim 1,D 0,00 X X 857634 D6101/16 U6/0V1g Aggregate $1,000,000 OEGCRRTION OF CPERATIONSTLOCATIOxG/VEHICLES(ACORD1p1, Atltl'N"aAelnunaAs SCNAJWo, rybe aUappetlNmerc Spam is rpgoA¢UI Subject to all policy terms, conditions, exclusions and endorsements. The City Of Santa Ana is listed as an additional Insured but only per the terms & conditions of the endorsement generated and subject to all policy terms, conditions, exclusions, and endorsements. 7JI//1`rlfI? (nj n�- Me/ �� `V� CERTIFICATE HOLDER CANCELLATION The City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Civic Center ACCORDANCE WITH THE POUCYPROVISIONS. 20 Civic Center Plaza AUTBOPoZFD REPRESENTATIVE Santa Ana CA 92701 4� 7-PAW,�(— ©1988-2015 ACORO CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ld 6994-IZ6-tllL LIOLUOIDSHuaydeis CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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 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 lieu of such endorsement(s). PRODUCER MAUR- T COMPLETE EQUITY MARKETS INC 1190 Flex Court Lake Zurich, IL 60047 dba Complete Equity Markets Insurance Agency, Inc. INSURED Stephen H. Solomon 18861 Ridgewood Lane Villa Park. CA 92861 INSURER(S) AFFORDING COVERAGE INSURERA: Underwriters at Llovd's Londl INSURER C : INSURER E : f`f1\/CD A!_CC (-FfPTIl7Ir ATF NI IMRFR• RFVISIf7N 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. IR LTWVD LTR TYPE OF INSURANCE INSD SUER POLICY NUMBER PO DD EFF MM/D Y t:7CP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR WhWG__E O RENTED PREMISES Ea occurrence $ 50 000 MED EXP (Any one person) $ 5,000 PERSONAL BADV INJURY $ EXCLUDED A X 1500249 2/5/2019 2/5/2020 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2.000.000 PRODUCTS - COMP/OP AGG $ 1,000,000 X POLICY PE r LOC $ OTHER: AUTOMOBILE LIABILITY COM$INEA SINGLE LIMIT Ea accdent $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE Par accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DIED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY \, / N ANY PROPRIETOR/PARTNER/EXECUTIVE PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N / A E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below Each Claim $1,000,000 Professional Liability X X 857634 611/2018 6/1/2019 re Aggregate 9ate $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) See pages 2, 3 and 4 for additional information. CERTIFICATE HOLDER CANCELLATION The City of Santa Ana Civic Center 20 Civic Center Plaza Santa Ana CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) © 1988-2015 ACORD CORPORATION The ACORD name and logo are registered marks of ACORD All rights reserved. Certificate of Insurance STEPHEN H. SOLOMON Policy Number: 1500249 / 857634 Subject to all policy terms, conditions, exclusions and endorsements of each respective policy. The City of Santa Ana, it's officers, employees, agents and representative are named as additional insured but only per the terms & conditions of the endorsement generated for each respective policy and subject to all policy terms, conditions, exclusions and endorsements. Waiver of Subrogation and 30 Day Notice of Cancellation applies to the General Liability policy. *General Liability policy is contingent upon receipt of premium due. SURPLUS LINES NOTICE TO POLICYHOLDER - PLEASE SEE ATTACHED i Lawrence T.P. Molloy binders*138 3 NOTICE: 1. THE INSURANCE POLICY THAT YOU HAVE PURCHASED IS BEING ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE STATE OF CALIFORNIA. THESE COMPANIES ARE CALLED "NONADMITTED" OR "SURPLUS LINE" INSURERS. 2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY REGULATION AND ENFORCEMENT THAT APPLY TO CALIFORNIA LICENSED INSURERS. 3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE INSURANCE GUARANTEE FUNDS CREATED BY CALIFORNIA LAW. THEREFORE, THESE FUNDS WILL NOT PAY YOUR CLAIMS OR PROTECT YOUR ASSETS IF THE INSURER BECOMES INSOLVENT AND IS UNABLE TO MAKE PAYMENTS AS PROMISED. 4. THE INSURER SHOULD BE LICENSED EITHER AS A FOREIGN INSURER IN ANOTHER STATE IN THE UNITED STATES OR AS A NON -UNITED STATES (ALIEN) INSURER. YOU SHOULD ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER,. OR "SURPLUS LINE" BROKER OR CONTACT THE CALIFORNIA DEPARTMENT OF INSURANCE AT THE FOLLOWING TOLL -FREE TELEPHONE NUMBER: 1-800-927-4357 OR INTERNET WEB SITE VVWW.INSURANCE.CA.GOV. ASK WHETHER OR NOT THE INSURER IS LICENSED AS A FOREIGN OR NON -UNITED STATES (ALIEN) INSURER AND FOR ADDITIONAL INFORMATION ABOUT THE INSURER. YOU MAY ALSO CONTACT THE NAIC'S INTERNET WEB SITE AT WWW.NAIC.ORG. 5. FOREIGN INSURERS SHOULD BE LICENSED BY A STATE IN THE UNITED STATES AND YOU MAY CONTACT THAT STATE'S DEPARTMENT OF INSURANCE TO OBTAIN MORE INFORMATION ABOUT THAT INSURER. 6. FOR NON -UNITED STATES (ALIEN) INSURERS, THE INSURER SHOULD BE LICENSED BY A COUNTRY OUTSIDE OF THE UNITED STATES AND SHOULD BE ON THE NAIC'S INTERNATIONAL INSURERS DEPARTMENT QID) LISTING OF APPROVED NONADMITTED NON -UNITED STATES INSURERS. ASK YOUR AGENT, BROKER OR "SURPLUS LINE" BROKER TO OBTAIN MORE INFORMATION ABOUT THAT INSURER. binders'138 7. CALIFORNIA MAINTAINS A LIST OF APPROVED SURPLUS LINE INSURERS. ASK YOUR AGENT OR BROKER IF THE INSURER IS ON THAT LIST, OR VIEW THAT LIST AT THE INTERNET WEB SITE OF THE CALIFORNIA DEPARTMENT OF INSURANCE: WWW.INSURANCE.CA.GOV. 8. IF YOU, AS THE APPLICANT, REQUIRED THAT THE INSURANCE POLICY YOU HAVE PURCHASED BE BOUND IMMEDIATELY, EITHER BECAUSE EXISTING COVERAGE WAS GOING TO LAPSE WITHIN TWO BUSINESS DAYS OR BECAUSE YOU WERE REQUIRED TO HAVE COVERAGE WITHIN TWO BUSINESS DAYS, AND YOU DID NOT RECEIVE THIS DISCLOSURE FORM AND A REQUEST FOR YOUR SIGNATURE UNTIL AFTER COVERAGE BECAME EFFECTIVE, YOU HAVE THE RIGHT TO CANCEL THIS POLICY WITHIN FIVE DAYS OF RECEIVING THIS DISCLOSURE. IF YOU CANCEL COVERAGE, THE PREMIUM WILL BE PRORATED AND ANY BROKER'S FEE CHARGED FOR THIS INSURANCE WILL BE RETURNED TO YOU. LMA9098A 04 May 2017 D-2 (Effective January 1, 2017) binders'138 Evidence of Insurance Policy Number: 18553-66-95 Policy Edition: 1 st Effective: 6/28/2016 12:01 AM Expiration: Continuous until cancelled Expiration Time: 12:01 AM Insured: Stephen Solomon Cynthia V Lavadia 17853 Santiago Blvd # 107-188 Villa Park, CA92861-41 13 Vehicle Information Year 2016 Coverages Coverage Type Make Model GmcTruck Yukon 4D 4X2 Denali Bodily Injury Liability Property Damage Liability Permissive User Limit of Liability Medical Coverage Uninsured Motorist Bodily Injury Comprehensive Limit/Deductible $500,000 each person $1,000,000 each accident $100,000 each accident Full (See Permissive User Limit of Liability in your policy) $5,000 each person $250,000 each person $500,000 each accident $100 Deductible itVA FARMERS INSURANCE Underwritten By: Mid -Century Insurance Company 6301 Owensmouth Ave. Woodland Hills, CA91367 YourAgent: EmberjoyStites PO Box 61644 Irvine, CA92602-6054 (949) 588-0204 FAX: (949) 266-9191 estites@farmersagent.com VIN 1 G KS 1 CKJXG R261059 Coverage Type Limit/Deductible Collision $250 Deductible .................................................................................................................... Additional Equipment ..................................................................................................................... $1,000 Uninsured Motorist Property Damage With Collision ..................................................................................................................... Covered Towing and Road Service ..................................................................................................................... Covered Other Covered This evidence is subject to all of the terms, conditions and limitations set forth in the policy and endorsements attached to it. It is furnished as a matter of information only and does not change, modify or extend the policy in anyway. It supersedes all previously issued certificates. farmers.com 25-8976 9-13 Page 1 of 2 Evidence of Insurance (continued) Loss payable provisions (Applicable only if lienholder is named, and no other Automobile loss payable endorsement is attached to the policy) It is agreed that any payment for loss or damage to the vehicle The lienholder shall do whatever is necessary to secure such described in this policy shall be made on the following basis: rights. No subrogation shall impair the right of the lienholder to 1. At our option, loss or damage shall be paid as interest may recover the full amount of its claim. appear to the policyholder and the lienholder shown in the We reserve the right to cancel this policy at anytime as provided Declarations, or by repair of the damaged vehicle. by its terms. In case of cancellation or lapse we will notify the 2. Any act or neglect of the policyholder or a person acting on lienholder at the address shown in the Declarations. We will give his behalf shall not void the coverage afforded to the the lienholder advance notice of not less than 10 days from the lienholder. effective date of such cancellation or lapse as respects his 3. Change in title or ownership of the vehicle, or error in its description shall notvoid coverage afforded to the lienholder. The policy does not cover conversion, embezzlement or secretion of the vehicle bythe policyholder or anyone acting in his behalf while in possession under a contract with the lienholder. A payment may be made to the lienholder which we would not have been obligated to make except for these terms. In such event, we are entitled to all the rights of the lienholder to the extent of such payment. Authorized Representative farmers.com interest. Mailing notice to the loss payee is sufficient to effect cancellation. The following applies as respects any loss adjusted with the mortgagee interest only: 1. Any deductible applicable to Comprehensive Coverage shall not exceed $250. 2. Any deductible applicable to Collision Coverage shall not exceed $250. 3/21/2019 Date 25-8976 9-13 Page 2 of 2