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HomeMy WebLinkAboutWATERWISEPRO TRAININGINSURANCE NOT ON FILE N-2019-137 WORK MAY NOT PROCUREEMENT TO PROVIDE WATER TREATMENT CLERK OF COUNCIL AND DISTRIBUTION TRAINING COURSES DATE; 6t0Z 9 0 9AV AW4-1� THIS AGREEMENT is made and entered into this 16th day of July, 2019 by and between WaterWisePro Training ("Contractor'), and the City of Santa Ana, a charter city and municipal corporation organized and y7 existing under the Constitution and laws of the State of California ("City"). RECITALS A. The City desires to retain a contractor to provide an on -site water distribution and treatment training courses. B. Contractor represents that it is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Contractor represents that it 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 contracting 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 shall furnish the services that are described in Exhibit A to this Agreement. 2. COMPENSATION a. City agrees to pay, and Contractor agrees to accept as total payment for its services, the rates and charges identified in Exhibit A. The total sum to be expended under this Agreement shall not exceed $25,000. b. Payment by City shall be made within thirty (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work that fails to meet the standards ofperformance set forth in the Recitals which may reasonably be expected by City. 3. 'tERM This Agreement shall commence on the date stated above and continue through July 15, 2020, unless terminated earlier in accordance with Section 13, below. The exact date(s) of the course shall be scheduled to occur during the term of the Agreement by mutual agreement by the parties. 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 perfomas 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. 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, 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, volunteers 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. Workers' Compensation Insurance. In accordance with the California Labor Code, Contractor, if Contractor has any employees, is required to be insured against liability for workers' 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 famished 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) Contractor shall supply City with a fatly executed additional insured endorsement. f. 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 terminate this Agreement. Such termination she not affect Contractor's right to be paid for its time and materials expended prior to notification 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. 6. INDEMNIFICATION Contractor agrees to and shall indemnify, defend, and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligence or willfirl misconduct of the Contractor or its, subcontractors, agents, employees, or other persons acting on their 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 clahms 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. Contractor's indemnification obligations in this section shall survive expiration of this Agreement. 7. 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. 8. 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 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. 9. 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 mamrer with the performance of services specified under this Agreement. 10. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in the mariner 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, CA92702-1988 Fax 714- 647-6956 With courtesy copies to: To Contractor: Executive Director Public Works Agency City of Santa Ana 20 Civic Center Plaza Santa Ana, CA 92702 WaterWisePro Training P.O. Box 772 Watsonville, CA 95077 Attn: Steve Hernandez 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. 11. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Contractor regarding the subject matter therein, 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 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 are not embodied herein. 12. 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 consultants retained by City. 13, TERMINATION This Agreement may be terminated by the City upon seven (7) 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 Contractorprior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, City may require Contractor to deliver to the City all work product completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Contractor consents to the City's use thereof for such purposes as the City deems appropriate. Payment need not be made for work that fails to meet the standard of performance specified in the Recitals of this Agreement. 14. NONDISCRIMINATION 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 or in connection with any activities under this Agreement. Contractor affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 15. JURISDICTION - VENUE This Agreement 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. 16. PROFESSIONAL LICENSES Contractor shall, throughout the tern 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 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. 17. 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 attomey's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: Daisy Gomez Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By:. JohnIvFunk Assistant City Attorney FOR APPROVAL: Fuad S. Sweiss,' E, PLS, Executive Director Public Works AuAncv CITY OF SANTA ANA Kristine Ridge City Manager CONTRACTOR: Name: Steve Hernandez Title: Instructor EXHIBIT A WWP WaterWisePro Training LLC June 23, 2019 Attn: Kathie Reyes / Rudy Rosas City of Santa Ana, Water Resources Division 220 S. Daisy Ave., Santa Ana, Ca 92703 Re: Request to Renew Contract Agreement for Water Professionals Training We humbly thank you for the interest in our program and the positive relationship we have created with your staff throughout the completed courses in the 2018-19 contract. WaterWisePro Training LLC courses have been under much demand and the 2019 schedule is filling up. We feel that the City of Santa Ana staff has grown tremendously throughout the 2018-19 courses by the level of engagement and demonstration of their knowledge that we have evaluated. The operators in our ever-growing industry are constantly faced with new challenges and by training, encouraging, and educating staff continuously, only then will you raise the level of professionalism, efficiency and skill -set of your Team. We have raised our priced by 50% for all other agencies, but we would like to continue our contract agreement with the City of Santa Ana in the 2019-20 year at the same price as 2018-19 contract with a two-day course option. Based on previous discussions, we are open to changing the focus of our courses to better fit the needs of City of Santa Ana Staff and to continue to provide value for the future growth of your organization. The following scope of work and proposal is for the requested (4) CaSWRCB Exam Prep Courses (2- Distribution and 2 Treatment) OR (2) 2-Day courses for both Distribution & Treatment. WaterWisePro Training LLC will provide an onsite operator training for City of Santa Ana Staff at the City facility on TBD dates. Courses provided will benefit both, employees preparing for the California SWRCB Water Distribution Exams Grades 1-5 and Water Treatment Exams Grades 1-4 as well as those that are in need of 8 approved SWRCB contact -hours for Certification renewal. Courses Include: Each class is exclusive to City of Santa Ana employees. • 1-day/ 8hr. Water Distribution Refresher Course for September 14'h, 2019 Exam o (40) 60-page WWP Distribution Study Guides for CaSWRCB Grades 1-5 0 8-contact hour certificate for SWRCB credit for all attendee o Lunch and refreshments for the day for all attendees • 1-day/ 8hr. Water Treatment Refresher Course for November 2nd 2019 Exam o (40) 60-page WWP Study Guides for CaSWRCB Grades 1-4 0 8-contact hour certificate for SWRCB credit for all attendee EXHIBIT A 1-day/8hr. Water Distribution Refresher Course forTBD Sorina of2020 0 60-page WWP Distribution Study Guides for CaSWRCB Grades 1-5 0 8-contact hour certificate for SWRCB credit for all attendee o Lunch and refreshments for the day for all attendees 1-day/ 8hr. Water Treatment Refresher Course for TBD Summer of 2020 0 60-page WWP Study Guides for CaSWRCB Grades 1.4 0 8-contact hour certificate for SWRCB credit for all attendee o Lunch and refreshments for the day for all attendee OR... 2-Day Option, with a more in-depth review of SWRCB Exam material. This option will be based on the needs of Staff to better prepare them for their upcoming exams. • 2-day/ 16hr. Water Distribution or Treatment Refresher Course 0 80-page WWP Study Guides for CaSWRCB Grades 1-5 0 16-contact hour certificate for SWRCB credit for all attendee o Lunch and refreshments for the day for all attendees • 2-day/ 16hr. Water Distribution or Treatment Refresher Course 0 80-page WWP Study Guides for CaSWRCB Grades 1.6 0 16-contact hour certificate for SWRCB credit for all attendee o Lunch and refreshments for the day for all attendees Cost of Services: WaterWisePro Training would like to facilitate operator training: for staff before each State exam (4- times per year) with the option of one- or two-day courses. The cost of services for professional water operator training Is based on the number of employees attending course: o 40+ attendees = $150/attendeeAhr. day o 30 attendees (max.)"— $185/attendee/8hr. day o 20 attendees (max.) _ $225/attendee/8hr. day • There is No charge for travel • Pricing is 50% lower than comparable competitors and still provides more services • Rprridimpni.gprirAe,Thrn,mA,,,i -_,_ Please note that our cost for other agencies is $225/person and the average cost for this level of training is anywhere from $175 - $400/person for an 8hr, course but does not include: exclusive onsite training, travel expenses and/or lunch. If there are any questions or concerns about the above scope of work, please contact us, Thank you again for this training opportunity and the consideration of our services, we look forward to continuing the positive relationship with you and your staff. Sincerely, Steve Hernandez WaterWisePro Training (831)750-9113 WaterWisePro angmail.com ALA o® CERTIFICATE OF LIABILITY INSURANCE DATE(MmmorfYYYj 01/22/2020 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. H 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: Hiscox Inc. d/bla/ Hiscox Insurance Agency in CA PNONE (888) 202-3007 FAX _ 520 Madison Avenue �DREBy, contact@hiscox.com 32nd Floor New York, NY 10022 INSURERS AFFORDING COVERAGE time INSURERA: Hiscout Insurance Company Inc 10200 INSURED INSURER B Steven Hernandez dba Water Wise Pro 1521 Memorial Drive INSURER C INSURER D : Apt, G INSURER E Hollister, CA 95023 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 OF INSURANCE ADDLTYPE J= BURR im POLICY NUMBER MM(POLICY EFF MOO OrICY UPLIMITS x COMMERCIALGENERALLIABILITY EACHOCCURRENCE $2,000,000 CLAIM&MADE 1XI OCCUR PREMISES E. .I s 100,000 MEDEXP onsperson) s 5.000 PERSONAL S ADV INJURY s2,DD0,DD0 A N Y UDC-1955669-CGL-19 04/1812019 04/18/2020 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 32,000,000 X POLICY ECT 7 LOC PRODUCTS - COMPIOP AGO SSIT Gen. AQg $ OTHER: AUTOMOBILE COMBINED SINGLE LIMIT iES accident) $ BODILY tNJURY (Per persanf s ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Par amJden) It HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE e .donl Par B $ UMBRELLA LIAR OCCUR EACH OCCURRENCE s AGGREGATE $ EXCESS LIAR CLAIMS -MADE DIED RETENTION 5 S WORKERS COMPENSATION ANOEMPLOYERS'LASILfTY YIN PER OTH- STATUTE ER ANYPROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $ OFFICERIMEMSEREXCLUDED? MIA E.L DISEASE - EA EMPLOYE $ frbndatory In NHj If Yyaes, describe under DESCRIPTION GF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPnON OF OKE nONS I LO nONS I VEHICLES (ACORD 1a1, AddiU naL Remy s Sehedule, may be atnched K mon apace is repair ) City of Santa Ana, its officem. employees. agents, and representatives are named as additional insured. Specifically the City Water Division, who services will be given to. 30' Days Notice of Cancellation with 10 Days' Notice for Non -Payment of Premium in Accordance with The Policy Provisions. Such Insurance as is afforded by the policy shall be primary, an d any insurance tamed by City shall be excess and noncontributory. CERTIFICATE HOLDER CANCELLATION CITY OF SANTA ANA RISK MANAGEMENT D I ION 4T FLO 20 CIVIC CENTER PLAZA RE( b AROVED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE SANTA ANA CA 92702 By ISk N4GEMENT DIVISION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. �J O2U'U AUTHORI2EDREPRESENTATIVE yY. © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD GEICO GEICO INDEMNITY COMPANY Washington DC VERIFICATION OF COVERAGE (SEE BELOW UNDER CAUTIONARY NOTE) MAILING ADDRESS Policy Number: 4188065843 ROSANA LOMELI AND STEVEN J Effective Date: 08-23-19 HERNANDEZ Expiration Date: 02-20-20 1521 MEMORIAL DR APT C Registered State: CALIFORNIA HOLLISTER CA 95023-5778 To whom it may concem: This letter is to verify that we have issued coverage under the above policy number for the dates indicated in the effective and expiration date fields for the vehicle listed. This should serve as proof that the below mentioned vehicle meets or exceeds the financial responsibility requirement for your state. This verification of coverage does not amend, extend or alter the coverage afforded by this policy Vehicle Year: 2019 Make: FORD Model: F-150 VIN: 1 FTFW 1 E49KKE 15903 COVERAGES Bodily Injury Liability Each Person/Each Occurrence State Minimum $15,000/$30,000 Property Damage Liability State Minimum $5,000 Uninsured & Undednsured Motorists Each Penton/Each Occurrence Comprehensive Collision Emergency Road Service Rental Reimbursement Mechanical Breakdown X Lienholder UNKNOWN Additional Information: Issued 12/18/2019 LIMITS DEDUCTIBLES $1MIL/$1MIL $25,000 $15,000/$30,000 Full $50 Per Day / $1.500 Max Additional Insured Interested Party $250 Ded $500 Ded/Waiver $250 Ded &AV ;� ',r 30 ; -;') If you have any additional questions, please call 1-800-841-3000. CAUTIONARY NOTE: THE CURRENT COVERAGES, LIMITS, AND DEDUCTIBLES MAY DIFFER FROM THE COVERAGES, LIMITS AND DEDUCTIBLES IN EFFECT AT OTHER TIMES DURING THE POLICY PERIOD. THIS VERIFICATION OF COVERAGE REFLECTS THE COVERAGES, LIMITS, AND DEDUCTIBLES AS OF THE ISSUED DATE OF THIS DOCUMENT WHICH IS SHOWN UNDER "ADDITIONAL INFORMATION" OR IF AN ISSUED DATE IS NOT SHOWN, THE DATE OF THIS FACSIMILE. U-33 10-07 WORKERS' COMPENSATION DECLARATION I Steve r+ornana.x. InsWdor hereby affum under penalty of perjury, the (NemeRitle) following declaration: I certify on behalf of WaterWiseProTraining — that during the term of my (Con nUComFwny Name) contract for WaterUeatment and diatr butltraining on t ain ng 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, I shall forthwith comply with those provisions and provide proof of workers' compensation coverage. DATE: 1 Z 101 By: Name: �— Steve Hemand Title: Instructor Telephone: 831, 75D — qll 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 (S100,000). E ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. & APPROVED w.vMENT DjV1510N 0 2020 M. LAMBERT Lambert, Samantha From: Lambert, Samantha Sent: Wednesday, January 22, 2020 4:57 PM To: RM D Subject: FW: Request for COI Review: WaterWisePro Training (re -submittal) Attachments: scan0021.pdf; 4188065843.Pdf; 1955669_CGL_Acord25_1 200122124726952.pdf Samantha M. Lambert I Risk Management Supervisor Human Resources 120 Civic Center Plaza I Santa Ana, CA 92701 714-647-6959 1 slambertCoDsanta-ana.ora http://www.santa-ana.org/ This e-mail (and attachments, if any) maybe subject to the California Public Records Act and as such, may, therefore, be subject to public disclosure unless otherwise exempt under the Act. From: Reyes, Kathia Sent: Wednesday, January 22, 2020 4:53 PM To: Lambert, Samantha <SLambert@santa-ana.org> Subject: Request for C01 Review: WaterWisePro Training (re -submittal) Hi Samantha, As requested vendor has resubmitted COI with verbiage (see attachment). Regarding professional services insurance this contractor is providing us with classroom training services for water distribution and treatment material, which is specified in contract. He cannot provide Water Resources Division with engineering services, legal services or architectural services. Thank you, Kathia Reyes Water Resources Division Ext. 3319/M-85 From: Lambert, Samantha <SLambert@santa-ana.ore> Sent: Monday, January 6, 2020 2:05 PM To: Reyes, Kathia <KReyes2@santa-ana.ore> Cc: Beckett, Denise <DBeckett@santa-ana.ora> Subject: FW: Request for COI Review: WaterWisePro Training Hi Kathia,