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HomeMy WebLinkAboutRANESES, MICHAEL-N-2020-091INSLI ,NCE NOT ON FILE N-2020-091 WORK MAY.NOT PROCEED CLERK OF COUNCIL DATE: ©#U N� Yw` gtit 16, L d f AGREEMENT WITH MICHAEL RANESES TO PROVIDE ADMINISTRATIVE HEARING SERVICESW THIS AGREEMENT is made and entered into on this 22nd day of April 2020 by and between Michael Raneses ("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 on -call professional administrative hearing services for the City. B. Contractor represents that Contractor 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 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 provide on -call administrative hearing services at the direction of the Executive Director of the Planning and Building Agency. Contractor 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 on -call administrative hearing services. 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 $10,000. b. 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 for a 2-year term with the Page 1 of 8 #19793v1 option for the City to grant a one 1-year renewal term, exercisable by a writing by 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, 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, Page 2 of 8 #19793vl 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 l ype text I' 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 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. Page 3 of 8 #19793v1 7. 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 I 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. 10. CONFIDENTIALITY If Contractor receives from the City information which due to the nature of such Page 4 of 8 #19793vl 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, gender identity, gender expression, gender, medical conditions, genetic information, or military and veteran status, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, termination or other employment related activities or any services provided 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. 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. 14. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Contractor, Page 5 of 8 #19793vl 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. 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 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 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. Page 6 of 8 #19793vl 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 & Building Agency City of Santa Ana 20 Civic Center Plaza (M-19) P.O. Box 1988 Santa Ana, California 92702 Fax: (714) 647-5897 To Contractor: Michael Raneses 2409 Miramonte Court Tustin, CA 92782 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 Page 7 of 8 #19793vl 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. The Agreement is the final and complete agreement and any prior or contemporaneous agreements between the parties is superseded by this Agreement. C. 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 Y APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: Lisa E. Storck Assistant City Attorney RECOMMENDED FOR APPROVAL: h Minh Thai Executive Director Planning & Building Agency CITY OF SANTA ANA Kristine Ridge 01 City Manager CONTRACTOR: Michael Raneses Page 8 of 8 #19793vl Michael Raneses 2409 Miramonte Court, Tustin, CA 92782 — 714,287.4999 - mikeraneses@gmail.com March 30, 2020 Alvaro Nunez Code Enforcement Supervisor City of Santa Ana Planning and Building Agency 20 Civic Center Plaza Santa Ana, CA 92701 Dear Mr. Nunez, 1 am submitting the following information for your consideration of my continuing as a Hearing Officer for your agency. Experience Please see enclosed resume Scope of Work Provision of a full range of Administrative Hearing services in accordance with the Santa Ana Municipal Code. Availability I am available to serve as a Hearing Officer a minimum of one day monthly. Fee Schedule I request a fee of $100 per hour for any time spent in case preparation and research, conducting hearings, and for preparation of necessary reports following hearings. Term of Contract I will commit to serve as a Hearing Officer for a term of one year, renewable yearly. Mr. Nunez, I appreciate your considering my application. I look forward to continuing to serve as a Hearing Officer for the City of Santa Ana. Siw Mike Re " ses Michael Raneses 2409 Miramonte Court • Tustin, CA 92782 (714) 287-4999 — MikeRaneses@gmail.com Objective To serve as a Hearing Officer for City of Santa Ana Code Enforcement Executive Summary 45 years employed in criminal justice profession 24 years criminal justice teaching experience. Former pastor with extensive counseling experience Retired military officer (Lieutenant Colonel, US Army Reserve) Master of Public Administration (MPA) Bachelor of Arts (BA), Criminal Justice Administration Professional Experience Parole Agent III, CA Department of Corrections (1987-2011) Training Officer, Office of Training & Professional Development Regional Training Coordinator Management Training Program Instructor Parole Agent Academy Instructor Investigator, Office of Civil Rights Employee Relations Officer Internal Affairs Investigator Parole Unit Supervisor Deputy Probation Officer, OC Probation Department (1982-1987) Supervision of adult offenders on probation Assoc. Pastor, Faith Community Church, Santa Ana, CA (1980-1982) Counseling, teaching, church ministry Deputy Sheriff & Sergeant, LA County Sheriff's Dept. (1967-1979) Performance and supervision of a wide variety of law enforcement functions: patrol, intelligence, internal affairs, custody, civil, recruitment, pre -employment investigation Teaching Experience University of Phoenix (January 2006 — Present) Organizational Behavior and Management Criminal Justice Ethics Santiago Community College (January 2016 - Present) Criminal Justice Ethics California Dept. of Corrections & Rehabilitation (1992-2010) Lead Instructor: California Public Safety Leadership & Ethics Program Parole Agent Academy Instructor — various subjects California State University, Fullerton (Sept. 2003-Feb. 2004) Introduction to Corrections Everest College (Sept 2001-Sept 2003) Introduction to Corrections Education Master of Public Administration (2001) CSU Fullerton, CA Bachelor of Arts, Criminal Justice (1995) CSU Fullerton, CA Family and Activities Proud husband of Ruth; blessed with six children, thirteen grandchildren, and six great grandchildren Christian Ministry: Elder. Leader of Home Fellowship and Marriage Ministries Director, Corrections Staff Fellowship, Inc. References Provided on request ACII CERTIFICATE OF LIABILITY INSURANCE 111 DATE(MM/ODnYYY) 01 /27/2020 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. If SUBROGATION IS WAIVED, subject to the terns 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/b/a/ Hiscox Insurance Agency in CA 520 Madison Avenue Floor PNC, No ExIl' (888) 202-3007 pA/C No : I. EMAIL ADDRESS: contact@hiscox.com INSURERS AFFORDING COVERAGE NAICH New York, NY 10022 INSURER A: Hiscox Insurance Company Inc 10200 INSURED MICHAEL RANESES INSURER B: 2409 MIRA MONTE CT INSURER C INSURER D TUSTIN, CA 92782 INSURER E : 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 SUER POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR Y UDC-2163525-CGL-20 02/01/2020 02/01/2021 EACHOCCURRENCE $ 1,000,000 DAMAGE TORENTED PREMISES Esoccummes $ 100,000 GEN'L X MEMO EXP (My one elsan) $ 5,000 PERSONAL S ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT ❑ LOC OTHER: GENERALAGGREGATE $2,000,000 PRODUCTS - COMP/OP AGO s S/r Gen. Agg $ AUTOMOBILE 1 LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Es accident $ BODILY INJURY(Per person) $ BODILY INJURY Per accitlent ( ) $ PROPERTY DAMAGE Per accident $ Is UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACHOCCURRENCE $ AGGREGATE $ DID RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE OFFICEWMEMBEREXCLUDEDP (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA I PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) 20 Civic Center PI Santa Ana, CA 92701 RT- a15k MpNpC1EMc,�• - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE gY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN n r]9 ryt ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD The ACORD name and logo are registered marks of ACORD reserved. 11643052 Michael Raneses Certificate Of Insurance 2/6/2020 4:12:59 PM A O® CERTIFICATE OF LIABILITY INSURANCE DATE/61202IYYVY) 2/s/2ozo 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 WANED, 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 endorsements . PRODUCER viinsureon Insureon (BIN Insurance Holdings LLC.) 30 N. LaSalle, 25th Floor, Chicago, IL 60602 CONTACT NAME: PHONE EA ACNo (800)301-6256 AIC No, 877-826-9067 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC N INSURER A : ACE Fire Underwriters Insurance Company 20702 INSURED INSURER B INSURER C Michael Raneses INSURER D 2409 Miramonle Ct, Tustin, CA, 92782 INSURER E NSURER 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 TRIN. TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/OI OYftYYY EFF Y EXP MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR OAMA E RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL &ADV INJURY $ AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ GEN'L PRODUCTS - COMP/OP AGO $ POLICY JECT LOC $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ H AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION PER OERH AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE E.L. EACH ACCIDENT $ E.L DISEASE -EA EMPLOYE $ OFFICERIMEMBER EXCLUDED? ❑NIA (Mandatory in NH) EL.DISEASE- POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below A Professional Liability(Eecrs and Omissions) EONCAF155700032 2/6/2020 216I2021 OccurrencelAggregate $1.000,000/$1,000,000 DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) The City of Santa Ana is named as Additional Insured as their interests may appear in regards to Errors and Omissions coverage. REVIEWED & AP►'K ... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE The Cityof Santa Ana y Risk ANAGEMENT DIVISION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN B M ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Drive Santa Ana, CA 92701 3 ORIZED REPRESENTATIVE ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD WORKERS' COMPENSATION DECLARATION I IeIC144% e4AIde56S hereby affirm under penalty of perjury, the (Namefrille) following declaration I certify on behalf of that during the term of my (CenauhanbCump:my Name) contract for fs18l t!:�6/c6ci 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: S'36 -o�"Ja M Name: �/�r 4454-- e•9itA� Title: lwl cpe-,G/L'eyl Telephone: ;?/y. o?g). el?9f90 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. ZIP Wk «�' %%A ADDL INFO ON NEXT PAGE MAIL MCH-M-1 UNITED SERVICES AUTOMOBILE ASSOCIATION RENEWAL OF (ARRVROCALINrERNSURANCEExCHANGE) Slate 08 09 tm f�11C,1' I�A.,Nffii USAW 9800Fredericksburg Road - San Antonio, Texas 78288 00186 66 18U 7101 0 CA 93 93 k�i CALIFORNIA AUTO POLICY PCL)CYPE39KD. (12:01 A.M. standard time) RENEWAL DECLARATIONS EFFECTIVE MAR 20 2020 TO SEP 20 2020 OPERATORS 01 MICHAEL EUGENE RANESES ATTACH TO PREVIOU POLICY Named Insured and Address 03 RUTH L RANESES MICHAEL EUGENE RANESES LTC USA RET 2409 MIRA MONTE CT TUSTIN CA 92782-9000 escnp on o e c e s V91USE* �ffi TRADE NAME M"]J� �DYTYPEAN NUAL IDBJTIRCAT10NNUNBER sw N 08 06 TOYOTA jHILNDR 4D 4D 10000 JTEDD21A760154136 P 09 17 TOYOTA HIGHLANDER 4D 12100 5TDKZRFH9HS524448 B the Vehicle(s) described herein is principally garaged at the above address unless otherwise stated. " wr—waa dmi VEH 08 TUSTIN CA 92782-9000 VEH 09 TUSTIN CA 92782-9000 Is otic � rove es thosecoveragesWhere a premium Is shown 0 ow- a limits shown diced by may e r policy provisions and may ,not be combined regardless of the number of vehicles for which a remium is listed unless s eclficall authorized elsewhere in this ofic . VEH VEH VEH VEH COVERAGES LIMITS OF LIABILITY 08 6-MONTH 09 6-MONTH ("ACV" MEANS ACTUAL CASH VALUE) D=DED PREMIUM D=DED I PREMIUM D=DED PREMIUM D=DED PREMIUM MOUNT $ AMOUNT S AMOUNT 5 MOUNT ?ART A - LIABILITY BODILY INJURY EA PER $ 100,00 EA ACC $ 300,000 91.29 156.51 PROPERTY DAMAGE EA ACC $ 100,000 100.77 159.65 ?ART B - MEDICAL PAYMENTS EA PER $ 2,000 6.31 9.55 ?ART C - UNINSURED MOTORISTS BODILY INJURY EA PER $ 100,00 EA ACC $ 300,OOC 34.76 48.45 ?ART D - PHYSICAL DAMAGE COVERAGE COMPREHENSIVE LOSS ACV LESS D 5C 27.19D 50 67.36 COLLISION LOSS ACV LESS D 50 141.20D 50 470.12 TOWING AND LABOR 6.94 6.94 TOTAL PRE IUM SEE FO LOWI G PAGE(S) kDDITIONAL INTEREST - EMPLOYER REVIEWED APP OVED RE RE CBE CITY OF SANTA ANA, OFFICER, SANTA ANA, CA VIE MANAGEMENT DIVISION ADDITIONAL INTEREST - EMPLOYER CBE CITY COSTA MESA OFFICERS,, COSTA MESA, CA ENDORSEMENTS: ADDED 03-20-20 - NONE ?EMAIN IN EFFECT(REFER TO PREVIOUS POLICY)- A073(05) RSGPCW( EXCLUSION OF NAMED DRIVER 5100CA(02) INFORMATION FORMS: NIPFCA(05) 320CA(05) CADS(05) 40CA(01) 13580(03) 999CA 19 1081 RMF50 00 9 RMM58 00 „ In WITNE WHERE , the ubscnberS at UNITED bLHVICES AUTUMUdILL A CCIA I ION have caused these presents to be signed by their Attorney -in -Fact on this date FEBRUARY 12, 2020 Laura Bishop President, USAA Reciprocal Attorney -in -Fact, Inc. 5000 U 07-11 53461-07.11 Michael Raneses 2409 Miramonte Court, Tustin, CA 92782 • 714.287.4999 • mikeraneses@gmail.com May 20, 2020 City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana, CA 92701 Hello, Here is my response to the various issues raised concerning my insurance coverage as a Hearing Officer for the City of Santa Ana: Automobile Liability Insurance Amount of Coverage When we were negotiating my initial contract with the City, I was informed by Sona Mooradian that the City Attorney agreed with my position that the requirement for $1,000,000 of auto liability insurance was excessive because I do not use my vehicle in the routine course of employment as a Hearing Officer. Since that time, I have been operating with the current level of insurance as indicated on the policy I submitted. Considering the amount of work that I receive from the City as Hearing Officer, it is not cost effective for me to pay the increased premium that a $1,000,000 policy would require. Scope of Coverage As indicated on the policy submitted, my USAA auto insurance covers the two vehicles own. I do not drive non -owned vehicles or hire vehicles. Required Language and Certificate Holder Information According to USAA, their policy templates will not fit the full verbiage that you are requesting, nor the complete agency address. Cancellation Policy According to USAA, policies are not cancelled before 60 days for nonpayment of premiums. That said, their cancellation policy is not specifically stated in the policy language. I have sent you a Third -Party Insurance Notification Notice that you can complete and send to USAA if you like. Professional Liability Insurance According to the following language, Professional Liability Insurance is not required: `7f the consultanUcontractor is not going to hire a professional, the consultant must state so on business letterhead with date and signature and submit for consideration." I have not hired, nor do I intend to hire a professional. Best Regards, M.E. Ra*x-,� Michael Raneses Hearing Officer Digitally signed by Francine R. Francine R. Villareal Villareal ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/11 /2021 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 Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA 5 Concourse Parkway Suite 2150 CONTACT NAME: PHONE 888202-3007 FAX A/C No Ext : ( ) A/C No): SS: contact@hiscox.com -ADDRESS: Atlanta GA, 30328 INSURER(S) AFFORDING COVERAGE NAIC# INSURERA: Hiscox Insurance Company Inc 10200 INSURED MICHAEL RANESES INSURER B 2409 MIRA MONTE CT INSURER 7 INSURER D TUSTIN CA 92782 INSURER E 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 SUBR NUMBER POLICPOLICY MM/DDY EFF MM/ DY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 FIVI CLAIMS -MADE OCCUR A AGE RENTED PREM SESOE. occurrence) ccurrrence $ 100,000 MED EXP (Any one person) $ 5,000 X Primary & Non Contributory PERSONAL & ADV INJURY $ 0 A Y UDC-2163525-CGL-21 02/01 /2021 02/01 /2022 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICYEl JECT LOC X PRODUCTS - COMP/OP AGG $ S/T Gen. Agg. $ OTHER: AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT 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 LAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANYPROPRIETOR/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 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) The City of Santa Ana, It's Officers, Officials, Employees, and volunteers are to be covered as additional insured s on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the contractor. including materials parts or equipment furnished in connection with such work or operations for any claims relating to this contract the contractors insurance coverage shall be primary and non contributory coverage as to respects of the entity It's Officers, Officials, Employees, and volunteers. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Risk Management Division SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20 Civic Center Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Santa Ana, CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �„oRaNc - RAMwagementDMsian _3, z REVIEWED & APPROVED BY: @ 1988-2015 ACORD C ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Risk Management Analyst 11 tfm HISCOX Policy Number: Named Insured: Endorsement Number: Endorsement Effective: UDC-2163525-CG L-21 MICHAEL RANESES 19 October 11, 2021 Hiscox Insurance Company Inc. III IR24ki11101*14IT, l4ki111111111191:/_10M4:1IN1:1aell1WM"A_1RIA0:F_111111 111111a_1N41111111111M ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons Or Organization(s) The City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana,CA 92702 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 © ISO Properties, Inc., 2004 �oRaN } z RAMwaganadDMsiun REVIEWED & APPROVED BY.- f R. V;&wd Risk Management Analyst +Aew HISCOX Policy Number: UDC-2163525-CGL-21 Named Insured: MICHAEL RANESES Endorsement Number: 18 Endorsement Effective: September 20, 2021 Hiscox Insurance Company Inc. III:IRIQIBiel : *1WiIQkIN:/_101104:1IN1:1a971111111[wiIIIIIIIIIIJ11IIIIIIA_1RIA0:F_1I1k1111111ey_1N41111111111M PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy, pro- vided: 1. you have agreed in a written contract or agreement to add such additional insured to a policy providing the type of coverage af- forded by this policy; and 2. you have agreed in a written contract or agreement with such additional insured that this insurance would be primary and would not seek contribution from any other insur- ance available to the additional insured. CGL E5581 CW (03/16) Includes copyrighted material of Insurance Services Office, Inc., with its permission �oRaN } z RiskMwagemedDMsfan REVIEWED & APPROVED BY.- f R. V;d Risk Management Analyst nO H I SOX Hiscox Insurance Company Inc. ECONOMIC AND TRADE SANCTIONS POLICYHOLDER NOTICE Hiscox is committed to complying with the U.S. Department of Treasury Office of Foreign Assets Control (OFAC) requirements. OFAC administers and enforces economic sanctions policy based on Presidential declarations of national emergency. OFAC has identified and listed numerous foreign agents, front organizations, terrorists, and narcotics traffickers as Specially Designated Nationals (SDN's) and Blocked Persons. OFAC has also identified Sanctioned Countries. A list of Specially Designated Nationals, Blocked Persons and Sanctioned Countries may be found on the United States Treasury's web site httr)://www.treas.clov/offices/enforcement/ofac/. Economic sanctions prohibit all United States citizens (including corporations and other entities) and permanent resident aliens from engaging in transactions with Specially Designated Nationals, Blocked Persons and Sanctioned Countries. Hiscox may not accept premium from or issue a policy to insure property of or make a claim payment to a Specially Designated National or Blocked Person. Hiscox may not engage in business transactions with a Sanctioned Country. A Specially Designated National or Blocked Person is any person who is determined as such by the Secretary of Treasury. A Sanctioned Country is any country that is the subject of trade or economic embargoes imposed by the laws or regulations of the United States. In accordance with laws and regulations of the United States concerning economic and trade embargoes, this policy may be rendered void from its inception with respect to any term or condition of this policy that violates any laws or regulations of the United States concerning economic and trade embargoes including, but not limited to the following: (1) Any insured under this Policy, or any person or entity claiming the benefits of such insured, who is or becomes a Specially Designated National or Blocked Person or who is otherwise subject to US economic trade sanctions; (2) Any claim or suit that is brought in a Sanctioned Country or by a Sanctioned Country government, where any action in connection with such claim or suit is prohibited by US economic or trade sanctions; (3) Any claim or suit that is brought by any Specially Designated National or Blocked Person or any person or entity who is otherwise subject to US economic or trade sanctions; (4) Property that is located in a Sanctioned Country or that is owned by, rented to or in the care, custody or control of a Sanctioned Country government, where any activities related to such property are prohibited by US economic or trade sanctions; or (5) Property that is owned by, rented to or in the care, custody or control of a Specially Designated National or Blocked Person, or any person or entity who is otherwise subject to US economic or trade sanctions. Please read your Policy carefully and discuss with your broker/agent or insurance professional. You may also visit the US Treasury's website at httr)://www.treas.clov/offices/enforcement/ofac/. INT N001 CW 01 09 ortaN RiskMmRgemerdDMsiun REVIEWED & APPROVED BY.- o z Risk Management Analyst A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 2/4/2021 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: Chubb Customer Service Center INSURANCE NOODLE LLC - INSUREON FAX PHONE 866-972-2727 A/C, No, Ext : (A/C, No): ADDRESS: chubbcsc@chubb.com 30 NORTH LASALLE ST INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : ACE Fire Underwriters Insurance Company 20702 CHICAGO, IL, 60602 INSURED INSURER B : INSURER C : Michael Raneses INSURER D : 2409 MIRA MONTE CT INSURER E : INSURER F : TUSTIN CA 92782 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ETT— CLAIMS -MADE ❑ OCCUR PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER : GENERAL AGGREGATE $ POLICY ❑PRO JECT ❑ LOC PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY (Ea accident) $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY HKUHEK I Y DAMAGE (Per accident) $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N - PER —FR— STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ 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 Errors and Omissions y EONCAF155700032 02/06/2021 02/06/2022 Aggregate Limit $1,000,000 Retention Each Claim $1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The insurance afforded by the policies described herein is subject to all terms, exclusions and conditions of such policies. The City of Santa Ana is listed as ADDITIONAL INSURED (AUTOMATIC PURSUANT TO CONTRACT PF19806), or its equivalent) included in the policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Drive AUTHORIZED REPRESENTATIVE Santa Ana, CA 92701 3 r RAMmRgmentDMsian ~ `" REVIEWED &APPROVED BY.- 3; z © 1988-2015 ACORD P1. V ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Risk Management Analyst POLICY NUMBER: EONCAF155700032-002 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES POLICY INFORMATION This endorsement modifies insurance provided under the following: Effective Date of Change: 2021-10-12 Named Insured: Michael Raneses E- Limits/Exposures ADDITIONAL NOTES Limits increased to $1,000,000/$2,000,000 The above amendments result in a change in the premium as follows: ADDITIONAL PREMIUM: $139.00 POLICY CHANGES ENDORSEMENT DESCRIPTION Added Forms: PF231120807 LIMITS AMENDED RETROACTIVE DATE AMENDED (SPECIFIED LAYER) Countersigned By: JOHN J. LUPICA, President (Authorized Representative) �oRaN } z a RAMarWmentDMsion REVIEWED & APPROVED BY.- p R. Vj&,Wd Risk Management Analyst fy�t■lr=�=� LIMITS AMENDED, RETROACTIVE DATE AMENDED (SPECIFIED LAYER) Named Insured Michael Raneses Endorsement Number PF231120807 Policy Symbol Policy Number Policy Period Effective Date of Endorsement EON EONCAF155700032 2021-02-06 To 2022-02-06 2021-10-12 -002 Issued By (Name of Insurance Company) ACEFire Insert the policy number. I ne remainder of the Intormation IS to be completed only when tnis endorsement IS Issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. It is agreed that the Policy is amended as follows: 1. Item 3 of the Declarations is deleted in its entirety and the following is inserted: Item 3. Limit ofLiability (including Claims Expenses) $ 1,000,000.00 Each Claim $ 2,000,000.00 Aggregate Limit $ 5,000.00 Disciplinary Proceeding Claims Expenses Aggregate Limit (in addition to the Each Claim and Aggregate Limits set forth above) 2. Solely with respect to that portion of the Aggregate Limit of Liability set forth in Item 3 of the Declarations which is $ 1,000,000.00 excess of $ 1,000,000.00 , Item 6 of the Declarations is deleted in its entirety and the following is inserted: Item 6. Retroactive Date (if applicable): 2021-10-12 All other terms and conditions of this Policy remain unchanged. PF-23112 (08/07) Authorized Representative �ortaN RAMmWmedDiMsfan REVIEWED & APPROVED BY. - Risk Management Analyst CHUBBe SIGNATURES Named Insured Michael Raneses Endorsement Number CC1K11i0218 Policy Symbol Policy Number Policy Period Effective Date of Endorsement EON EONCAF155700032 02-o6-2021 to 02-o6-2022 10-12-2021 -002 Issued By (Name of Insurance Company) ACE Fire Underwriters Insurance Company THE ONLY COMPANY APPLICABLE TO THIS POLICY IS THE COMPANY NAMED ON THE FIRST PAGE OF THE DECLARATIONS. By signing and delivering the policy to you, we state that it is a valid contract. INDEMNITY INSURANCE COMPANY OF NORTH AMERICA (A stock company) BANKERS STANDARD INSURANCE COMPANY (A stock company) ACE AMERICAN INSURANCE COMPANY (A stock company) ACE PROPERTY AND CASUALTY INSURANCE COMPANY (A stock company) INSURANCE COMPANY OF NORTH AMERICA (A stock company) PACIFIC EMPLOYERS INSURANCE COMPANY (A stock company) ACE FIRE UNDERWRITERS INSURANCE COMPANY (A stock company) WESTCHESTER FIRE INSURANCE COMPANY (A stock company) 436 Walnut Street, P.O. Box 1000, Philadelphia, Pennsylvania 191o6-3703 REBECCA L. COLLINS, Secretary CC-1K11i (02/18) JOHN J. LUPICA, President HortaN 3 z ' Risk ManagementDMsian REVIEWED & APPROVED BY.- 4' Risk Management Analyst PAGE 6 UNITED SERVICES AUTOMOBILE ASSOCIATION ADDL INFO ON N XXT EWAL OP�AGE MAfL MCH-M-1 1 i; Q (A RR"- iM'ERNSURAtVCF EXaONCF) tag VA 08 09 uh PCI_1C!' N.. BMUSAA 9800 Fredericksburg Road - San Antonio, Texas 78288 93 93 X-& 00186 66 18U 7101 0 CALIFORNIA AUTO POLICY PC UCYPERIOD. (1201 A.M. standard time) RENEWAL DECLARATIONS EFFECTIVE MAR 20 2021 TO SEP 20 2021 OPERATORS 01 MICHAEL EUGENE RANESES ATTACH TO PREVIOUS POLICY) Named Insured and Address 03 RUTH L RANESES MICHAEL EUGENE RANESES LTC USA RET 2409 MIRA MONTE CT TUSTIN CA 92782-9000 Descrip ion o e IC es VEH USE' '� At- VEH YEAq TRADE NAME Mcce_ 60DYTYPE DENTIFCATUNNUMSER SYMWE 08 06 TOYOTA HILNDR 4D 10000 JTEDD21A760154136 P 09 17 TOYOTA HIGHLANDER 4D 12000 5TDKZRFH9HS524448 B The Vehicle(s) described herein is principaliy garaged at the above address unless otherwise stated. r TA -'W-ukjSg - - P41 VEH 08 TUSTIN CA 92782-9000 VEH 09 TUSTIN CA 92782-9000 Is go is rove esthose-cover ages where a premium Is shown below. a limits shown by and be the may e rMced policy provisions may not combined regardless of number of vehicles for which a premium is listed unless specifically authorized els6where in this ROlicv. VEH VEH VEH VEH COVERAGES LIMITS OF LIABILITY 08 6—MONTH 09 6—MONTH ('ACV' MEANS ACTUAL CASH VALUE) D-DFD PREMIUM D-DFD PREMIUM D=DED PREMIUM D-flED PREMIUM MOUNT NMOJNT IWOUNITI $ PART A — LIABILITY BODILY INJURY EA PER $ 100,00 EA ACC $ 300,0092.16 159.16 PROPERTY DAMAGE EA ACC $ 100,000 102.81 160.24 PART B — MEDICAL PAYMENTS EA PER $ 2,000 6.31 9.91 PART C — UNINSURED MOTORISTS BODILY INJURY EA PER $ 100,00 EA ACC $ 300,000 34.81 48.4 PART D — PHYSICAL DAMAGE COVERAGE COMPREHENSIVE LOSS ACV LESS D 50 27.43D 50 67.9 COLLISION LOSS ACV LESS D 50 142.59D 50 483.64 TOWING AND LABOR 6.94 6.94 TOTAL PREMIUM SEE FOLLOWING PAGE(S) DDITIONAL INTEREST — EMPLOYER THE CITY OF SANTA ANA, OFFICER, 5 TA , CA DDITIONAL INTEREST — EMPLOYER TEE CITY COSTA MESA OFFICERS,, COSTA MESA, CA DDITIONAL INTEREST — EMPLOYER THE ROSSMOOR COMMUNITY SERVICE, ROSSMOOR, CA ENDORSEMENTS: ADDED 03-20-21 — NONE MAIN IN EFFECT(REFER TO PREVIOUS POLICY')— A073(05) RSGPCW(01) EXCLUSION OF NAMED DRIVER 5100CA(02) INFORMATION FORMS: NIPFCA(05) 320CA(05) CADS(05) 40CA(01) 13580(03) 999CA 19 €` 8 RMF51 00 91 RMM59 00 - In VVI I NLJS WHLHEut-,the bubscnoers at UNI I EU bEKVlUtZb AU I UMUbILt A,6(x;iAT SUN have causedtt their Attorney -in -Fact on this date FEBRUARY 12, 2021 +� Laura President, USAA Re{l;;:� 5000 U 07-11 53461-07-11 presents to be signed by ?� REVIEWED & APPROVED BY.- \�a Risk Management Analyst Michael Raneses 2409 Miramonte Court, Tustin, CA 92782 • 714.287.4999 • mikeraneses@gmail.com June 28, 2021 City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana, CA 92701 Hello, Here is my response to the various issues raised in past years concerning my auto liability insurance coverage as a Hearing Officer for the City of Santa Ana: Amount of Coverage When we were negotiating my initial contract with the City, I was informed by Sona Mooradian that the City Attorney agreed with my position that the requirement for $1,000,000 of auto liability insurance was excessive because I do not use my vehicle in the routine course of employment as a Hearing Officer. Since that time, I have been operating with the current level of insurance as indicated on the policy submitted. Considering the amount of work that I receive from the City as Hearing Officer, it is not cost effective for me to pay the increased premium that a $1,000,000 policy would require. Scope of Coverage As indicated on the policy submitted, my USAA auto insurance covers the two vehicles I own. I do not drive non -owned vehicles or hire vehicles. Required Language and Certificate Holder Information According to USAA, their policy templates will not fit the full verbiage requested, nor the complete agency address. Cancellation Policy According to USAA, policies are not cancelled before 60 days for nonpayment of premiums. That said, their cancellation policy is not specifically stated in the policy language. Best Regards, Michael Raneses Hearing Officer RAMmVmedDMsiun REVIEWED & APPROVED BY. - Risk Management Analyst CITY OF SANTA ANA RISK MANAGEMENT a dam 4 HUMAN RESOURCES Managing Risk e►awh Posldve Chan WORKERS' COMPENSATION DECLARATION M.E. Raneses/Hearing Officer (Name/Title) following declaration: hereby affirm under penalty of perjury, the certify on behalf of Michael Raneses (Consultant/Company Nome) of my contract for Hearing Officer that during the term services with the City of Santa Ana, (Type of service 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: June 28, 2021 Print Name: Michael E. Raneses Print Title: Hearing Officer Signature: 7,�iPz--Z� Telephone: 714.287.4999 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. I:Risk Mgmt�lnsurance Requirements�WC Declaration 08152019 a �ortaN Risk MwaganedDMsiun 3 REVIEWED & APPROVED BY.- -ERisk Management Analyst