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HomeMy WebLinkAboutRCS INVESTIGATIONS & CONSULTING, LLC.INSURANCE ON FILE OTOWORK MAY UNTIL NSURANCEEEXPIRES N-2021-138 0611A/2o2-L CLERK OXI9MMENT FOR PERSONNEL INVESTIGATION SERVICES DATE: This agreement for personnel investigation services ("Agreement") is made and entered into this 27th day of April, 2021, by and between RCS Investigations & Consulting, LLC, a California limited liability company ("Investigators"), and the City of Santa Ana, a charter city and municipal corporation duly organized and existing under the constitution and laws of the State of California ("City"). 0'. H( RECITALS � ,lnol�►�,l � ie- A. City desires to emp cy Investigators to assist the Executive Director of Human Resources in conducting personnel investigations, and B. Investigators represent that they are experienced investigators with special experience and knowledge in the field of conducting personnel investigations including investigations involving peace officers. 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: I. RETENTION OF INVESTIGATORS City hereby agrees to and does retain Investigators, for the compensation hereinafter specified, to assist the Executive Director of Human Resources as needed with conducting personnel investigations. Investigators accept said retention and agree to perform, in a timely and efficient manner, all such services as may be requested by the Executive Director of Human Resources. Investigators shall confirm their acceptance of work requested by City in writing by e-mail or letter. 2. PAYMENT FOR SERVICES RENDERED a. FEES City agrees to compensate Investigators, and Investigators agree to accept from City, as and for payment in full for all services provided under this Agreement, compensation at the rate of $125 an hour for all Investigators and $40 an hour for transcription services. Investigators will not bill for travel time. During the term of this Agreement, the total amount authorized for services pursuant to this Agreement is fifty thousand dollars and no cents ($50,000.00). b. REIMBURSEMENT FOR COSTS City agrees to reimburse Investigators for out- of-pocket expenses, including but not limited to, mileage, copying costs, mail services, and other related costs authorized by the Executive Director of Human Resources in connection with the performance of duties under this Agreement. Copying charges will be reimbursed at the rate of 10 cents per page. Any costs in excess of $500 requires approval of the Executive Director of Human Resources prior to incurring the expense. All expenses must have supporting documentation submitted with the invoice. 3. METHOD OF PAYMENT Investigators shall submit a monthly statement specifying the services performed, dates and number of hours, and an itemization of expenses related thereto with supporting documentation (i.e. receipts, invoices, copy of check, etc.). 4. CONTROL OF INVESTIGATIVE MATTERS Investigators agree that each and every matter or proceeding in which they undertake to assist the Executive Director of Human Resources, 006085.00095 13457441.1 as aforesaid, shall be and remain under, and subject to the control and direction of said Executive Director of Human Resources at all stages, and that they shall at all times keep the Executive Director of Human Resources informed of all matters pertaining thereto. City will keep Investigators informed of all significant developments in matters relating to any representation undertaken by Investigators under this Agreement. Investigators further agree, if and when their retention hereunder is terminated by City, as hereinafter specified, they shall provide to the Executive Director of Human Resources the original of any and all files then in their possession, concerning each and every matter or proceeding in which conducted an investigation for the City pursuant to this Agreement. 5. LIMITATION ON INVESTIGATIVE SERVICES Investigators will make factual findings, utilizing Investigators' skills, knowledge, and experience in so doing. Investigators will not render a legal determination whether there was unlawful discrimination, harassment, violation of public policy, a violation of any other law or statute, or violation of a City policy for investigations under this Agreement. The City and Investigators intend that Investigators' investigations will be confidential to the extent legally permitted. 6. CITY COOPERATION City agrees to make available the witnesses and documents requested by Investigators to permit Investigators to perform this independent investigation. The City will designate an employee as the primary point of contact for the City for each investigation performed under this Agreement. This will include arranging access to witnesses and documents and arranging a location for interviews. 7. NO GUARANTEES It is understood that there is no guarantee or assurance that any particular result will be reached in any investigation conducted under this Agreement. 8. REPORTING REQUIREMENTS Unless otherwise directed, Investigators will provide a written report to the Executive Director of Human Resources for each investigation conducted under this Agreement. 9. TERM The term of this Agreement shall commence on the date first written above and terminate one (1) year thereafter, unless terminated earlier pursuant to Section 19 below. The term of this Agreement may be extended upon a writing executed by both parties, including the City Manager and the City Attorney. 10. INDEPENDENT CONTRACTORS It is mutually agreed by and between the parties that, in the performance of their covenants hereunder, Investigators are and shall be independent contractors, and not officers or employees of city. 11. INSURANCE Investigators shall provide to the Executive Director of Human Resources proof of Prior to undertaking performance of work under this Agreement, Investigators shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability (CGL): Insurance Services Office Form CG 00 01covering CGL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, 006085,00005 Z 13457441.1 either the general aggregate limit shall apply separately to this project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall be twice the required occurrence limit. Automobile Liability: Insurance Services Office Form Number CA 0001 covering, Code 1 (any auto), or if Instructor has no owned autos, Code 8 (hired) and 9 (non - owned), with limits no less than $1,000,000 per accident for bodily injury and property damage. c. Workers' Compensation: as required by the State of California, with Statutory Limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident for bodily injury or disease. d. Professional Liability (errors and omissions) insurance: with a combined single limit of not less than $1,000,000 per claim, and maintain such insurance throughout the terns of this Agreement. e. If the Investigators maintains broader coverage and/or higher limits than the minimums shown above, the City of Santa Ana requires and shall be entitled to the broader coverage and/or the higher limits maintained by the Investigators. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City of Santa Ana. f. Other Insurance Provisions - The insurance policies are to contain, or be endorsed to contain, the following provisions: i. Additional Insured Status- The City of Santa Ana, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Investigators including materials, parts, or equipment furnished in connection with such work or operations. General liability coverage can be provided in the form of an endorsement to the Investigators' insurance (at least as broad as ISO Form CG 20 10 11 85 or if not available, through the addition of both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 20 37 if a later edition is used). ii. Primary Coverage- For any claims related to this contract, the Investigators' insurance coverage shall be primary coverage at least as broad as ISO CG 20 01 04 13 as respects the City of Santa Ana, its officers, officials, employees, and volunteers. Any insurance or self-insurance maintained by the City of Santa Ana, its officers, officials, employees, or volunteers shall be excess of the Investigators' insurance and shall not contribute with it. Notice of Cancellation- Certificate of Insurance shall provide thirty (30) day prior written notice of cancellation in a form approved by the City. g. Waiver of Subrogation- Investigators hereby grants to City of Santa Ana a waiver of any right to subrogation which any insurer of said Investigators may acquire 006085.00005 13457441A against the Entity by virtue of the payment of any loss under such insurance Investigators agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation, but this provision applies regardless of whether or not the Entity has received a waiver of subrogation endorsement from the insurer. h. If Investigators fail or refuse to produce and maintain the insurance required by this section, or fail or refuse to famish 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 Investigators' right to be paid for its time and materials expended prior to notification of termination. 12. INDEMNIFICATION Investigators agree to and shall indemnify and hold harmless the City, its officers, agents, employees, and representatives from liability for personal injury, damages, restitution, judicial or equitable relief arising out of Investigators' negligent or wrongful performance or conduct related to this Agreement. Since the purpose of the Investigators' engagement is to assist the City in determining the facts related to internal personnel complaints, the City agrees to the following limited indemnity language. The City agrees to indemnify, defend and hold Investigators, its successors and assigns, and each of its officers and employees, harmless from any and all claims, suits, demands, losses and expenses, including reasonable Investigators' fees, accruing or resulting to any and all persons, firms, or other entity arising out of Investigators' performance or non-performance of its obligations under this Agreement, unless an error or erroneous omission by Investigators cause such damage or loss. The City shall not indemnify Investigators for any matter involving a claim by the City of professional negligence, or any matter for which Investigators shall have been adjudicated to have acted in bad faith or engaged in willful misconduct or any conduct outside the scope of its retention under this Agreement. 13. RELATED POST -INVESTIGATION SERVICES If Investigators are asked or required to prepare for and/or testify, including, without limitation, at deposition, trial, arbitration, administrative hearing, or any other proceeding, because of services rendered under this Agreement, if Investigators must respond to subpoenas or discovery or otherwise respond or perform services with respect to any matter relating to or arising out of the services performed for City, City agrees to pay Investigators for all time expended (including preparation time) at Investigators' then current regular hourly rate and to reimburse Investigators for reasonable costs and expenses incurred, whether or not the investigation has been concluded. Payment is due upon presentation of a bill for services, costs, and expenses. 14. CONFIDENTIALITY Investigators will receive information from the City, which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Investigators agree that it shall not use or disclose such information except in the performance of this Agreement, and further agree 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 Investigators, disclosed in a publicly available source; (c) is in rightful 006095,00005 13457441.1 4 possession of the Investigators without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Investigators without reference to information disclosed by the City. 15. CONFLICT OF INTEREST CLAUSE Investigators covenant that it presently has no interests and shall not have interests, direct or indirect, that would conflict in any manner with performance of services specified under this Agreement. 16. 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 Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, California 92702-1988 Fax:(714) 647-6956 Courtesy Copy: Executive Director of Human Resources City of Santa Ana 20 Civic Center Plaza (M-24) Santa Ana, California 92702 Fax:(714) 647-6930 To Investigators: Attention: Steve Rodig RCS Investigations & Consulting, LLC. P.O. Box 29798 Anaheim Hills, California 92809-9798 Phone: (714) 779-2300 A party may change its address by giving notice in writing to the other party. Thereafter, any notice, tender, demand, delivery, or other 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 facsimile, 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. 17. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Investigators, 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 Investigators. The parties agree that any terms or conditions of any 006085.00005 13457441.1 5 purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Investigators 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 parties, which are not embodied herein. 18. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Investigators, Investigators 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 of this Agreement performed by City personnel or by other Investigators retained by City. 19. TERMINATION This Agreement may be terminated by City at any time. hi such event, Investigators shall be entitled to receive and the City shall pay Investigators compensation for all services performed by Investigators prior to receipt of such notice of termination. As a condition of such payment, Investigators shall deliver to the City all files and records generated under this Agreement as of such date. Investigators may terminate this Agreement, subject to their obligation to provide written reasonable notice of at least thirty (30) days. 20. NON-DISCRIMINATION Investigators 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, training, utilization, promotion, termination or other employment related activities. Investigators affirn that it is an equal opportunity employer and shall comply with all applicable federal, state, and local laws and regulations. 21. 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 fuuther agree that Orange Comity, 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. 22. PROFESSIONAL LICENSES Investigators shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 23. MISCELLANEOUS PROVISIONS Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. 006085.00005 6 13457441.1 N-2021-138 24. COUNTERPARTS: SIGNATURES This Agreement may be executed in counterparts, secured via facsimile transmission, email, or otherwise, each of which shall be deemed to be an original. Photocopies of any executed counterpart shall have the same force and effect as an original. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the day and year first above written. ATTEST: V0 Daisy Gomez, CMC Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney Laura A. Rossini Chief Assistant City Attorney FOR APPROVAL: rason Motsick Executive Director of Human Resources CITY OF SANTA ANA KiTstific Ridge City Manager RCS INVESTIGATIONS & CONSULTING, LLC By: Nan Title 006085.00005 13457441.1 ""nny""b, rand„. n. Francine R. Villareal V11flaraal "'e"'.... sa:"9 (P ID: MN A4cli`�✓ CERTIFICATE OF LIABILITY INSURANCE GATE06110/20211012021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Alliance Mgt. & Insurance Sew 355 Via Vera Cruz #7 CA AgentlBroker Lic#0737966 San Marcos, CA 92078 Michelle A. Nowell CONTACT Michelle Nowell PHONE FAX AICNOEXt:760-471.7116 A/c,Ne:760-471-9378 E-mnowellamiscorMAIL ADDREss: mnowell@amiscorp.com PRODUCER CUSTOMER ID #: RCSIN-1 INSURER 5 AFFORDING COVERAGE NAIC # INSURED RCS Investigations & Consulting, LLC PO Box 29798 Anaheim, CA 92809-9798 INSURERA:Peleus Insurance Company 34118 INSURER B INSURER C : INSURER D : 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. III TYPE OF INSURANCE DDL UBR POLICYNUMBER MMIDDmVV MMIDCY EXP DIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADEIII OCCUR X X PKV0000663 06/1912021 06119/2022 PREMISES Ea occurrence $ 100,00 MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 X Errors & Omission GENERAL AGGREGATE $ 4,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGE $ 1,000,00 X POLICY 7 PRO- El LOG - A $-AUTOMOBILE LIABILITY ANY AUTO PKV0000663 0811912021 0611912022 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Peraccident) $ X SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (PER ACCIDENT) $ X NON -OWNED AUTOS $ $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 A X EXCESS LIAB CLAIMS -MADE UMV0000182 0611912021 0611912022 DEDUCTIBLE $ $ RETENTION s WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE❑ OFFICERIMEMBER EXCLUDED? NIA WC STATU- OTH- TORYLIMITS ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Professional Liab PKV0000663 0611912021 06/1912022 Occurrence 1,000,00 Aggregate 5,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 1 1, Additional Remarks Schedule, If more space Is required) Cit ,Qf Santa Ana its officers,a ents emplo ees, n voluunteers are named as additional insured with respec�s to the woryk pe ormed by named insured. Primary Wording and Waiver of Subrogation Included. Investigation, CA - - 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. Risk Management Division 20 Civic Center Plaza 4th FI AUTHORIZED REPRESENTATIVE Santa Ana, CA 92702-1988 ll��, RkIrManaganardDMNmt :y \�� REVIEWED & APPROVED By. ©1988-2009 ACORD CO I 444'i4#+e Z, V1," ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 1 1111 Risk Management Analyst POLICY NUMBER: PKV0000663 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the fallowing: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Automatic Status Included Where Required by Written Contract. All Where Required by Written Contract. Section II - Who Is An Insured is amended to in- clude as an additional insured the person(s) or organization(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 omissions 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. R:ak�orw"inn �< REVIEWED6 APPROVEDRY. CG 202607 04 © ISO Properties, Inc., 2004.00 ? fa uw� R, Vx � RNk Management Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTING INSURANCE ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART To the extent that this insurance is afforded to any additional insured under this policy, SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance, is deleted in its entirety and replaced with the following condition: 4. Otherinsurance If all of the other insurance permits contribution by equal shares, we will follow this method unless the insured is required by written contract signed, by both parties, to provide insurance that is primary and non-contributo y and the insured contract is executed prior to an loss. Where required by a written contract signed by both parties, this insurance will be primary and non-contributing only when and to the specific extent required by that contract. However, under the contributory approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the proportional ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. This endorsement forms a part of the Policy to which attached, effective on the inception date of the Policy unless otherwise stated herein. (The following information is required only when this endorsement is issued subsequent to preparation ofthe Policy.) Endorsement effective 06-19.2021 Policy No. PKV0000663 CIGL 30 0114 �, RlekMan�irumtDbislmi REMWEO &DDAP'PR.OAAVV�E)� BY. FA.lroYvO+e ^. Y.A.ca�k4k �t Risk k9awgeimnt/Nnlyst POLICY NUMBER: PKV0000663 COMMERCIAL GENERAL LIABILITY CG 2404 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any Person or Organization for whom the insured, prior to a claim, occurrence or incident for which the insured could reasonably expect a claim or occurrence to arise, was required via written agreement or contractual obligation, to waive such rights. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV - Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard" This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 0Insurance Services Office, Inc., 2008 risk yi' gig. LDMabn RE\A2&9D' R0VM BY; Risk Management Analpt INVESTIGATIONS & CONSULTING, LLC WORKERS' COMPENSATION DECLARATION P.O. Box 29798 Anaheim Hills, CA 92809-9798 w ,msinvestigi6ons.eom (714)779-2300 I, Steve Rodig, Partner, hereby affirm under penalty of perjury, the following declaration: I certify on behalf of RCS Investigations and Consulting, a California Limited Liability Company Partnership [E1N 20-5065414] that during the term of my contract for investigative 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 forthwitheomply with those provisions and provide proof of workers' compensation coverage. Steve Rodig RCS Investigations and Consulting, LLC Partner/Owner 714-779-2300 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. PJAMenarnenu) elan i eC� RE\neneo&pAPPRovmar: IW lL:r FAA1�liA*C M V(��AneRl Risk ManagementMayst FarmW-9 Request for Taxpayer (Ray. October Zola) identification NuMber and Certification Give Form to the 0epartmenl ofihe Treasury requester. Do not Internal Revenw service ►Go to www.Irs.gov/FormWg far Instructions and the iciest infnrmatlon. send to the Ina, 1 Name (as shown on your Income tax return). Hama Is requred on title Iine; tlo doll this Iine blank. I INVESTIGATIONS AND CONSULTING, LLC mFE) Checkappropriate box for federal tic class'restbn of the person whose name is entered on line 1, Chock only one of tit, 4 Exemptions (codes appry "I Rg seven boxes. o. certain entitles, not Intlivlduala: see oitlual/sok ro rietor or inabuctlons on a e3: le -member LLC ❑ GComoration ❑ $Corporation❑ parinership❑ TmsVes[atep g )o'o Exempt payee code (If any) .�.'ypted liahllty company. Enter the tax Classification(C=C corporation,$=S corporation, p=partnershlp)� P o: Check the appropriate box In the Iine above for the tax classification of the single -member owner. Do not shack 19 if the LLG is classified as a single -member LLC that is disragarded from the owner u Exemption from FATCA reporting w_her LLC that Is not disregarded from the owner for U.S. federal tax purposes. Otherwlae. a slag 0-member LLC that ( » sregarded from the owner should cheek the appropriate box forth, tax clasalkatlon of its owner,coda if an . .. ifoas.-.-0 , 0W%d."Ina") �S PO BOX 29798 CA 92809 enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this Is generally your social security number (SSN), However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for part I, later. For other entitles, it Is your employer identification number (EIN). If you do not have a number, see How to gat a TIN, later. Note: If the account Is in more than are name, see the instructions for line 1. Also see What Name and Number To Giva the Requester for guidelines on whose number to enter. under penalties of perjury, I earl that; 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be )$Sued to me); and 2. 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all iril or dividends, or (a) the IRS has notified me that I am no longer subject to backup withholding; and 3.1 am a U.S. oltlzen or other U.S. person (defined below); and 4. The FATCA wdo(s) entered on this form (if any) Indicating that I am exempt from FATCA reporting is correct. Certification instructions, you must areas out item 2 above If you have been noticed by the. IRS that you era currently subject to backup Withholding because or real acquis tlon or abandonment of secured Prodividends pery, Cancellation of debreturn.t, contributions to an Individual retctions, item iremeont arrannot gement ntFor (IRAJ and geneinterest rally, payments other than Interest and dividends, yoy.gre not required to sign the certification, but you must provide your correct TIN, See the inermirions for Parr n Iare. $I �� tgn signature at Here iparsons General instr'I Section references are to the Internal Revenue Code unless otherwise noted, Future developments. Forthe latest Information about developments related to Form W-9 and its Instructions, such as legislation enacted after they were published, go to www.Irs.gavfFmmW,9. Purpose of Form An Individual or entity (Form W-9 requester) who Is required to file an Information return with the IRS must obtain your correct taxpayer Identification number (RN) which may be your social security number (SSN), Individual taxpayer idantificatlon number (ITIN), adoption taxpayer iderri fication number (ATIN), or employer identification number (EIN), to report on an Information return the amount paid to you, or other amount reportable on an areal return. Examples of Information returns include, but are not limited to, the following. • Form 1099-INT (Interest earned or paid) Data ® / Q • Form 1099-DIV (dividends, Including those from funds) storks or mutual • Form 1099-MISC (various typos of income, prizes, awards, or gross proceeds) • Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) • Form 1098 (home mortgage Interest), 1098-F (student loan interest), 1098-T (tultlon) • Form 1099-G (canceled debt) • Form 1099-A (acquisition or abandonment of secured properly) Use Form W-0 only if you are a U.S. person (Including a resident alien), to provide your correct TIN. If you do not return Farm W-9 to the requester with a 77N, you might be subject to backup withholding. Can What Is backup withholding, later. Cat. No. 10231X Form W-9 (nay, 10.2018) Rle,ManegmsentUbdelon . REVIEWED 6 APpi By: v; j�l 26k Management Analyst