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HomeMy WebLinkAboutSAXE-CLIFFORD, SUSAN, PH.D. (2)INSURANCE NOT ON FILE �NORK MAY NOT PROCEED r CLERK OF COUNCIL DATE: r 6'�alice�GMu'�S D�sa�l)(au)1 N-2019-208-01 FIRST AMENDMENT TO AGREEMENT WITH SUSAN SAXE-CLIFFORD FOR PSYCHOLOGICAL EVALUATION SERVICES THIS FIRST AMENDMENT to the above -referenced agreement is entered into on May 2, 2022, by and between Susan Saxe -Clifford, Ph.D,.("Consultant', and the City of Santa Ana, a charter city and municipal . corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. The parties entered into Agreement No. N-2019-208 ("Agreement") dated June 12, 2019, to provide psychological evaluation services for the Santa Ana Police Department from July 1, 2019 through June 30, 2022. The Agreement is current and in -effect. B. The parties wish to amend the Agreement to extend the term for an additional three (3) month period. The Parties therefore agree: 1. Section 3, Term is hereby amended to extend the term of the Agreement until September 30, 2022. 2. Except as modified by this First Amendment, all terms and conditions of the Agreement, shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the Agreement on the date and year first written above. ATTTT//E``ST /t c'M A n , r' DAISY GOMEZ 3a Clerk of the Council APPROVED AS TO FORM SONIA R. CARVALHO City Attorney By: ' NN4 f L — _ Tamara Bog"an Senior Assistant City Attorney RECOMMENDED FOR APPROVAL: DAVID Y.AnNTIN of Police CITY OF SANTA AINA RRISTINE RI City Manager CONSULTANT Al Susan Saxe Clifford, Ph.D. President Page I of t Ejhjubmmz!tjhofe!cz!Upsj!Qjfstpo! Upsj!Qjfstpo Ebuf;!3133/17/3:!25;36;59!.18(11( DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06/22/2022 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). CONTACT PRODUCER Donna Kilroy NAME: FAX PHONE Worthington Insurance Services(562) 795-5744(562) 795-5740 (A/C, No): (A/C, No, Ext): E-MAIL ADDRESS: 4784 Katella Ave. INSURER(S) AFFORDING COVERAGENAIC # Los AlamitosCA90720Employers Assurance Co. INSURER A : INSURED INSURER B : Dr. Susan Saxe-Clifford, PhD INSURER C : 16530 Ventura Blvd. Ste. 603 INSURER D : INSURER E : EncinoCA91436 INSURER F : CL225305341 COVERAGESCERTIFICATE 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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE$ DAMAGE TO RENTED CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY$ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ (Ea accident) ANY AUTOBODILY INJURY (Per person)$ OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS HIREDNON-OWNEDPROPERTY DAMAGE $ (Per accident) AUTOS ONLYAUTOS ONLY $ UMBRELLA LIAB OCCUREACH OCCURRENCE$ EXCESS LIAB CLAIMS-MADEAGGREGATE$ DEDRETENTION$$ PEROTH- WORKERS COMPENSATION STATUTEER AND EMPLOYERS' LIABILITY Y / N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ AY N / A YEIG4990812-0004/29/202204/29/2023 OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Blanker Waiver of Subrogation applies per attached WC 04 03 06. CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana Risk Management Division 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE Santa AnaCA92702 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD