HomeMy WebLinkAboutMARTINEZ, LUIS RAUL (2)INSURANCE ON FILE
WORK MAY PROCEED
UNTIL INSURANCE EXPIRES
12.11D1102Z.
CLERK OF COUNCIL
DATE
n 1 3 2022
A-2022-147
S E AGREEMENT WITH LUIS MARTINEZ
TO PROVIDE COUNSELING SERVICES
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THIS AGREEMENT, made and entered into this l9th day of July, 2022, by and between
Luis Martinez (hereinafter "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
(hereinafter "City").
RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field
of counseling and/or instructional services encompassing the fields of anger
management, stress reduction, conflict management/resolution, domestic violence
avoidance, chemical dependency, life skills/family issues and community resources to
the inmates housed at the Santa Ana City Jail.
B. Consultant represents that Consultant is able and willing to provide such services to the
City.
C. In undertaking the performance of this Agreement, Consultant represents that he is
knowledgeable in his field, and that any services performed by Consultant under this
Agreement will be performed in compliance with such standards as may reasonably be
expected from a professional consulting firm in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to
the terms and conditions hereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
Consultant and City shall perform those services as set forth in Exhibit A to this Agreement,
which include counseling and/or instructional services to inmates in the areas of anger agreement,
stress reduction, conflict management/resolution, domestic violence avoidance, chemical
dependency, life skills/family issues and community resources.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for services an
hourly rate of sixty-five dollars ($65.00) for all scheduled instructional and counseling sessions.
The total sum to be expended shall not exceed $120,000 during the term of this Agreement.
b. City shall compensate Consultant for services provided from July 1, 2022 through the
effective date of the Agreement detailed above.
c. Payment by City shall be made within thirty (30) 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,
'91MEWWRT
This Agreement shall commence on the date first written above and terminate on June 30,
2025 unless terminated earlier in accordance with Section 12, below.
4. INDEPENDENT CONTRACTOR
Consultant 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 Consultant
performs the services which are the subject matter of this Agreement; however, the services to be
provided by Consultant shall be provided in a manner consistent with all applicable standards and
regulations governing such services. Consultant shall pay all salaries and wages, employer's social
security taxes, unemployment insurance and similar taxes relating to employees and shall be
responsible for all applicable withholding taxes.
5. INSURANCE
Prior to undertaking performance of work under this Agreement, Consultant shall maintain
and shall require its subcontractors, if any, to obtain and maintain insurance as described below:
a. Professional Liability (Errors and Omissions) Insurance appropriates to the
Consultant's profession, with limit no less than $1,000,000 per occurrence or claim. If a
general aggregate limit applies, 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. If a general aggregate limit applies, 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.
Other Insurance Provisions
The insurance policies are to contain, or be endorsed to contain, the following provisions:
Additional Insured Status
The City, 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 Consultant including materials, parts, or equipment furnished in connectionwith such
work or operations. General liability coverage can be provided in the form of an endorsement to
the Consultant's insurance (at least as broad as ISO Form CG 20 10 11 85 or bothCG 20 10, CG
20 26, CG 20 33, or CG 20 38; and CG 20 37 forms if later revisions used).
Primary Coverage
For any claims related to this contract, the Consultant's insurance coverage shall be primary
insurance primary coverage at least as broad as ISO CG 20 01 04 13 as respects the City, its
officers, officials, employees, and volunteers. Any insurance or self-insurance maintained by the
City, its officers, officials, employees, or volunteers shall be excess of the Consultant's insurance
and shall not contribute with it.
Notice of Cancellation
Each insurance policy required above shall state that coverage shall not be canceled, except with
notice to the City.
Waiver of Subrogation
Consultant hereby grants to City a waiver of any right to subrogation which any insurer of said
Consultant may acquire against the City by virtue of the payment of any loss under such insurance.
Consultant 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 City has received a waiver
of subrogation endorsement from the insurer.
Self -Insured Retentions
Self -insured retentions must be declared to and approved by the City. The City may require the
Consultant to purchase coverage with a lower retention or provide proof of ability to pay losses
and related investigations, claim administration, and defense expenses within the retention. The
policy language shall provide, or be endorsed to provide, that the self -insured retention may be
satisfied by either the named insured or City.
Acceptability oflnsurers
Insurance is to be placed with insurers authorized to conduct business in the state with a current
A.M. Best's rating of no less than ANII, unless otherwise acceptable to the City.
Claims Made Policies
If any of the required policies provide coverage on a claims -made basis:
1. The Retroactive Date must be shown and must be before the date of the contract or the
beginning of contract work.
2. Insurance must be maintained and evidence of insurance must be provided for at least five
(5) years after completion of the contract of work.
3. If coverage is canceled or non -renewed, and not replaced with another claims -made policy
form with a Retroactive Date prior to the contract effective date, the Consultant must
purchase "extended reporting" coverage for a minimum of five (5) years after completion
of contract work.
Verification of Coverage
Consultant shall furnish the City with original Certificates of Insurance including all required
amendatory endorsements (or copies of the applicable policy language effecting coverage required
by this clause) and a copy of the Declarations and Endorsement Page of the CGL policy listing all
policy endorsements to City before work begins. However, failure to obtain the required
documents prior to the work beginning shall not waive the Consultant's obligation to provide them.
The City reserves the right to require complete, certified copies of all required insurance policies,
including endorsements required by these specifications, at any time.
Subcontractors
Consultant shall require and verify that all subcontractors maintain insurance meeting all the
requirements stated herein, and Contractor shall ensure that City is an additional insured on
insurance required from subcontractors.
Special Risks or Circumstances
City reserves the right to modify these requirements, including limits, based on the nature of the
risk, prior experience, insurer, coverage, or other special circumstances.
6. INDEMNIFICATION
Consultant agrees to and shall indemnify and hold harmless the City, its officers, agents,
employees, consultants, special counsel, and representatives from liability; (1) for personal injury,
damages, just compensation, restitution, judicial or equitable relief arising out of claims for
personal injury, including death, and claims for property damage, which may arise from the direct
or indirect operations of the Consultant or its contractors, subcontractors, agents, employees, or
other persons acting on their behalf which relates to the services described in section 1 of this
Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution,
judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement.
This indemnity and hold harmless agreement applies to all 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 Consultant 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.
CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such information
is reasonably understood to be confidential and/or proprietary, Consultant 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 Consultant
disclosed in a publicly available source; (c) is in rightful possession of the Consultant without an
obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is
independently developed by the Consultant without reference to information disclosed by the
City.
8. CONFLICT OF INTEREST CLAUSE
Consultant 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.
9. 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 telefaesimile or other telegraphic
communication in the manner provided in this Section, to the following persons:
To City: Cleric 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:
Santa Ana City Jail — Contract Services Supervisor
City of Santa Ana
20 Civic Center Plaza M-88
P.O. Box 1988
Santa Ana, California 92702
Fax 714- 647-8116
To Consultant: Luis Martinez
301 West 2nd Street, #241
Santa Ana, CA 92701
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 telefacsimile, 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.
10. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and.
Consultant, and supersedes any and all other agreements, oral or written, between the parties. In
the event of a conflict between the terms of this Agreement and any attachments hereto, the terms
of this Agreement shall prevail. This Agreement may not be modified except by written instrument
signed by the City and by an authorized representative of Consultant. The parties agree that any
terms or conditions of any purchase order or other instrument that are inconsistent with, or in
addition to, the terms and conditions hereof, shall not bind or obligate Consultant nor 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.
11. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Consultant,
Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior
written consent of the City and any such assignment, transfer, delegation or subcontract without
the City's prior written consent shall be considered null and void. Nothing in this Agreement shall
be construed to limit the City's ability to have any of the services which are the subject to this
Agreement performed by City personnel or by other consultants retained by City.
12. TERMINATION
This Agreement maybe terminated by the City with or without cause upon thirty (30) days
written notice of termination. In such event, Consultant shall be entitled to receive and the City
shall pay Consultant compensation for all services performed by Consultant prior to receipt of
such notice of termination, subject to the following conditions:
a. As a condition of such payment, the City Manager may require Consultant to deliver
to the City all work product completed as of such date, and in such case such work product shall
be the property of the City unless prohibited by law, and Consultant 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.
13. NON-DISCRIMINATION
Consultant 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. Consultant affirms that it is an equal opportunity employer and shall comply
with all applicable federal, state and local laws and regulations.
14. 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.
15. PROFESSIONAL LICENSES
Consultant 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
A-2022-147
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.
16. 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.
b. The Agreement is the final and complete agreement and any prior or
contemporaneous agreements for similar services between the parties is superseded
by this Agreement. This shall not apply where the Parties are currently engaged
and Consultant is providing services not contemplated 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:
4-/Clerk of the
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Attorney
By:
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Tamara Bogosian
Senior Assistant City Attorney
RECOMMENDED FOR APPROVAL:
(]D ALENTIN
Chief of Police
CITY OF SANTA ANA
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KRISTINE RIDGE
City Manager
CONSULTANT
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EXHIBIT A
SCOPE OF SERVICES
1. CITY'S Responsibilities:
The CITY shall provide the following assistance to CONSULTANT:
a. Identify a contact person who shall be responsible for scheduling and coordinating the
services to be provided by CONSULTANT. The subject matter, the number of hours and the
scheduling of hours shall be at the sole discretion of the CITY.
b. Schedule and record CONSULTANT'S time worked during meetings, instruction and
counseling sessions.
c. Provide an adequate facility that will allow CONSULTANT to perform the services required
under this agreement in an efficient and timely manner.
d. Provide prompt notice to the CONSULTANT whenever the CITY observes or otherwise
becomes aware of any defect in the services provided under the terms of the agreement.
2. CONSULTANT'S Responsibilities:
CONSULTANT shall provide the following services to CITY:
a. Deliver instructional and/or counseling services in the following program areas to
selected inmates:
(1) anger management
(2) stress reduction
(3) conflict management/resolution
(4) domestic violence
(5) chemical dependency
(6) life skills/family issues
(7) community resources
b. Coordinate with CITY staff to facilitate delivery of program material.
c. Collect specific diagnostic and statistical information regarding inmates in attendance
and program material.
d. Assign inmates tasks to perform and goals to reach in relation to the program material.
e. Provide inmates in attendance with referrals to other agencies and community resources
that can provide additional instruction and/or counseling as follow-up to the program
material already delivered.
HEALTHCARE PROVIDERS SERVICE E PSQ
ORGANIZATION PURCHASING GROUP
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OCCURRENCE PROFESSIONAL LIABILITY POLICY FORM Date: 2022.08.0211: 9;58
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Print Date: 7/20/2022
The application for the Policy and any and allsupplementary information, materials, and statements submitted therewith shall I
be maintained on file by us or our Program Administrator and will be deemed attached to and incorporated into the Policy as I
if physically attached. I
PRODUCER BRANCH PREFIX POLICY NUMBER POLICY PERIOD
018098 970 HPG 0697816243 From: 12/10/21, to 12/10/22 at 12:01 AM Standard Time
Named Insured and Address: Program Administered bv:
Luis Martinez
301 W 2nd St Apt 241
Santa Ana, CA 92701-5295
Medical specialty:
Alcohol/Drug Counselor
Excludes Cosmetic Procedures
80723
Healthcare Providers Service Organization
1100 Virginia Drive, Suite 250
Fort Washington, PA 19034
1-800-982-9491
www.hpso.com
Insurance Provided by:
American Casualty Company of Reading, Pennsylvania
151 N. Franklin Street
Chicago, IL 60606
Professional Liability $ 1,000,000 each claim $ 3,000,000 aggregate
Your professional liability limits shown above Include ththe following:
* Good Samaritan Liability * Malplacement Liability * Personal Injury Liability
* Sexual Misconduct Included in the PL limit shown above subject to $ 25,000 aggregate sublimit
Coverage Extensions
License Protection
$ 25,000
per proceeding
$ 25,000
aggregate
Defendant Expense Benefit
$ 1,000
per day limit
$ 25,000
aggregate
Deposition Representation
$ 10,000
per deposition
$ 10,000
aggregate
Assault
$ 25,000
per incident
$ 25,000
aggregate
Includes Workplace Violence Counseling
Medical Payments
$ 25.000
per person
$ 1 D0,000
aggregate
First Aid
$ 10,000
per incident
$ 10,000
aggregate
Damage to Property of Others
$ 10,000
per incident
$ 10,000
aggregate
Information Privacy (HIPAA) Fines and Penalties
$ 25,000
per incident
$ 25,000
aggregate
Media Expense
$ 25,000
per incident
$ 25,000
aggregate
General Liability
General Liability $1,000,000 each claim / $2,000,000 aggregate
Fire & Water Legal Liability Included In the GL limit shown above subject to $250,000 aggregate sublimit
Personal Liability $1,000,000 aggregate
Total $ 465.00
Base Premium $465.00
Premium reflects Self Employed , Part Time
Policy Forms and Endorsements (Please see attached list of policy forms and endorsements)
Chairman of the card Secretary
Keep this Certificate of Insurance In a safe place. It and proof of payment are your proof of coverage. There Is no coverage in
force unless the premium is paid in full. To activate your coverage, please remit premium in full by the effective date of this
Certificate of Insurance.
Coverage Change Date: Endorsement Date: 7/19/2022 Masi
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CNA93692 (11-2018) iS jF1 7764 ;Dlrndm
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POLICY FORMS & ENDORSEMENTS
The following are the policy forms and endorsements that apply to your current professional liability policy.
COMMON POLICY FORMS & ENDORSEMENTS
FORM #
G-121500-D (04-08)
G-121501-C1(07-01)
CNA94164 (11-18)
G-145184-A (06.03)
G-147292-A (03-04)
GSL15563 (02-10)
GSL15564 (10-09)
GSL15565 (03-10)
GSL17101 (02-10)
GSL13424 (05-09)
CNA80051 (09-14)
CNA80052 (10-14)
G-123846-D04(07-01)
CNA81753 (03-15)
CNA81758 (01-21)
CNA82011 (04-15)
CNA89027 (10.17)
CNA79575 (07-14)
CNA89026 (05-17)
G-121504-C (07-01)
G-123828-B (07-01)
G-141231-A (07-01)
FORM NAME
Common Policy Conditions
Occurrence Policy Form - California
Amendment Definition of Claim Endorsement
Policyholder Notice - OFAC Compliance Notice
Policyholder Notice - Silica, Mold & Asbestos Disclosure
Information Privacy Coverage Endorsement HIPAA Fines, Penalties & Notification Costs
Sexual Misconduct Sublimits of Liability Professional Liability & Sexual Misconduct Exclusion
Healthcare Providers Professional Liability Assault Coverage
Exclusion of Specified Activities Reuse of Parenteral Devices and Supplies
Services to Animals
Amended Definition of Personal Injury Endorsement
Distribution or Recording of Material or Information in Violation of Law Exclusion Endorsement
California Cancellation and Non -Renewal
Coverage & Cap on Losses from Certified Acts Terrorism
Notice - Offer of Terrorism Coverage & Disclosure of Premium
Related Claims Endorsement
Entity Exclusion Endorsement
Exclusion of Cosmetic Procedures
)Additional Insured General Liability
Media Expense Coverage
General Liability Form
Certificate Holder
Additional Insured Healthcare Entity
PLEASE REFER TO YOUR CERTIFICATE OF INSURANCE FOR THE POLICY FORMS & ENDORSEMENTS SPECIFIC
TO YOUR STATE AND YOUR POLICY PERIOD.
For NJ residents: The PLIGA surcharge shown on the Certificate of Insurance is the NJ Property & Liability Insurance
Guaranty Association.
For KY residents: The Surcharge shown on the Certificate of Insurance is the KY Firefighters and Law Enforcement
Foundation Program Fund and the Local Tax is the KY Local Government Premium Tax.
As required by 806 Ky. Admin Regs. 2:100, this Notice is to advise you that a surcharge has been
applied to your insurance premium and is separately itemized on the Declarations page or billing
instrument attached to your policy, as required KRS. §136.392,
For WV residents: The surcharge shown on the Certificate of Insurance is the WV Premium Surcharge.
For FL residents: The FIGA Assessment shown on the Certificate of Insurance is the FL Insurance Guaranty Association
- 2012 Regular Assessment.
Form #:CNA93692 (11-2018)
Master Policy #: 188711433
Named Insured: Luis Martinez
Policy #: 0697816243
0 Copyright CNA All Rights Reserved.
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HEALTHCARE PROVIDERS
GENERAL LIABILITY COVERAGE PART ENDORSEMENT
Additional Insured — General Liability
In consideration of the premium paid, and subject to the General Liability limit of liability shown on the
certificate of insurance, it is agreed that the GENERAL LIABILITY COVERAGE PART is amended as
follows:
The person or entity named below (the "additional insured") is an insured under this Coverage Part but
only as respects its liability arising out of named insured's operations, or premises owned by or rented by
the named insured and solely to the extent that:
1. a general liability claim is made against the named insured and the additional insured; and
2. In any ensuing litigation arising out of such claim, the named insured and the additional insured
remain as co-defendants.
In no event is there any coverage provided under this policy for an occurrence that is the direct liability of
the additional insured.
Additional Insured: CITY OF SANTA ANA RISK MANAGEMENT DIVISION
20 CIVIC CENTER PLAZA
SANTA ANA CA 92702
This endorsement Is a part of your policy and takes effect on the effective date of your policy, unless
another effective date is shown below. All other provisions of the policy remain unchanged.
Must Be Completed
ENDT. NO. I POLICY NO.
1 697816243
Complete Only When This Endorsement Is Not Prepared with the Policy_
Or Is Not to be Effective with the Policy
LUIS MARTINEZ
G-123827-B (07/2001)
AMERICAN CASUALTY COMPANY OF READING, PA
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HEALTHCARE PROVIDERS
aRnFFRSIONAL LIABILITY COVERAGE PART ENDORSEMENT
Additional Insured — Healthcare Professional or Entity
In consideration of the additional premium paid, and subject to the Professional Liability limit of liability
shown on the certificate of insurance, it is agreed that the PROFESSIONAL LIABILITY COVERAGE
PART is amended as follows:
The person or entity named below (the "additional Insured") is an insured under this Coverage Part but
only as respects its liability for your medical incidents and solely to the extent that:
1. a professional liability claim is made against you and the additional Insured; and
2. in any ensuing litigation arising out of such claim, you and the additional insured remain as co-
defendants.
In no event is there any coverage provided under this policy for a medical incident that is the direct
liability of the additional insured.
Additional Insured: CITY OF SANTA ANA RISK MANAGEMENT DIVISION
20 CIVIC CENTER PLAZA
4TH FLOOR
SANTA ANA CA 92072
This endorsement Is a part of your policy and takes effect on the effective date of your policy, unless
another effective date is shown below. All other provisions of the policy remain unchanged.
Must Be Completed Complete Only When This Endorsement Is Not Prepared with the Policy
Or is Not to be Effective with the Policy
ENDT. NO. POLICY NO. ISSUED TO ENDORSEMENT EFFECTIVE DATE
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G-141231-A (07/2001) —
HEALTHCARE PROVIDERS
GENERAL LIABILITY COVERAGE PART
OCCURRENCE
THIS IS AN OCCURRENCE COVERAGE PART AND, SUBJECT TO ITS PROVISIONS, APPLIES ONLY TO ANY
CLAIM WHICH IS THE RESULT OF INJURY OR DAMAGE THAT OCCURRED ON OR AFTER THE EFFECTIVE
DATE OF COVERAGE, AND BEFORE THE EXPIRATION OF THE POLICY PERIOD STATED ON THE
CERTIFICATE OF INSURANCE. CLAIM EXPENSES ARE IN ADDITION TO THE LIMIT OF LIABILITY.
I. COVERAGE AGREEMENT
A. GENERAL LIABILITY
Subject to paragraph B below, we will pay all amounts, up to the General Liability limit of liability stated on the
certificate of insurance, which you become legally obligated to pay, including host liquor liability and
products liability, as a result of injury or damage to which this coverage part applies. We will also pay claim
expenses. The injury or damage must be caused by an occurrence that happens anywhere in the world,
Including the workplace during the policy period.
B. FIRE & WATER LEGAL LIABILITY
With respect to the named insured's legal liability for damage to property in which the named insured does
not have a financial interest or own, caused by:
1, fire;
2. discharge, leakage or overflow of water or steam from a plumbing, heating, refrigeration or air conditioning
system; or
3. rain which enters directly into the building through open doors, windows, skylights, transoms or ventilators;
we will pay up to $250,000 provided that the named insured does not assume liability under a contract or
agreement greater than is imposed by law. The damage must be caused by an occurrence that happens
anywhere in the world, including the workplace, during the policy period.
C. PERSONAL LIABILITY
Where the named insured is a natural person, we will pay all amounts, up to the Personal Liability limit of
liability stated on the certificate of insurance, that the named insured becomes legally obligated to pay for
Injury or damage as a result of a personal liability claim. The injury or damage must be caused by an
occurrence that happens at named Insured's residence and arises out of named Insured's non -business
activities. This coverage shall not apply to damage to property the named insured owns, rents, occupies or
uses, or which is in the named insured's care, custody or control.
Coverage for personal liability claims will only apply if the named insured is a natural person with no
employees.
II. DEFENSE AND SETTLEMENT
We have the right and duty to defend any claim. We will:
A. do this even if any of the charges of the claim are groundless, false or fraudulent;
B. investigate and settle any claim as we feel appropriate.
Our payment of the limit of liability ends our duty to defend or settle. We have no duty to defend any claims not
covered by this Coverage Part.
G-121504-C (7/2001)
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III. ADDITIONAL DEFINITIONS
For purposes of this coverage part only, words in bold have the meaning set forth below:
"Host Liquor Liability" means injury or damage arising out of the giving or serving of alcoholic beverages at
functions incidental to your business providing:
1. you are not engaged in the business of manufacturing, distributing, selling or serving of alcoholic
beverages; or
2. there has not been an intentional violation of any statute, regulation or ordinance relating to the sale, gift,
distribution or use of alcoholic beverages, committed by you, or at your direction.
"Injury" means bodily injury, sickness, disease, mental or emotional distress sustained by a person, or death.
"Insured Contract" means:
1. a lease of business premises;
2. a sidetrack agreement;
3. an easement or license agreement except in connection with construction or demolition operations on or
within 50 feet of a railroad;
4. an obligation, as required by ordinance, to indemnify a municipality, except in connection with work for a
municipality;
5. an elevator maintenance agreement; or
6. that part of any other contract or agreement pertaining to the named insured's business, including an
indemnification of a municipality in connection with work performed for a municipality, under which the
named insured assumes the tort liability of another party to pay for injury or damage to a third party if the
contract or agreement is made prior to the injury or damage.
"Insured Contract" does not mean that part of any contract or agreement:
1. that indemnifies any entity for injury or damage arising out of construction or demolition operations, within
50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road beds, tunnel,
underpass or crossing;
2. that indemnifies an architect, engineer or surveyor for injury or damage arising out of:
a. preparing, approving or failing to prepare or approve maps, drawings, opinions, reports, surveys,
change orders, designs or specifications; or
b. giving directions or instructions, or failing to give them, if that is the primary cause of the injury or
damage; or
3, that Indemnifies any entity for damage by fire to business premises rented or loaned to the named
insured.
"Occurrence" means an accident, including continuous or repeated exposure to conditions, which results in
Injury or damage.
"Personal liability claim" means a claim arising out of injury or damage to a third party that happens at the
named insured's personal residence and arises out of non -business activity.
"Product" means:
1. any healthcare goods or items manufactured or modified by:
a, the named insured; or
b, others trading under the named Insured's name; or
c. an entity whose business or assets the named insured has acquired; or
2. containers (other than vehicles), materials, parts or equipment furnished
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"Product" does not include real property, or any goods and items that the named insured sells.
"Products Liability" means Injury or damage caused by a product.
"You" or "Your" means the named insured and, if the named insured is not a natural person:
1. any individual who, during the policy period, is or becomes a partner, officer, director, stockholder -
employee, manager, member or employee of the named insured, but only while acting within the scope
of their employment by the named insured; or
2. any Individual who, during the policy period, is or becomes a substitute health care provider, other than a
physician, dentist, nurse anesthetist, nurse mid -wife, chiropractor, self-employed periusionist, or podiatrist,
that the named insured contracts with, but only while acting within the scope of their employment by the
named insured; or
3. any individual previously affiliated with the named insured as its partner, officer, director, stockholder -
employee, manager, member or employee but only while acting within the scope of their employment by
the named insured, during the course of such employment.
IV. EXCLUSIONS
We will not defend any claim for, or pay any amounts, including claim expenses, based on, arising out of, or
related to:
A. injuryto:
1, an employee of the named insured arising out of and in the course of employment by the named
insured; or
2. a family member of that employee as a consequence of 1 above; or
3. the named insured's family member.
This exclusion applies:
1. whether the named insured may be liable as an employer or in any other capacity; and
2. to any obligation to share amounts with or repay someone else who must pay amounts because of the
injury or damage;
B. amounts which the named insured or any party must pay under any unemployment or workers'
compensation, disability benefits, or other similar law;
C. injury or damage resulting from any professional services, placement services or personal injury;
D. any liability the named insured assumes under any contract or agreement, other than an insured contract.
This exclusion does not apply to:
1. liability the named insured assumes under a contract with a Health Maintenance Organization, Preferred
Provider Organization, Independent Practice Association, or any other similar organization; but only for
such liability as is attributable to your alleged negligence; or
2. a warranty of fitness or quality of any therapeutic agents or supplies the named insured has furnished or
supplied in connection with treatment you have performed;
E. any liability you have for a business or profession, including consulting services, other than that named on
the certificate of insurance;
F. injury or damage resulting from an occurrence which is also a willful violation of a statute, ordinance or
regulation imposing criminal penalties. We will defend any civil suit against you seeking amounts that would
be covered If this exclusion did not apply. In such case, we will pay only claim expenses related to such
defense;
G. injury or damage for which you may be held liable as a result of:
1. causing or contributing to the alcoholic beverage Intoxication of any person; or
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2. furnishing of alcoholic beverages to a person under the legal drinking age or under the influence of
alcohol;
This exclusion does not apply to host liquor liability;
H. injury or damage based upon, arising out of, directly or indirectly resulting from, in consequence of, or in any
way involving you owning, using, taking care of, operating, leasing or renting, loading or unloading of patients
or property from, transporting patients in, or entrusting to others an auto, mobile equipment, watercraft or
aircraft, including an auto, mobile equipment, watercraft or aircraft which is loaned to the named insured or
which is operated for the named insured by it's employee, including an employee -owned auto;
I. loss, under any circumstances, due to nuclear reaction, radiation, or contamination, regardless of cause;
J. the return or withdrawal of fees or government payments imposed directly upon you; any fines, penalties or
sanctions; punitive or exemplary amounts; or the multiplied portion of any multiplied award, imposed by law;
K. injury or damage you expected or intended, or which a reasonable person would have expected. This
exclusion does not apply to injury or damage resulting from the use of reasonable force to protect persons or
property;
L. any claim arising out of actual or alleged involvement in any:
1. federal or state anti-trust law violation; or
2. agreement or conspiracy to restrain trade•,
M. any loss, cost or expense:
1. which would not have happened, in whole or in part, but for the actual, alleged or threatened discharge,
dispersal, seepage, migration, release or escape of pollutants at any time; or
2, arising out of any:
a. claim or suit by or on behalf of a governmental authority for amounts because of testing for,
monitoring, cleaning up, containing, treating, detoxifying or neutralizing, or In any way responding to,
or assessing the effects of pollutants; or
b. request, demand or order that you or others test for, monitor, clean up, remove, contain, treat, detoxify
or neutralize, or in any way respond to, or assess the effects of pollutants;
N. any loss, cost or expense arising out of, relating to, or involving the actual, alleged or threatened exposure at
any time to asbestos; or that may be awarded or incurred:
1. by reason of a claim or suit relating to asbestos; or
2. in complying with a governmental directive or request to test for, monitor, clean up, remove, contain, or
dispose of asbestos;
O. damage to property you own, rent or occupy, hold for sale, or which has been given to you for storage or
safekeeping except to the extent coverage would apply under Section I, paragraph B, Fire & Water legal
liability;
P. loss of use of tangible property which has not been physically damaged if:
1. a delay in or lack of performance has been caused by or on your behalf under any contract or agreement;
or
2. products or work completed on the named insured's behalf do not meet the standards the named
Insured has warranted or represented;
We will cover loss of use of tangible property if:
1. the loss results from a sudden and accidental physical damage to or destruction of products or work
completed by or on the named insured's behalf; and
2. products or work has been put to use by a person or organization other than the
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Q. damage to property while on the business premises to have operations performed on the property by or on
the named insured's behalf;
R. damage to tools or equipment while being used to perform operations;
S. damage to property in your custody which you are to install, erect or use in any construction;
T. damage to any property away from the business premises:
1. upon which you or someone on your behalf is performing operations at the time the damage occurs; or
2. which must be restored, repaired or replaced because of faulty workmanship by or on your behalf;
U. injury or damage on leased business premises:
1. after the named Insured ceases to be a tenant of the leased business premises; or
2, for structural alterations, new construction or demolition operations performed by or for the owner of the
business premises.
V. any act of sexual intimacy, sexual molestation or sexual assault. We shall provide you with a defense of such
claim unless or until such act has been determined to have occurred, by any trial verdict, court ruling,
regulatory ruling or legal admission, whether appealed or not. Such defense will not waive any of our rights
under this Policy. Criminal proceedings are not covered under this Policy regardless of the allegations made
against you;
W. any direct or consequential injury or damage arising out of any:
1. refusal to employ; or
2. termination of employment; or
3, coercion, demotion, reassignment, defamation, harassment, humiliation, discrimination or other
employment related practices, policies, act or omissions;
X. by or on behalf of you against any other of you.
V. LIMIT OF LIABILITY
A. Each Occurrence
The limit of liability stated on the certificate of insurance for each occurrence, is the limit of our liability for all
injury or damage arising out of, or in connection with the same occurrence. This limit applies regardless of
the number of persons or organizations who are covered under this policy.
B. Aggregate
Subject to provision A. above, the total limit of our liability for all injury and damage shall not exceed the limit
of liability stated on the certificate of insurance as aggregate. The aggregate limit of liability applies to each
policy period for all occurrences for which claims are made.
C. Claim expenses are in addition to the limit of liability.
VI. DUTIES IN THE EVENT OF AN OCCURRENCE, OFFENSE OR CLAIM
The named Insured must notify us, or our program administrator, in writing, as soon as practicable, of an
occurrence, an offense which may result in a claim, or a claim. To the extent possible, notice should include:
A. How, when and where the occurrence, offense or claim took place;
B. The names and addresses of any injured persons or witnesses; and
C. The nature and location of any injury or damage arising out of the occurrence, offense or claim.
G-121504-C (712001)
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DranPPRRInNAI I IARILITY INSURANCE ENDORSEMENT
Agreement to Provide Notice of Cancellation
In consideration of the premium paid, it is agreed that if the policy to which this endorsement is attached is
cancelled before the expiration date, we will endeavor to mail notice to the person or entity named below.
However, failure to mail such notice shall impose no obligation or liability of any kind upon the company,
its agents or representatives.
Person or Entity Name and Address: CITY OF SANTA ANA RISK MANAGEMENT DIVISION
20 CIVIC CENTER PLAZA
4TH FLOOR
SANTA ANA CA 92072
This endorsement is a part of your policy and takes effect on the effective date of your policy, unless
another effective date is shown below. All other provisions of the policy remain unchanged.
Must Be Completed
ENDT. NO. POLICY NO.
1 697816243
G-123828-B (7/2001)
MARTINEZ
to be
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WORKERS' COMPENSATION DECLARATION
I, Luis R. Martinez
(Name/Title)
following declaration:
hereby affirm under penalty of perjury, the
I certify on behalf of Luis R. Martinez that during the term
(Cansultant/Company Name)
of my contract for Mental Health counseling _ services with the City of Santa Ana,
(Type of service provided)
I will not employ any person in any manner so a.s 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 provisionsand provide proof of workers' compensation coverage
immediately.
Date: March 15, 2022
Print Name; Luis R. Martinez
Print Title: Mental Health Counselor
Signature: ` — "
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Telephone: 114 469-401
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.
k�Rlsk MgmtjInsurance RequirementslWC 0edaration 08152019
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March 15, 2022
City of Santa Ana
Risk Management Division
20 Civic Center Plaza
Santa Ana, CA 92702
Re: Auto Insurance Requirement
Dear City of Santa Ana Risk Management Division:
[Company Name] has intent to enter into an agreement with the City of Santa Ana,
Throughout the course of this agreement, [Company Name] attests to the following:
1. Luis R. Martinez will not use/drive any vehicle during the course and scope of
the services provided in the agreement/contract.
2, Luis R, Martinez will not use any owned/rented/leased vehicles during the
course and scope of the services provided in the agreement/contract
3. Luis R. Martinez consultants/independent eontraetors/employees utilize their
personal vehicles/non-company awned, borrowed, or rented/leased vehicles for
transportation to and. from work and if applicable carry their own automobile
insurance.
By signing below, I, Luis R. Martinez attest that I possess the legal authority to enter into
an agreement with the City of Santa Ana as well as the legal authority to attest to the
statements above. If at any time it is found that Luis R, Martinez is not adhering to.
any/all statements in this document and has not provided the minimum Auto liability
insurance coverage of$1 million per occurrence, the contract will be considered null and
void and the company will be held fully liable for any and all damages.
�L
uik R, Martinez
Mental Health Counselor
301 W, 2"d Street, Apt. 241
Santa Ana, CA 92701
714 469-4011
luisraul@martinez,net
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