HomeMy WebLinkAboutCLODIG,JOHN B. 1-2003 ON FILE ~?
WORKINSURANCEMA,~ PROCEED ~
UNTIL IN~U.~ANCE EXPIRES
OL~RK OF COUNGIL
N-2003-032
STANDARD CONSULTANT AGREEMENT
.~,,x THIS AGREEMENT, made and entered into this 7th day of March, 2003 by and between
J.ohn B. Clodig, dba KeyMOVES (hereinafter "Consultant"), and the City of Santa Ana, a charter
c~ty and municipal corporation organized and existing under the Constitution and laws of the
State of California (hereinafter "City").
RECITALS
Ao
The City desires to retain a consultant having special skill and knowledge in the field of
training personnel in methods of safe and efficient movement to reduce muscoskeletal
injuries in the workplace.
B. Consultant represents that Consultant is able and willing to provide such services to the
City.
Co
In undertaking the performance of this Agreement, Consultant represents that it is
knowledgeable in its field and that any services performed by Consultant under this
Agreement will be performed in compliance with such standards as may reasonably be
expected fi:om 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 shall perform those services as set forth in Exhibit A to this Agreement.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services,
the rates and charges identified in Exhibit A. The total sum to be expended under this
Agreement, shall not exceed $9,999.99 during the term of this Agreement.
b. 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.
3. TERM
This Agreement shall commence on the date first written above and terminate not later
than June 30, 2004, unless terminated earlier in accordance with Section 12, below. The term of
this Agreement may be extended upon a writing executed by the Executive Director of the
Personnel Services Agency and the City Attorney.
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. Commercial General Liability Insurance. Consultant 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 Consultant'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. Consultant shall supply City with a fully executed
additional insured endorsement in substantially the form attached hereto as Exhibit B upon
execution of this Agreement and shall be approved in form by the City Attorney.
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 3300
of the Labor Code, Consultant, if Consultant 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, Consultant agrees to obtain and maintain any
employer's liability insurance with limits not less than $1,000,000 per accident.
d. If Consultant 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.
e. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section:
(i)
(ii)
(iii)
Consultant shall maintain all insurance required above in full force and
effect for the entire period covered by this Agreement.
Certificates of insurance shall be furnished to the City upon execution of
this Agreement and shall be approved in form by the City Attorney.
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.
f. If Consultant 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 effect Consultant's right to be paidfor its
time and materials expended prior to notification of termination. Consultant waives the right to
receive compensation and agrees to indemnify the City for any work performed prior to approval
of insurance by the City.
6. INDEMNIFICATION
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 health, and claims for property damage, which may arise fi-om 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) fi:om 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 fi:om 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.
7. 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 telefacsimile 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, California 92702-1988
telefacsimile (714) 647-6956
With courtesy copies to:
Executive Director
Personnel Services Agency
City of Santa Ana
20 Civic Center Plaza (M-24)
P.O. Box 1988
Santa Ana, California 92702-1988
telefacsimile (714) 647-6930
4
and,
City Attomey
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6515
To Consultant:
KeyMOVES
1308 E1 Nido Drive
Fallbrook, California 92028
Attn: John B. Clodig
telefacsimile (760) 728-5859
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, any notice, tender, demand, delivery, or other
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, any notice, tender, demand, delivery, or
other 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 are 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 may be terminated by the City 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 Executive Director 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. DISCRIMINATION
Consultant shall not discriminate because of race, color, creed, religion, sex, marital
status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited
by applicable law, in the recruitment, selection, training, utilization, promotion, termination or
other employment related activities. 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 and all questions relating to its validity, interpretation, performance, and
enforcement shall be government and construed in accordance with the laws of the State of
California. 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 in writing of her 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
a. Each undersigned represents and warrants that its signature hereinbelow has the power,
authority and right to bind their respective parties to each of the terms of this Agreement, and shall
indemnify City fully, including reasonable costs and attomey's fees, for any injuries or damages to'
City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn.
b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set
forth in the body of this Agreement.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST: /
Clerk of the Council
CITY OF S~
City Manager
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
B enj'amin K~af~n/~n
Ch)'ef Assistant City Attorney
RECOMMENDED FOR APPROVAL:
Enrique "~ ~.nry',/j. A~a
Executi~3 5ire. tor~
Personnel ~ ervlces Agency
City of Santa Aha
CONSULTANT
/' 5oq
~/lndividual SS #
K e y MOVES
Principles of Movement
SAFETY PROGRAM
John B. Clodig, Director
1308 El Nido Drive
Fallbrook, California 92028
Tel: (760) 728-8823
Fax: (760) 728-5859
February 4, 2003
Ms. Emilyn Buenafe
Loss Control Technician
Risk Management Division
CITY OF SANTA ANA
P.O. Box 1988 M-28
Santa Aha, CA 92702
Re: KeyMOVES Safety Education Training Program Proposal
Dear Ms. Buenafe,
Pursuant to our earlier conversations, we propose to train personnel from the City of
Santa Ana Public Works, Parks and Recreation, Fire and Police Departments in methods of safe
and efficient movement to reduce muscoskeletal injuries in the work place. Training is proposed
to commence March 2003.
Attachment A, entitled General Work Functions, is a sample format of the instructional
program prepared for the multiple departments of the Hilton Hotels and the University of
California, Irvine, Riverside and San Diego. We will tailor a similar format for your
departments, with your input and approval. For example, Parks and Recreation personnel might
be instructed in walking and carrying loads on adverse surfaces and conditions including uneven
terrain, shoveling, raking, lifting and placing tree branches onto trucks, etc.
Page 1 of 3
EXHIBIT A (nine pages)
To maximize savings for you, while satisfying the difficulties of scheduling, KeyMOVES
proposes to train 600 personnel from these departments in one of three options: 1. Five (5) full days, or
2. Four (4) full days and two (2) half days, or
3. Three (3) full days and four (4) half days, but charge the same discounted amount
of $9,999.00.
Three full days and four half days normally would be $12,300.00. Four full days and two
half days normally would be $11,400.00. Five full days normally would be $10,500.00.
Depending on the option you choose, will result in a savings range to you between $501.00 and
$2,301.00, while the training cost would be less than $16.70 per employee trained.
Per your request, there will be two (2) hour sessions with 30 personnel in each session.
120 personnel can be trained in a full day, while 60 personnel can be trained in a half day.
The training will include KeyMOVES principles and techniques for generic tasks, such
as: handling poled and powered tools, equipment and loads, pushing, pulling and lifting objects
and loads, individual and team carrying objects, walking on adverse surfaces and under adverse
conditions, climbing and descending ramps, stairs, ladders and uneven terrain.
In addition, instruction will include principles and techniques for specific tasks unique to
each department. This may involve methods to move safely and efficiently while turning valves,;
exiting a vehicle while wearing a gun belt, lifting and carrying various equipment and loads.
Hopefully, this proposal will cover your needs and we can soon start sharing the
KeyMOVES Program with the City of Santa Ana personnel, and reduce injuries and claims.
Very truly yours,
o ' B. Clodig, Directot'
Encl. Proposal
Page 2 of 3
KeyMOVES
Principles
SAFETY
of Movement
PROGRAM
John B. Clodig, Director
1308 El Nido Drive
Fallbrook, California 92028
(760) 728-8823
FAX (760) 728-5859
March 11, 2003
Ms. Emilyn Buenafe
Loss Control Technician
Risk Management Division
CITY OF SANTA ANA
P.O. Box 1988 M-28
Santa Ana, CA 92702
Re: KeyMOVES Safety Education Training Program
City Of Santa Ana Standard Consultant Agreement, dated 3-07-03
Dear Ms. Buenafe:
Enclosed please find the three (3) original copies of the
Agreement executed by myself. I understand that upon the Agreement
being fully executed by all named parties, an original copy will
be sent 'to me.
Per our telephone conversation this date, it is our agreement
that KeyMOVES will provide five (5) days of direct training, or a
combination of direct training and Train the Trainer training, for
a contract price of $9,999.00.
It is also understood that not all 600 City of Santa Ana
personnel (as described in the aforesaid Agreement and attachments)
may be available for direct training during these same five days.
Thus, it is our agreement that KeyMOVES will provide the City Train
the Trainer training, for at least six (6) personnel selected by
the City, for the portion, or balance, of said five (5) days that
the original 600 City personnel are not available for direct training.
The five (5) days of training will be dates mutually agreeable,
and the dates need not be back-to-back consecutive. It is also
understood that the likely start date will be April 16, 2003, followed
by April 23, 2003.
Emilyn Buenafe
March 11, 2003
Page Two
Hopefully, this will allow you to complete the necessary
paperwork in time for the proposed start date. We look forward
to sharing our program with you and the City personnel.
Encl.
Very truly yours,
/'~hn B. Clodig,~irector
>~KeyMOVES
executed Standard Consulting Agreement, three (3) originals
KeyMOVES
Principles of Movement
Safety Program
John B. Clodig, Director
1308 El Nido Drive
Fallbrook, CA 92028
Tel: (760) 728-8823
Fax: (760) 728-5859
Mr. Jeff Stevens
Risk Manager
CITY OF SANTA ANA
Risk Management Division M-28
20 Civic Center Plaza
Santa Aha, CA 92701
Re: KeyMOVES Safety Education Training Program
TRAINING PROPOSAL - JOB DESCRIPTION
Ms. Emilyn Buenafe
Loss Control Technician
Risk Management Division
CITY OF SANTA ANA
P.O. Box 1988 M-28
Santa Ana, CA 92702
Five (5) full days of Direct Training, or Four (4) Full days and Two (2) Half days, or
Three (3) Full days and Four (4) Half days of Direct Training, to train approximately
600 personnel from Public Works, Parks and Recreation, Fire and Police Departments
in said 5, 6 or 7 days, as agreed.
ITEM/ZED PROPOSAL: TIME AND MATERIALS
AMOUNT
Al.
600 Personnel from Public Works, Parks and Recreation, Fire
and Police Departments to be trained in one of three options
above, with training to commence March 2003
30 Personnel to be trained per session with each
session to be Two (2) hours duration.
Full Day shall consist of Four (4) Two hour sessions.
Half/Day shall consist of Two (2) Two hour sessions. TOTAL
$9,999.00
Page 3 of 3
GENERAL WORK FUNCTIONS
As you know, safety training is still a necessity. However, there is also an urgent need for
useful and immediately applicable training, vice a mere management check-offcourse, or
entertaining (but quickly forgotten) video tape. As one client stated "the best way to get into trouble,
is to rely on a back safety video."
82% of all employee injuries is due to improper body movement by the employee. The best
way to teach safe and efficient body movement is hands-on training. If you want to learn to swim or
ride a bike, you must get into the water or onto the bike. If a picture is worth 1,000 words, the one
"feeling" is worth 1,000 photos. This emphasis on "feeling" correct movement allows for easy
instruction to multilingual groups.
These movements are simple and non-athletic and permit easy training of aged, out-of-shape,
and inexperienced employees. Since principles of movement are emphasized, employees can sculpt
their own solutions to new problems as they arise.
The KeyMOVES safety program would include instruction on the following:
Principles of Movement
How to size up a job so it can be done safely
How to avoid injury by recognizing high risk tasks and taking the appropriate precautions of
avoiding them if resources are too limited
How to increase stability when performing work tasks
How to achieve maximum balance and stability under any situation
How to position the body to use the most powerful muscles for a task instead of training
weaker muscles
How to position the body to use the skeletal system to produce the leverage of a machine
Coordinate the mind and body to achieve maximum efficiency with minimum effort
Handling, Pushing, Pulling and Lifting
How to get maximum gripping power under differing conditions
How to push and pull heavy objects with less effort
How to create a "strong line" in your body to minimize strain during a lift
How to get maximum power lifting and moving awkward objects with minimum effort
How to sequence muscle movement to increase lifting efficiency
How to safely handle, push, pull or lift objects on your knees or in restricted spaces
How to get up safely from the seated or kneeling position
How to get extra lifting capacity by proper breathing
Using specific mental images that automatically induce correct movement
Page 1 of 4
Slips, Trips and Falls
Walking forward, backward and laterally over adverse surfaces and conditions
How to avoid slips, trips and falls while walking in zero visibility
How to safely ascend/descend ramps stairs, ladders and vehicles
How to carry objects or team carry
How to maintain balance on a l-noving platform
How to prevent a slip from becoming a fall
What to do when a fall is inevitable
What to do on the ground, if you fall, to avoid aggravating possible injuries
How to safely get up from the ground after a fall
University Work Functions, Tasks, Problem Areas
The program would also apply the KeyMOVES principles and techniques to the work
functions, tasks and problem areas specific to the University, including some of the following
examples:
Dormitory Housekeeping Tasks
Cart Use - Moving heavy cart (push, pull) on carpeted hallways, around corners, in and out
of guest rooms/storage rooms, in and out of elevators
Setup - Load carrying (heavy lifting) trash on/offcart, linen bags (heavy, soiled towels, etc.)
on/off cart; buckets and vacuums on/off carts
Stewards: lifting large rolled carpets on/off carts, moving and lifting large potted plants
Room Servicing - Moving objects i.e. mattress moving for cleaning and making beds, turning
over mattresses
Furniture moving: tables, chairs, couches
Vacuuming carpets (pushing, pulling)
Mopping floors (slippery floors: slips, trips and falls)
Cleaning Bathroom fixtures/tubs and showers (slips, trips and falls)
Window cleaning (reach, climb/descend)
Awareness training of other hazards: Chemical safety, bio hazards, sharp cuts, burns
Maintenance/Craftsmen Tasks
General Maintenance, including, but not limited to the following examples:
· Lifting- carrying heavy equipment
· Climbing/descending - ladders: painting, changing light bulbs
· Push/Pull/Handling - valves, levers on boilers, laundry washers/dryers/presses/air
conditioner/heating/plumbing equipment
· Slippery surfaces (slip, trip, and fall)
plumbing problems, cleaning pool side, grounds keeping surfaces
Food Preparation/Kitchen
Slip, Trip & Fall
Page 2 of 4
Floor, edges of mat
Pick-up mat to clean, walk on un-matted floor
Carrying objects from sandwich tables to coolers
Trip on produce box or floor
Passages and Walk-in coolers
Dish-cleaning area
Service stations for waiters & waitresses-handling coffee, milk, soup, water, ice,
silverware, dirty dishes, hot food, soup to warmer
Prolonged standing (with or without mats)
Lifting - 80 quart pots and 5 gallon buckets, with and or without handles, produce
boxes
Handling - gripping knife, cutting with knife, staples on boxes, serrated paper cutter
Food Services/Banquets/Restaurants/Dining Room
Lifting and Carrying - tray service, 2 man carry: tables & chairs, long distance carry: dirty
dishes, linen, trash
Slip, Trip & Fall
· Changing surfaces, borders, edges (i.e. tile to carpet, interior to exterior - grass or
pool, carrying large trays with or without folding stands
· Wet floors: walking through kitchen, dish-cleaning area
· Carrying loads on wet surfaces (i.e. dirty dishes to dish room (bus tubs), dirty linen in
full bags, moving glasses of water to tables, moving ice/liquor to remote stations
· Walking with blocked vision - rearward walking as to move a table, etc.
· Heavy load carrying/overhead carrying of trays with plates of food/beverages
· Pans of hot food for buffet service
· Beverage trays through crowded rooms
· Two men carrying/carts - moving tables, carts of plated entrees, or deserts, porta bars
· "Bumping" co-workers/guests avoiding - reaching for trays, plates, refilling
beverages
Clerks/Managers/Auditors
Prolonged standing, sitting, carpal tunnel syndrome - computer keyboard, switchboard ~tuties
Security
Slip, Trip & Fall
· Fast walking on adverse surfaces (i.e. water, ice, mud, grease, loose soil) or uneven
surfaces (i.e. borders: carpet changes to tile, edges, cracks, holes)
· Arresting/detaining techniques
Freight - Package Delivery: Loading/Unloading Large Trucks/Carrier Vans
Entering, exiting vehicles
Loading, unloading packages
Lifting, carrying packages
Page 3 of 4
Walking around vehicles, parking lots
· Avoid slip, trip and fall in adverse weather conditions and adverse surfaces:
· Rain, snow, ice, mud, loose soil, grease
· Potholes, border areas, steps and stairs
Truck Unloading/Conveyor Belt
Reaching, bending
Push, pull, lift to unload
Kneeling: load, unload, turning on knees
Sorting
Lifting bags from carts
Lifting, reaching for top shelves
Wrist injury from letter tossing/small packages sorting
Loading & Stacking Containers
Bending, reaching
Mid-thigh lift, turn, carry
Reach, unload
Re-lift to re-stack
Moving Large Containers
Methods to push-pull to avoid twisting Iow back/waist
Methods of walking to avoid slipping, pulling rnuscles/tendinitis re shoulder
Avoid tripping
Avoid falling
Righting self
Method of falling
Rising from a fall (more injuries caused by rising improperly i.e. embarrassment)
kcy.gcnfunctionsU
Page 4 of 4
EXHIBIT B
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY POLICY
Insurance Company
This endorsement modifies such insurance as is afforded by the provisions of Policy
# relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its
officers, employees, agents, volunteers and representatives are named as additional insureds
("additional insureds") with regard to liability and defense of suits arising from the operations
and uses performed by or on behalf of the named insured.
2. With respect to claims arising out of the operations and uses performed by or on
behalf of the named insured, such insurance as is afforded by this policy is primary and is not
additional to or contributing with any other insurance carried by or for the benefit of the
additional insureds.
3. This insurance applies separately to each insured against whom claim is made or
suit is brought except with respect to the company's limits of liability. The inclusion of any
person or organization as an insured shall not affect any right which such person or organization
would have as a claimant if not so included.
4. With respect to the additional insureds, this insurance shall not be cancelled, or
materially reduced in coverage or limits except after thirty (30) days written notice has been
given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701.
(Completion of the following, including countersignature, is required to make this endorsement
effective.)
Effective
Policy #
Issued to
, this endorsement form as a part of
Named Insured
Countersigned by
Authorized Representative
01/17/03 12:09
Name Insured:
KeyMoves l:Yinciples of Movement
1308 El Nido Drive
Fallbrook, CA 92028
FAX 780 728 5859 John B Clodlg
Certificate of lnsurance
Sparta Program
Named Additional Insured:
SANTA ANA (SPARTA)
20 Civic Center Plaza PO BoY. 1988
Santa Aaa CA 92701
002
Certificate #
Coverage
Limits
Deductible.~
Terms
Conditiotts
Exclusions
SSA03-0012
SPARTA INSURANCE PROGRAM: Commercial General Liability - Hazard 1
Conu'act Valuc: $10,000.00
Coverage Period: 419/2003 to 4/9/2004
Insurance Carrier: Essex Insurance Company
Master Policy: 3CJ8801
Master Policy Effective Date: 1 I/15/2002 to expiration
$2.000,000 General AggregaTe / $1,000,000 Each occurrence / $1,000,000 Products/COmpleted operations /
$1,000,000 Personal & Advertising Injury/S50,000 Fire Damage / Medical Payments Excluded I Si,000,000
Designated Professional Liability / / $1,000,000 Designated Professional Liability / / $1,000,000 Nonowncd
Automobile Liability coverage for the city, county or public entity only. No coverage is provided for the Certificate
Holder. Coverage is limltcd to the insured operation covered by this certificate and for vehicles not owned or hired
by the city, county or public cmiry.
$500 B! & PD Per Claimant Including Loss Adjustment Expense
$1,450.00 Premium (Fully Earned)
$47.13 Taxes (Fully Earned)
$ 100.00 Certificate Fee (Fully Earned)
$1,597.13 Total Amt
I. ~o Cancellations Allowed
2. Operations and R~dng Based:Consultant - Safety trai~ing program for The CiD' of Saat~/ma Employees.
3. Contractual on a Limited Fo.'Tn.
4. Additional Insured(s): N/A
5. Depar~nent: Santa Ann Risk Managcmen~ Department
6. Additional Terms and Conditions: 6. NP PUBLIC EXPOSURE WORKING WITH THE CITY OF SANTA RNA
AND THEIR DEPARTMENTS ONLY.
Per the Master policy, a copy is available by wriaen request to: Municipality Insurance Services, Inc. 1920 East
17th St Suite 136, Santa Ann, CA 92705
The Insurance afforded under the specified policy above is subject to all the terms, conditions, and exclusions of'
such policy. (A copy of thc policy is available upon writxen requesL) This coverage applies only to the contracxor or
event no~¢d above and does not extend to any other activities or work performed by the holder.
ROVED AS TO FORM
City Attorney
Carol Frost / President
Municipality Insurance Services, Inc.
1920 East 17th St Suite 136
Santa Ans. CA 92705
1920 East 17th St Suite 136 .qanta Aaa. CA 92705 (800) 420-0555 (714) 550-5040 fax (714) 550-5044 License# 0C04849
12:09 FAX 760 728 5859 John B C1od16 ~003
04/17/03
ENDORSEMENT
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
NON-OWNED/HIRED AUTO LIABILITY
This endorsement, effective on 4/9/2003 forms a part ,of
Policy Number: 3CJ8801 Certificate Number: SSA03-0012
:
Issued To: KeyMoves Principl~ of Movement
By: Essex Insurance Company
This endorsement modifies insurance;.provided under the following:
COMMERCIAL GENERAL LIAi~iLITY COVERAGE PART
SC.EDUL£
COVERAGE
ADDITIONAL PREMIUM
Non-Owned / Hired Auto Liabiliry
NON-OWNED/H/RED AUTO LIABILITY
Coverage applics only to The City el'Santa
Ami a.~: limited by thc specific work
Pcrformcd under this certificate. No covcmgc
Aff0rdcd to certificate holder
The insurance provided under COVERAGE A (Section l) applies to "bodily injury" or "property damage" arising
out of the use of any "non-owned/hired auto" in your business by any person other than you.
With respect to the insurance provided by this endorsement:
The exclusion, under COVERAGE A (Section I), other than exclus,ons A. B, D, F and 1 are deleted and the
following exclusions are added:
I. "Bodily injury"
(a) To an "employee" of the insured arising out ofandiin the course of employment by
the
/nsurcd;
or
(b) To thc spouse, child, parent, brother or sister of that "employee" as a consequence of paragraph (a)
above.
injury.
This exclusion applies:
(a) Whether the insured may be liable as an employer ~r in any other capazity; and
(b) To any obligation to share damages with or repay spmcone else who must pay damages because of the
Page I of 2
This exclusion does not apply to:
..... ,.ovED AS TO FORM
Dcpu[y City Attorney~
04/17/03
12:09 FAX 760 728 5859 John B Clodtg
tn) LinbBi~y a~sumcd by the insured under ~m "insured conu'-~ct"; or
(b) "Bodily injury" arising out of and in the course, ofdomesii¢ cmptoyment by the iasured unless
bencfils t'or such inju~ are in whole or in part tidier p:,yable nr required to be provided under any
workers compensation law. '.
"Property damage: too: :
(a) PropenT owned or being b'ansponed by, or rente~l or loaned to d~e insured; or
(b) Property in the care, custody or conn-ol of the i~ured.
WHO IS AN INSURED (Section Itl) is replaced by the following:
Each of the following is an in~ured under this insurance to thc e~ent set forth bclow:
i
I. You;
Any panner or executive officer ofyoun, bur only while such "non-owned&ired auto" is being used in your
business;
Any other person or organization, but only with respect to thdr [iabitib, because of acts or
omissions of an insured under I or 2 above.
None of thc following is aa insured:
Any person engaged in the b~iness of'his or hcr employer with respect to "bodily injury" [o any co-
"employee" or.~uch person injured in the course of c~ployment;
Any parmcr or executive officer with respect to any "auto" owned by such panner or'officer or a member
of his or her hou. schold;
Any person while employed in or otherwise engaged in duties in connection with an "auto
business", other than an "auto business? you operate; !
4. The owner of a "non-owned aulo" or any agent or "employee" of any such owner or lessee;
5. Any person or brganiz~tion with respec~ to the conduct of any current or past parmcrship, joint venture, or
limited llabili~ company that i; not shown as a Named Insured in the Declarations.
The followiug additional definitions apply:
"Auto business" means the business or occupation of selling, repairing, servicin§, storing or parking "autos".
"Non-owned auto" means any "auto" you do not own, lea~e, hire, rent or borrow which is used in connection with
your business. However, if you are a pannership a "non-owned auto" does not include any auto owned by any
partner.
Representative Date
Page 2 of 2
APPROVED AS TO FORM
~adra Sheedy ~
Deputy City Attorney
004
04/17/03 12:09 FAX 760 728 5859 John[ B Clodig
005
ESSEX INSURANCE COMPANY
PROFESSION~L LIABILITY ENDORSEM~ENT
A]TACI-IED TO AND FORMING ~ ENDORSEMENT I INSURED AGENCg' & CObE
PART OF EFFECTIVE:
POLICY NUMBER MO. DAY YR.
I [_ , Movement
THI~; ENDoRsEMENT CHANGES THE POLICY'. PLEASE RE~,6 IT CAREFULLY, '-
This endorsement modifies insurance provided under the tallowing:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Description of Operations: Consultant
(if no entry appears above, information required to compleie this endorsement will be shown in the
Declarations as applicable to_ this endorsement.)
1. INSURING AGREEMENT 2." AD-DITI~)NAL EXCLUSIONS "
Insuring Agreement a. under Coverage A (Section The f~llowing exclusions are added to
I) is replaced by the following: COVERAGES A. B and C (Section
a. We will pay those sums that the insured Tl~is insurance does not apply to "bodily injury."
becomes legally obligated to pay as damages "property damage," "personal injury,'
because of "bodily injury" or "property damage" to "advertising injury" or medical payments:
which this insurance applies and will include
damages ar[sing out of any negligent act, error or a. Due to services rendered white under the
omission in rendering or failure to render influence of intoxicants or drugs;
professional services of the type described in the
Schedule of this policy. We will have the right and b. Either directly or indirectly adsing from
duty to defend any 'suiF seeking those damages, employed or contracted physicians, surgeons.
We may at our discretion investigate any osteopaths, podiatrists, dentists, orthodontists.
'occurrence' and settle any claim or "suit" that chiropractors, psychiatrists or psychologists;
may result.
But' c. Arising out of the rendering of Or failure to
render professional services not described in the
(1) The amount we will pay for damages is Schedule;
limited as described in this endorsement;
and d. Arising out of any goods or products manufactured
by, bottled by, rebottled by, packaged by, or
(2) Our right and duty to defend end when we repackaged by you or any other insured, or sold
have used up the applicable limit of under the label of you or any other insured, unless
insurance in the payment of judgments or specifically scheduled on the Declarations;
settlements under Coverages A and B or
medical expenses under Coverage C. e. For the use of application of any product., the use
No other obligation or liability to pay sums or sale of which is prohibited under Federal, State
or perform acts or services is covered or Municipal law;
unless explicitly provided for under
SUPPLEMENTARY PAYMENTS f. Adsing from expressed or implied warranties or
COVERAGES A AND B. guarantees made by you;
~r'D AS TO FORM
City Attorney
12:09 FAX 760 728 5859 John B Clodlg ~006
04/17/03
Arising out of operations conducted at any
location or premises not scheduled on the
Declarations;
From the conduct of any business enterprise
owned by you or which is controlled, operated
or managed by you. either individually or in a
fiduciary capacity, including the ownership,
maintenance or use of any property in
connection therewith, other than in connection
with the normal and professional services
shown in the Schedule;
Either directly or indirectly arising from your
activities as an officer or director of any
corporation, company or business other than
those designated on this policy;
From any dishonest, fraudulent, criminal or
malicious act or omissions of the insured.
partner or employee or any person for whom
you are legally responsible;
For false arrest, detention or imprisonment.
malicious prosecution, wrongful entry or
eviction, invasion of privacy, libel or slander,
unless specifically endorsed on the
Declarations;
I. For coercion, conversion or misappropriation of
others' funds or property;
m. For or arising out of the infringement of any
copyright, trademark or patent;
n. Arising out o! the insolvency or bankruptcy of
the insured;
Oo
Based upon or arising out of the Securities Act
of 1933 or the Securities Exchange Act of 1934
or any amendment thereof or addition thereto or
any State Securities Act (also known as the
"blue sky laws") or amendments thereof or
additions thereto.
3. WHO IS AN INSURED
Subparagraph (2) of item 2.a. of WHO IS AN
INSURED (Section II) is replaced by the following:
(2) However, no employee is an insured for "bodily
injury" or "personal injury" arising out of his
or her providing or failing to provide
professional services except for those
services shown in the Schedule of this
endorsement and only while acting within
the scope of their duties as such and
subject to the exclusions of this policy; or
4. LIMITS OF INSURANCE
The limits of Insurance shown in the Declarations
and the rules set forth in Section III - LIMITS OF
INSURANCE fix the most we will pay regardless of
the number of insureds, claims made or "suits"
brought, or persons or organizations making claims
or bdnging "suits."
The LIMITS OF INSURANCE of this endorsement
shall be included in and a pad of.
a. The Each Occurrence Limit for damages under
Coverage A; and
b. The General Aggregate limit for damages under
Coverage A.
This insurance is not intended to nor shall it provide
additional limits of insurance except where
specifically endorsed herein
All other terms and Conditions of this
Policy remain unchanged.
APPROVED AS TO FORM
Deputy City Attorney
SD
CERTHOEDER COPY
STATE
P.O. BOx 807; SAN FRANCISCO,CA 94142-0807
COMPENSATION : ~ ::
IN SUIRANCE; : ~
I=UND CERTIFICATE OF WORKERS" COMPENSATION :INSURANCE
ISSUE DATE: 04-01-2003
C1TY OF SANTA ANA,
p O BOX t988 M;28
20 CIVIC CENTER PLAZA
SANTA ANA CA 92701
: GROUP:
; : POLICY NUMBER: 1608608-2003
CERTIFICATE ID: 1
CERTIFICATE EXPIRES: 04-01-2004
04-0'1--2003/04-0'1-2004
RISK MANAGEMENT DIVISION :: JOB: ATTN: ~EFF STEVENS, RISK
EM! L0N BUENAFE
This is to Certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California InSurance Commissioner to the employer nameci below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon lodays' advance written notice to the employer.
We will also give you 10 days' advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policies listed herein. Notwithstanding any requirement, term, or condition of any contract or other document
with respect to which this certificate of insurance maybe issued or may pertain, the insurance afforded by the
policies ciescribed herein is subject to all the terms, exclusions an0 conditions of such policies.
AUTHORIZED REPRESENTATIVE PRES DENT
EMPLOYER/S LZABZLITY LZMZ:T ZNCLUDZNG DEFENSE COSTS: $1,000;000.O0 PER OCCURRENCE.
EMPLOYER
KEY MOVES
1308 EL NI. DO DR
FALLBROOK C'A 92028
LEGAL NAME
UOHN B CLODZG APC AND/OR
CLODZG, UOI-IB B
PRINTED:
03-17-2003
P040B