HomeMy WebLinkAboutROMERO, KARINAINSURANCE ON FILE N-2024-302
WORK MAY PROCEED
UNTIL GG3URANCE EXPIRES
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CITY :CL
GATE: IP 0 4 2024
o: COUNCIL AIDE PROFESSIONAL SERVICES AGREEMENT
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THIS AGREEMENT is made and entered into on this 21' day of August, 2024 by and between Karina
Romero ("Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized
and existing under the Constitution and laws of the State of California ("City").
RECITALS
A. The City desires to obtain the services of a Consultant to provide administrative, constituent, and
legislative support for a member of the Santa Ana City Council.
B. Consultant represents that Consultant is qualified to perform these services.
C. In undertaking the performance of this Agreement, Consultant represents that Consultant 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 from a
professional in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms
and conditions hereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
a. Consultant shall perform during the term of this Agreement, the tasks and obligations including
all labor, materials, tools, equipment, and incidental customary work required to fully and
adequately provide administrative, constituent, and legislative support services for
Councilmember Vazquez ("Councilmember") as provided in this Agreement and in the Scope
of Services as described in subsection b below.
b. At the direction of Councilmember, Consultant shall perform a variety of administrative,
constituent, and legislative functions and tasks, including but not limited to, conducting
complex administrative studies, researching and responding to constituents' inquiries, drafting
written communications involving strategy, policies, and/ or procedures, coordinating assigned
project activities, and serving as a liaison, where necessary.
c. As may be required for services performed while at City Hall, the City may provide access to
the Councilmember's office space — consistent with City procedures — should Consultant
require limited access to perform services required by the Councilmember. Consultant shall
maintain a business location separate from City and Consultant understands that such access
to office space is not required by the City but provided to the Consultant on an as -needed basis
and should only be used when City Hall is open to the public or while the Councilmember is
present.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services for City,
the hourly pay rate of $35.00 for services rendered pursuant to this Agreement. Consultant
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agrees and understands that no changes to this pay rate shall be made during the term of this
Agreement and that monthly billing pursuant to this Agreement, shall not exceed a total sum
of five thousand dollars ($5,000.00) per month. The total sum to be expended under this
Agreement shall not exceed sixty thousand dollars ($60,000.00) during the term of this
Agreement.
b. Consultant agrees and understands that the not -to -exceed amount, provided above, includes
reimbursement for all out-of-pocket expenses, including but not limited to, mileage, copying
costs, and mail services authorized at the sole direction of the Councilmember in connection with
the performance of duties under this Agreement. The City shall not make any separate payments
for any of the above expenses.
c. Consultant shall submit monthly invoices to City for work performed during the billing period.
Payment by City shall be made within thirty (30) days following receipt of proper invoice
evidencing work performed, subject to City accounting procedures. Monthly invoices shall be
in substantially the form attached hereto as Exhibit "A."
3. TERM
This Agreement shall commence on August 21, 2024 and terminate on June 30, 2025, unless
terminated earlier in accordance with Section 19, 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, benefits, employer's social security taxes, unemployment insurance, and
similar taxes relating to employees and shall be responsible for all applicable withholding taxes.
5. POLITICAL CAMPAIGN ACTIVITIES
a. Consultant is prohibited from the following political campaign activities while this
Agreement is in place:
1) Acting as campaign treasurer/manager or a campaign consultant for any candidate
for Santa Ana City Council or Mayor;
2) Campaigning for any candidate for Santa Ana City Council or Mayor and at the
same time, working pursuant to this agreement and/or charging the City for the time
spent campaigning pursuant to this agreement;
3) Using City equipment, supplies or resources to campaign for any candidate for
Santa Ana City Council or Mayor;
4) Accepting any campaign contributions on behalf of any candidate for Santa Ana
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City Council of Mayor;
5) Campaigning while wearing any attire or logo that identifies you as a Consultant
for the City of Santa Ana;
6) Campaigning while using any City room, building, or location that has not been
specifically designated for political speech;
7) Receiving any payment or reimbursement from a campaign candidate for Santa
Ana City Council or Mayor or their campaign account; and/or
8) Opening a campaign committee or pulling nomination papers to run as a candidate
for Santa Ana City Council or Mayor.
b. Consultant will sign the declaration attached hereto as Exhibit B acknowledging said
prohibitions.
6. PROHIBITION AGAINST APPOINTMENT TO CITY BOARD OR COMMISSION
Consultant is prohibited from accepting appoint or continuing with any prior appointment to any
City Board or City Commission set forth in Chapter 2 of the Santa Ana Municipal Code while this
Agreement is effective.
BACKGROUND CHECK
Consultant agrees to submit to a background check including, but not limited to, a live scan and
records check to City's satisfaction. Failure to do so is grounds for termination of this Agreement.
8. OWNERSHIP OF MATERIALS
This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, reuse,
or sublicense any and all copyrights, designs, and other intellectual property embodied in plans,
specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any
tangible medium of expression, including but not limited to, physical drawings or data magnetically or
otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Consultant
under this Agreement ("Documents & Data"). Consultant shall require all subcontractors to agree in
writing that City is granted a non-exclusive and perpetual license for any Documents & Data the
subcontractor prepares under this Agreement. Consultant represents and warrants that Consultant has the
legal right to license any and all Documents & Data. Consultant makes no such representation and
warranty in regard to Documents & Data which were provided to Consultant by the City. City shall not
be limited in any way in its use of the Documents and Data at any time, provided that any such use not
within the purposes intended by this Agreement shall be at City's sole risk.
9. INSURANCE
Prior to undertaking performance of work under this Agreement, Consultant shall maintain and
shall require any subcontractors to obtain and maintain insurance as described below for the entire Term
of this Agreement against claims for injuries to persons or damage to property which may arise from or
in connection with services, products and materials supplied to City. Total cost of such insurance shall be
borne by Consultant.
Page 3 of 12
Minimum Scope and Limit of Insurance.
Automobile Liability: Insurance Services Office Form CA 00 01 covering Code I (any
auto), with limits no less than $1,000,000 combined single limits. In the event Consultant
does not maintain commercial automobile liability insurance, City will accept evidence of
personal automobile insurance.
Workers' Compensation: as required by the State of California, with Statutory Limits,
and Employer's Liability Insurance with limit of no less than $1,000,000 per accident,
policy or employee, for bodily injury or disease. Coverage is not required if Consultant has
no employees and signs request to waive such insurance.
If Consultant maintains broader coverage and/or higher limits than the minimum
requirements for each line of coverage shown above, City requires and shall be entitled to
the broader coverage and/or the higher limits maintained by Consultant. Any available
insurance proceeds in excess of the specified minimum limits of insurance and coverage
shall be available to City.
Other Insurance Provisions. The above required insurance policies are to contain or be endorsed
to contain the following provisions:
• City, its City Council, its officers, officials, employees, agents, and volunteers are to be
covered as additional insureds, under Consultant's CGL, Professional Liability, and
Automobile Liability policies, with respect to any liability arising out of work or operations
performed by or on behalf of the Instructor including materials, parts, equipment, and
personnel furnished in connection with such work or operations.
• Consultant's Insurance company(ies) agrees to waive all rights of subrogation against City,
its City Council, its officers, officials, employees, agents, and volunteers for losses paid
under the terms of any policy which arise from work performed by Consultant under this
Agreement.
• For any claims related to this contract, Consultant's insurance coverage shall be primary
and any insurance maintained by City, its City Council, its officers, officials, employees,
agents, or volunteers shall not contribute with it.
• A severability of interest provision must apply for all the additional insureds, ensuring that
Consultant's insurance shall apply separately to each insured against whom a claim is made
or suit is brought, except with respect to the insurer's limits of liability.
• Insurance policies required herein shall provide that coverage shall not be canceled,
suspended, voided, reduced in coverage or in limits, non -renewed by the carrier, or
materially changed except after thirty (30) days prior written notice has been given to City.
Ten (10) days prior written notice shall be provided to City for policy cancellation or non -
renewal due to non-payment of premium.
• Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa Ana,
Attention: (Name of Department Staff Responsible for Agreement), 20 Civic Center
Plaza M-XX (Responsible Staffs Department Mail Box), Santa Ana, CA 92701. The
name and location of project must be included in the Description of Operations section of
each certificate.
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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.
Acceptability of Insurers. Insurance is to be placed with insurers authorized to conduct business
in the State of California with a current A.M. Best rating of no less than A:VII, unless otherwise acceptable
to City.
Verification of Coverage. Consultant shall furnish 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 before work begins. However, failure to obtain the required documents
prior to the work beginning shall not waive Consultant's obligation to provide them. City reserves the
right to require complete, certified copies of all required insurance policies, including endorsements
required by these specifications, at any time.
Special Events Coverage. Special events coverage is available and can be purchased by
Consultant. Use this link to learn more: https://2sparta.com/selip application php.
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.
10. INDEMNIFICATION
Consultant agrees to defend, and shall indemnify and hold harmless the City, its officers, agents,
employees, contractors, special counsel, and representatives from liability: (1) for personal injury,
damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal
injury, including death, and claims for property damage, which may arise from the negligent operations
of the Consultant, its subcontractors, agents, employees, or other persons acting on its 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.
11. INTELLECTUAL PROPERTY INDEMNIFICATION
Consultant shall defend and indemnify the City, its officers, agents, representatives, and employees
against any and all liability, including costs, for infringement of any United States' letters patent,
trademark, or copyright infringement, including costs, contained in the work product or documents
provided by Consultant to the City pursuant to this Agreement.
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12. RECORDS
Consultant shall keep records and invoices in connection with the work to be performed under this
Agreement. Consultant shall maintain complete and accurate records with respect to the costs incurred
under this Agreement and any services, expenditures, and disbursements charged to the City for a
minimum period of three (3) years, or for any longer period required by law, from the date of final payment
to Consultant under this Agreement. All such records and invoices shall be clearly identifiable.
Consultant shall allow a representative of the City to examine, audit, and make transcripts or copies of
such records and any other documents created pursuant to this Agreement during regular business hours.
Consultant shall allow inspection of all work, data, documents, proceedings, and activities related to this
Agreement for a period of three (3) years from the date of final payment to Consultant under this
Agreement.
13. 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.
14. CONFLICT OF INTEREST CLAUSE
a. Consultant represents that neither it nor any of its officers, partners or employees has a financial
interest, as defined in Section 87103 of the Government Code, in the subject matter of this
Agreement other than the right to receive payment from City for services rendered.
b. Consultant agrees that it shall not make, participate in making, or in anyway attempt to use its
position as consultant to influence any decision of City in which Consultant knows, or has
reason to know, that any of its officers, partners or employees has a financial interest as defined
in Section 87103 of the Government Code.
c. Consultant warrants that neither Consultant nor any of its officers, partners or employees, has
any financial interest in any real property, building or structure within 2,500 feet of the location
of any project or assignment to which this Agreement may apply in the City of Santa Ana.
Consultant agrees to disclose to City any financial interest in such property as may be acquired
by its officers, partners or employees during the term of this Agreement.
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d. In accordance with the City's Conflict of Interest Code, if determined by the City Manager to
be a designated position, Consultant shall file a Statement of Economic Interests (Form 700)
with the Fair Political Practices Commission.
15. NON-EXCLUSIVE
Consultant understands and agrees that this is a non-exclusive Agreement and City may enter into
other agreements with other consultants and may use any of the contractors with whom City has contracts
and, therefore, the City cannot estimate nor guarantee the volume or amount of work to be received by
Consultant under this Agreement.
16. 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 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.
17. 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 or the City. Each party to this Agreement acknowledges that no representations,
inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting
on behalf of any party, which is not embodied herein.
18. 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.
19. TERMINATION
This Agreement maybe 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:
Page 7 of 12
a. As a condition of such payment, Consultant may be required to deliver to the City all work
product(s) completed as of such date, and in such case such work product shall be the
property of the City unless prohibited by law, and 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.
Consultant's term shall automatically terminate immediately if, at any time, the Councilmember
is no longer an elected member or Mayor of the Santa Ana City Council.
20. WAIVER
No waiver of breach, failure of any condition, or any right or remedy contained in or granted by
the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving
the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed
a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver
constitute a continuing waiver unless the writing so specifies.
21. JURISDICTION - VENUE
This Agreement has been executed and delivered in the State of California and the validity,
interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined
and governed by the laws of the State of California. Both parties 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.
22. 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 its inability to
obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be
cause for termination of this Agreement.
23. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be
in writing and shall be deemed to be properly given if delivered in person or mailed by first class or
certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided
in this Section, to the following persons:
To City:
City Clerk
City of Santa Ana
Page 8 of 12
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
With courtesy copies to:
City Manager
City of Santa Ana
20 Civic Center Plaza
P.O. Box 1988
Santa Ana, CA 92702
Fax:
To Consultant:
Farina Romero
A party may change its address by giving notice in writing to the other party. Thereafter, any
communication shall be addressed and transmitted to the new address. If sent by mail, communication
shall be effective or deemed to have been given three (3) days after it has been deposited in the United
States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by
fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time
set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth
above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays
shall be excluded.
24. MISCELLANEOUS PROVISIONS
a. 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. All Exhibits referenced herein, if any, and attached hereto shall be incorporated as if fully
set forth in the body of this Agreement.
[signatures appear on following page]
Page 9 of 12
SIGNATURE PAGE TO COUNCIL AIDE PROFESSIONAL SERVICES AGREEMENT
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above
written.
ATTEST
APPROVED AS TO FORM
SONIA R. CARVALHO
City Attorney
B
onathan T. Martinez
CITY7FSTA
Alvaro Nunez
City Manager
CONSULTANT
Karina Romero
Assistant City Attorney Tax ID#.
Page 10 of 12
EXHIBIT A
Street Address Invoice #:
City, ST Zip Code
Phone
Agreement #:
Date:
Bill To:
City of Santa Ana
20 Civic Center Plaza
Hourly Rate:
Santa Ana, CA 92701
Total Billable Hours:
Amount Due:
Page 11 of 12
EXHIBIT B
Acknowledgment Regarding Political Activities Prohibitions
1, Karina Romero am an independent contractor working as a Council Aide pursuant to this
Agreement.
1. I acknowledge and agree that during the term of this Agreement, I will not participate or conduct
the following political activities:
a) Acting as campaign treasurer/manager or a campaign consultant for any candidate
for Santa Ana City Council or Mayor;
b) Campaigning for any candidate for Santa Ana City Council or Mayor and at the
same time, working pursuant to this agreement and/or charging the City for the time
spent campaigning pursuant to this agreement;
c) Using City equipment, supplies or resources to campaign for any candidate for
Santa Ana City Council or Mayor;
d) Accepting any campaign contributions on behalf of any candidate for Santa Ana
City Council of Mayor;
e) Campaigning while wearing any attire or logo that identifies you as a Consultant
for the City of Santa Ana;
f) Campaigning while using any City room, building, or location that has not been
specifically designated for political speech;
g) Receiving any payment or reimbursement from a campaign candidate for Santa
Ana City Council or Mayor or their campaign account; and/or
h) Opening a campaign committee or pulling nomination papers to run as a candidate
for Santa Ana City Council or Mayor.
2. I acknowledge and understand that failure to abide by any of the above prohibitions are grounds
for immediate termination of this Agreement.
Signed this 22 day of August 20 2.4
Karina Romero
(Name of Consultant)
08/22/2024
Date
Daniel A. Soto
(Name of Witness)
Page 12 of 12
(Signature of Consultant)
(Signature of Witness)
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Office: 714-647-5155 1 Email: Cmora5Cu)-santa-ana.org I santa-ana.orq/human-resources I Linkedln
Instagram
City Hall hours are 8 a.m. to 5 p.m. Monday through Thursday, and 8:00 a.m. to 5:00 p.m. every other Friday. Click
here for a list of observed holidays and Friday closure dates.
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Click here to report an issue directly from the City website.
From: Ulmer, Anna <aulmer@santa-ana.org>
Sent: Monday, December 23, 2024 1:15 PM
To: RMD <rmd@santa-ana.org>
Cc: Mills, Susan <smills@santa-ana.org>; Cruz, Yesenia <YCruz5@santa-ana.org>; Lee, Tina Do <tlee@santa-ana.org>;
Vazquez, Sylvia <SVazquez@santa-ana.org>
Subject: RE: Request for COI Review - Karina Romero, Consultant Services for Councilmember Benjamin Vazquez
Hello Cynthia,
My apologies for the delay. Karina Romero has current coverage and has
also provided her coverage which commences in January 2025.
Please let me know if you need any further information.
Respectfully,
Anna
TAB ANA
1 -61?
Anna Ulmer I Executive Assistant
City of Santa Ana, City Manager's Office
20 Civic Center Plaza, Santa Ana, CA 92701
(714) 647-52301 aulmer _santa-ana.orq
N
State Farm Mutual Automobile Insurance Company
PO Box 2358
Bloomington IL 61702-2358
AT2 A-6406 A
ROMERO, ANTONIO & AIDE &
KARINA
Digitally signed
Tu Tran byTuTran
APPROVED Nguyen
By Tu Tran Nguyen at 11:33 am, Apr 21, 2025 N g uyen D, 34 032O04.21
Policy Number:
Policy Period: January 27, 2025 to July 27, 2025
Vehicle:
2018 ACURA TLX
Principal Driver:
KARINAA ROMERO
Notice of insurance information collection practices -
personal, family, or household insurance transactions:
We may collect customer information from persons other
than the individual or individuals applying for coverage.
Such customer information as well as other personal or
privileged information subsequently collected may, in certain
circumstances, be disclosed to third parties without your
authorization as permitted by law.
Policy Number:
Prepared December 5, 2024
1004583
AUTO RENEWAL
PREMIUM PAID: $1,091.49
DO NOT PAY.
Your premium is billed through the State Farm Payment Plan
State Farm Payment Plan Number:
Your State Farm Agent
ARACELI PADILLA INS AGENCY INC
Office: 714-543-5858
Address: 2424 N GRAND AVE STE B
SANTA ANA, CA 92705-8757
If you have a new ordierent car, have added any ddvers orhave moved,
please contact your agent.
Thank you for choosing State Farm.
You have the right to submit a written request to access,
correct, amend, or delete your personal information and the
right to receive a response within 30 days of submitting your
request. If we deny your request, you have the right to file a
statement with us containing the information you feel is
accurate and fair along with the reasons you disagree with
our denial. Instructions on how to file such request and our
full privacy notice can be found
(continued on next page)
Page number 1 of 5
143562 202 01-15-2018
Thanks for being part
of our neighborhood.
You mean a lot to us. If you need anything,
call State Farm' Agent ARACELI PADILLA
INS AGENCY INC at 714-543-5858.
TP31
A * StateFairm
www.statefarm.com/customer-care/privacy-security/privacy
or contact your State Farm Agent.
When you provide a check as payment, you authorize us
either to use information from your check to make a
one-time electronic fund transfer from your account or to
process the payment as a check transaction. When we use
VEHICLE INFORMATION
information from your check to make an electronic fund
transfer, funds may be withdrawn from your account as soon
as the same day we receive your payment, and you will not
receive your check back from your financial institution.
Review your policy information carefully. If anything is incorrect, or if there are any changes to your vehicle information, please
let us know right away.
Vehicle Identification
Vehicle Description Number (VIN) Who principally drives this vehicle? How is this vehicle normally used?
2018 ACURA TLX KARINA ROMERO, a single individual, who To Work, School or Pleasure.
will have 10 years of driving experience as
of January 27, 2025.
Other Household Vehicle(s)
Your premium may be influenced by other State Farm
policies that currently insure the following vehicle(s)
in your household:
2015 MERCEDES GLK350
2018 MAZDA CX-5
2002 GMC YUKON XL
2018 FORD F150
The premium on the expiring policy term was based on
18,500 miles per year.
The premium on the renewal policy term was based on
18,500 miles per year.
Premium Adjustment
Each year, we review our medical payments and personal
injury protection coverages claim experience to determine
the vehicle safety discount that is applied to each make and
DRIVER INFORMATION
Other Household Driver(s)
In addition to the Principal Driver(s) and Assigned
Driver(s), your premium may be influenced by the
drivers shown below and other individuals permitted to
drive your vehicle. This list does not extend or expand
coverage beyond that contained in this automobile
policy. The drivers listed below are the drivers reported
to us that most frequently drive other vehicles in your
household.
ERIKA ROMERO
ANTONIO ROMERO
AIDE ROMERO
model. In addition, we review the comprehensive, collision,
bodily injury and property damage claim experience
annually to determine which makes and models have
earned decreases or increases from State Farm's standard
rates. If any changes result from our reviews, adjustments
are reflected in the rates shown on this renewal notice.
Policy Number: Page number 2 of 5
Prepared December 5, 2024
Stat eFarm
Driver excluded: GIOVANNI ROMERO EFF 06-19-2023.
Principal Driver & Assigned Drivers
For each automobile, the Principal Driver is the individual
who most frequently drives it.
Each driver is designated as an Assigned Driver on the
household automobile that they most frequently drive. Your
premium may be influenced by the information shown for
these drivers.
COVERAGE AND LIMITS See your policy for an explanation of these coverages.
A
Liability
Bodily Injury 250,000/500,000
Property Damage 100,000
$355.59
D
Comprehensive
$256.44
G
1000 Deductible Collision
$362.22
H
Emergency Road Service
$4.18
U
Uninsured Motor Vehicle
Bodily Injury 250,000/500,000
$105.84
U1
Uninsured Motor Vehicle
Property Damage
$7.22
Total Premium
$1,091.49
If any coverage you carry is changed to give broader
protection with no additional premium charge, we will give
DISCOUNTS These adjustments have already been applied to your premium.
you the broader protection without issuing a new policy,
starting on the date we adopt the broader protection.
Multiple Line
✓
Multicar
✓
Driving Safety Record
✓
California Good Driver
✓
Loyalty
✓
Total Discounts
$3,737.64
SURCHARGES AND DISCOUNTS
Driving Safety Record Rating Plan
Your driving safety record, along with other rating factors,
determines what you pay for Liability, Medical Payments,
Comprehensive, Collision, and Uninsured Motor Vehicle
Coverages. Policyholders with no accidents and convictions
pay less than those with accidents and convictions.
The Driving Safety Record Rate Level that is assigned to
your policy moves up, down, or stays the same every policy
renewal, depending upon your driving record. For every 12
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Policy Number: 711
December 5, 2024
Page number 3 of 5
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months since the renewal following the occurrence of a
chargeable accident or the conviction of a minor violation,
the initial assigned Driver Record Level for that chargeable
accident or conviction shall be lowered by 1 level. For each
12 month period since the conviction of a major violation,
the initial assigned Driver Record Level for that conviction
shall be lowered by 2 levels. The Rate Level is increased if
there are subsequent chargeable accidents or convictions.
Definition of Chargeable Accidents
Chargeable accidents for new business are those which
resulted in bodily injury or death or in payment(s) by an
insurer due to damage to any property in the amount of
more than $1000. For accidents occurring prior to
December 11, 2011, an accident shall be chargeable
provided it resulted in death or in payment(s) by an insurer
due to damage to any property in the amount of more than
$750.
ADDITIONAL INFORMATION
IMPORTANT NOTICE
For your protection California law requires the
following to appear with this policy: Any person who
knowingly presents false or fraudulent information to
obtain or amend insurance coverage or to make a claim
for the payment of a loss is guilty of a crime and may be
subject to fines and confinement in state prison.
For applicants without prior insurance at the time of the
accident, an accident shall be chargeable provided it
resulted in damage to any property in the amount of more
than $1000 (more than $750 if the accident occurred prior to
December 11, 2011).
Chargeable accidents for renewal business are those which
resulted in bodily injury or death or State Farm claim
payments totaling more than $1000 (more than $750 for
accidents occurring prior to December 11, 2011) under
property damage liability coverage and collision coverage
combined.
For more information about the rating plan, please contact
your State Farm agent.
Superior Driver Rate Level
If any information on this renewal notice is incomplete or
inaccurate, or if you want to confirm the information we have
in our records, please contact your agent. For additional
information regarding discounts or coverages, see your
State Farm agent or visit statefarm.com®.
Important Notice Regarding Your Premium
State Farm works hard to offer you the best combination of price, service, and protection. The amount you pay for automobile
insurance is determined by many factors including:
• The coverage you have
• Where you live
• The kind of car you drive
• How the car is used
• Who drives the car
Any premium adjustment is reflected on this Auto Renewal. If you have any questions, please contact your agent.
Buying a new car? Remember to contact your agent!
When you buy an additional car or one that replaces a car already on your policy, you need to report the change to your agent
promptly. Even though the dealership you purchased the car from may offer to notify your agent or insurance company, you, as
the named insured, are responsible for reporting all changes to your auto policy. By contacting your agent, you can help:
• avoid any complications or lack of coverage in the event of an accident or loss,
• avoid insurance verification problems with a lienholder, the police, or the department of motor vehicles, and
• ensure that you receive any new discounts you may be entitled to.
Your current State Farm policy automatically provides certain coverages for a new or replacement car for up to a specified, limited
number of days after you take possession of the car. Please refer to your policy for the number of days that applies in your state.
If you have any questions about coverage for a newly acquired car, please contact your State Farm agent.
(continued on next page)
Policy Number: Page number 4 of 5
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Disclaimer.- This message is provided for informational purposes only and does not grant any insurance coverage. The terms and
conditions of coverage are set forth in your State Farm Car Policy booklet, the most recently issued Declarations Page, and any
applicable endorsements.
Policy Number: 711 number 5 of 5
Prepared December 5, 2024