HomeMy WebLinkAboutWITTMAN ENTERPRISES , LLC 4 - 2005
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A-2005-217
STANDARD CONSULTANT AGREEMENT
THIS AGREEMENT, made and entered into this day of September, 2005 by and
between Wittman Enterprises, LLC, a California Limited Liability Company (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 in providing ambulance and
paramedic billing and collection services for the City's Emergency Medical Services
Program.
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 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 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 shall perform those services as set forth in Exhibit A-I to this Agreement.
2. COMPENSATION
City agrees to pay, and Consultant agrees to accept as total payment for its services a fee
equal to 6.8% of net collections obtained by Consultant. Consultant shall bill for Emergency
Medical Services at the rates established by City Council Resolution. Total compensation under
this Agreement shall not exceed $210,000.00, annually, 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 on June 30,
2008, unless terminated earlier in accordance with Section 12, below. In an effort to provide
uninterrupted services, the parties agree that billing services provided from July 1,2005 shall be
included within the Scope of this Agreement. The term of this Agreement may be extended for
two additional one-year terms upon a writing executed by the Fire Chief and the City Attorney,
for the City and by Consultant.
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.
S. 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. 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.
c. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section:
(i) Consultant shall maintain all insurance required above in full force and
effect for the entire period covered by this Agreement.
(ii) Certificates of insurance shall be furnished to the City upon execution of
this Agreement and shall be approved in form by the City Attorney.
(iii) 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.
d. 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 paid for 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 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 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 I of 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 ofthe 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 oflaw; 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:
Fire Chief
City of Santa Ana
1439 S. Broadway (M-80)
Santa Ana, California 92702
telefacsimile (714) 647-5779
and
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6515
To Consultant:
Wittman Enterprises
21 Blue Sky Court Suite A
Sacramento, California 95826
telefacsimile: (916) 381-5047
Attn: Dona Wittman
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 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 ofrace, 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 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
indenmify 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 and attached hereto shall be incorporated as if fully set
forth in the body of this Agreement.
II
II
II
II
II
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
CITY OF SANTA ANA:
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DAVION. REAM
City Manager
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-"",,,A TRICIA E. HEALY",
l/Clerk of the Council
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
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~~~r~~he~d~ --\...., I,;
Assistant City Attorney
WITTMAN ENTERPRISES
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DONA WITTMAN
P..resi,knt /!dJ
Tax 10# 1oJ' - {YY5(;{.),.< /
EXHIBIT A
SCOPE OF SERVICES
A. GENERAL PERFORMANCE REQUIREMENTS
1. CONSULTANT shall provide the City of Santa Ana with billing and
collections services for the CITY's Emergency Medical Services and
emergency medical transport services as specified herein.
2. CONSUL T ANT shall be able to function at the start of the contract with the
CITY's Paramedic Ambulance Subscription Program participants. The
computer system must be capable of referencing patients by membership
numbers assigned by the CITY.
3. CONSULTANT shall furnish all supplies, equipment, personnel, computer
hardware and software, billing forms, insurance forms, lien forms,
envelopes, postage and supplies necessary to function on a day to day basis
in the administration of the CITY's accounts receivable.
4. CONSULTANT shall provide software and hardware as required to accept
electronic account file transfer from Fire Department Record Management
System. CONSULTANT shall also have the option to provide software and
hardware to accept electronic file transfer of remittance information from
City Treasury Division.
5. CONSUL TANT shall invoice within two (2) working days of receipt of
billing information.
6. CONSULTANT shall provide all billing statements in Spanish and English,
and shall maintain a necessary staff of full-time bilingual (Spanish/English)
account representatives.
7. In accordance with coding provided by CITY, CONSULTANT shall have
the ability to create fully itemized statements showing all procedures and
supplies.
8. In order to provide human contact for patients requiring assistance,
CONSUL T ANT shall provide a toll free 800 number at no additional cost to
CITY.
9. CONSUL T ANT shall have the ability to handle third party payor
submission and inquiries regarding insurance claims.
10. CONSULTANT shall be able to show claim submission date, follow-up
payments to be made on account, source of payment, and automatic audit
trail up to collection assignment.
II. In the event that members of the CITY's Paramedic subscription program
have third party insurance, a diligent and timely effort shall be made by the
CONSUL T ANT to identify, bill, and pursue payment from these sources.
12. CONSULTANT shall electronically convey all Medicare and Medi-Cal
invoices to the appropriate payor. All secondary insurance, coinsurance and
co-payments for Medicare/Medi-Cal, shall be transferred to the appropriate
pay source and promptly billed to that source.
13. CONSUL T ANT shall bill private insurance, supplemental insurance,
secondary insurance and workers compensation in accordance with
applicable requirements. Any correspondence necessary to secure insurance
payment shall be performed by CONSULTANT.
14. CONSULTANT shall perform all billing functions, including all mailings,
with no additional cost for postage, data mailers or telephone collection that
is performed. Additionally, CONSULTANT shall follow bill to adjudication
with Medicare, Medi-Cal, and private insurance.
15. CONSUL TANT shall provide a typical private billing schedule as follows.
I. Invoice in English and Spanish
2. Statement
3. Delinquency Notice
4. Collection Notice
5. Final Demand
Immediately
30 days
20 days
15 days
10 days
Medi-Cal, Medicare, and Insurance company billing schedules shall be as needed.
16. CONSULTANT shall maintain records that are in accordance with
generally accepted bookkeeping and accounting practices.
17. CONSULTANT agrees that all account files are the property of the CITY.
Furthermore, CONSULTANT agrees to relinquish all active account files to
the CITY at termination of contract.
18. Account file information must be updatable in order to maintain accurate records.
Information that may require updating would include but not be limited to: Patient
Name, address, city, state, age, phone, sex, insurance, alternate source of payment,
diagnosis, collection follow-up notes.
19. CONSULTANT shall have the ability to retain a record of charges to the
patient account.
20. CONSULTANT shall have the ability to cross reference patient files in
various methods; i.e. last name, Social Security number, address (either
pickup or residence), date of birth, date of service, and Paramedic
Subscription program membership number.
21. The CONSULTANT agrees to abide by the provisions of all laws of the
State of California, and to abide by any applicable ordinances of the CITY.
22. CONSUL TANT shall be responsible for program updates if the
requirements of Medicare and Medi-Cal fiscal intermediaries change during
the contract period.
23. CONSUL T ANT shall bill the CITY for services rendered under this contract
via monthly invoice. Said invoice shall be submitted to CITY along with
monthly reports outlined in Section D "Reporting". CITY agrees to make
payment within 30 days of receipt of said reports and invoice.
24. When notified of insufficient funds/returned checks, CONSULTANT will
immediately contact the patient by telephone, or if necessary, letter. The
returned check will be posted to the account along with any applicable check
charges deemed appropriate by the CITY.
B. PERFORMANCE MONITORING
1. CONSULTANT agrees to allow the CITY, or any agent or Consultant as
they deem so qualified, to monitor, audit, review, examine, or study the
methods, procedures and results of the billing and collection methods used.
2. The CONSULTANT agrees to exercise with diligent intent those suggestions
or requests made for modification by either the CITY or other agent as they
may deem so qualified to make such suggestion and modification.
C. ACCOUNTS RECEIVABLE
In an effort to create an audit trail for accounts receivable and secure the funds that
are received as a result of services provided by the CITY, the following shall be
required as the primary method of tracking and receiving cash receipts.
I. Any and all funds, no matter what the source, are to be processed by the City.
Information relating to such payments shall be transmitted to CONSULTANT.
2. CONSULTANT shall have the ability to have payment information posted to the
patient account, noting the source of payment at the time of posting, thus
becoming part of the permanent file.
3. CONSULTANT agrees to maintain a separate set of accounts receivable records
which will be available for review at the discretion of the CITY.
4. CONSULTANT agrees to forward to CITY any payments made directly to
CONSUL T ANT as a result of CONSULTANT billing.
D. REPORTING
1. CONSULTANT must be able to provide at the onset ofthe contract, daily,
monthly, ad hoc, and annual reports. These reports must demonstrate clear audit
trails, detailed payment adjustments and account balance experience by account.
These reports must be in accordance with customary accounting practices. A
sample report list would include:
a. Monthly Billing Survey
b. Monthly Sales Journal
c. Monthly Cash Receipts Journal
d. Monthly Receivables Aging
e. Management Accounts Receivable Analysis
f. Statistical Reports
2. The CONSULTANT shall submit an annual report at the end of each CITY fiscal
year (July 1 through June 30).
3. The annual report shall be stated with references to Paramedic Subscription
program members and non-members separately.
4. The annual report shall include, but not be limited to a full accounting of the
year's activities, including average number of billing days and average number of
payment days by category. This shall include but not be limited to:
a. Private bills
b. Third party bills
c. Insurance bills on behalf of the patient
d. Medicare
e. Medi-Cal
G. SPECIAL ACCOUNT HANDLING
I. CONSULTANT shall have the ability to track and generate accounts that require
special handling and follow-up.
2. The CONSULTANT agrees to cooperate with the CITY in its wishes as to how
certain accounts are to be handled. These special accounts shall include but not be
limited to elderly in specific age classifications, handicapped, certain social
dependent situations.
3. CONSULTANT shall not refer any account to a collection agency without the
CITY'S review and approval.
4. CONSULTANT shall allow installment billing as allowed by CITY in cases of
financial hardship.
5. During the course of the program there is certainty that there will be required the
services of a collection agency. There is to be an understanding that the selected
collection agency must be licensed in the State of California as a collection
agency. The CONSULTANT shall not have any direct or indirect financial
interest in the collection agency.
6. Rates and fees charged by the selected collection agency must be approved by the
CITY prior to any accounts being turned over for formal third party collections.
The CITY shall be a signatory to the contract for third party collections services,
to assure that the terms and conditions of said contract are agreeable to the City.
H. RELEASE OF PATIENT RECORDS OR RELATED DOCUMENTS
I. CONSUL T ANT agrees to act as Custodian of Records. Only upon receipt of
the properly executed permission forms for release of confidential information
by the patient or patient's legal representative, will CONSULTANT provide any
information to any inquiring agencies, associations or entities who demonstrate
need for such information.
2. The CONSULTANT shall appoint an individual to contact for release of
information. Confidential and classified information is to be released through
the CITY in order to maintain confidentiality.
3. CONSUL I' ANT agrees to retain all source documents including attachments for
six (6) years. All Medicare and Medi-Cal audits for periods during which this
contract is in effect shall be referred to CONSUL I' ANT.
4. CONSULTANT agrees to abide by all CITY established policies, standards and
security procedures and procedures relating to the release of information
concerning injured or treated parties.
5. CONSULTANT, as custodian of records, shall be entitled to direct payment for
costs associated with research, copying, and mailing of information to requests
within this capacity.
1. OFFSET PROVISIONS
The CONSUL I' ANT recognizes that disputed amounts may be offset against
payment due CONSULTANT.
J. CONTINUATION DURING DISPUTES
The CONSUL I' ANT agrees that, notwithstanding the existence of any dispute
between the parties, insofar as possible under the terms of the contract to be entered
into, each party will continue to perform the obligations required of it during the
continuation of any such dispute, unless enjoined or prohibited by any court.
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EXHIBIT B
A,DDIJIONAL INSTJRED ENDORSEMENT
FOR COMJ\1ERCIAL GEhEE.AL LIABILITY POLICY
"J'._
Insurance Company
HARTFORD CASUALTY INSURANCE COMPANY
This endorsement modifies such insurance as is afforded by the provisions of Policy
I;. 57SBMT6490 relating to the following:
1, The City of Santa Ana, 20 Civic Cemer Plaza, Santa Ana, California 9271) 1; its
ottieers, employees, agents, volunteers and representatives are !lamed as additional insureds
("additional insureds") with regard to liability and defense of suits al'i3jng from the operations
and uses performed by or on beh.q[f of me illllned insured.
., With respect to claims arising out of the operations and uses performed by or Of)
behalf of the named insured, such insurance <1" ;~ afforded by this policy is primary 3l1d is not
additional to or eomributing with any other insorallce carxied by or for the hcnefit oftbe
addnional insureds.
3. This insurance applie" separately to each insured against whom c1",im is made <g
slli! i[, brought eXClOpt with respect to thc company's limits of liabiJ.ity. The inc1u.sion of ~ll\"
persoll Qr organizati,on as an insured shall not affect any right which such person, or organizatioTl
would have as a claimant ifno! so ineludcu.
4. With respect to the additioMI ir;sureds, this insurance shaU not be c;;!ncelled, or
nlaterially rcduced in coverage or limits except after thirty (30) days "'Tittcn notice has been.
given to the City of Santa Ana, 20 Civic Cent~r Plaza, Santa Ana, Califomia 9270] .
(Completion of the foJlowing, including countersignature, is required to make this endorscmeDl
effective.)
Effective
Policy;;
L.med [0
7/1/05
57SBAAT6lo90
WITrMAN ENTtRPRISES,
, this endorselTlent fonn as G part of
LLC
N'm'd Im:/ r7
Countersigned by ~ L
Authorized Represent.:ui ve
WITTENT-01
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CERTIFICATE OF LIABILITY INSURANCE
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;A rno lIC #0352275
10 obblerock Drive, Suite 100
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THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITIO"I OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAj!;j THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
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:81716616
7/112005
1$1,000,000 Limit
,
$7,500 deductible
i EACH OCCURRENCE I s
i:~;~:-~';"---- ---.- ni';'-~----
,------_.,--------- '-"r;---~
r - _u.___.._.._____.__. '$
!--- - ------t-;- --
I ,$
x' wc STATU. 1 IO"TH_I"
:___J.lQ8XJ...!1",.!.T,S-'_____ .LE.-j._ ,. ______ ___._..,____
I_E~..E.:."~_,'Iccle~_::._,_____b_ ____ ,.___ __~~~~~
i~~D_'_::~AS~__.:.~~~?_~EEi--~---_ .__ 1,000,000
I E L DISEASE _ POL~CY LIMIT I $ -1-:-000~OOO
!
Dk:SCR~PT10N OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate holder is included as add' I insured per SS 044905 93 attached. subject to 10 day notice of cancellation for non-payment
of premium.
AFP;?J)\' t~~) ,~:. 10 L-U.;~,.l
CERTiFICATE HOLDER
. 1 - . /
_~._).;,yL_/ ./ L c.
.,7T
., J
C';:'NCELLA TION
City of Santa Ana
1439 Broadway
Santa Ana, CA 92701-
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER W1LL~~~AIL 3Q~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Bc<r)tXl)A]IItl06ti(IXi:l(~
X*l(S(lil(lfIl(JU_~~)(~~~XJl(_~~~Kllil(XX)
)(~)(_X~IO(
'<",-\, -,'
AUTHORIZED REPRESENTATIVE
---~ -~
~-~
- - - . "_._---------~- --_.~_.._-------- ----
ACORD 25 (2001/08)
@ACORDCORPORATION 1988
WITTENT-01
DUBR
IMPORTANT
II the certificale holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed, A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
\ ~
',1'1
,'..1
''''''.:
,-' : '. ~\.t
~"/'"
~ . ~,
......'--"'.
,/--...--...---.-
~ ,f' ?>
~""" ~..
_.._._~----'----
.\
ACORD 25 (2001/08)
" .
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED-- DESIGNATED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
BUSINESS LIABILITY COVERAGE FORM
Name of Person or Organization:
SCHEDULE
CITY OF SANTA ANA, ITS OFFICERS,
AGENTS, REPRESENTATIVES, AND EMPLOYEES
1439 BROADWAY
SANTA ANA, CA 92701
ALL CALIFORNIA OPERATIONS
Who IS an insured in the BUSINESS LIABILITY COVEAGE FORM is amended to included as an insured the
person or organization shown in the Declarations, but only with respect to liability arising out of tr,e operation
of the named insured,
For Losses covered under the BUSINESS L1ABILlL TY COVERAGE of this policy this insurance is primary to
other valid and collectible insurance, which is available to the person or organization shown in the
Declarations as an Additional Insured.
,
SS 04 49 0593 Printed in U,S.A. (NS)
Copyright, Hartford Fire Insurance Company, 1993
;\ f'PU. i '00 ' I '" .
. ''-.' ,C.d''-J
':~:'>r.<, '~l,,-o_.______
WITTENT-01
DUBR
ACORD," CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDIVYYY)
6/30/2005
PRODUCER (916) 231-1741 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Acardia of California Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
CA 001 L1C #0352275 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
11017 Cobblerock Drive, Suite 100
Rancho Cordova, CA 95670 , INSURERS AFFORDING COVERAGE NAIC#
--c ------------- -- -------.-....-
INSURED Wittman Enterprises, Lie INSURER A Hartford Casualty Insurance C,,-mpany
P. O. Box 269110 i INSURER 8: Republic Indemnity of America
Sacramento, CA 95826-9110 ~~;~-R--~:Executive Risk Indem_r'l_i~.!_I_~~.____
It - ;;"OOd.. - 073
r~~-~~~g:------------------------------ -- --------- -- ----
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLlCIES_ AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
I~~: D~~ POLICY NUMBER POLICY EF~ECTIVE ,POL.ICY EX~IRATION L.IMITS
GENERAL LIABILITY
A X C0~.1MERC!AL GENER!.~ U,\8!UTY !S7SBAA T6490
I CLAIMS MADE xj OCCUR
i GEN'L AGGREGATE LIMIT APPLIES PER
j~OT LaC
AUTOMOBILE LIABILITY
! ANY AUTO
I ALL OWNED AUTOS
SCHEDULED AUTOS
X , HIRED AUTOS
X NON.OWNED AUTOS
'57SBAA T6490
EACH OCCURRENCE 2,000,00
7/1/2005 7/1/2006 --------------- -
ff3:~MLsE_;;;_~_~~I,!E~~~0lL --~-$----- 300,00
-----------
MEO EXP{~ny one person) $ 10,00
PERSONAL & AOV INJURY $ 2,000,000
GENERAL AGGREGATE $ 4,000,00
------------- _________n
,PRODUCTS - COMP/OP AGG $ 4,000,00
----------------------
COMBINED SINGLE LIMIT 2,000,00
7/1/2005 7/1/2006 (Eaaccident)
A
I
I
i BODILY INJURY
! (Per person)
i
j$
__L-__
BODILY INJURY
(Per accident)
PROPERTY DAMAGE
(Peraccidenl)
GARAGE LIABILITY
ANY AUTO
'\;~J"I)f}()VI;;:" j"
. _ ..', _ _ ___q' -'~3
ro j.: JRrVJ
AUTO ONLY - EA ACCIDENT ,$
OTHER THAN
AUTO ONLY
_ EA A~_~_$_
AGG $
EXCESS/UMBRE1.L.A L.IABIL.ITY
- - I OCCUR CLAIMS MADE
.;.;.c'l:~ ft:~.--;,:.-
" ,,_; J: ~__" i\ l
EACH OCCURRENCE $
AGGREGATE $
$
DEDUCTIBLE
RETENTION
! WORKERS COMPENSATION AND
B ! EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
ilfyes,describeunder
SPECIAL PROVISIONS below
i OTHER
,
C IProfesionalliability
~-----
$
;16620401
7/1/2005
7/1/2006
$
v we ST P-TU- OTI-I-
.~'~.~~: ~~~":~N~- EJLt;
E.L DISEASE - EA EMPLOYEE! $
--+-
E,L. DISEASE - POLICY LIMIT $
1,000,00
-----------
1.000,00
1,000,00
,81716616
711/2005
7/1/2006
1$1,000,000 Limit
$7,500 deductible
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate holder is included as add' I insured per SS 04 49 05 93 attached. subject to 10 day notice of cancellation for non-payment
of premium.
CERTIFICATE HOLDER
CANCELLATION
City of Santa Ana
1439 Broadway
Santa Ana, CA 92701-
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCEL.L.ED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WlLL~lfl(~AIL. 3~ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOL.DER NAMED TO THE L.EFT, B~X1DlC)66())G()OUt
_:U__III__lCilll*ll1lfli<_MUlilI:_KlIi<XX
lUt_XMK
AUTHORIZED REPRESENTATIVE
~
-- ---------------
-~
ACORD 25 (2001/08)
@ ACORD CORPORATION 1988
WITTENT-01
DUBR
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
.-\PPR(}VLj) /.:'~ HJ i~_) l\'i
t....
/ .
._-~,'_..,~:?:)
;/,
,..[,,;,
,___'L .,'
ACORD 25 (2001/08)
.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED-- DESIGNATED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
BUSINESS LIABILITY COVERAGE FORM
Name of Person or Organization:
SCHEDULE
CITY OF SANTA ANA, ITS OFFICERS,
AGENTS, REPRESENTATIVES, AND EMPLOYEES
1439 BROADWAY
SANTA ANA, CA 92701
ALL CALIFORNIA OPERATIONS
Who is an insured in the BUSINESS LIABILITY COVEAGE FORM is amended to included as an insured the
person or organization shown in the Declarations, but only with respect to liability arising out of the operation
of the named insured.
For Losses covered under the BUSINESS L1ABILlL TY COVERAGE of this policy this insurance is primary to
other valid and collectible insurance, which is available to the person or organization shown in the
Declarations as an Additional Insured.
SS 04 49 05 93 Printed in U.S.A. (NS)
Copyright, Hartford Fire Insurance Company, 1993
\ i';'lt(jV t'~l) /\:.~ I'f) '~, "(){Z\[
'J-'-y, //3
.~._._.. _ ..--.../----- -_.-..._- -.' ... .-----.---------.
.ll r" ~, t \1
,:.;1; ~
~ " WITTENT-Ol DUBR
A ORD,. CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDDIYYYY)
6/27/2006
PRODUCER (916) 231-1741 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Acardia of California Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
CA 001 L1C #0352275 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,
11017 Cobblerock Drive, Suite 100
Rancho Cordova, CA 95670 INSURERS AFFORDING COVERAGE NAIc:.# -----
INSURED Wittman Enterprises, Lie INSURER A: Hartford Casualty Insurance Company
p, 0, Box 269110 INSURER B: Republic Indemnity of America ......-..-....--
Sacramento, CA 95826-9110 INSURER c: Executive Risk Indemnity, Inc.
It- ;).()D0 - ;).11 --..
INSURER 0:
.--
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
it;:- ~,~i'~- ........" -------;~-~;Y NU~;;~- POLICY-EFFECTIVE ----
POLICY EXPIRATION LIMITS
- !GENERAL LIABILITY EACH OCCURRENCE , 2,000,00
A X rX 57SBAAT6490 7/1/2006 7/1/2007 I UAMA~" . .-~ --
COMMERCIAL GENERAL liABILITY , 300,000
I CLAIMS MADE [K] OCCUR ~.REMISES (Ea occurencel --.-~---- 10,000
~_~XP (Anyone person) ,
.-----
..... PERSONAL & ADV INJURY , 2,000,000
-.-..-.----- -~~
- GENERAL AGGREGATE , 4,000,000
---._- .,cc
~'l AGG:EnE L1MI~ APPlS PER PRODUCTS COMPtOP AGG , 4,000,000
-.--
X i POLICY I ~!:-9;. laC
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 2,000,000
-- ,
A ANY AUTO 57SBAAT6490 7/1/2006 7/1/2007 (Eaaccidenl)
- -
- ALL OWNED AUTOS BODILY INJURY
,
- SCHEDULED AUTOS (per person)
X HIRED AUTOS
X BODILY INJURY ,
.:.c.. NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE ,
(Peraccidenl)
~":,GE LIABILITY -/$0-- yh; 113 AUTO ONLY. EA ACCIDENT ,
..-
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY' AGG! $
OESS/UMBRELLA LIABILITY V EACH OCCURRENCE ,
, OCCUR D CLAIMS MADE ! AGGREGATE ,
, .
-. - , .-.
.
R DEDUCTIBLE ,
-
RETENTION , ,
WORKERS COMPENSATION AND . X I T~~~IfJ#s I I oJ~-
EMPLOYERS' LIABILITY . -.----.
B 16620402 7/1/2006 7/1/2007 EL EACH ACCIDENT , 1,000,000
i ~~~I~~:MR~~~~~~~~I~6~giECUTIVE EL. DISEASE - EA EMPLOYEE , 1,000,000
tlyes, describe under 1,000,00C
SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT ,
OTHER
C Professional Liability 81716616 7/1/2006 7/1/2007 $1,000,000 Limit $7,500 Ded.
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDEO BY ENDORSEMENT I SPECIAL PROVISIONS
Certificate holder is included as add'l insured per 55 0449 05 93 attached. subject to 10 day notice of cancellation for non-payment of premium.
CERTIFICATE HOLDER CANCELLATION
City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
20 Civic Center Plaza DATE THEREOF, THE ISSUING INSURER WILL~MAIL 3~ DAYS WRITTEN
Santa Ana, CA 92701- C. '- ' NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, B~
-~ XX)
-
AUTHORIZED REPRESENTATIVE -~~ -~
..
ACORD 25 (2001/08) @ACORD CORPORATION 1988
I
WITTENT-01
DUBR
,.
.
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
nz/b
ACORD 25 (2001/08)
j.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY
ADDITIONAL INSURED.. DESIGNATED PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:
BUSINESS LIABILITY COVERAGE FORM
Name of Person or Organization:
SCHEDULE
City of Santa Ana, Its Officers, Employees, Agents,
Volunteers and Representatives
20 Civic Center Plaza
Santa Ana, CA 92701
Who is an insured in the BUSINESS LIABILITY COVEAGE FORM is amended to included as an insured the
person or organization shown in the Declarations, but only with respect to liability arising out of the operation
of the named insured.
For Losses covered under the BUSINESS L1ABILlL TY COVERAGE of this policy this insurance is primary to
other valid and collectible insurance, which is available to the person or organization shown in the
Declarations as an Additional Insured.
~3!)
SS 04490593 Printed in U.S.A. (NS)
Copyright, Hartford Fire Insurance Company, 1993
ACORD.
CERTIFICATE OF LIABILITY INSURANCE
OPID
WITTM-1 05/29/07
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
DATE IMMlOOlYYY'f)
PRODUCER
Intercare Insurance solutions
3010 Lava Ridge Ct" Ste 110
Roseville CA 95551
Phone:915-577-2100 Fax:915-577-2473
Wittman Enterprises LLC
Jean Kohlmeister
21 Blue Sky Court Suite A
Sacramento CA 95828
INSURERS AFFORmNG COVERAGE
~._-~.
iN5LJRr.RA Republic _~ndemn~_t:.X
,NSIJRER B
N$lJRERC
iN$vRER D
IN$URERE
NAIC#
INSURED
Ins Co
COVERAGES
THE POLICIES OF INSURANCE U$1EO BhOw HA\lE !JtlN ISSU~[l ro THE INSUREO NAMEDAOOVE FOR THE POLICY PERIOD 'NDlCATED. NOn....I'HSTA'<DING
AN" foIEQUIRUA!;:i'lT T tRM OR t:()Nl)iTl0~ CF A,"JY C....1NTRAC r OR ()1 HE:R DOCUMENT WI'! H Ht:,sPlt: r 1 () WHICH THIS Ct:HnFi(:A'ff MA Y BE ISSlJf"n (;R
!;lAY PFJ.lTAIN THE INSURANCE AFFORDE-) BY THE POUCl'ES r.i:SCR18ED HERFIN 15 SIJBJECT TO _lI.lL Hlf TERMS, fXCllJSIQNS ANa COND;fIONS OF suet-'
POliCIES AGGREGATE L1VITS SHOWN r..V\Y HAVF REEN REDIJCED BY PAiD GlNMS
lTR ~~1i TYPE Of INSURANCE POUCY NUMBER ---'-'PD~If~YJ~m,aVE" :1'8IW-~~bRrM~N"j LIMITS
GENERAl.. LIABILITY i'A::H O<:CURRENCE
Cc.AIMS MADE
OCCl)t<:
:mepers::m,
<"';'JMMERCiAl GE:NSRA~ UABJLlTY
S!:N'L AGGREGATE UMlT APPLIES PE,'<
::8T lOe
AUTOMOBIL E LIABILITY
$
.
PRODUCTS, COMP;OP AGG S
CCMBINED SINGLE LIMIT
cb;l..'~c;oe1t:
,
1'!}<lOAUIOg
Al PROV LD AS Tp FU1CVl
~.0y
L;lura ~;Ul ')l,_i.:di
SODIL y INJUR....
iP",' p~rl;;:)ll
,
ALL O\NNED Al)TQS
SGHEDULED AUTOS
NON O"'INED ",UTOS
I;K'DiLY I'<JIJRY
;V-i)'iKI:>:iar,1
rcv
PROPERTY D>\MAGE
(pe" a.c~1Centi
G"'RAGE lIABlUT'f
FA AC::IrFNT S
ANY AUTU
ci,HlRTt1AN
AJTO JNlY
EAACC
.\.GG
EXC!:SSiUMBRELLA UABILlTV
OL:CUR
ClArl..1SMA(JF
tACH OCCiJr~RENCE
AGGREGA,E
,
!..)('DUCT:m...E
A
REfENnON
WORKERS COMPENSATlON AND
EMPLOYERS' LIABilITY
MY "~OPR1EroRlP..II.i'<fr.;t.KcX!:CliTl'iE
i OFICERMEMBER EXCUIDW"
~rbl~'~~V!S~ONS tee,;.".
OTHER
15620403
,
07/01/07
07/01/08
E: L f.:A'.'":H ti::>:':;DENf S 1000000
--..-.. .-........--------
L' O!Gb\SE tALMPlOYf:,Ei_:s 1000000
~ -----.
f L lJiSE:.SE-POlICYUtST $1000000
DESCR1PTlON OF OPERATIONS i "lOCATfQNS j VEl-ffCl.ES i EXCLUSIONS ADDEO 6'1 eNDORSEMENT I SPECIAL P~OWSlONS
CERTIFICATE HOLDER
CANCELLATION
SANTANA
SHOULD ANY OF THE ABO\lE DESCRIBED POLICIES Se- CANCELLED BEFORE THE EXPIRATtON
DATE THEREOF. THE ISSUING INSURER \'I.1"lL ENDEAVOR TO MAIL 30 DM'S WRITTEN
NOTICE TO THE CERTlFlCATE HOLDER NAMED TO THI: LEFT. SUT FAILURE TO no so SHALL
IMPOSE ~OBUGAnCNOR UABIUTY OF Y KINO UPON THE INSU1U,r<:,ITSAGENTS OR
1988
The Ciity of Santa Ana
1439 Broadway
Santa Ana CA 92701
REPRESEWATIVES.
AUTHORIZED REPRESENT.a. fiVE
ACORD 25 (2001108)
Kristen K tonen