HomeMy WebLinkAboutBENTON, BETSY 1 - 2008City of Santa Ana
Clerk of the Council
AGREEMENT TERMINATION
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Please complete this form when the attached agreement is no to ?g in ` effect
Return form to the Clerk of the Council Office (M -30). 9 s
Call 647 -6520 if you have any questions, $;' '`? "'A
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and final payment has been made.
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N- 2008 -006
J Q -Z�aB PROFESSIONAL SERVICES AGREEMENT
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THIS AGREEMENT made and entered into this J J� day of November, 2007 by and between
Betsy Benton (hereinafter "Contractor "), 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 Contractor having special skill and knowledge in the field of
arbitration and mediation to provide professional administrative hearing services.
B. Contractor represents that Contractor is able and willing to provide such services to the City.
C. In undertaking the performance of this Agreement, Contractor represents that she is
knowledgeable in the field and that any services performed by Contractor 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
Contractor will provide professional Administrative Hearing services for the City of Santa Ana
Community Preservation Department and Public Works Department, as set forth Exhibit A. Said
hearings may include Vehicle Abatement, Administrative Citation Appeals, and Alternative Public
Nuisance Abatement. Administrative Hearing officer services may be utilized by other agencies within
the City of Santa Ana.
2. COMPENSATION
a. City agrees to pay, and Contractor 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
$10,000.00 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 November 1, 2007 and terminate on December 31, 2008,
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 Planning and Building Agency, the
Executive Director of the Public Works Agency and the City Attorney and Contractor.
4. INDEPENDENT CONTRACTOR
Contractor 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 Contractor performs the services which are
the subject matter of this Agreement; however, the services to be provided by Contractor shall be
provided in a manner consistent with all applicable standards and regulations governing such services.
Contractor 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, Contractor shall maintain and
shall require its subcontractors, if any, to obtain and maintain:
a. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the
Labor Code, Contractor, if Contractor has any employees, Contractor 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, Contractor agrees to obtain and maintain any employer's liability
insurance with limits not less than $1,000,000 per accident.
b. Professional liability (errors and omissions) insurance, with a combined single limit of not
less than $1,000,000 per claim.
c. The following requirements apply to the insurance to be provided by Contractor pursuant to
this section:
(i) Contractor 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.
6. INDEMNIFICATION
Contractor 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 operations of the Contractor
or its contractors, subcontractors, agents, employees, or other persons acting on their behalf which relates
to the provision of services described in Section 1 of this Agreement.
7. CONFIDENTIALITY
If Contractor receives from the City information which due to the nature of such information is
reasonably understood to be confidential and/or proprietary, Contractor 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 Contractor disclosed in a publicly available source; (c) is in rightful
possession of the Contractor without an obligation of confidentiality; (d) is required to be disclosed by
operation of law; or (e) is independently developed by the Contractor without reference to information
disclosed by the City.
8. CONFLICT OF INTEREST CLAUSE
Contractor 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, CA 92702 -1988
telefacsimile (714) 647 -6956
With courtesy copies to:
and
Executive Director of Planning and Building)
City of Santa Ana
20 Civic Center Plaza (M -20)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 973 -1461
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 Contractor: Betsy Benton
422 West Santa Clara Avenue
Santa Ana, California 92706
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
Contractor, 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 Contractor. 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 Contractor 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 Contractor,
Contractor 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 contractors retained by City.
12. TERMINATION
This Agreement may be terminated by either party upon thirty (30) days written notice of
termination. In such event, Contractor shall be entitled to receive and the City shall pay Contractor
compensation for all services performed by Contractor 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 Contractor to deliver to the
City written Findings and Determination for any case in which Contractor has served as a hearing officer, and
in such case such Findings and Determination shall be the property of the City unless prohibited by law, and
Contractor 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
Contractor shall not discriminate because of race, color, creed, religion, sex, marital status, sexual
orientation, age, national origin, ancestry, or disability, as deemed and prohibited by applicable law, in the
recruitment, selection, training, utilization, promotion, termination or other employment related activities.
Contractor affirms that it is an equal opportunity employer and shall comply with all applicable federal,
state and local laws and regulations.
4
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
Contractor 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. Contractor 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.
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 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.
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above
written.
ATTEST:
ot
,t
PA CIA E. HEALY
Clerk of the Council
APPROVED AS TO FORM:
JOSEPH W.FLETCHER
City Attorney
By:
Laufa Sheedy f
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
Y M. TREVINO
Executive Director of the
Planning & Building gei y
ive Director of the
Works Agency
CITY OF SANTA ANA
. w
DAVID N. RE
City Manager
BETSY BENTON
BETSY BE T N
Tax ID #
EXHIBIT A
SCOPE OF SERVICES
I. Backs round
In order to provide effective and expeditious hearings to individuals cited for violation of the Santa
Ana Municipal Code, the City would like to develop a list of Hearing Officers to conduct
administrative hearings regarding alleged violations of the City's Municipal Code. In an effort to
streamline the hearing process, the City proposes to establish a list of qualified hearing officers
that can be assigned as needed on a rotating basis.
Contractor shall conduct Administrative Hearings for the City of Santa Ana. Primarily the
Contractor will hear administrative citation appeals, alternative nuisance abatement proceedings
and vehicle abatement proceedings associated with action of the City's Planning & Building
Agency and Public Works Agency. Contractor may be asked to provide administrative hearings
for other City Agency's.
The Hearing Officer will be charged with making a just determination as to whether a municipal
code was violated, whether the property owner is still in violation, and will also make
determinations as to whether the process for the abatement of a nuisance, including inoperative
vehicles, will move forward. Hearings will be held in accordance with the City of Santa Ana
Municipal Code sections 1 -21.8, 16 -119, 17 -105, 17 -108, and 17 -135.
General Information
It is the intent of the City to establish a list of qualified Hearing Officers. The actual number of
hearing officers to be utilized will depend on the total number of qualified candidates established
by the proposal process, and the number of hearings to be provided.
A. When appropriate, the City will provide forms and information in its possession relevant to the
conduct of a fair hearing, including but not limited to Notices of Violation, Administrative
Citations, and Vehicle Abatement Notices.
B. The Hearing Officer shall be responsible for the review of documents provided by the City
prior to the hearing.
C. All documents and other products used or developed during preparation for a hearing will
become the property of the City.
Contractor shall preside over the City's administrative hearings. Cotnractor will be required
to independently evaluate the facts of each case and make a determination as to the merits
of that case based upon the information presented at the hearing and the Santa Ana
Municipal Code. The Hearing Officer must be experienced and knowledgeable in
administrative hearing procedures. The Hearing Officer shall be responsive and maintain
excellent working relationships with property owners, residents, business representatives,
and City staff. Contractor's service will include preparation of findings of facts, hearing
dispositions, billing statements, and other documents as necessary.
Job Requirements for Administrative Hearing Officers
A. A hearing officer must be independent and impartial. In this regard, a hearing officer may not:
1. be an employee of the City of Santa Ana or any public agency that is involved in testifying
at a hearing; be a member of any board of commission of the City of Santa Ana;
2. have a personal or professional interest that would conflict with his or her objectivity in
the hearing;
7
B. All hearings will be conducted at Santa Ana City Hall, at dates and times to be determined by the
City.
C. A hearing officer must possess the necessary support and equipment to perform his/her duties as
a hearing officer. At a minimum, the hearing officer must have and maintain in good working order
(1) a telephone (monitored during business hours by a secretary, answering service or answering
machine or system); (2) a facsimile machine; (3) a personal computer, with internet service,
running Windows and Microsoft Office compatible software; and (4) an electronic mail address.
D. A hearing officer must possess standards of neutrality and confidentiality.
E. A hearing officer must organize and maintain individual case files along with detailed records of
activity on each case, such as research, drafting of orders, decisions, and correspondence.
F. A hearing officer must comply with all legal and contractual timelines, including but not limited to:
1. rendering a final written decision, including findings of fact disposing of all issues raised
by the parties in a hearing not later than the 10th day following the date on which the
request for hearing was filed;
2. mailing the final written decision to the City on the date the decision is rendered;
3. returning individual case files to the City within 30 days of rendering a final decision. The
files which must be organized and maintained by the hearing officer are the property of
the City of Santa Ana and must be maintained in accordance with the Agency's record
retention schedule. It is therefore imperative that the files are returned to the Agency
within 30 days of the date of the issuance of the final decision.
4. Upon notification that the agency has received a request for a document pursuant to the
public information act, the relevant document must be provided to the City immediately.
G. The hearing officer shall prepare and submit to either the Planning & Building Agency and /or the
Public Works Agency by the fifth of each month a standard invoice detailing the activities and
expenses by case. An invoice template will be provided. Payment for services and
reimbursement of expenses by the City to a hearing officer are further conditioned upon:
1. The reasonableness of the amount of time spent by the hearing officer on the case(s) for
which the hearing officer is seeking payment/reimbursement;
2. The hearing officer's timely submission of reasonable and acceptable documentation
supporting all expenses being claimed by the hearing officer; and
3. The hearing officer's prompt return to the City of all file materials relating to closed cases.
4. Contractor's services will be billed to the nearest quarter hour.
Providing hearing officer services to other clients is not barred so long as the hearing officer does
not decline the request for hearing services more than two consecutive times; specifically, the
hearing officer must:
1. maintain the ability to respond to requests for hearings and prehearing motions within 24
hours;
2. meet all applicable time lines; and
3. demonstrate that such outside practice does not conflict with contractual work with the
City of Santa Ana.
J. Comply with the decision format requirements set by the City pursuant to the rules governing a
hearing officer's decision as per SAMC 1 -21.8, 16 -119, 17 -105, 17 -108, and 17 -135. The
decisions of the hearing officer must include formal findings of fact, and meet in all respects the
minimum requirements applicable to the decisions of executive agencies conducting contested
cases.
K. There is no guarantee as to the number of cases that will be assigned to a hearing officer. The
City anticipates that it will establish a list of qualified hearing officers and assign hearings all on a
given date based on a rotation of the names on the list.
COMPENSATION
City agrees to pay and Contractor agrees to accept as total compensation for all services and costs, a
rate of $100.00 per hour, to the nearest quarter hour, for all hearing officer services provided to City. Said
services include review of the materials provided by City, holding of the hearing and providing findings
and determination. With the exception of City validating parking receipts for the time that hearing officer
is performing services for City, City will not pay costs associated with providing the hearings including
travel time to and from the hearing site.
'—TM. L;hK I IFI(;A I t VI- LIAI31L1 I Y INSUKAN(;t JAN 1408
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
E.L.M. INSURANCE BROKERS, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. BOX 2668 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1990 E, GRAND AVE STE 210 CA LIC OD28706 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
EL SEGUNDO CA 90245 -1768
PHONE: 310 - 322 -1301 INSURERS AFFORDING COVERAGE NAIC #
---Agency Lic #: OD28706
INSURED
BETSY BENTON
422 W. SANTA CLARA AVENUE
SANTA ANA CA 92706
N- 2008 -006
rnvconncc
INSURER A: Lloyds of London
INSURER B:
INSURER C.
INSURER D:
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INS
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
OLICY
DATE MM /DD /YY )
PE
EXPIRATION
DATE MM /DD/YY
LIMITS
�GENERAL LIABILITY
NOT INCL
EACH OCCURRENCE
�$
COMMERCIAL GENERAL LIABILITY
CLAIMS MADE, OCCUR
',,,
_ -_ -
$
DAMAGE TO RENTED PREMISES PREMISES (Ea occurence)
MED. EXP (Any One Person)
PERSONAL & ADV INJURY
GENERALAGGREGATE
$
$
GEN'L AGGREGATE LIMIT APPLIES PER:
.,
PRODUCTS - COMP /OP AGG.
$
POLICY
j AUTOMOBILE LIABILITY NOT INCL
I
COMBINED SINGLE LIMIT
ANY AUTO
(Ea accident
$
ALL OWNED AUTOS ',
BODILY INJURY
SCHEDULED AUTOS
(Per person)
$
L - HIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY
(Per accident)
$
PROPERTY DAMAGE
_ -
$
GARAGE LIABILITY
_.
ANY AUTO
NOT INCL
AUTO ONLY - EA ACCIDENT $
—.- - - -- - -.:.
OTHER THAN EA ACC
AUTO ONLY: AGG
ABILITY
ri OCCUR - -. CLAIMS MADE
NOT INCL
EACH OCCURRENCE
AGGR i
EGATE $
_
- ---
$
DEDUCTIBLE
- --
~
—
RETENTION $
- --
-- -- - - - - -_.
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
NOT INCL
we s7ATU- I OTHER
__._ TORY LIMITS
ANY PROPRIETOR /PARTNERIEXECUTIVE
E.L. EACH ACCIDENT I$
OFFICER /MeMBER EXCLUDED?
If yes, describe under
E.L. DISEASE -EA EMPLOYEE �$
_._
SPECIAL PROVISIONS below
E.L. DISEASE - POLICY LIMIT $
OTHER: PROFESSIONAL LIABILITY 0608- 00067145D JUN 28 07
A CLAIMS MADE FORM
JUN 28 08
$1,000,00041,000,000 LIMITS FOR THE
PERIOD FROM 11/1/07 - 6/28/08.
$250,000/$500,000 LIMITS FOR THE
DESCRIPTION OF OPERATIONS /LOCATION /VEHICLES /EXCLUSIONS ADDED ENDORSEMENT/ SPECIAL PROVISIONS
CERTIFICATE IS FOR PROOF OF ARBITRATORS & MEDIATORS PROFESSIONAL LIABILITY COVERAGE. NOTHING IN THIS CERTIFICATE
SHALL ALTER, AMEND OR EXTEND COVERAGE PROVIDED BY THE ABOVE MENTIONED POLICY. ALL OTHER TERMS AND CONDITIONS OF
THE REFERENCED POLICY REMAIN IN FULL FORCE AND EFFECT. 6/28/04 RETRO DATE. ///
CITY OF SANTA ANA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
20 CIVIC CENTER PLAZA M -30
P.O. BOX 1988
SANTA ANA, CA 92702 -1988
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
INSURER, IT'S AGENTS OR REPRESENTATIVES.
Attention: CLERK OF THE CITY COUNCIL
AUTHORIZED REPRESENTATIVE
m%,vnv zu kcuOI1VO) uemncale v Jrsoz rreaenCK J. rlsner U6U //99
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.
4CORD 25 -S (2001/08) Certificate #3852
E.L.M. Insurance Brokers, Inc.
P.O. Box 2668
W 1990 E. Grand Ave Ste 210 Ca Lic OD28706
El Segundo CA 90245 -1768
&I'MYN PIA
Phone 310 - 322 -1301 Fax 310 - 322 -1302
mainofc @e -o.com Agency Lic #: OD28706
July 3, 2007
Insured:
BETSY BENTON
Company:
Lloyds of London
Policy #:
0608- 00067145D
Policy Period:
JUN 28 07 To: JUN 28 08
Agency Lic #:
OD28706
Betsy Benton
Betsy Benton
422 W. Santa Clara Avenue
Santa Ana CA 92706
Re: Arbitrators & Mediators Professional Liability
Dear Ms. Benton:
Thank you for allowing us to obtain your coverage. We enclose your binder, which evidences the
insurance coverages in force, until the original policy issuance.
Please note that this binder covers only professional liability hazards. We urge you to review your
other policies to ensure you have coverage for all of your insurance exposures. We have markets
offering competitive terms and may be able to refer you to other carriers that can assist on your other
insurance exposures.
Please take the time to review your expiring policy and be sure to report to them any incident that
might give rise to a claim. Failure to do so could jeopardize the availability of coverage should a
claim later be made.
Our invoice is enclosed, for your files. Note that the invoice enclosed does not reflect any payments
that might have been sent toward this policy. We have received your check and show your policy as
paid in full.
As always, we appreciate the opportunity to work with your company and if you have any questions,
please call.
Very truly yours,
Kathleen S. Wahl
Account Manager
ksw
I NI5 BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS FORM.
PRODU PHONE CER (AJC. No, ExQ 310- 322 -1301 COMPANY BINDER #
E.L.M. INSURANCE BROKERS, INC. Lloyds of London 19832
P.O. BOX 2668 DATE EFFECTIVE TIME DATE EXPIRATION TIME
1990 E. GRAND AVE STE 210 CA LIC OD28706 - ----- -
EL SEGUNDO CA 90245 -1768 X AM � X 12:01 AM
PHONE: 310- 322 -1301 JUN 28 07 12 :01 PM AUG 28 07 LNOON
FAX: 310- 322 -1302 -- -- - - — - - - - THIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANY
CODE, SUB CODE. PER EXPIRING POLICY #:
AGENCY 29878 DESCRIPTION OF OPERATIONSNEHICLESlPROPERTY (Including Location)
C11STONIFIFt In-
INSURED ALTERNATIVE DISPUTE RESOLUTION SERVICES
BETSY BENTON
422 W. SANTA CLARA AVENUE POLICY #0608- 00067145D
SANTA ANA CA 92706
1 1 M ITC
vv v crvw�.�
COVERAGE/FORMS DEDUCTIBLE i
TYPE COINS %
OF INSURANCE
AMOUNT
t
PROPERTY OF LOSS NOT INCLUDED
BASIC ;BROAD (SPEC
GENERAL LIABILITY PROFESSIONAL LIABILITY SUBJECT TO A $5,000 ;
EACH OCCURRENCE �
- -- - -
$ 250,000
-
COMMERCIAL GENERAL LIABILITY PER CLAIM (LOSS /EXPENSE) DEDUCTIBLE 4DAMAGE
TO RENTED PREMISES -
$NOT INCLUDED
Xi CLAIMS MADE ! OCCUR.
MEDICAL EXPENSE (Any one person)
$NOT INCLUDED
X PROFESSIONAL LIABILITY
PERSONAL & ADV INJURY
9VOT INCLUDED
GENERAL AGGREGATE
$ rjQ(j QO0!
RETRO DATE FOR CLAIMS MADE. JUN 28 04
PRODUCTS - COMP /OP AGG
$ NOT INCLUDED
AUTOMOBILE LIABILITY NOT INCLUDED
COMBINED SINGLE LIMIT ;
$
ANY AUTO
BODILY INJURY(Per person)
$
ALL OWNED AUTOS �.
BODILY INJURY (Per accident)
$
_$ -- __ - - --
SCHEDULED AUTOS
PROPERTY DAMAGE
i$
HIRED AUTOS
MEDICALPAYMENTS
$
NON -OWNED AUTOS
PERSONAL INJURY PROT
$
I
UNINSURED MOTORIST
$
�
AUTO PHYSICAL DAMAGE DEDUCTIBLE ALL VEHICLES I SCHEDULED VEHICLES
+
ACTUAL CASH VALUE _
1
COLLISION NOT INCLUDED
STATED AMOUNT $
-
-
OTHER THAN COLL
I
OTHER
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
NOT INCLUDED
ANY AUTO
I OTHER THAN AUTO ONLY
-
EACH ACCIDENT
-
$
AGGREGATE.!$
EXCESS LIABILITY 1 NOT INCLUDED
EACH OCCURENCE
$
UMBRELLA FORM
'AGGREGATE$
-- ---- - - - - --
OTHER THAN UMBRELLA FORM RETRO DATE FOR CLAIMS MADE:
SELF - INSURED RETENTION
$
NOT INCLUDED
WC STATUTORY LIMITS
'r -_ -- - -- - - -.. -- -- - -- -- --
WORKER'S COMPENSATION
E.L. EACH ACCIDENT $
AND
EMPLOYER'S LIABILITY !
-- - - -- - --
! E.L. DISEASE - EACH EMPLOYEE $
-- - -- - - - --- --- -- - - - -- - -t -- - - -- - -
i E.L. DISEASE -POLICY LIMIT $
SPECIAL
I FEES $
CONDITIONS/
TAXES $
�r-
OTHER
_- ____ i - -
COVERAGES
! ESTIMATED TOTAL PREMIUM $
NAMt & AUUKtbb
1 MORTGAGEE I ADDITIONAL INSURED
I LOSS PAYEE
AUTHORIZE ESENTATIVE
ATTENTION:
OC72477
ACORD 75 -S (2001101) NOTE: IMPORTANT STATE INFOR ON REVEK5E SIUt v AcvKU t um-ur A 1 wry , vyo
Ipvl,
CONDITIONS
This Company binds the kind(s) of insurance stipulated on the reverse side. The Insurance is subject to the
terms, conditions and limitations of the policy(ies) in current use by the Company.
This binder may be cancelled by the Insured by surrender of this binder or by written notice to the Company
stating when cancellation will be effective. This binder may be cancelled by the Company by notice to the
Insured in accordance with the policy conditions. This binder is cancelled when replaced by a policy. If this
binder is not replaced by a policy, the Company is entitled to charge a premium for the binder according to the
Rules and Rates in use by the Company.
Applicable in California
When this form is used to provide insurance in the amount of one million dollars ($1,000,000) or more, the title
of the form is changed from "Insurance Binder" to "Cover Note ".
Applicable in Delaware
The mortgagee or Obligee of any mortgage or other instrument given for the purpose of creating a lien on real
property shall accept as evidence of insurance a written binder issued by an authorized insurer or its agent if
the binder includes or is accompanied by: the name and address of the borrower; the name and address of the
lender as loss payee; a description of the insured real property; a provision that the binder may not be canceled
within the term of the binder unless the lender and the insured borrower receive written notice of the cancel-
lation at least ten (10) days prior to the cancellation; except in the case of a renewal of a policy subsequent to
the closing of the loan, a paid receipt of the full amount of the applicable premium, and the amount of
insurance coverage.
Chapter 21 Title 25 Paragraph 2119
Applicable in Florida
Except for Auto Insurance coverage, no notice of cancelation or nonrenewal of a binder is required unless the
duration of the binder exceeds 60 days. For auto insurance, the insurer must give 5 days prior notice, unless
the binder is replaced by a policy or another binder in the same company.
Applicable in Nevada
Any person who refuses to accept a binder which provides coverage of less than $1,000,000.00 when proof is
required: (A) Shall be fined not more than $500.00, and (B) is liable to the party presenting the binder as proof
of insurance for actual damages sustained therefrom.
ACORD 75 -S (2001/01)
Invoice Number: 37111
CLIENT #: 29878
Due Date: DUE UPON RECEIPT
Total amount due: $318.66
Remit To: OD28706
Amount of remittance: $
E.L.M. Insurance Brokers, Inc. p
D
P.O. Box 2668
1990 E. Grand Ave Ste 210 Ca Lic OD28706
EI Segundo, CA 90245 -1768
Please return this portion with payment
Invoice Date: JUL 3 07 (Unposted)
Type: A
Invoice # 37111
Trans
Code
Coverage
Eff Date
Policy#
Line of Business
Description
Amount
RE
JUN 28 07
0608- 00067145D
Arbitrators & Me
Lloyds E &O Renewal
$309.00
ST
JUN 28 07
0608- 00067145D
Arbitrators & Me
SL Tax @ 3%
$9.27
SF
JUN 28 07
0608- 00067145D
Arbitrators & Me
SL Fee @.125%
$0.39
E.L.M. Insurance Brokers, Inc.
P.O. Box 2668
1990 E. Grand Ave Ste 210 Ca Lic OD28706
El Segundo, CA 90245 -1768
PHONE: 310 - 322 -1301
Betsy Benton
422 W. Santa Clara Avenue
Santa Ana, CA 92706
FAX: 310- 322 -1302
TOTAL AMOUNT DUE: $318.66
Ins,
i
EXECUTIVE LIABILITY {MANAGERS
INSUORCE BROKERS
NOTICE
1. THE INSURANCE POLICY THAT YOU HAVE PURCHASED IS
BEING ISSUED BY AN INSURER THAT IS NOT LICENSED BY THE
STATE OF CALIFORNIA. THESE COMPANIES ARE CALLED
"NONADMITTED" OR "SURPLUS LINE" INSURERS.
2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL SOLVENCY
REGULATION AND ENFORCEMENT WHICH APPLIES TO
CALIFORNIA LICENSED INSURERS.
3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE
INSURANCE GUARANTEE FUNDS CREATED BY CALIFORNIA
LAW. THEREFORE, THESE FUNDS WILL NOT PAY YOUR
CLAIMS OR PROTECT YOUR ASSETS IF THE INSURER BECOMES
INSOLVENT AND IS UNABLE TO MAKE PAYMENTS AS
PROMISED.
4. CALIFORNIA MAINTAINS A LIST OF ELIGIBLE SURPLUS LINE
INSURERS APPROVED BY THE INSURANCE COMMISSIONER.
ASK YOUR AGENT OR BROKER IF THE INSURER IS ON THAT
LIST.
5. FOR ADDITIONAL INFORMATION ABOUT THE INSURER YOU
SHOULD ASK QUESTIONS OF YOUR INSURANCE AGENT,
BROKER, OR "SURPLUS LINE" BROKER OR CONTACT THE
CALIFORNIA DEPARTMENT OF INSURANCE, AT THE
FOLLOWING TOLL -FREE TELEPHONE NUMBER; 1-804- 9274357.
6. IF YOU, AS THE APPLICANT, REQUIRED THAT THE INSURANCE
POLICY YOU HAVE PURCHASED BE BOUND IMMEDIATELY,
EITHER BECAUSE EXISTING COVERAGE WAS GOING TO LAPSE
WITHIN TWO BUSINESS DAYS OR BECAUSE YOU WERE
REQUIRED TO HAVE COVERAGE WITHIN TWO BUSINESS DAYS,
AND YOU DID NOT RECEIVE THIS DISCLOSURE FORM AND A
REQUEST FOR YOUR SIGNATURE UNTIL AFTER COVERAGE
BECAME EFFECTIVE, YOU HAVE THE RIGHT TO CANCEL THIS
POLICY WITHIN FIVE DAYS OF RECEIVING THIS DISCLOSURE.
IF YOU CANCEL COVERAGE, THE PREMIUM WILL BE
PRORATED AND ANY BROKER FEE CHARGED FOR THIS
INSURANCE WILL BE RETURNED TO YOU.
SF 199222.2 73670 00741 D -2 (EFFEC77VE JANUARY 1, 2005 THROUGH DECEMBER 31, 2007)