Loading...
HomeMy WebLinkAboutWITTMAN ENTERPRISES, LLC 5 -2008INSURANCE ON FILE WORK MAY PROCEEC UNTIL INSURANCE EXPIRES '~-~ -C)~ CLERK OF COUNCIL naTE: ~~ 1 5 2008 o: Fir W is STANDARD CONSULTANT AGREEMENT A-2008-179 l~ , I I ~ ~'~ th THIS AGREEMENT, made and entered mto this 7 day of July, 2008 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 provide EMS billing and collection services as set forth in Exhibit A, attached to this Agreement and incorporated by reference. 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. b. Payment by City shall be made within thirty (30) days following receipt of proper invoice evidencing collections received by City, 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 July 1, 2008 and terminate on June 30, 2009, unless terminated earlier in accordance with Section 12, below. Services provided since July I, 2008 shall be within the Scope of Services of this Agreement. The term of this Agreement may be extended for three 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. 5. INSURANCE Prior to undertaking performance of work under this Agreement, Consultant shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Due to the nature of services provided, CGL insurance is not required. 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. 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 1 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 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 confdential and/or proprietary, Consultant agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Consultant without reference to information disclosed by the City. 8. CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 9. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by telefacsimile or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, California 92702-1988 telefacsimile (714) 647-6956 With courtesy copies to: 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 Sacramento, California 95828 telefacsimile: (800) 906-6552 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 of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 14. JURISDICTION -VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 15. PROFESSIONAL LICENSES Consultant shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in writing of her inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 16. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and 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. c. Consultant agrees that, notwithstanding the existence of any dispute between the parties, insofar as possible under the terms of this Agreement, 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. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: PATRICIA E. HEAL Clerk of the Council APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney BY~ ~~~ c La a Sheedy Assistant City Attorney CITY OF SANTA ANA: ~~~~ DAVID N. REAM City Manager WITTMAN ENTERPRISES CORRINE WITTMAN-WON Chief-Executive Officer Tax I D# ~ ,~ ~ y5-~, ~~~/ EXHIBIT A SCOPE OF SERVICES A. GENERAL PERFORMANCE REQUIREMENTS Consultant shall provide the City of Santa Ana with Billing and Collection services for the City's Emergency Medical Services and Emergency Medical transport services as specified herein. BILLING Consultant shall prepare all invoices and follow-up mailings. Initial invoicing with both English and Spanish instructions will be on 8xl 1 billings and will be placed in envelopes, sealed and mailed, postage prepaid. Initial invoicing occurs within three (3) days of receipt of transport ticket. Initial invoicing is fully itemized statement stating all procedures and supplies. Toll Free 800 telephone number provided to patients. An initial telephone call will also be made at time of initial invoicing to elicit any insurance information from the patient or patient's family. If Consultant receives no answer on this call, Consultant will send and inquiry letter in addition to the initial invoice. The standard bill schedule is as follows: 1. Invoice in English and Spanish Immediately 2. Statement 30 days 3. Past Due 20 days 4. Final Demand 10 days MEDICARE, MEDI-CAL 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 Consultant shall be responsible for program updates if the requirements of Medicare and Medi-Cal fiscal intermediaries change during the contract period. WORKERS' COMPENSATION AND PRIVATE INSURANCE Consultant shall bill private insurance, supplemental insurance, secondary insurance and workers compensation in accordance with applicable requirements. Electronic billing of insurance companies is performed where appropriate. Any correspondence for additional information or follow up necessary to secure insurance payment shall be performed by Consultant. 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 CONSULTANT to identify, bill, and pursue payment from these sources. Medi-Cal, Medicare, and Insurance company billing schedules shall be as needed. DELINQUENT CLAIMS Consultant shall track accounts requiring special handling and follow-up. Consultant will honor City requests for special handling of accounts including but not limited to elderly, handicapped and social dependent situations. Patients with claims aging over 45 days will be contacted by telephone for payment arrangements. Telephone follow up will continue until payment in full is received or account is dismissed by the City to an outside collection agency. Consultant will utilize installment billing as allowed by the City in cases of financial hardship. RECEIPTS PROCESSING Consultant will receive copies of payments deposited by City and post those payments to the correct patient account within one (1) day of receipt. Consultant will forward to City any payments made directly to Consultant. REPORTS Consultant shall perform accurate month end close procedures that will result in the following reports: a. Monthly Ticket Survey b. Monthly Sales Journal c. Monthly Cash Receipts Journal d. Monthly Receivables Aging e. Management Accounts Receivable Analysis f. Statistical Reports B. RECORDS Consultant shall maintain records in accordance with generally accepted bookkeeping and accounting practices. Consultant must keep claim submission date, follow-up payments made on account, source of payment and automatic audit trail to assignment for collection. Consultant agrees that all account files remain the property of the City and will be returned to City at termination of this Agreement. Account file information including patient name, address, age, diagnosis, contact information, billing and payment information shall be updated as necessary to maintain accurate records. Patient records shall be cross referenced by name, Social Security number, address, date of birth, date of service and Paramedic Subscription program membership number. RECORDS RETENTION Consultant agrees to retain all source documents including attachments for seven (7) years. All Medicare and Medi-Cal audits for periods during which this contract is in effect shall be referred to Consultant.. Consultant shall comply with City established policies, standards and security procedures and procedures relating to the release of information concerning injured or treated parties. C. CITY RESPONSIBILITIES • Submit necessary transport information, including pay source information and patient condition to Consultant for billing purposes . , • Forward to Consultant all necessary information relating to patient transport services, payments and patient eligibility • Notify Consultant of any accounts requiring special attention/handling • Obtain signature of patient or guardian • Provide patient's Social Security number \A/ITTGIIT AI l~ ~ ll1 ~A~~RD CERTIFICATE OF LIABILITY INSURANCE I-I• I -V I I~1/91~11 DATE(MMIDD1YYYlf) ,~ 6/27/2008 PRODUCER (916) 231-1741 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Wells Fargo of California Insurance Services, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE CA DOI LIC #0352275 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1 1017 Cobblerock Driv S it 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. . e, u e Rancho Cordova, CA 95670 A-208-179 INSURERS AFFORDING COVERAGE NAIC # INSURED Wittman Enterprises, Llc INSURER A: Hartford CaSUBIty Insurance Company P. O. Box 269110 S t C INSURER B: Executive Risk Indemnity, Inc. acramen o, A 95826-9110 INSURER C: INSURER D: INSURER E: :IJVCK 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. INSR DD' POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE S 210001Q0 A X X COMMERCIAL GENERAL LIABILITY 57SBAAT6490 7/ 11L008 7/1/21309 PREMISES Ea occurence 3 SOV,~71) CLAIMS MADE a OCCUR MED EXP (Any one person) a 10,00 PERSONAL 8 ADV INJURY S 21000rQQ GENERAL AGGREGATE S 41000100 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG 3 4r000IQQ X POLICY PRO- LOC AUT OMOBILE LIABILITY A ANY AUTO 57SBAAT6490 711 /2008 7/1 /2009 COMBINED SINGLE LIMIT (Ea accident) 3 2,000rQQ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) S X HIRED AUTOS I X NON-OWNED AUTOS LY INJURY BOD (Per accdent) S PROPERTY D M E A AG (Per accdent) 5 GARAGE LU161LITY AUTO ONLY - EA ACCIDENT E ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESS/UMBRELLA LU181LITY EACH OCCURRENCE _ S 2rQQQrQQ A OCCUR ~ CLAIMS MADE 57SBAAT6490 7/1/2008 7/1/2009 AGGREGATE $ 2r000rQQ a DEDUCTIBLE y X RFTENTI71d S 10,000 _ $ WORKERS COMPENSATION AND ' _ WC STATU- OTH- T R I IT EMPLOYERS LU181LITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT S OFFICER/MEMBER EXCLUDED If d ib d E.L. DISEASE - EA EMPLOYEE S yes, escr e un er SPECIAL PROVISIONS Delow E.L. DISEASE -POLICY LIMIT S B OTHER Errors 8 Omissions 81716616 7/1/2008 7N /2009 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES !EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS ubject to 10 day notice of cancellation for non-payment of premium. ~ c~ L~%i I L I IVLY Lf~ 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 WILL~X~MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, B AUTHORIZED REPRESENTATNE AGVKU LO (LVU7/UtS) ©ACORD CORPORATION 1988 WITTENT-01 MAM 1 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 1S 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. ACORD 25 (2001/08) r t _ - - ~~~~~~ ' / t ~ YtiiTTFP~T-01 NtAMI _. s (DATE {MbAtt3L'fYWY; ~ ~»~2QOS Pr~~~uer~z X915} 2~1-'t741 THt~ u-R7(FICATE IS ISSUER AS A f~tIATTER C1F IIHFC}RATICtN € V!/alls Faro o€ Callfornla Ins~rrance services, Inc. GNLY ANI) CC7I~IFERS Nt7 RIGHTS UPt7N THE i~ERT1FlCATE 3 ~A I7C~I t.IC #(1352275 HC3LDER. THIS CEI2TIFiGATE 13Cf1»S N~RT ANE~ND, EXTE~t13 C3R ALTER THE CtJVIvRAGE AFFC7R71*t7 EiY THE POLICIES BEl.t7W. 11p17 Cobblerock [7rive, ~rtaite 1Q€~ _ .~~ ;Rancho Ccsrdova, OA 9567(7 INSURERS AFFOFZ[71NG CpVERAGE !NAIL # . ~_ __ -'> 'Mittman 1=nfe aria=tea, _~~ , ___ ~atff4'~1 r~~k3ait d;~st~r~ne€~ CompOny P. E.?, Hex Z:~S110 ~ ExevliYiv~ fti~k Indeni~ity lr~c - - - ' Sacrament, OA 95f3~6-~1 ~9 ._...... _ _~ _.__. ._._. _~ .__ __ _. _ r COVERAGES _ _ ~ _ _~. THE PflLlC€ES rJF €NS:.€RA~'JCc Li3TEL'~ ~ELC}b^! N~tYE BEEP~€ ISSEJED TC7 THE 19~`;', 2F_:} M;~r9EC3 ABGVE ~ (?f2 T"HE P~JICY Y~EfZlG4C3 tIVII€CAT ~.J. C .. "~dSTp?~dCIN } ANY FtE~i9€RE149ENT TEf~tt~ i3R CG~N~9TI~}N flF AI*~Y CL}NT^rtr ; " 4~~ ^.>l`FiER £>UC~;?tRER ~ l+~!€TI^3 RE`.~'i'f=CT TQ ~1VH{~H TH€S CEPT(FI~ATE t+tF.Y !' tSo ,°c'} C7F~ [ t~~tAY PERTA,N. THE tP~St,pRA1~tCE AFF~"' °~5F&`} EY THE P~LkC'!r" + t.~_FS~R18E© HF§z; '~ 3S SU?~JEf~T Tt} ALl THE TERM5, EJtCL;359t~!~tS AIVC3l;~tJt.. aJf~:; t.JF SUCH I PAC :;'c:S Ai>Gi2EGATE ~IP.~;TS S4-iC}. , . ;;`t ~lAVE E3EE v :..'.~,'En t3Y Pf I ( =;P;t P _r-t of Et, .IE PCY€~Y£XPfPA T0,1 ` - ` tt R ~ ~k? 7YP£ Of ~i~sllRf+s~t£ _ ~. P~i1GY NU'"BER UA.: v~' ~ =~'t'~ 'JATE,~,Art yam. ]"{ li"f5 ^.~Rat cane, aT~ _ _ ~,{lO+~.Q4 ~' A X ,': ~ - , e '67S~3AAT64'~tt 71'1r2U08 ~ 7f1~1Ut}9 ., ~ ~,a~ ~ - ~ _~ ~L . - -x ~_ _ ~ati:~;~ N ~r-, ~ _~ ~w__ z,i~c~o,~aa _. ... ~ _ ___ a.~oa;QOa _ .. - _ __ _ a~~ - - ~ a.~st~t~,r~ot ~~ , ~~ ___ _ x ~,~.a E~ . ~~~ .," ~ i ~s s~rrors t~ Um,gscons 81716S1S ~'11t~t1{18 d~ftaPTa6N QF ~P£RATS6N8 ~ IOCrZ'TION$ t #EHtCIES t EXGIt)5iQN5 Atft!£D 19Y EN045RS£btEN71 SP€CIRL FR(3Vl5f9%; Certificate Holder is named as additic~srtal insured per atfached SS 04 49 U5 83. ;Subject to 117 day nutlce esf cancellation fear nan-payment of premium. TE HCJ~C?i_"R '~.t$y of SdTSta. ATIs'3 1 d39 Broadway JC~#ntra Aria, ~~. 92741- 7t1J21}~9 F'erAc~g~reg~tell~~rflaPctt f,~arrz~taoi SHCI~.ltrt ANY OP TN£ ABZ3V£ tXESCf2£BECt #'Q1.ECi~3 63E CAtAC£LLe G' BEPflR£ Et#£ EXPafkiiTiON c~Axr TN£~£aF, T~~ IsS~EiNG €~su~a£a wx.a.~d~lf#6~67(7~+sN<. 3fI_~ DAYS'+SdRtTTEN NC?Y1~E To 7HE C£R7IFBCAT£ H©t.DElt?ikMEET T4? THE tEP7, BX~i~~L AU'SH6RiZEr1 R£P82ESENTATNE w-- ACflR~ CORPC}RATI,~Iv 19~$ V~iTT~td"f-t31 M~MI if the ce t ~_~~te holder is an ~C3Csl;Eflt~AL IN~Uft~€~, the policy{ies~ rrsust be endorsed. A statement on this c~. ate doses not confer rights to the certificate holder in lieu of such end~rs,en~ent{s}- Ef SLeBRflflr~TlGN'S ~i~r~I~AEQ subject to the terms and cxsnditic~ns tsf the policy. certain policies nay require an endorsement. A Statement on this certificate does nest confer rights to the certificate holder it lieu s~f such endorsen~ent(s}, [~IC~AlNfiER The t;ertificate of Insurance on the reverse side of this ftarrn does not constitute a contract between the issuing insurer(s), authorized retsresentative ar produc-3r, and the certificate holder, nor d<ses it af€irmativedy or negatively arr~end, extend or alter tfie ct : ; _ a''orded tsy the policies listed thecer>n. ~.,..~t ~.4~,~,....,~.K, POLICY fdR1MBER; 57SSAAT~49t3 NAIUIEa PNSUREt3: i~ITTMAN ENTERPRISES, LLC COMPAf~1Y NAIVIE: NiARTF'fl1`t[3 CASUALTY iNSURAN'CE COMPANY THIS EIdDflRSE~1EIdT CHANGES THE POLICY. PLEASE REAl3 IT CAf2EFULLY ADI3lTlflN,4L INSUREt~-- t~ESIGNATEi~ PEf•2SON OR t~RGANIZATIflN This endorsement modifies insurance provided under the fglic~wina: Bt1SlNESS LIABILITY COVERAGE FORM SCHE©llLE Dame afi Persan ar f.?rgeni~atian: Ci i Y ~JF Sr~NTA ANA, ITS OFFiCEI~S, AGENTS, REPRESENTATIVES, AND EPLC.}YEES 1439 BRC~AC3WAY SANTA ANA, CA 927U1 ALL CALiFtlRhilA C~PERATi(~NS Who is an insured in the BUSINESS LIABILITY C~JJVEAGE FARM is amended to included as an insured the person or organization shown ire the C3eciarations, but only with respect to liability arising out of tt~e op~ratlor~ of ttre named ns_.ed. For Losses ccvereti under the Sl3Sli~ESS LIABiLILTY GC111ERAt3E of this pol~ y insurance is prlrnary to other valid and collectible insurance, which is avaIable to the person ar organization shown in the C3eciarations as an Additional Insured. SS €}4 49 05 93 Printed in U,S.A. {NS} Copyright, Hartford Fire insurance Company, 1993 ~ . 4 ~•_-~ ~6~~~~a~ __.r.. _Y _ _.~_ .~._.~ __ r -_ ~cr-~. TH~~ CERTIFICATE !5 lssUEl~ kS .~ =, aT r~~~~;,. 9,~r"i~RA°~iC7h! C}I'i t'Y' AG Ct7.hiFER.S tiff RIGHT6 t~FD~I i ^c C _f?TiFtC:AI`E Int~rcar~ 2nsuraa~c~ SoLuti<3x~s NDL{7ER_ TiiIS CEFFT@FlCd~TE DOSES hrtlT 1'~i~fisD, E~tTEHD flR 3I)1C7 Lc~vr'a R~rlge Ct . , Sty 11Q ALTER THE GC}VERAGE AEFC~RDEG BY THE Pt?LICIES IiEt~Ut^I, Ftc?s~xvil3e CA 95661 ~~~... P~~ee9b&-6'17-210~I Faxs97,6-677-?~73 I1~1~,uR€S~i~Ft:=t'~'-dN(aGf?VERA€",,€ NAC# __ _ _ _ .~ ~~r~sbi`_ ~ Ix`~c3esnsa~c r drys Cc5 3rlittm2^ E:~~erprzses ~,~C . PD Box 2 0 913Q _- _. __ a~ramen~o CA 95826 _ _ _ __ _ ~r..,a~,t rs ;r~€ ~c,, _. ACY€~ED ~'~ CERTIFICATE HOLDER CANCE~.LAtivr,~ SAP3'~'ANd~ stipuc.P%-~;~c.- .., -.;c~vsra~sc~,~ccF.:~:cs'rsaEuax~e~~~t;t3Ernar:trsrxa€s:~xi~r~ ~ va,~rae_ - y ~.r,.vcssa?~~t><rr 3Q carsov~':€,`r~rs N'JT7Cf ' }'(" „.'... .. -.: ~ , T: t.EF' , .. ..,..... -:c `6 Di~: Sf5 St-ALL ~h~ C ° t~ of Saxi~a i32Y:i ~.rr~t~S~ -a:~ <; 4,_ .,~t„~~ rI ,<_ sn.. h s» aGi 'vs a ii~2 1A39 Pxoat7way n,=a , ~~;:~~ ~~~ CA 927{}1 :;rx;~r - aa€sErar -~ i~risten 77a• ACC5F2D 25 ~..,Cs' :%A~, ~~ .~:,~Giii{ATEG?7V 1984