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HomeMy WebLinkAboutMEDINA, ANTHONY (2) INSURANCE ON FILE WORK MAY PROCEED �UNTIL INSURANCE EXPIRES N-2025-186 CITY CLERK DATE: JUL 1 0:GM 0 (a?) COUNCIL AIDE PROFESSIONAL SERVICES AGREEMENT sylviaVgzvel— 9 THIS AGREEMENT is made and entered into on this I" day of July, 2025 by and between, Anthony Medina("Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. The City desires to obtain the services of a Consultant to provide administrative, constituent, and legislative support for a member of the Santa Ana City Council, B. Consultant represents that Consultant is qualified to perform these services. C. In undertaking the performance of this Agreement, Consultant represents that Consultant is knowledgeable in its field and that any services performed by Consultant under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES a. Consultant shall perform during the term of this Agreement,the tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately provide administrative, constituent, and legislative support services for Councilmember Hernandez ("Councilmember") as provided in this Agreement and in the Scope of Services as described in subsection b below. b. At the direction of Councilmember, Consultant shall perform a variety of administrative, constituent, and legislative functions and tasks, including but not limited to, conducting complex administrative studies, researching and responding to constituents' inquiries, drafting written communications involving strategy,policies,and/or procedures,coordinating assigned project activities, and serving as a liaison,where necessary. c. As may be required for services performed while at City Hall, the City may provide access to the Councilmember's office space — consistent with City procedures — should Consultant require limited access to perform services required by the Councilmember. Consultant shall maintain a business location separate from City and Consultant understands that such access to office space is not required by the City but provided to the Consultant on an as-needed basis and should only be used when City Hall is open to the public or while the Councilmember is present. 2. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services for City, the hourly pay rate of$30.00 for services rendered pursuant to this Agreement. Consultant Page 1 of 12 agrees and understands that no changes to this pay rate shall be made during the term of this Agreement and that monthly billing pursuant to this Agreement, shall not exceed a total sum five thousand dollars ($5,000.00) per month. The total sum to be expended under this Agreement shall not exceed thirty thousand dollars ($30,000.00) during the term of this Agreement. b. Consultant agrees and understands that the not-to-exceed amount, provided above, includes reimbursement for all out-of-pocket expenses, including but not limited to, mileage, copying costs, and mail services authorized at the sole direction of the Councilmember in connection with the performance of duties under this Agreement. The City shall not make any separate payments for any of the above expenses. c. Consultant shall submit monthly invoices to City for work performed during the billing period. Payment by City shall be made within thirty (30) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Monthly invoices shall be in substantially the form attached hereto as Exhibit"A." 3. TERM This Agreement shall commence on July 1,2025 and terminate on June 30,2026,unless terminated earlier in accordance with Section 19, below. 4. INDEPENDENT CONTRACTOR Consultant shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer-employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Consultant performs the services which are the subject matter of this Agreement;however,the services to be provided by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services. Consultant shall pay all salaries and wages, benefits, employer's social security taxes, unemployment insurance, and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 5. POLITICAL CAMPAIGN ACTIVITIES a. Consultant is prohibited from the following political campaign activities while this Agreement is in place: 1) Acting as campaign treasurer/manager or a campaign consultant for any candidate for Santa Ana City Council or Mayor; 2) Campaigning for any candidate for Santa Ana City Council or Mayor and at the same time,working pursuant to this agreement and/or charging the City for the time spent campaigning pursuant to this agreement; 3) Using City equipment, supplies or resources to campaign for any candidate for Santa Ana City Council or Mayor; 4) Accepting any campaign contributions on behalf of any candidate for Santa Ana Page 2of12 l City Council of Mayor; 5) Campaigning while wearing any attire or logo that identifies you as a Consultant for the City of Santa Ana; 6) Campaigning while using any City room, building, or location that has not been specifically designated for political speech; 7) Receiving any payment or reimbursement from a campaign candidate for Santa Ana City Council or Mayor or their campaign account; and/or 8) Opening a campaign committee or pulling nomination papers to run as a candidate for Santa Ana City Council or Mayor. b. Consultant will sign the declaration attached hereto as Exhibit B acknowledging said prohibitions. 6. PROHIBITION AGAINST APPOINTMENT TO CITY BOARD OR COMMISSION Consultant is prohibited from accepting appointment or continuing with any prior appointment to any City Board or City Commission set forth in Chapter 2 of the Santa Ana Municipal Code while this Agreement is effective. 7. BACKGROUND CHECK Consultant agrees to submit to a background check including, but not limited to, a live scan and records check to City's satisfaction. Failure to do so is grounds for termination of this Agreement. 8. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy,use,modify,reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Consultant under this Agreement ("Documents & Data"). Consultant shall require all subcontractors to agree in writing that City is granted a non-exclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Consultant represents and warrants that Consultant has the legal right to license any and all Documents & Data. Consultant makes no such representation and warranty in regard to Documents & Data which were provided to Consultant by the City. City shall not be limited in any way in its use of the Documents and Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. 9. INSURANCE Prior to undertaking performance of work under this Agreement, Consultant shall maintain and shall require any subcontractors to obtain and maintain insurance as described below for the entire Term of this Agreement against claims for injuries to persons or damage to property which may arise from or in connection with services,products and materials supplied to City. Total cost of such insurance shall be borne by Consultant. Page 3 of 12 I Minimum Scope and Limit of Insurance. • Automobile Liability: Insurance Services Office Form CA 00 01 covering Code I (any auto), with limits no less than$1,000,000 combined single limits. In the event Consultant does not maintain commercial automobile liability insurance, City will accept evidence of personal automobile insurance. • Workers' Compensation: as required by the State of California, with Statutory Limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident, policy or employee,for bodily injury or disease. Coverage is not required if Consultant has no employees and signs request to waive such insurance. • If Consultant maintains broader coverage and/or higher limits than the minimum requirements for each line of coverage shown above, City requires and shall be entitled to the broader coverage and/or the higher limits maintained by Consultant. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to City. Other Insurance Provisions. The above required insurance policies are to contain or be endorsed to contain the following provisions: • City, its City Council, its officers, officials, employees, agents, and volunteers are to be covered as additional insureds, under Consultant's CGL, Professional Liability, and Automobile Liability policies,with respect to any liability arising out of work or operations performed by or on behalf of the Instructor including materials, parts, equipment, and personnel furnished in connection with such work or operations. • Consultant's Insurance company(ies)agrees to waive all rights of subrogation against City, its City Council, its officers, officials, employees, agents, and volunteers for losses paid under the terms of any policy which arise from work performed by Consultant under this Agreement. • For any claims related to this contract, Consultant's insurance coverage shall be primary and any insurance maintained by City, its City Council, its officers, officials, employees, agents, or volunteers shall not contribute with it. • A severability of interest provision must apply for all the additional insureds, ensuring that Consultant's insurance shall apply separately to each insured against whom a claim is made or suit is brought, except with respect to the insurer's limits of liability. • Insurance policies required herein shall provide that coverage shall not be canceled, suspended, voided, reduced in coverage or in limits, non-renewed by the carrier, or materially changed except after thirty(30)days prior written notice has been given to City. Ten(10) days prior written notice shall be provided to City for policy cancellation or non- renewal due to non-payment of premium. • Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa Ana, City Manager's Office,20 Civic Center Plaza M-31, Santa Ana, CA 92701. The name and location of project must be included in the Description of Operations section of each certificate. Self-Insured Retentions. Self-insured retentions must be declared to and approved by the City. The City may require the Consultant to purchase coverage with a lower retention or provide proof of Page 4 of 12 ability to pay Iosses and related investigations, claim administration, and defense expenses within the retention.. Acceptability of Insurers. Insurance is to be placed with insurers authorized to conduct business in the State of California with a current A.M.Best rating of no less than A:VII,unless otherwise acceptable to City. Verification of Coverage. Consultant shall furnish City with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage required by this clause)and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive Consultant's obligation to provide them. City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. Special Events Coverage. Special events coverage is available and can be purchased by Consultant. Use this link to learn more: https://2spaita.com/seliP aPp lication.Ph2. Special Risks or Circumstances. City reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. 10. INDEMNIFICATION Consultant agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, contractors, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Consultant,its subcontractors,agents, employees, or other persons acting on its behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered,by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. The Consultant further agrees to indemnify, hold harmless,and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party challenging the validity of this Agreement, or asserting that personal injury, damages,just compensation,restitution,judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. 11. INTELLECTUAL PROPERTY INDEMNIFICATION Consultant shall defend and indemnify the City,its officers,agents,representatives,and employees against any and all liability, including costs, for infringement of any United States' letters patent, trademark, or copyright infringement, including costs, contained in the work product or documents provided by Consultant to the City pursuant to this Agreement. Page 5 of 12 12. RECORDS Consultant shall keep records and invoices in connection with the work to be performed under this Agreement. Consultant shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three(3)years,or for any longer period required by law,from the date of final payment to Consultant under this Agreement. All such records and invoices shall be clearly identifiable. Consultant shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours. Consultant shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Consultant under this Agreement. 13. CONFIDENTIALITY If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Consultant agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that(a)has been disclosed in publicly available sources; (b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Consultant without reference to information disclosed by the City. 14. CONFLICT OF INTEREST CLAUSE a. Consultant represents that neither it nor any of its officers,partners or employees has a financial interest, as defined in Section 87103 of the Government Code, in the subject matter of this Agreement other than the right to receive payment from City for services rendered. b. Consultant agrees that it shall not make,participate in making, or in any way attempt to use its position as consultant to influence any decision of City in which Consultant knows, or has reason to know,that any of its officers,partners or employees has a financial interest as defined in Section 87103 of the Government Code. c. Consultant warrants that neither Consultant nor any of its officers,partners or employees,has any financial interest in any real property,building or structure within 2,500 feet of the location of any project or assignment to which this Agreement may apply in the City of Santa Ana. Consultant agrees to disclose to City any financial interest in such property as may be acquired by its officers,partners or employees during the term of this Agreement. Page 6 of 12 d. In accordance with the City's Conflict of Interest Code, if determined by the City Manager to be a designated position, Consultant shall file a Statement of Economic Interests (Form 700) with the Fair Political Practices Commission. 15. NON-EXCLUSIVE Consultant understands and agrees that this is a non-exclusive Agreement and City may enter into other agreements with other consultants and may use any of the contractors with whom City has contracts and, therefore, the City cannot estimate nor guarantee the volume or amount of work to be received by Consultant under this Agreement. 16. NON-DISCRIMINATION Consultant shall not discriminate because of race, color, creed,religion, sex,marital status, sexual orientation, gender identity, gender expression, gender, medical conditions, genetic information, or military and veteran status, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in any services provided under this Agreement. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 17. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant, and supersedes any and all other agreements,oral or written,between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto,the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Consultant. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Consultant or the City. Each party to this Agreement acknowledges that no representations, inducements,promises or agreements, orally or otherwise,have been made by any party,or anyone acting on behalf of any party, which is not embodied herein. 18. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Consultant, Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other Consultants retained by City. 19. TERMINATION This Agreement 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: Page 7 of 12 I a. As a condition of such payment, Consultant may be required to deliver to the City all work product(s) completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. Consultant's term shall automatically terminate immediately if, at any time, the Councilmember or Mayor is no longer an elected member or Mayor of the Santa Ana City Council. 20. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 21. JURISDICTION-VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 22. PROFESSIONAL LICENSES Consultant shall, throughout the term of this Agreement, maintain all necessary licenses,permits, approvals,waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 23. NOTICE Any notice,tender,demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail,postage prepaid,or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: City Clerk City of Santa Ana Page 8 of 12 20 Civic Center Plaza(M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 With courtesy copies to: City Manager City of Santa Ana 20 Civic Center Plaza(M-31) P.O. Box 1988 Santa Ana, California 92702 To Consultant: Medina Solutions Anthony Medina A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified,with postage prepaid, and addressed as set forth above. If sent by fax,communication shall be effective or deemed to have been given twenty-four(24)hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 24. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City frilly, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits referenced herein, if any, and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. [signature page to follow] Page 9 of 12 SIGNATURE PAGE - COUNCIL AIDE PROFESSIONAL SERVICES AGREEMENT FOR ANTHONY MEDINA IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: ,.„r, CITY OF ANA AJenniferHa Alvaro Nunez City Manager APPROVED AS TO FORM: SONIA R. CARVALHO CONSULTANT City Attorney A By: onathan T. Marti - Anthony Medina Assistant City Attorney Medina Solutions Page 10 of 12 EXHIBIT A Month and Year Invoice Your Name Street Address Invoice#: City, ST Zip Code Agreement#: Phone Date: Bill To: City of Santa Ana 20 Civic Center Plaza Hourly Rate: Santa Ana, CA 92701 Total Billable Hours: Amount Due: Date Start Time Time Out Description Performed 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Page 11 of 12 EXHIBIT B Acknowledgment Regarding Political Activities Prohibitions I, Anthony Medina, am an independent contractor working as a Council Aide pursuant to this Agreement. 1. I acknowledge and agree that during the term of this Agreement, I will not participate or conduct the following political activities: a) Acting as campaign treasurer/manager or a campaign consultant for any candidate for Santa Ana City Council or Mayor; b) Campaigning for any candidate for Santa Ana City Council or Mayor and at the same time,working pursuant to this agreement and/or charging the City for the time spent campaigning pursuant to this agreement; c) Using City equipment, supplies or resources to campaign for any candidate for Santa Ana City Council or Mayor; d) Accepting any campaign contributions on behalf of any candidate for Santa Ana City Council of Mayor; e) Campaigning while wearing any attire or logo that identifies you as a Consultant for the City of Santa Ana; f) Campaigning while using any City room, building, or location that has not been specifically designated for political speech; g) Receiving any payment or reimbursement from a campaign candidate for Santa Ana City Council or Mayor or their campaign account; and/or h) Opening a campaign committee or pulling nomination papers to run as a candidate for Santa Ana City Council or Mayor. 2. I acknowledge and understand that failure to abide by any of the above prohibitions are grounds for immediate termination of this Agreement. Signed this g_day of JUNE , 20_25_. Anthony Medina /Medina Solutions /Aok�,-'Iwo (Name of Consultant) (Signature of `onsultant) 06/30/25 Date (Name of Witness) (Signature of Witness) Page 12 of 12 CITY OF SANTA ANA Risk Management a division of Human Resources Managing Risk through Awareness and Action AFFIDAVIT OF EXEMPTION FOR WORKERS' COMPENSATION INSURANCE 1 ANTHONY MEDINA (Owner) ('`Representative"),attest that I am an authorized (Name and Title of Vendor Representative) representative of MEDINA SOLUTIONS ("Company"),and (Consul tandCompany Name) possess the authority to legally bind Company. In my capacity as Representative of Company, I represent and confirm the following, as relates to the agreement between Company and City of Santa Ana, agreement number TSD provide administrative, constituent, and legislative support ("Agreement")to p ( Services"): (Services to be provided under agreementicontract) During the course and scope of Company's agreement with the City of Santa Ana,Company will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if Company should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, Company shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately. If at any time it is found that Company is not adhering to any and/or all of the statements in this document and does not maintain the minimum workers`compensation insurance coverage as required in the Agreement,it will be considered a breach of Agreement rendering the Agreement null and void and Company will be fully liable for any and all damages. 6/30/205 Signature Late ANTHONY MEDINA Print Name CITY COUNCIL AID Title Contact Information,i.e-,Telephone Number and/or Email Address WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBYECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSANT DOLLARS($I00,000),IN ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST,AND ATTORNEY'S FEES. Affidavit of Exemption for Workers'Compensation Insurance 1L12.2024 Li State Farm Mutual Automobile Insurance Company PO Box 2358 StateFarm Bloomington It_8 f 702-2358 AT2 038363 0009 A-8761 A MEDINA, ANTHONY AUTO RENEWAL PREMIUM PAID; $696.45 DO NOT PAY. Ill`ill"I1 tl l l l I'III'I'I"th l l l'l l l li l It I"I"l l"i ll l�'t"'I I I I Your premium is billed through the State Farm Payment Plan State Farm Payment Plan Number: ro Your State Farm Agent PEGGY BATES Policy Number: Office: 714-543-0422 Policy Period: June 10, 2025 to December 10, 2025 Address; 2723 N BRISTOL ST STE D1 Vehicle: SANTA ANA, CA 92706-1419 2014 FORD FOCUS If you have a new or d#Terent car,have added any drivers,or have moved, Principal Driver: please contact your agent ANTHONY MEDiNA Thank you for choosing State Farm. A new California law increases minimum limits for Liability Thank you for choosing State Farm for your auto insurance. Coverage and Uninsured Motor Vehicle Coverage: You are important to us, and we value your business. Your • For Liability Coverage, the minimum will be$30,000 policy currently has Liability Coverage and/or Uninsured per,person and$60,000 per accident for bodily injury, Motor Vehicle Coverage with limits below the new state and$15,000 per accident for property damage. minimum. Effective with this renewal your limits will be • For Uninsured Motor Vehicle Coverage, the minimum raised to meet the new state minimums. We will mail you will be$30,000 per person and$60,000 per accident your updated Declarations Page with the increased coverage(s) and your premium will reflect the added for bodily injury. protection. If you need a hand,your State Farm agent is (continued on next page) Policy Number:737 4537-F10-75B APPROVED Page number 1 of 5 Prepared April 18,2025 By Tu Tran Nguyen at 8:26 am,May 29,2025 1004583 143532 202 01-15-2018 Tu Tran Digitally signed by Tu Tran Nguyen Nguyen os27:54-o°oog for being part of our neighborhood. 41 You mean a lot to us. If you need anything, 4 _ call State Farm Agent PEGGY BATES at 714-543-0422. 107144 StateFarm available to you and ready to heap. We have increased your farm State FarmAgent. have Bodily Injury Liability Coverage limit to S30,o00IS60,000.We o contact Y ourhave increased your Uninsured coverage limit to Your auto insurance rates are impacted by vehicle is do verl To ensure we've priced our�insurance your ��o,000rsso,aao. Notice of insurance information collection practices- coverage accurately based on the number of miles you personal,family, or household insurance transact�Oenrs: drive,e e through a third part we tried to obtain y provide�.lWermation for were unable to We may collect customer information from persons og e w an average than the individual or individuals applying for coverage. obtain odometer readings and have applied g Such customer information as well as other personal or annual mileage using information from a third party provider privileged information subsequently collected may,in certain and some of your vehicle and policy characteristics.Please circumstances,be disclosed to third parties without your contact your State Farm agent with questions. authorization as permitted by law. When you provide a check as payment,you authorize us You have the right to submit a written request to access, either to use information from your check to make a correct, amend,or delete your personal information and the one-time electronic fund transfer from your account or to right to receive a response within 30 days of submitting your process the payment as a check transaction.When we use request. If we deny your request,you have the right to file a information from your check to make an electronic fund statement with us containing the information you feel is transfer, funds may be withdrawn from your account as soon accurate and fair along with the reasons you disagree with as the same day we receive your payment, and you will not our denial. Instructions on how to file such request and our receive your check back from your financial institution, full privacy notice can be found VEHICLE INFORMATION Review your policy information carefully. if anything is incorrect, or if there are any changes to your vehicle information, please let us know right away. Vehicle Identification Vehicle Description Number(VIN) Who principally drives this vehicle? How is this vehicle normally used? 2014 FORD FOCUS ANTHONY MEDINA,a single individual, To Work,School or Pleasure. who will have 10 years of driving experience as of June 10,2025 Other Household Vehicle(s) Your premium may be influenced by other State Farm policies that currently insure the following vehicle(s) in your household. 2002 FORD F150 2015 HONDA ACCORD 200413MV11 5301 1997 SATURN SATURN 2015 BM 4281 2013 DODGE CHALLENGER 2014 FORD FIESTA The premium on the expiring policy term was based on Premium Adjustment 4,000 miles per year. Each year,we review our medical payments and personal The premium on the renewal policy term was based on injury protection coverages claim experience to determine 10,000 miles per year. the vehicle safety discount that is applied to each make and model. In addition,we review the comprehensive,collision, bodily injury and property damage claim experience (continued on next page) Policy Number. Page number 2 of 5 Prepared April 18.2025 .� Sta e F rr VEHICLE INFORMATION continued annually to determine which makes and models have rates, If any changes result from our reviews, adjustments earned decreases or increases from State Farm's standard are reflected in the rates shown on this renewal notice. Mlllu ; DRIVER INFORMATION Assigned Driver(s) ° The following driver(s)are assigned to the vehicle(s)on this policy. 'n O Driving Experience as of Marital Name June 10, 2025 Status ANTHONY MEDINA 10 years Single Other Household Driver(s) in addition to the Principal Driver(s)and Assigned Driver(s),your premium may be influenced by the drivers shown below and other individuals permitted to drive your vehicle. This list does not extend or expand coverage beyond that contained in this automobile policy. The drivers listed below are the drivers reported to us that most frequently drive other vehicles in your household. SANDRA MEDINA ANTONIO R MEDINA ALEXIS MEDINA Principal Driver&Assigned Drivers premium may be influenced by the information shown for For each automobile, the principal Driver is the individual these drivers. who most frequently drives it. Each driver is designated as an Assigned Driver on the household automobile that they most frequently drive. Your COVERAGE AND LIMITS See your policy for an explanation of these coverages. A Liability Bodily Injury 30,000/50,000 Property Damage 25,000 $608.85 H Emergency Road Service S4.74 U Uninsured Motor Vehicle Bodily Injury 30,000160,000 $63.94 U1 Uninsured Motor Vehicle Property Damage $18.91 Total Premium $595.45 Policy Number Page number 3 of 5 Prepared April 18 2025 107145 you the broader rotection without issuing a new policy, if any coverage you carry is changed to give broader startin on the lake we adopt the broader protection. protection with no additional premium charge,we will give 9 DISCOUNTS These adjustments have alreadybeen applied toyeurpremium. Multicar ✓ Driving Satety Record ✓ califomia Good Driver Loyalty $1,532.95 Total Discounts SURCHARGES AND DISCOUNTS Driving Safety Record Rating Plan more than$1000. For accidents occurring prior to Your driving safety record, along with other rating factors, December 11, 2011, an accident shall be chargeable determines what you pay for Liability, Medical Payments, provided it resulted in death or in payment(s) by an insurer Comprehensive, Collision,and Uninsured Motor Vehicle due to damage to any property in the amount of more than Coverages. Policyholders with no accidents and convictions $750, pay less than those with accidents and convictions. For applicants without prior insurance at the time of the The Driving Safety Record Rate Level that is assigned to accident, an accident shall be chargeable provided it Your policy moves up, down,or stays the same every policy resulted in damage to any property in the amount of more renewal, depending upon your driving record. For every 12 than$1000(mare than$750 if the accident occurred prior to months since the renewal following the occurrence of a December 11, 2011). chargeable accident or the conviction of a minor violation, Chargeable accidents for renewal business are those which the initial assigned driver Record Level for that chargeable resulted in bodily injury or death or State Farm claim accident or conviction shall be lowered by 1 level. For each payments totaling more than$1000(more than$750 for 12 month period since the conviction of a major violation, accidents occurring prior to December 11, 2011)under the initial assigned Driver Record Level for that conviction property damage liability coverage and collision coverage shall be lowered by 2 levels. The Rate revel is increased if combined. there are subsequent chargeable accidents or convictions. For more information about the rating plan, please contact Definition of Chargeable Accidents your State Farm agent. Chargeable accidents for new business are those which Driving Safety Record Rate Level 1 resulted in bodily injury or death or in payment(s)by an insurer due to damage to any property in the amount of ADDITIONAL INFORMATION IMPORTANT NOTICE If any information on this renewal notice is incomplete or For your protection California law requires the inaccurate,or if you want to confirm the information we have following to appear with this policy: Any person who in our records, please contact your agent. For additional knowingly presents false or fraudulent information to information regarding discounts or coverages, see your obtain or amend insurance coverage or to make a claim State Farm agent or visit statefarm.com®. for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. Important Notice Regarding Your Premium State Farm works hard to offer you the best combination of price, service,and protection. The amount you pay for automobile insurance is determined by marry factors including: The coverage you have (continued on next page) Policy Number Page number 4 of 5 Prepared April 18,2025 State Farm Mutual Automobile Insurance Company PO Sax 2358 # State f Bloomington It_61702-2358 6 AT2 039568 0009 A-8761 A MEDINA, ANTHONY PREMIUM PAID: $554.99 Do N, II'�''I I II I I"III"I III II' 'll'I Ij" I`I"�'I II II.II I II I11I' Your premium is billed through the State Farris Payment Plan Tu TranbYTtAly,ig d State Farm Payment Plan Number, rc APPROVED Nguye oatee° By Tu Tran Nguyen at 9:43 am,Nov 13, 2025 n o9434'8'-0800 Your State Farm Agent PEGGY BATES Policy Number: Office: 714-543-0422 Policy Period: December 10, 2025 to June 10. 2026 Address: 2723 N BRISTOL. ST STE D1 Vehicle: SANTA ANA, CA 92706-1419 2014 FORD FOCUS lfyou have anew ordifl'erent car,have added anydrrvers.orhave moved, Principal Driver: please contact your agent. ANTHONY MEDINA Thank you for choosing State Farm. Notice of insurance information collection practices- You have the right to submit a written request to access, personal, family, or household insurance transactions: correct, amend, or delete your personal information and the We may collect customer information from persons other right to receive a response within 30 days of submitting your than the individual or Individuals applying for coverage. request. If we deny your request, you have the right to file a Such customer information as well as other personal or statement with us containing the information you feel is privileged information subsequently collected may, in certain accurate and fair along with the reasons you disagree with circumstances, be disclosed to third parties without your our denial Instructions on how to file such request and our authorization as permitted by law. full privacy notice can be found (continued on next page) Policy Number Page number 1 of 5 Prepared October 17,2025 1004583 1435U 202 01-15-2018 Thanks for being part of our neighborhood. r'o_ , } You mean a lot to us, If you need anything, ;~ call State Farm' Agent PEGGY BATES at 714-543-0422. gyp, 'i 0. • �s TP31 114189 0 Other Household Driver(s) In addition to the Principal Drivers) and Assigned Driver(s), your premium may be influenced by the drivers shown below and other individuals permitted to drive your vehicle. This list does not extend or expand coverage beyond that contained in this automobile policy. The drivers listed below are the drivers reported to us that most frequently drive other vehicles in your household. �o rp o SANDRA MEDINA ANTONIO R MEDINA ALEXIS MEDINA It is your responsibility to inform us of all regular For business related vehicles, also include the drivers of your vehicles and changes to those drivers business owner(s) and employee(s)that drive the throughout the life of your policy. Failure to disclose vehicle(s) in any capacity drivers may result in denial of coverage. Regular Principal Driver&Assigned Drivers drivers. regardless of their relationship to the primary For each automobile, the Principal Driver is the individual named insured or their residence address, include: who most frequently drives it. • All drivers who drive the vehicles)on the policy Each driver is designated as an Assigned Driver on the once or more in a typical month household automobile that they most frequently drive. Your • All drivers who regularly drive the vehicle(s) at premium may be influenced by the information shown for least three months of the year these drivers. COVERAGE AND LIMITS See your policy for an explanation of these coverages A Liability Bodily Injury 30,000/60,000 Property Damage 25,000 S47419 H Emergency Road Service $4 74 U Uninsured Motor Vehicle Bodily Injury 30,000I60,000 $58 70 U1 Uninsured Motor Vehicle Property Damage $17 36 Total Premium $554.99 If any coverage you carry is changed to give broader you the broader protection without issuing a new policy, protection with no additional premium charge, we will give starting on the date we adopt the broader protection. DISCOUNTS These adjustments have already been applied to your premium Multicar Driving Safety Record (continued on next page) Policy Number: Page number 3 of 5 Prepared October 17, 2025 11419C StateFarm, Buying a new car? Remember to contact your agent! When you buy an additional car or one that replaces a car already on your policy, you need to report the change to your agent promptly. Even though the dealershlp you purchased the car from may offer to notify your agent or Insurance company, you, as �.-. . the named insured, are responslble for reporting all changes to your auto policy. By contacting your agent, you can help; f avoid any complications or lack of coverage In the event of an accident or loss, • avoid insurance verification problems with a Ilenholder, the police, or the department of motor vehicles, and • ensure that you receive any new discounts you maybe entitled to. 6 Your current State Farm policy automatically provides certain coverages for a new or replacement car for up to a specified, limited n CD o number of days after you take possession of the car. Please refer to your policy for the number of days that applies In your state. If you have any questions about coverage for a newly acqulred car, please contact your State Farm agent. Disclaimer This message is provided for informational purposes only and does not grant any insurance coverage. The terms and conditions of coverage are set forth in your State Farm Car Policy booklet, the most recently issued Declarations Page, and any applicable endorsements. Policy Number Page number 5 of 5 Prepared October 17, 2025 1W9f State Farm www,statefarm.comlcustomer-care/privacy-securitylprivacy information from your check to make an electronic fund or contact your State Farm Agent. transfer, funds may be withdrawn from your account as soon When you provide a check as payment, you authorize us as the same day we receive your payment, and you will not either to use information from your check to make a receive your check back from your financial institution. one-time electronic fund transfer from your account or to process the payment as a check transaction. When we use VEHICLE INFORMATION Review your policy information carefully. If anything is incorrect, or if there are any changes to your vehicle information, please let us know right away. Vehicle Identification Vehicle Description Number(VIN) Who principally drives this vehicle? How is this vehicle normally used? 2014 FORD FOCUS ANTHONY MEDINA,a single individual, To Work,School or Pleasure. who will have 10 years of driving experience as of December 10,2025. Other Household Vehicle(s) Your premium may be influenced by other State Farm policies that currently insure the following vehicle(s) In your household; 2002 FORD F150 2015 HONDA ACCORD 2004 BMW 5301 2016 BMVV 4281 2013 DODGE CHALLENGER 2014 FORD FIESTA The premium on the expiring policy term was based on model. In addition,we review the comprehensive, collision, 9,700 miles per year. bodily injury and property damage claim experience The premium on the renewal policy term was based on annually to determine which makes and models have 9,700 miles per year, earned decreases or increases from State Farm's standard Premium Adjustment rates. If any changes result from our reviews, adjustments Each year,we review our medical payments and;personal are reflected in the rates shown on this renewal notice, injury protection coverages claim experience to determine the vehicle safety discount that is applied to each make and DRIVER INFORMATION Assigned Driver(s) The following driver(s)are assigned to the vehicle(s)on this policy. Driving Experience as of Marital Name December 10, 2025 Status ANTHONY Mt DINA 10 years Single Policy Number, Page number 2 of 5 Prepared October 17,2025 "5tateFarm DISCOUNTS continued California Good Driver ✓ Loyalty Total Discounts $1.574.41 SURCHARGES AND DISCOUNTS Driving Safety Record Rating Plan more than $1000. For accidents occurring prior to Your driving safety record, along with other rating factors, December 11, 2011, an accident shall be chargeable determines what you pay for Liability, Medical Payments, provided It resulted in death or in payment(s) by an insurer Comprehensive, Collision, and Uninsured Motor Vehicle due to damage to any property in the amount of more than Coverages. Policyholders with no accidents and conVotions $750. pay less than those with accidents and convictions. For applicants without prior insurance at the time of the The Driving Safety Record Rate Level that is assigned to accident; an accident shall be chargeable provided it your policy moves up, down, or stays the same every policy resulted in damage to any property in the amount of more renewal, depending upon your driving record. For every 12 than $1000 (more than $750 if the accident occurred prior to months since the renewal following the occurrence of a December 11, 2011). chargeable accident or the conviction of a minor violation, Chargeable accidents for renewal business are those which the initial assigned Driver Record Level for that chargeable resulted In bodily injury or death or State Farm claim accident or conviction shall be lowered by 1 level. For each payments totaling more than $1000 (more than $750 for 12 month period since the conviction of a major violation, accidents occurring prior to December 11, 2011) under the Initial assigned Driver Record Level for that conviction property damage liability coverage and collision coverage shall be lowered by 2 levels. The Rate Level is increased if combined there are subsequent chargeable accidents or convictions. For more information about the rating plan; please contact Definition of Chargeable Accidents your State Farm agent Chargeable accidents for new business are those which Superior Driver Rate Level resulted in bodily injury or death or in payment(s) by an insurer due to damage to any property in the amount of ADDITIONAL INFORMATION IMPORTANT NOTICE If any information on this renewal notice is incomplete or For your protection California law requires the Inaccurate, or if you want to confirm the information we have following to appear with this policy: Any person who in our records, please contact your agent. For additional knowingly presents false or fraudulent information to information regarding discounts or coverages, see your obtain or amend insurance coverage or to make a claim State Farm agent or visit statefarm.com0 for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. Imporiani Notice Reg. ng Your Premium State Farm works hard to offer you the best combination of price, service, and protection. The amount you pay for automobile insurance is determined by many factors including. • The coverage you have • Where you live • The kind of car you drive • How the car is used • Who drives the car Any premium adjustment is reflected on this Auto Renewal. If you have any questions, please contact your agent (cor&rmed on next page) Policy Number: Page number 4 cf 5 Prepared October 17.2025 PCA Stare FBI[me StateFarm Providing Insurance and Financial Services • PO Box 2358 Bloomington IL 61702.2358 Attached as requested are your replacement insurance identification cards. If the attached cards are not accepted by a law enforcement agency or your Department of Motor Vehicle office, please contact your agent to receive additional assistance. Thank you for choosing State Farm for your insurance needs. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - IMPORTANT- IDENTIFICATION CARDS STATE FARM StateFarm StateFarm CALIFORNIA THIS CARD MUST BE KEPT IN THE INSURED MOTOR ••® VEHICLE FOR PRODUCTION UPON DEMAND. INSURANCE CARD • ® State Farm Mutual Automobile Insurance Company IF YOU HAVE AN ACCIDENT-NOTIFY THE POLICE IMMEDIATELY PO Box 2358 Bloomington IL 61702.2358 1.Get names,addresses,and phone numbers of persons involved and witnesses. INSURED MEDINA,ANTHONY MUTL Also get driver license numbers of persons involved and license plate VOL numbers/states of vehicles. 2.Don't admit fault or discuss the accident with anyone but State Farm or police. 3.Promptly notify your agent,log on to statefarm.com@,or use the State Farm mobile app to file a claim. For EMERGENCY ROAD SERVICE use the State Farm mobile app,log on to statefarmcom,or call POLICY NUMBER EFFECTIVE 1-877-627-5757.EX.4MINE POLICY EXCLUSIONS CAREFULLY.T7i/SFORMDOES YR 2014 MAKE FORD DEC 102025 TO JUN102026 NOT CONS77TUTE ANY PART OF YOUR INSURANCE POLICY. MODEL FOCUS VIN How to identify your coverage.See policy for full name and definition AGENT PEGGY BATES 8761-B8A PHONE (714)543.0422 NAIC 25178 A Liability H Emergency Road Service U Uninsured Motor Vehicle COVERAGE PROVIDED BY THE POLICY MEETS THE MINIMUM LIABILITY OMITS C Medical Payments L Physical Damage U1 Uninsured Motor Vehicle PD PRESCRIBED BY LAW. D Comprehensive R1 Car Rental and Travel Expenses Z Loss of Earnings COVERAGES A H U U1 G Collision S Death,Dismemberment and Loss of Sight KEEP A CARD IN YOUR CAR. THIS CARD IS INVALID IF THE POLICY FOR WHICH IT WAS ISSUED LAPSES OR IS TERMINATED. KEEP YOUR CURRENT CARD UNTIL THE EFFECTIVE DATE OF THIS CARD. ONE COPY OF THIS FORM SHOULD BE CARRIED IN THE VEHICLE AT ALL TIMES.THE FORM MAYBE NEEDED AS EVIDENCE OF INSURANCE IN COURT. SUBMIT ONE CARD,OR A PHOTOCOPY OF A CARD,WITH YOUR VEHICLE REGISTRATION RENEWAL Emergency Road Service information is located on your insurance card. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - IMPORTANT- IDENTIFICATION CARDS STATE FARM StateFarm StateFarm CALIFORNIA THIS CARD MUST BE KEPT IN THE INSURED MOTOR • ® INSURANCE CARD •=® VEHICLE FOR PRODUCTION UPON DEMAND. State Farm Mutual Automobile Insurance Company IF YOU HAVE AN ACCIDENT-NOTIFY THE POLICE IMMEDIATELY PO Box 2358 Bloomington IL 61702.2358 1.Get names,addresses,and phone numbers of persons involved and witnesses. INSURED MEDINA,ANTHONY MUTL Also get driver license numbers of persons involved and license plate VOL numbers/states of vehicles. 2.Don't admit fault or discuss the accident with anyone but State Farm or police. 3.Promptly notify your agent,log on to statefarm.com®,or use the State Farm mobile app to file a claim. For EMERGENCY ROAD SERVICE use the State Farm mobile app,log on to statefarm.com,or call POLICY NUMBER EFFECTIVE 1-877-627-5757.EXAMINE POLICY EXCLUSIONS CAREFULLY.TMS FORM DOES YR 2014 MAKE FORD DEC 10 2025 TO JUN 10 2026 NOT CONS77TUTE ANY PART OF YOUR INSURANCE POLICY. MODEL FOCUS VIN How to identify your coverage.See policy for full name and definition AGENT PEGGY BATES 8761-138A PHONE (714)543-0422 NAIC 25178 A Liability H Emergency Road Service U Uninsured Motor Vehicle COVERAGE PROVIDED BY THE POLICY MEETS THE MINIMUM LIABILITY OMITS C Medical Payments L Physical Damage U1 Uninsured Motor Vehicle PD PRESCRIBED BY LAW. D Comprehensive R1 Car Rental and Travel Expenses Z Loss of Earnings COVERAGES A H U U1 G Collision S Death,Dismemberment and Loss of Sight KEEP A CARD IN YOUR CAR. THIS CARD IS INVALID IF THE POLICY FOR WHICH IT WAS ISSUED LAPSES OR IS TERMINATED. KEEP YOUR CURRENT CARD UNTIL THE EFFECTIVE DATE OF THIS CARD. ONE COPY OF THIS FORM SHOULD BE CARRIED IN THE VEHICLE AT ALL TIMES.THE FORM MAYBE NEEDED AS EVIDENCE OF INSURANCE IN COURT. SUBMIT ONE CARD,OR A PHOTOCOPY OF A CARD,WITH YOUR VEHICLE REGISTRATION RENEWAL 143295.3 (ol eccal d) 01-15-2018 Emergency Road Service information is located on your insurance card. OCT 17 2025