HomeMy WebLinkAboutMAGDALENO, VALERIE (9) N-2026-197
toy 2-0 2-k,
o,cnno(0) COUNCIL AIDE PROFESSIONAL SERVICES AGREEMENT
5.C10fCtia CDz)
THIS AGREEMENT is made and entered into on this 10`h day of July, 2026 by and
between Valerie Magdaleno ("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 Jessie Lopez ("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, preparing
creative projects, and serving as a Iiaison, 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.
Page 1 of 9
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 $60.00, for services rendered pursuant to this
agreement, and that monthly billing pursuant to this Agreement, shall not exceed a
total sum of five thousand dollars ($5,000) per :month. Consultant agrees and
understands that no changes to this pay rate shall be made during the term of this Agreement.
The total sum to be expended under this Agreement shall not exceed$50,000 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
Councilrnember 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 1,2026,and terminate on June 30,2027,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
Page 2 of 9
i
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 City Council of Mayor;
S) 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
S) 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.
S. 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 fined 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
Page 3 of 9
f
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
Insurance requirements are attached hereto as Exhibit C.
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.
It. INTELLECTUAL PROPERTY INDEW41FICATION
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.
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
Page a of 9
1
I
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
far 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 maybe acquired by its officers, partners or employees
during the term of this Agreement.
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 ofthe contractors with whom
Page 5 of 9
i
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 I
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 conflict between the terms ofthis 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.
1.8. ASSIGNME+NT
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;
a. As a condition of such payment,Consultant maybe 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
Page 6 of 9
i
performance specified in the Recitals of this Agreement.
Consultant's term shall automatically terminate immediately if, at any time, the
Councilmember is no longer an elected member or Mayor of the Santa Ana City Council.
20. WAIVER
No waiver of breach, failure of any condition, or any right or remedy contained in or
granted by the provisions of this Agreement shall be effective unless it is in writing and signed
by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or
right,or remedy shall be deemed a waiver of any other breach,failure,right or remedy,whether
or not similar,nor shall any waiver constitute a continuing waiver unless the writing so specifies.
21.. JURISDICTION-VENUE
This Agreement has been executed and delivered in the State of California and the
validity, interpretation, performance, and enforcement of any of the clauses of this Agreement
shall be determined and governed by the laws of the State of California. Both parties fiirther
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,
hermits, 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 pewits, 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
20 Civic Center plaza(M-30)
P.O.Sox 1988
Santa Ana, CA 92702-1988
Page 7 of 9
With courtesy copies to:
City Manager
City of S anta Ana
20 Civic Center Plaza(M-31)
P.O.Box 1988
Santa Ana,CA 92702
To Consultant:
Valerie Magdalene
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 hereia below has the
power, authority and right to bind their respective parties to each of the terms of
this Agreement, and shall indemnify City fully, including reasonable costs and
attoiney's fees,for any injuries or damages to City in the event that such authority
or power is not,in fact,held by the signatory or is withdrawn.
b. All Exhibits referenced herein, if any, and attached hereto shall be incorporated
as if fully set forth in the body of this Agreement.
[signatures appear on followingpage]
Page 8 of 9
SIGNATURE PAGE TO COUNCIL AIDE PROFESSIONAL SERVICES AGREEMENT
IN WITNESS WHEREOF,the parties hereto have executed this Agreement the date and year
first above written.
ATTEST CITY PF SANT A
� th
per•,'.
nifer L. 1 -` ' Alvaro Nunez
City Clerk City Manager
APPROVED AS TO FORM CONSULTANT
SONIA R. CARVALHO
City Attorney
ti I V4YV�f i V4A✓4V 4VV'LV
By: Valerie Magdaleno(AW28.2026 15:35:02 PDT)
Jonathan T. Martinez Valerie Magdaleno
Assistant City Attorney
Page 9 of 9
EXHIBIT A
Month+ and
Year Invoice Name
Street Address Invoice#:
City, ST Zip Code Agreement #:
Phone Date:
Bill To:
City of Santa Ana
20 Civic Hourly Rate:
Center Plaza Total Billable Hours:
Santa Ana, CA Amount Due:
92701
Date
Performed
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
OM
0.00
0.00
,,EXHIBIT B
Acknowledgment Regarding Political Activities Prohibitions
1,Valerie Magdaleno , am an independent contractor working as a Council Aide pursuant to this
Agreement.
1. 1 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. 1 acknowledge and understand that failure to abide by any of the above prohibitions are grounds
for immediate termination of this Agreement.
Signed this day of
Valerie Magdaleno W erle Nay-o g4ekl0
g Valerie Magdaleno(AIM,2025 15:19 12 PDT)
(Name of Consultant) (Signature of Consultant)
06/07/2026
Date
(Name of Witness) (Signature of With s)
EXHIBIT C
Insurance Requirements
Consultant shall procure and maintain for the duration of the agreement, the following insurance
coverages:
MINIMUM SCOPE AND Ll[MIT OF INSURANCE
Consultant shall maintain limits.of insurance coverage in the following minmum amounts and shall
be at least as broad as:
* Automobile Liability(AL): Insurance Services Office Form CA 00 01 covering Code 1 (any
auto), with combined single limits of$1,000,000. In the event Consultant does not maintain
commercial automobile liability insurance, City will,accept evidence of personal automobile
insurance,provided that such policy is endorsed for business use and provides coverage with
a minimum limit of $1,000,000. Required policy limits can be met with primary and
umbrella/excess insurance policies.
I
If Consultant maintains broader coverage and/or higher limits than the minimums 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 insurance policies are to-contain,-or-be-endorsed to-contain,-the-fol-lowing-provisions; -- - - -
1. City of Santa Ana,its City Council,its officers,officials,employees,agents,and volunteers
are to be covered as additional insureds on Consultant's AL policy with respect to liability
arising out of work or operations performed by or on behalf of the Consultant including
materials, parts, equipment, and personnel furnished in connection with such work or
operations.
2. 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 the Consultant's AL policy which arise from work performed by Consultant for
City.
3. All required insurance policies: 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.
4. All required insurance policies: 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.
5, Each insurance policy 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.
6, The Certificate Holder on each Evidence of Insurance certificate shall be: City of
Santa Ana,Attention: City Manager's Office M-31, Santa Ana,CA 92701.The name
and location of event should be included in the Description of Operations section of each
certificate.
SeIf-Insured Retentions
Self-insured retentions must,be declared to and approved by the City. City may require Consultant f
to purchase coverage with a lower retention or provide proof of ability to pay losses and related
investigations, claim administration, and defense expenses within the retention.
Acceptability of Insurers
Insurance is,to be placed with insurers authorized to conduct business in the state of California
with a current A.M. Best rating of no less than A.:VII,unless otherwise acceptable to City.
Verification of Coverage
Consultant shall furnish City with original Certificates of Insurance including all required
amendatory endorsements(or copies of the applicable policy language effecting coverage required E
by this clause) and a copy of the Declarations and Endorsement Page of the COL policy listing all ;
policy endorsements to Entity 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.
Claims Made Policies
If any of the required policies provide coverage on a claims-made basis:
1..The retroactive date must be shown and must be before the date of the contract or the beginning
of work.
2. Insurance must be maintained and evidence of insurance must be provided for at least three(3)
years after completion of work.
3.If coverage is canceled or non-renewed,and not replaced with another claims-made policy form
with a retroactive date prior to the contract effective date, Consultant must purchase "extended
reporting"coverage for a minimum of three(3)years after completion of work.
Subcontractors
Consultant shall require and verify that all sub-contractors maintain insurance meeting
all the requirements stated herein,and Consultant shall ensure that City is an additional
insured on insurance required from sub-contractors.
t
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. i
Valerie Magdaleno CAO Signed
Final Audit Report 2026-07-28
Created: 2026-07-10
By: Stephanie Garcia(SGarcia5@santa-ana.org)
Status: Signed
Transaction ID: CBJCHBCAABAABs1j7EJYPCYEJ-ozu-WPngYWd8AvzOAo
"Valerie Magdaleno - CAo Signed" History
r1 Document created by Stephanie Garcia (SGarcia5@santa-ana.org)
2026-07-10-6:04:47 PM GMT
C Document emailed to vmagdaleno@santa-ana.org for signature
2026-07-10-6:04:53 PM GMT
`i Email viewed by vmagdaleno@santa-ana.org
2026-07-10-6:05:03 PM GMT
L I Email viewed by vmagdaleno@santa-ana.org
2026-07-17-7:37:50 PM GMT
21 'Email viewed by vmagdaleno@sartta-ana.org
2026-07-24-6:41:33 PM GMT
�a Signer vmagdaleno@santa-ana.org entered name at signing as Valerie Magdaleno
2026-07-28-10:35:00 PM GMT
C-�',D Document e-signed by Valerie Magdaleno (vmagdaleno@santa-ana.org)
Signature date:2026-07-28-10:35:02 PM GMT-Time Source:server-Signature Appearance Selected:TYPE
® Agreement completed.
2026-07-28-10:35:02 PM GMT
Q Adobe Acrobat Sign
Renewal auto policy declarations ®Allstate.
Your policy effective date is February 17,2026
APPROVED Page 1 of 3
By Tu Tran Nguyen at 7:18 am,Jul 29,2026
Information as of January 13,2026
Total Amount Due for the Policy Period
Please review your insured vehicle and verify its VIN is correct. Summary
Vehicle covered Identification Number Premium Named Insured(s)
2022 Toyota Camry $1,600.49 Valerie Magdaleno
California Fraud Assessment Fee 0.88 Mailing address
Total* $1,601.37
*Your bill will be mailed separately.Before making a payment,please refer to your Policy number
latest bill,which includes payment options and installment fee information.if you do 1804 022 975
not pay in full,you will be charged an installment fee(s). Your policy provided by
See the Important payment and coverage information section for details about Allstate Northbrook Indemnity
installment fees. Company
Policy period
Discounts (included in your total premium) Beginning February 17,2026 through
August 17,2026 at 12:01 a.m.standard
Anti-theft $6.60 Good Driver(20%) $382.41 time
Distinguished $318.80 Your Allstate agency is
Driver Moe Kajeh Agency
Total discounts $707.81 1015 Kraemer#218
Placentia CA 92870-6110
(714)241-3055
Discounts per vehicle
Some or all of the information on your
2022 Toyota Camry $707.87 policy Declarations is used in the rating
Anti-theft $6.60 Good Driver(20%) $382.41
Distinguished $318.80 of your policy or it could affect your
eligibility for certain coverages.Please
Driver notify us immediately if you believe that
any information on your Policy
Listed driver on your policy Declarations is incorrect.We will make
Valerie Magdaleno corrections once you have notified us,
and any resulting rate adjustments,will
Excluded drivers from your policy be made only for the current policy
period or for future policy periods.
None Please also notify us immediately if you
believe any coverages are not listed or
are inaccurately listed.
n
0
Q
.Y� -
Renewal auto policy declarations Page 2 of 3
Policy number:
Policy effective date: February 17,2026
Coverage detail for 2022 Toyota Camry
Coverage Limits Deductible Premium
Automobile Liability Insurance Not applicable $656.23
• Bodily Injury $30,000 each person
$60,000 each occurrence
• Property Damage $25,000 each occurrence
Auto Collision Insurance Actual cash value $1,000 $573.14
Waiver of deductible applies
Auto Comprehensive Insurance Actual cash value $250 $125.41
Rental Reimbursement up to$30 per day for a maximum of 30 Not applicable $27.03
days
Towing and Labor Costs $100 each disablement Not applicable $4.28
Uninsured Motorists Insurance for Bodily $30,000 each person Not applicable $214.40
Injury $60,000 each accident
Automobile Medical Payments Not purchased*
Coordinated Medical Protection Not purchased*
Sound System Not purchased*
Tape Not purchased*
Total premium for 2022 Toyota Camry $1,600.49
*This coverage can provide you with valuable protection. To help you stay
current with your insurance needs,contact your Allstate agent to discuss
coverage options and other products and services that can help protect
you.
VIN Lienholder
Toyota Motor Credit Corp
Rating information
Your premium is determined based on certain information,including the
following:
• This vehicle is driven 3-9 miles to work/school,unmarried person
licensed 12 years.
• The number of miles that this vehicle is driven annually is 9,500-
9,999.and was previously 9,500-9,999.
If any of the information shown above is incorrect,missing or changes in the future,please contact your Allstate
representative.Please keep in mind that a change in any of the information may result in an adjustment to your premium. it
0
w
Q
d.o
o�
ID
Additional coverages
N 4
Automobile Death Indemnity Insurance Not purchased* o
00
Automobile Disability Income Protection Not purchased* o 0
(continued) '
M
Q O_
O M
V
O
O
N 0
U
O d,
ryO
X Q
Renewal auto policy declarations WAllstate.
Policy number: Page 3 of 3
Policy effective date: February 17,2026
Identity Theft Expenses Not purchased*
*This coverage can provide you with valuable protection. To help you stay
current with your insurance needs,contact your Allstate agent to discuss
coverage options and other products and services that can help protect you.
Your policy documents
Your automobile policy consists of this Policy Declarations and the documents in the following list. Please keep these together.
• Allstate Automobile Policy-AU104-3 ■ California Amendatory Endorsement-AU14629-3
• Amendment of Policy Provisions-AU14626-1 • California Paperless Disclosure-AU14943
Important payment and coverage information
Here is some additional,helpful information related to your coverage and paying your bill:
►If we cancel or non-renew your policy,a copy of the notice of cancellation will be sent to all listed drivers on the policy.
►Your bill will be sent to you in a separate mailing and will list any payment option(s)available to you. If you are eligible to pay
your premium in installments,your first/renewal bill will reflect your available payment options, including the option to pay in
full or to pay in monthly installments.
If you decide to pay your premium in installments,there will be a$3.50 installment fee charge for each payment due. If you
make 6 installment payments during the policy period,and do not change your payment plan method,then the total amount of
installment fees during the policy period will be$21.00.
If you are on the Allstate'] Easy Pay Plan,there will be a$1.00 installment fee charge for each payment due. If you make 6
installment payments during the policy period,and remain on the AllstateOl Easy Pay Plan,then the total amount of installment
fees during the policy period will be$6,00.
If you are on the Recurring Credit Card Plan,there will be a $3.50 installment fee charge for each payment due. If you make 6
installment payments during the policy period,and do not change your payment plan method,then the total amount of
installment fees during the policy period will be$21.00,
If you change payment plan methods or make additional payments,your installment fee charge for each payment due and the
total amount of installment fees during the policy period may change or even increase.
Please note that the Allstate'` Easy Pay Plan allows you to have your insurance payments automatically deducted from your
checking or savings account.
Allstate Northbrook Indemnity Company's Secretary and President have signed this policy with legal authority at Northbrook,
Illinois.
Vold &4eqtAd� &Vz_
Phil Telgenhoff Courtney Welton
President Secretary
0
m
0
0
V
Important notices Page 1 of 3
Policy number:
Policy effective date: February 17,2026
Reasons for Extension, Cancellation or However,please be aware that you still have options
concerning coverage for damages to your insured auto that you
Nonrenewal are legally entitled to recover from the owner or operator of an
uninsured motor vehicle.
California law requires Allstate to provide you with reasons
why your policy may be extended,canceled or nonrenewed or The following options are available for each vehicle under your
your premium increased. policy. Please see your Policy Declarations to determine your
current coverages for each of your vehicles.
Allstate may cancel or nonrenew your policy for one or more of • If your vehicle is insured for Auto Collision Insurance,we
the following reasons: are offering a Waiver of your Collision Coverage
• Nonpayment of premium; Deductible to apply when the vehicle is damaged in an
• Fraud or material misrepresentation affecting the policy or accident caused by an uninsured motor vehicle,
the insured;or • If your vehicle is not insured for Auto Collision Insurance
• Substantial increase in the hazard we insure against. and is insured for Uninsured Motorists Insurance for bodily
In addition,your policy may be nonrenewed or your premium injury,we are offering you the opportunity to extend your
may be increased for any of the following reasons:
Uninsured Motorists Insurance to cover property damage.
Accident involvement by an insured and whether the • You still have the option of rejecting either the Waiver of
• insured is at fault in the accident; Collision Coverage Deductible or Uninsured Motorists
A change in,or addition of,an insured vehicle; Insurance for property damage,or both coverages,
®
A change in,or addition of,an insured under the policy; If a vehicle insured under your policy is damaged by an
• uninsured motor vehicle and you are legally entitled to recover
• A change in the location of garaging of an insured vehicle; damages,we will,depending on the coverage you purchase,
• A change in the use of an insured vehicle; either:
• Conviction for violating any provision of the Vehicle Code • Pay the collision deductible on the insured motor vehicle
or Penal Code relating to the operation of a motor vehicle; when you have purchased collision coverage,or
• The payment made by an insurer due to a claim filed by an • Pay for the damage to the insured motor vehicle when you
insured or a third party; have not purchased collision coverage but have purchased
• Any other reason that is lawful and not unfairly Uninsured Motorists Insurance for property damage.
discriminatory. Payment shall not include damage to personal property or loss
Accidents and convictions for violating any provision of the of use of a motor vehicle and shall not exceed the smaller of:
Vehicle Code or Penal code relating to the operation of a motor • The amount of the collision deductible,
vehicle that occur within the 36-month period ending on the • The actual cash value of the insured motor vehicle,
effective date of the policy may lead to an increase of your • $3500,
premium.You have the right to be informed,upon your
request,of any increase in premium,in whole or in part, The law also permits you to reject these coverages completely.
charged to you because of an accident or conviction. If you would like to purchase one of these coverages or make
Under certain circumstances,if we fail to send your renewal any other changes concerning these coverage options,please
00
offer at least 20 days prior to your renewal effective date or if call your Allstate Agent.
we fail to send your nonrenewal notice at least 30 days prior to a
the nonrenewal effective date,California law requires us to If You Have a Problem with Your Insurance o
extend your existing policy term for 30 days from the date the please contact your Allstate representative if you have any m o
notice is mailed or delivered to you. questions or concerns about your insurance.If a problem N o
Other Uninsured Motorist Coverage Options arises that you and your Allstate representative are unable to o
00
Your policy has been issued with the coverages and options resolve satisfactorily,please call or write to; o
you requested.Please refer to the enclosed Policy Declarations Allstate Customer Service o
to verify that your policy has been issued according to your PO Box 660598,Dallas,TX 75266.0598
requests. 1-800-ALLSTATE'm(1-800-255-7828) W o
Q�
�r r
o�
N Q
.D
oa
a�
N�
X Q
Important notices WAllstate.
Policy number: Page 2 of 3
Policy effective date, February 17,2026
If the problem remains unresolved,you may contact the The Good Driver Discount gives a driver the opportunity to
California Department of Insurance at: receive a discount for having a good driving history.
Consumer Services Division Depending on your driving experience and information in your
California Department of Insurance driving record,(such as the number of traffic violation
300 South Spring Street,Los Angeles,CA 90013 convictions or accidents),you could be eligible for a 20%
Consumer Hotline: 1-800-927-4357
discount on your auto insurance premiums.
Website:
http://www.insurance.ca.,eov/01-consumers/101-help/index please Note:If a driver is no longer eligible for a Good Driver
.cfm Discount policy because of the driving safety record or years of
Please contact the Department of Insurance only if you have
driving experience of any other person,the good driver is
been unable to satisfactorily resolve the problem with your eligible to purchase a Good Driver Discount policy which
Allstate representative and with Allstate. excludes such other persons from coverage, If you want to
X5126-4 exclude such other persons from your auto policy so that
Allstate can offer you the Good Driver Discount policy,please
contact your Allstate agent or representative.This change may
Voluntary Provider Networks affect your premium and any discounts currently on your
policy.
We want to let you know about a program that may be Questions?
available to you. If you think you may qualify,have any questions regarding the
If you,or anyone covered under your policy,is injured in a loss Good Driver Discount or your coverage in general,please feel
covered under your auto policy,a Voluntary Provider Network free to contact your Allstate agent or representative.
may be available to you.A Voluntary Provider Network X73866
includes a variety of participating medical providers that can
treat those injuries.
Important info on minor traffic
Voluntary Provider Networks maintain lists of their
participating providers. In the event that you experience a loss, violation(s) while driving for commercial
your claims representative can provide you with contact use
information for any participating Allstate networks that may be
available in your state at that time. Your personal automobile insurance premium may not be
You are under no obligation to use a medical provider who is a increased if you receive a minor traffic violation while driving
member of one of these networks,and you are free to seek for commercial use,as defined by California Insurance Code
medical services from a provider of your choice.There is no 488.
penalty if you choose a provider outside the network. If you are What is driving for commercial use?
injured and treated by a provider who is a member of one of the To be eligible,you must be driving for commercial use as
participating networks,we may review their bills for covered defined by California Insurance Code 488:
medical services for re-pricing based on the approved rate for
that provider's network. • Individuals whose specific job duties involve driving
their employer's motor vehicles(not their own
You do not need to make a choice about these networks at this personal vehicle);or
time.Please keep in mind that using a provider within a . Individuals who have authority in their name from the
network should not be considered a confirmation that you have Public Utilities Commission to operate as a traffic
coverage.This notice is for informational purposes only.
X73469 carrier and who are the registered owners or lease
operators of the motor vehicle used in the operation as
a highway carrier
Important information about the Good What you have to do:
If you received a minor traffic violation while driving for
Driver Discount commercial use, please contact your Allstate Agent or
Important notices Page 3 of 3
Policy number:
Policy effective date: February 17,2026
representative to complete a signed declaration form. Please
note:this declaration is made under the penalty of perjury,
Questions?We're here to help.
Please contact your Allstate Agent or representative at the
number on the top of this page,or chat with us at
allstate.com/help.
X7428,4
a
rn
CO
0
w
�o
00
%Dri
O
.o
N
O
O O
o d'
CO
0
00
00
Oa
0
ai O
O M
w O
Q V
d
NN N
0
0�
o F-
N�
x¢
CITY OF SANTA ANA
Risk Management a division of Human Resources ~„
Managing Risk through Awareness and Action
AFFIDAVIT OF EXEMPTION FOR WORKERS' COMPENSATION INSURANCE
I Valerie M ag d a l e n o ("Representative"), attest that 1 am an authorized
(Name and Title of Vendor Representative)
representative of C o u n e i Iwo m a n Jessie Lopez ("Company"), and
(Consultant/Company 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 Santa Ana
("Agreement")to provide Council aide services ("Services"):
(Services to be provided under agreement/contract)
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 professional liability 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.
d� 07/28/2026
Sieneuure Date
Valerie Magdaleno
Print Name
Community Engagement Director
Title
Vmagdaleno aasanta-ana.org
Contact Information,i.e.,Telephone Number and/or Email Address
WARNING: FAILURE TO SECURE WORKERS'COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT 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 11.12.2024