HomeMy WebLinkAboutCENTER FOR HEARING HEALTH, INC. 1-2012INSURANCE ON FILE N- 2012 -084
VdORK MAY PROCEED
UNTIL INSURANCE EXPIRES
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CLERK OF COUNCIL .IUL 2 4 2012
MATE- � CONSULTANT AGREEMENT
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THIS AGREEMENT, made and entered into this 1 8u' day of June, 2012 by and between Center
for Hearing Health, Inc., a California corporation, (hereinafter "Consultant "), and the City of Santa Ana, a
charter city and municipal corporation organized and existing under the Constitution and laws of the State
of California (hereinafter "City ").
RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
audiometric services.
B. Consultant represents that it is able and willing to provide such services to the City.
C. In undertaking the performance of this Agreement, Consultant represents that it is
knowledgeable in its field and that any services performed by Consultant under this Agreement
will be performed in compliance with such standards as may reasonably be expected from a
professional consulting firm in the fteld.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms
and conditions hereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
Consultant shall perform noise assessments, audiometric testing for covered employees, and
hearing conservation training, as set forth in Exhibit A attached hereto and incorporated by reference.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services, the rates
and charges identified in Exhibit B, attached hereto and incorporated by reference. The total sum to be
expended under this Agreement shall not exceed $25,000 during the term of this Agreement.
b. Payment by City shall be made within thirty (30) days following receipt of proper invoice
evidencing work performed, subject to City accounting procedures. Payment need not be made for work
which fails to meet the standards of performance set forth in the Recitals which may reasonably be
expected by City.
3. TERM
This Agreement shall commence on the date first written above and terminate on expenditure of
allocated funds, unless terminated earlier in accordance with Section 12, 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, employer's social security taxes, unemployment insurance and
similar taxes relating to employees and shall be responsible for all applicable withholding taxes.
INSURANCE
Prior to undertaking performance of work under this Agreement, Consultant shall maintain and
shall require its subcontractors, if any, to obtain and maintain insurance as described below:
a. Commercial General Liability Insurance. Consultant shall maintain commercial general
liability insurance which shall include, but not be limited to protection against claims arising from bodily
and personal injury, including death resulting therefrom and damage to property, resulting from any act or
occurrence arising out of Consultant's operations in the performance of this Agreement, including,
without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following:
single limit coverage applying to bodily and personal injury, including death resulting therefrom, and
property damage, in the total amount of $1,000,000 per occurrence. Such insurance shall (a) name the
City, its officers, employees, agents, volunteers and representatives as additional insured(s); (b) be
primary and not contributory with respect to insurance or self - insurance programs maintained by the City;
and (c) contain standard separation of insureds provisions.
b. Business automobile liability insurance, or equivalent form, with a combined single limit of
not less than $1,000,000 per occurrence. Such insurance shall include coverage for owned, hired and
non -owned automobiles.
c. Worker's Compensation Insurance. In accordance with the provisions of Section 3700 of the
Labor Code, Consultant, if Consultant has any employees, is required to be insured against liability for
worker's compensation or to undertake self - insurance. Prior to commencing the performance of the work
under this Agreement, Consultant agrees to obtain and maintain any employer's liability insurance with
limits not less than $1,000,000 per accident.
d. Professional liability (errors and omissions) insurance, with a combined single limit of not less
than $1,000,000 per claim.
e. The following requirements apply to the insurance to be provided by Consultant pursuant to
this section:
(i) Consultant shall maintain all insurance required above in full force and effect for
the entire period covered by this Agreement.
(ii) Certificates of insurance shall be furnished to the City upon execution of this
Agreement and shall be approved in form by the City Attorney.
(iii) Certificates and policies shall state that the policies shall not be canceled or
reduced in coverage or changed in any other material aspect without thirty (30)
days prior written notice to the City.
2
f. If Consultant fails or refuses to produce or maintain the insurance required by this section or
fails or refuses to furnish the City with required proof that insurance has been procured and is in force and
paid for, the City shall have the right, at the City's election, to forthwith terminate this Agreement. Such
termination shall not effect Consultant's right to be paid for its time and materials expended prior to
notification of termination. Consultant waives the right to receive compensation and agrees to indemnify
the City for any work performed prior to approval of insurance by the City.
6. INDEMNIFICATION
Consultant agrees to and shall indemnify and hold harmless the City, its officers, agents,
employees, consultants, special counsel, and representatives from liability: (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 direct or indirect
operations of the Consultant or its contractors, subcontractors, agents, employees, or other persons acting
on their behalf which relates to the services described in section 1 of this Agreement; 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.
7. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such information is
reasonably understood to be confidential and/or proprietary, Consultant agrees that it shall not use or
disclose such information except in the performance of this Agreement, and further agrees to exercise the
same degree of care it uses to protect its own information of like importance, but in no event less than
reasonable care. "Confidential Information" shall include all nonpublic information. Confidential
information includes not only written information, but also information transferred orally, visually,
electronically, or by other means. Confidential information disclosed to either party by any subsidiary
and /or agent of the other party is covered by this Agreement. The foregoing obligations of non -use and
nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources;
(b) is, through no fault 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.
CONFLICT OF INTEREST CLAUSE
Consultant covenants that it presently has no interests and shall not have interests, direct or
indirect, which would conflict in any manner with performance of services specified under this
Agreement.
3
9. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall
be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or
certified mail, postage prepaid, or sent by telefacsimile or other telegraphic communication in the manner
provided in this Section, to the following persons:
To City: Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M -30)
P.O. Box 1988
Santa Ana, CA 92702 -1988
Fax 714- 647 -6956
With courtesy copy to: Personnel —Risk Management
City of Santa Ana
20 Civic Center Plaza (M -28)
P.O. Box 1988
Santa Ana, California 92702
Fax 714- 647 -5475
To Consultant: Trent Lubiens
Center for Hearing Health
2945 Bell Road #122
Auburn, California 95603
A party may change its address by giving notice in writing to the other party. Thereafter, any
communication shall be addressed and transmitted to the new address. If sent by mail, communication
shall be effective or deemed to have been given three (3) days after it has been deposited in the United
States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by
telefacsimile, communication shall be effective or deemed to have been given twenty -four (24) hours
after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed
as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City
holidays shall be excluded.
10. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and
Consultant, and supersedes any and all other agreements, oral or written, between the parties. In the event
of a conflict between the terms of this Agreement and any attachments hereto, the terms of this
Agreement shall prevail. This Agreement may not be modified except by written instrument signed by
the City and by an authorized representative of Consultant. The parties agree that any terms or conditions
of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and
conditions hereof, shall not bind or obligate Consultant nor the City. Each party to this Agreement
acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have
been made by any party, or anyone acting on behalf of any party, which are not embodied herein.
11. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Consultant,
Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior written
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consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior
written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit
the City's ability to have any of the services which are the subject to this Agreement performed by City
personnel or by other consultants retained by City.
12. TERMINATION
This Agreement may be terminated by the City upon thirty <30) days written notice of
termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant
compensation for all services performed by Consultant prior to receipt of such notice of termination, subject
to the following conditions:
a. As a condition of such payment, the Executive Director may require Consultant to deliver to the
City all work product completed as of such date, and in such case such work product shall be the property of
the City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes as the
City deems appropriate.
b. Payment need not be made for work which fails to meet the standard of performance specified in
the Recitals of this Agreement.
13. DISCRIMINATION
Consultant shall not discriminate because of race, color, creed, religion, sex, marital status, sexual
orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the
recruitment, selection, training, utilization, promotion, termination or other employment related activities.
Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal,
state and local laws and regulations.
14. JL7RISDICTION -VENUE
This Agreement has been executed and delivered in the State of California and the validity,
interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined
and governed by the laws of the State of California. Both parties further agree that Orange County,
California, shall be the venue for any action or proceeding that may be brought or arise out of, in
connection with or by reason of this Agreement.
15. PROFESSIONAL LICENSES
Consultant shall, throughout the term of this Agreement, maintain all necessary licenses, permits,
approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by
the laws and regulations of the United States, the State of California, the City of Santa Ana and all other
governmental agencies. Consultant shall notify the City immediately and in writing of its inability to
obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be
cause for termination of this Agreement.
16. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature hereinbelow has the power, authority
and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City
fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such
authority or power is not, in fact, held by the signatory or is withdrawn.
b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the
body of this Agreement.
iN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above
written.
ATTEST:
MARIA D. HL7IZAR
Clerk of the Council
APPROVED AS TO FORM:
SOMA R. CARVALHO
City Attorney C /
Laura Sheedy
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
�u�_
EDWARD RAYA
Executive Director — Personnel Agency
0
CITY OF SANIT- A A %NA
�A,� 1
PAUL M. WALTERS
City Manager
CENTER FOR HEARING HEALTH
` �i'���
TRENT LUBIENS
President
�1 C � � � Canter for
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ME/�RrHG C�MSERrLTlON 5FRY6CE5
SERVICE CONTRACT AGREEMENT
Hearing Conservation Program
This agreement is between hereinafter known as the "Company" and Center for Hearing
Health, Inc., herinafter known as "CHH ". The purpose of this agreement is to bring together the resources and commitment
required to achieve the objectives of both parties.
a) CHH agrees to perform audiometric hearing tests on a mutually agreeable date, time, and place for employees of the Company.
b) The on -site hearing tests will be conducted onboard CHH's mobile van within aself- contained soundroom that has been constructed
by the manufacturer to meet the acoustical test environment criteria Each audiometer receives and annual exhaustive calibration and
is reassessed at each setup for performance accuracy.
c) Hearing tests will be performed by an audiometric technician who is certified by the Council of Accreditation in Occupational Hearing
Conservation. In addition to an academic degree, the supervising Audiologist holds a "Certificate of Clinical Competency in
Audiology" issued by the American Speech, language and Hearing Association and a current license from the state's Boazd of
Medical Quality Assurance.
d) Each employee will receive and audiometric pure tone air conduction test at the frequencies of 500, 1000, 2000, 3000, 4000, 6000,
and 8000 Hz taken separately for each eaz. Compliance with the permissible noise level of the test environment is measured and
monitored throughout the test procedure. CHH policy further directs the technician to record observations of each employee's
otoscopic exam and, when applicable, determine and perform retest verification, i.e., spurious or "problem" audiograms.
e) Test results will be individually reviewed and classified. A problem audiogram includes the reviewing Audiologist's stated opinion
and recommended action.
f) CHH manages the Company's hearing test records electronically. Ancillary forms (or master forms) used as a source of information
are provided by CHH. Note: CHH is classified "not a covered entity" pertaining to compliance with the privacy of medical records,
commonly known as HIPAA. Therefore, CHH is not required to obtain the employee's written consent to gather information, perform
a hearing test, or maintain related documents on file.
p)� CHH will present a summary Report to Management that documents all audiometric recordkeeping requirements along with
individual test results, specific instruction to guide the Program Manager's responsibility in the fulfillment of requirements and
recommendations, and a preprinted Audiologist Review Report for each employee whose test results suggest a medical and/or legal
follow -up, Generally, this report is delivered within l0 business days following completion of the on -site testing.
h) The CHH insurance portfolio includes general liability, auto liability, and workers' compensation coverage consistent with best business
practices.
Terms: Net 10 Days
The foregoing services are provided by CHH to the Company at the current published rate unless arranged otherwise at noted below:
Other considerations and/or comments:
Company Authorized Signature �
Center for Hearing Health
� � - - Trent Lubiens - President
-4
Date: � ■ - Date: July 13, 2011
r �
80_0- 228 -6067 530- 888 -9977 fax 530- 888 -1177 / 2945 Bell Rd., #122, Auburn CA 95603
_ chh .centerforhearinQhealth_com / www.CenterforHearingHealth_com
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Cal OSHA Hearing Conservation Program (HCP) Overview
Noise Assessment - Section 5097, (b)
An initial noise survey must be performed to document exposures for the various jobs and departments. This
will determine who is exposed to 85 dBA TWA or greater, the CaI OSHA Action Level, as well as which
employees are required to wear hearing protection (exposures above the Permissible Exposure Limits —Table
N -1). Dosimetry must be used if there are situations of variable noise levels, mobile positions, or a significant
component of impulse noise. Noise surveys must be repeated when there are changes to production, process,
equipment, or controls where more employees may be exposed or the hearing protectors are no longer
adequate.
Employer: Perform updated measurements that are triggered by changes in equipment, process, or controls.
Recommended to update readings at least every three years. Measurements to be taken by employer safety
personnel with Cal OSHA approved equipment.
Noise Abatement — Section 5096, (b)
When there are exposures above the Permissible Exposure Limits, feasible administrative or engineering
controls shall be used_
Employer: Document any efforts to reduce employee noise exposures (eg: preventive maintenance to
equipment, purchase of new equipment that produces lower noise then previous / alternative equipment,
engineering controls).
Audiometric Testing — Section 5097. (c)
Baseline testing shall be performed on any employees exposed at or above 85 dBA TWA. It is strongly
recommended to baseline all employees, from a Worker's Compensation standpoint. Annual audiometric
testing must be performed on all employees exposed to 85 dBA TWA or greater. The annual testing must be
compared to the baseline (there are mathematical calculations for age- adjusted Standard Threshold Shifts
(STS's) and OSHA Log 300 recordability, so having a software program to track the data is very important).
An audiologist or physician must review "problem" audiograms and determine is further testing and /or
evaluation is warranted. These review reports need to be generated for documented follow -up with the
affected employees. �.
Emptoyer: Ensure annual audiometric testing is conducted on all required employees. Review report and
perform any required /recommended follow -up, as indicated. For employees who miss annual testing, ensure
that testing is performed either by CHH or a clinic_ If testing is performed at a clinic, forward results to CHH for
data processing ,and. audiologist. review_
- - : r-'-� _ -�--
„/ _ �
Em lo� ee education./ Trainin — Section 5099
Annual training must be provided to a ,employees exposed to 85 dBA TWA or greater. The training must
include :a. effects of noise on hearing; purpose and procedure of annual audiometric testing; and instruction in
the proper fit�use,iand care of hearing protection devices. The Cal OSHA Standard must be available to all
employees -and permanently posted in a central work location.
Employer: Ensure annual employee education on hearing conservation to include the required topics_
Document the training in terms of: date, presenter, employees in attendance, information reviewed.
Exhibit 8 _
Fee Schedule
Audiometric Testing and Training
$19.50 audiometric test with training
$15.00 audiometric test
$5.00 enter, review, and report on clinic test
$1.00 back enter of prior test data
Noise Assessment
$3,450.00` Comprehensive Noise Survey
`Survey will require at least 2 days of monitoring in order to collect adequate data. The first day
is billed at $1850.00 and the second, consecutive day at $1600.00. Any additional days would
be billable at $1600.00
Jun 29 12 03:17p GARY WENBERG AGENT STAT
408"374 `2258 p.1
�'`°R °� CERTIFICATE OF LIABILITY INSURANCE
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THIS CERTIFICATE !S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE C6RTIF)CATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE PdLIC1ES
6�iDW- THIS CERTI FiCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSVING INSURER(S), AUTHORIZED
REPRESENfTATIVE OR PRODUCER, AND TKE CERTIFICATE HOLDER.
[NIPORTANT: 11 the certificate holder Is an ADDITFONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, sub]ec[ to the
Ee rrrrs aril coridltiorLS of the policy, certain policies may require an endorsement A statement on this eerHNeate does not confer rights to the
certificate holder in Iieal of such endorsement(3).
PROaucER GARY J WENBERG, AGENT LICENSE #0448533
120 W CAMPBELL AVE STE G
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CAMPSELL CA 95009
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Laura Skit heady"
,�c�.'atxn7�. Lily �SLLOrriel,
CITY OF SANTA ANA, ITS OFFICERS, EtVIPLOYEES, AGENTS AND
REPRESENTAT]VE:S
2D CMC CENYER PLAZA
SANTA ANA CA 92701
THE A90VE DESCRIBED POLdES BE CANCeLLED BEFORE TIE
THEREOF, NOTICE WILL BE OELIYERED IN ACCORDANCE Wi'r?t THE
ACORD 25 (2009109] The ACgRD name and logo aTa registerf -d mOrk�F A�ORD 7007466 132849.4 02 -ti -2070
Jul 10 12 01 :29p GARY WENBERG AGENT STAT 408 *374 *2258 p.2
P'ofjcy Number DECLARATIONS PAGE AMENDED JUN 20 20t2
97- BZ- C3i429 -7
STATE FARM GENERAL INSURANCE: COMPANY ••^��
900 OLD RIVER RD., BAKERS FIELD CA 9331 1 -6000
A STOCK COMPANY UVITH HOME OFFICES IN BLOOMINGTON, ILLINOIS
Named Insured and Melling Address
02- 6912 -F155 R
CENTER FOR HEARINQ HEALTH INC
2945 SELL RD STE 122
AUBURN CA 95603 -2540
Cov A - Inflation Coverage Index_ NfA
BUSINESS POLICY - SPECIAL FORM 3 Cov B - Consumer Price Index: 226.9
AUTOMATIC RENEWAL - If the POLICY PERIOD iS shown as i2 RAONTHS, this olicY will be renewed automaticaliY
subject to the premiums; rules and forms in effect for each succeedinct pollc perio+ii If this policy is terminated, we will
give you and itte tvtortgagee /Lienholder written notice in compliancewi<h the ypglicy provisions or as required by law.
Policy Period: 12 Months The policy period begins and ends at 12:01 am standard time at the
Effective Date: DEC 18 2011 premises location.
Expiration Date: DEC 18 2012
Location of Covered Premises:
7005 LUTHER DR UNIT 3
SACRAMENTO CA 95823 -1828
Coverages 8c Property
SeC110R 1
A Buildings
B Business Personal Property
C Loss of Income - 12 Months
Section Il
L Business Liability
M Medical Payments
Products - Completed Operations
(PCO) Aggregate
Qeneral Agggregate (Other
Than PCO)
Limits of Insurance
Excluded
5 400
Actual !'_oss
2,oao,aao
5,000
4,000,000
$ 4,000,000
Forms Options, -and Endorsements
Special Form 3
FQ -6143
`Section II Additional Insured
FE -6609
Amendatory Endorsement
FE -6205
Tree Debris Removal
FE -6451
Policy Endorsement
FE- 6506.2
Policy Endorsement - Business
FE -6464
Glass Deductible - Section I
FE- 6538.1
' New Form Attached
Your ppolicy is amended JUN 20 2012
ADDITEONAL INSURED ADDED
PREMIUM ADJUSTMENT
ENDORSEMENT FE -6609 ADDED
ancy: mercan
Deductibles - Section 1
$ 500 Basic
In case of lass under this policy the deductible will be
app[Eed to each occurrence and will be deducted from the
amount of the loss. Other deductibles may apply -refer to
DOIICV_
Endorsement Premium
Increase � 19.84
Discounts Applied:
Renewal Year
Years in Business
Sprinkler
Claim Record
Continued on Reverse Side of Page
Prepared OTHER LIMITS AND EXCLUSIONS MAY
JUN 28 2012 ���
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PPLY -REFER TD YOUR PDLICY
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06/1993 GARY WEN33
Your policy consists of this page, any endorsements (409) 374 -3D80
and the policy Form_ PLEASE KEEP THESE TOGETHER.
(0 7 i2172b
Jul 10 12 Q1:29p GARY WENBERG AGENT STAT
408 *3 74 *22 58 p. 3
F E -6609
Page � of 1
SEGTION Il ADDITIONAi_ INSURED ENDORSEMENT
Policy No.: 97- BZ- G429 -7
Named insured-
,,.
CENTER FOR HEARING HEALTH INC
2945 SELL RD STE 122
AUBURN CA 956Q3 -2540
Additional Insured (include atldress):
VOLUNTEERS 8c REPIiGSENTAT`1VE30FFICERS, EMPLOYEES, AGENTS,
ATTN RISK MANAGEMENT M -ZS
20 CIVIC CENTER PLZ
SANTA ANA CA 92701 -4058
WHO IS AN INSURED, under SECTION 11 DESIGNATION OF INSURED, is amended to include as an insured the
Additional Insured shown above, buf only to the extent that liability is imposed on that Additional Insured solely because
of your worn performed for that AddKional Insured shown above.
Any insurance provided to the Additional Insured shall only apply with respect to a claim made or sui: brought for
damages for which you are provided coverage_
The Primary Insurance coverage below applies only when there is an "X" in the box.
® Primary Insurance. The insurance provided to ttte Additional Insured shown above shall be primary Insurance.
Any insurance carried by the Additional Insured shall be noncontributory with respect to coverage provided to
you.
Alt other provisions of the policy apply.
FE -6609
Aug 191403:53p
p.2
CERTIFICATE 08 H 12014
_OF LIABILITY INSURANCE 0 M
089 9/2014
i IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
IS NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE q qCO1rVER�1A�GE AFFORDED BY THE POLICIES
iTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEMI HffUL16�If�G IItl Uf R(($) AUTHORIZED
OR PRODUCER, AND THE CERTIFICATE HOLDER. a
- - - -- '-' -- -"" - .•..,w•,,. ^�....rw.., . Iu Pvxcypes) must no annotated. It SUBROGATION IS WAIVEO Subject to the
temts and conditions of the PDlloy, c9nam policies may require an endorsement. A statement �F, (��rc�NtFlc kf of f N hW 10 the
certificate holder In lieu Of Such endorsemen s), ti'l'l' "l 9
PROOuo" GARY J WENBERG, AGENT LICENSE# 0448533 NA °ME THI HDNIAN
120 W CAMPBELL AVE STE G PHONE 17C 3p8 — P - --
B•MAI ol'"
&2ai�eF�sm PO BOX 942 ADnRBSg ka011,hOrnan Iws6 stala(arm.Dam____
. CAMPBELL CA 95009 Al -RO /� °08 V - _INMu_nts Al FFCrRDirvecOVEnADe
nAic u
INwxeb `- ---m- INSURenpr5 le Flenerel lnsnranCO Cum�Rny _ 1
CENTER FOR HEARING HEALTHINC NweEna1SA12±4 vmMutuaALIOMObllaieaumnCecamgnnv p
2945 BELL RD STE 122 I980N41t2_-9 nle A Ffreend Casua �C any �z
AUBURN CA 95603 INSUREAD:
_. -. O ._.-._--_..,....... REVISION NUMBER: - --
THIS W-TO CERTIFY THAT THE POLICIES OF WSURANCE LISTED BELOW NAVE BEEN ISSUED i0 THE INSURED
INDICATED.
NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE
NAMED ABOVE FOR THE POLICY PERIOD
OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH LIMNS SHOWN MAY HAVE BEEN
yDDPA��''OUCIES, REDUCED BY
TA 6EBEl1( —°
PAID CLAIMS.
TYPEOFFRISURANCE POLICYEFF
PDUCVNNMoen MMIOD
POIJ: VB%P •"" —"'— °— --
!t_'
A GENERAL UA6ILRY 97- BZ- G429.7 12/18/2013
COMMERCIAL UCHF,RALUARk"
V UMRS
120102014 EACH OCCURRENCE $ 2,Otlq,wO
-
CIAIySJ,WOE OCCUR I I
DTtdi[GE10W•GTt9 -` --- —
,}',.t,4SR-s IEn WaaLyel: i
MEO EXP An mM pnrrcan} S 6,000
_PCRSONALBAOV INJURY -a
OENi AGGREGATE LIMITAPpUES PER,
GENER_nLACGREG A_ 4. /,000,000
X POLICY X .PRO- LOO
9R04UC1B- COMPIOP AGO ! 4.000,000
9 AUTOMOBILE UASILRY 2468689 1211812013
ANY AUTO
s
121181201{ Ea oaidanr I t R E 2,D00
2486690 1211812013
AUTO OWNED x AUTOSOgULEO
,000
12/1812014 _eODaYINJURY(PorPatton)
�_ _ ,�
HIRED AUTOS I NON-OWNED 24$6691 12118/2013
,-
12N812094 DOOLYlNduav(Peraccuarl) 1
-PF10 '— '---
AUTOS
2789473 1211812013
eNTY -°-- --
12/18/2014 owe _mnre
UMERELLALMO OCCUR
=
EXCESS
EXCESS LIpB CLAIMS-10A DE
EACH OCCURRENCE y
CEO RETENTIONI
- AGGREGATE s
G WORKERS COMPENSATKN
1
AND EMPLOYERS' LIABILITY
ANY PROPRIETCRMARTNERODECUTIVE YIN 97m ®4.23664 12131f2013
777 WC AT 0 M
12)31/2074 rr!$ x 01
OFFICEIMEMRER EXCLUDED Y NIA
ZMan4 wyea NH)
EL EACH ACCIDENT 1 1,0001000
-
IIyogd.WesundM.
EL LIISEASE•EA CFAPLOYE A 11000.000
E.L. DISEASE - POLICY UMR' a 11000,000
OSSCIU ON OF OPERATIONS LOCANONS I VENICLES(AtacN ACORD 401, Add10ane1 Ranurka SRNaduia. It mom apace M MgUIM"
'Fo
AUTOMOBILE LIABILITY CONTINUED: POLICY 288 0078 POLICY EFF 12118/2013, 1271812014
A,S ro
rn nv
gtralsa
Joseph
mtorneY
C RTIRCATE HOLDER ."'—"° �":
City
CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES AND SHOULD ANY OF THE ABC
REPRESENTATIVES THE EXPIRATION DATE
ACCOROANCG`WITH THE
20 CIVIC CENTER PLAZA
SANTA ANA CA 92701 nuruDmx xPSr:Hr/K r:
POLICIES BE CANCELLED BEFORE
)TICE WILL BE DELIVERED IN
ACORD 25 (2018106) The ACORD name and logo"' I'a11is1 0� lka 90 2010 ACORD ACORD CORPORATION. All rights reserved.
1001486 132849,8 01.23.2013
RECEIVE: NO.0640 08/19/2014/TUE 01:33PM ��
Aug 1914 03:54p
UUM Policy No.: 97 BZG429 7
SECTION II ADDITIONAL INSURED ENDORSEMENT
Policy No.: 97 BZG429 7
Named Insured: CENTER FOR HEARING HEALTH INC
Additional Insured (include address):
CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES,
AGENTS, VOLUNTEERS AND REPRESENTATIVES
20 CIVIC CENTER PLAZA
SANTA ANA, CA 92701
p.4
FE-6809
LED
WHO IS AN INSURED, under SECTION it DESIGNATION OF INSURED, is amended to include as
an insured the Additional Insured shown above, but only to the extent that liability is imposed on that
Additional Insured solely because of your work performed for that Additional Insured shown above.
Any insurance provided to the Additional Insured shall only apply with respect to a claim made or a
suit brought for damages for which you are provided coverage.
The Primary Insurance coverage below applies only when there is an 'XI in the box.
® Primary Insurance. The insurance provided to the Additional Insured shown above shall be
primary insurance. Any insurance carried by the Additional Insured shall be noncontributory
with respect to coverage provided to you.
All other policy provisions apply.
FE-6609
Printed in U S.A.
RECEIVE: N0.0640 08/19/2014/TUE 01 :33PM