HomeMy WebLinkAboutBEST MEDICAL ENTERPRISE 1-2013INSURANCE ON FILE
WORK MAY PROCEED
UNTIL INSURANCE EXPIRES
W -,?s -/ V
CLERK OF COUNC 13
DATE:. NOV
Agreement No.
p ; CC A /Work C-tr.
E^relyn Le112
ON- THE -JOB TRAINING AGREEMENT
UNDER THE WORKFORCE INVESTMENT ACT
N- 2013 -149
THIS AGREEMENT is made and entered into this 4th day of November, 2013 between
the City of Santa Ana, a charter city and municipal corporation duty organized and existing
under the Constitution and laws of the State of California (hereinafter "CITY ") and Best Medical
Enterprise (hereinafter "EMPLOYER ").
WITNESSETH
Recitals:
A. CITY has been designated a Local Workforce Investment Area ( "LWIA ")
pursuant to Section 116 of the Workforce Investment Act ( "WIA "), P.L. 105 -220, 29 USC
Section 2801, to receive federal funds to promote effective delivery of job training services to
local area residents.
B. The State of California has created the California Workforce Investment Board
pursuant to Section 111 of the Workforce Investment Act, P.L. 105 -220, 29 USC 2821 to
administer the WIA programs operated by the State of California.
C. As a LWIA, CITY is entitled to receive federal funds to establish programs to
prepare eligible unskilled youth, adults and dislocated workers for entry into the labor market,
and to provide job training to those individuals who face serious barriers in obtaining productive
employment ( "said Program ").
D. EMPLOYER is able and willing to train eligible unskilled applicants for entry
into the labor market and is willing to operate said program pursuant to the WIA and applicable
federal, state and local laws.
WHEREFORE, for and in consideration of the respective and mutual covenants and
promises hereinafter contained and made, and subject to all the terms and conditions hereof, the
parties hereto do hereby agree as follows:
1. Term. The effective term of this Agreement is for the period beginning November 4,
2013, and ending May 30; 2014. The term of this Agreement may be extended upon
agreement of all parties and execution of an amendment of the term.
2. Scope of Work. The EMPLOYER shall employ and train one employee (hereinafter
"Trainee ") in the occupation and in accordance with the OJT Training Outline set forth in
Exhibit A, attached hereto and incorporated herein by this reference.
Said Trainee shall be referred by the City of Santa Ana W /O/R/K Center. Training must
significantly raise the Trainee from his/her prior position in both level of skill and salary
by the end of the training period.
3. Funding. CITY shall reimburse the EMPLOYER an amount not to exceed $4,504.50 in
accordance with the Cost Computation included in Exhibit A. EMPLOYER shall bill the
CITY monthly on an invoice provided by CITY for actual and reasonable cost for
providing the services described in this Agreement. Reimbursement of EMPLOYER
under this Agreement shall be limited to the costs incurred during the basic work week,
excluding overtime and any paid holidays or sick leave.
4. Subcontracting Prohibited. The EMPLOYER shall not subcontract or assign the OJT
Training. Any attempt by the EMPLOYER to delegate or assign OJT training duties
under this Agreement shall void, and permit CITY to immediately terminate, this
Agreement.
5. Employer Obligations. During the training, the EMPLOYER shall ensure that the
Trainee:
a. is on the EMPLOYER's payroll, not paid as a contracted employee /independent
contractor; and,
b. receives the same benefits as EMPLOYER's other employees performing similar
work; and,
C. is paid the salary as indicated in Exhibit A with appropriate payroll taxes withheld
and reported; and,
d. is provided Worker's Compensation Insurance coverage, pursuant to state law;
and,
C. is provided by EMPLOYER with safety instructions and equipment necessary for
reasonable protection against injury and damage. CONTRACTOR shall maintain
appropriate standards for health and safety in work and training situations. Where special
clothing or equipment is provided to the EMPLOYER's regular employees, EMPLOYER
shall provide the same type of clothing or equipment to the Trainee performing similar
work.
6. Employment of Trainee. The EMPLOYER shall employ the Trainee as a regular
member of EMPLOYER's work force. If EMPLOYER wants to continue to employ the
Trainee upon the successful completion of the training period under this Agreement, said
employment shall be subject to the same conditions of employment applied to
EMPLOYER's other regular employees, including termination for unsatisfactory
performance.
2
Patent, Copyrights and Rights in Data. The EMPLOYER will disclose to the CITY any
invention, written product, computer program developed or data assembled as a result of
performance of work under this Agreement within seventy four (74) days of invention,
development or assembly. The CITY, State of California, and U.S. Department of Labor
will have the right to patent any invention and copyright any written product or computer
program or data generated by EMPLOYER. Upon written request, EMPLOYER will
transfer all pertinent information, specifications and right, title and interest to the
designated agency.
8. INVENTIONS, PATENTS AND COPYRIGHTS.
A. Reporting Procedure. If any project produces patentable items, patent
rights, processes, or inventions in the course of work under a U.S. Department of Labor (DOL)
grant or agreement, the CONTRACTOR shall report the fact promptly and fully to the CITY.
The CITY shall report the fact to the Grant Officer, at the DOL. Unless there is a prior
agreement between the CITY and the DOL and its representative on these matters, the DOL shall
determine whether to seek protection on the invention or discovery. The DOL and its
representative shall determine how the rights in the invention or discovery, including rights
under any patent issued thereon, will be allocated and administered in order to protect the public
interest consistent with the "Governmental Patent Policy" (President's Memorandum for Heads
of Executive Departments and Agencies, August 23, 1971, and Statement of Government Patent
Policy).
B. Copyright Policy.
1. Unless otherwise provided in the terms of the grant or agreement, when
copyright -able material is developed in the course of or under a DOL Grant or agreement, the
author and the CITY which developed the work is free to copyright material or to permit others
to do so. The EMPLOYER and the Workforce Investment Board (WIB) shall have a royalty -
free, nonexclusive and irrevocable license to reproduce, publish, use and to authorize others to
use all copyrighted material.
2. The DOL reserves a royalty -free, nonexclusive, and irrevocable license to
reproduce, publish or otherwise use, and to authorize others to use, for Federal Government
purposes: (a) The copyright in any work developed under any grant, sub - grant, or contract under
a grant or subgrant; (b) Any right of copyright to which a grantee, subgrantee or a EMPLOYER
purchases ownership with grant support; and (c) EMPLOYER shall comply with the
requirements of 29 CFR Part 97.34.
C. Rights to Data. The DOL and the CITY shall have unlimited rights to
any data first procured or delivered under this Agreement.
Hold Harmless. The EMPLOYER shall indemnify, defend and hold harmless CITY, and
its officers, agents and employees, from and against any and all damages to property or
injuries to or death of any person or persons, including property and employees or agents
of CITY, and shall indemnify, defend and hold harmless CITY, and its officers, agents
and employees, from any and all claims, demands, suits, actions or proceedings of any
kind or nature, including, but not limited to, workers' compensation claims, resulting
from or arising out of the negligent acts, errors or omissions of EMPLOYER, its
employees, agents or subcontractors.
10. Insurance. The EMPLOYER shall obtain at its sole cost and file with the City of Santa
Ana — Santa Ana W /O/R/K Center, upon execution of this Agreement, and maintain for
the period covered by this Agreement, a policy or policies of commercial general liability
insurance or a certificate of such insurance, satisfactory to the City Attorney of CITY,
naming CITY, and its officers, agents and employees, as insured or additional insured
(see attached Additional Insured Endorsement, Exhibit C), which provides coverage not
less than that provided in the form of a comprehensive general liability insurance policy
against liability for any and all claims and suits for damages or injuries to persons or
property resulting from or arising out of operations of EMPLOYER, and its officers,
agents, or employees. Said policy or policies of insurance shall provide coverage for
both bodily injury and property damage in no less than One Million Dollars ($1,000,000).
Said policy of comprehensive public liability insurance shall be endorsed to provide to
CITY and to the State of California, Employment Development Department, at least
thirty (30) days written notice prior to cancellation; name CITY, its officers, agents,
employees, and volunteers, and the State of California, its officers, employees, and
volunteers as additional insured; and state that such coverage is primary to any other
coverage or self - insurance of the State of California and CITY. Governmental entities
may substitute a certificate of self - insurance.
11. Record Keeping. CITY, the State of California and the United States government and /or
their representatives shall have access for purposes of monitoring, auditing and
examining of EMPLOYER'S activities, performance, books, documents, papers, and
records of EMPLOYER'S subcontractors, bookkeepers and accountants, and employees
and participants related to this Agreement. Such agencies or representatives shall also
schedule on -site monitoring in their discretion. Monitoring activities may also include,
but are not limited to, questioning employees and participants and entering any premises
or onto any site in which any of the services or activities funded hereunder are conducted
or in which any of the records of EMPLOYER are kept. Nothing herein shall be
construed to require access to any privileged or confidential information as set forth in
federal or state law.
In the event EMPLOYER does not make the above - referenced documents available
within the City of Santa Ana, California, EMPLOYER agrees to pay all necessary and
reasonable expenses incurred by CITY in conducting any audit at the location where said
records and books of account are maintained.
All accounting records and evidence pertaining to all costs of EMPLOYER and all
documents related to this Agreement shall be kept available at the location where
EMPLOYER conducted the program, as well as in the County of Orange, for the duration
of this Agreement and thereafter for three (3) years after completion of an audit. Records
which relate to (a) complaints, claims, administrative proceedings or litigation arising out
of the performance of this Agreement, or (b) costs and expenses of this Agreement to
which CITY, the State of California or the United States Government take exception,
m
shall be retained beyond the three (3) years until resolution of disposition of such appeals,
litigation, claims, or exceptions.
12. Government Funding. This Agreement is valid and enforceable only if sufficient funds
are made available to the State by the United States Government for the same Fiscal Year
as for this Program. In addition, this Agreement is subject to any additional restrictions,
limitations, or conditions enacted by Congress or any statute enacted by Congress which
may affect the provision, terms or funding of this Agreement in any manner.
13. Payment Cap. City's OJT payments to EMPLOYER shall not exceed a maximum of
fifty percent (50 %) of the wages paid by EMPLOYER during the training period
specified in Exhibit A.
14. Amendment of Agreement. No alteration or variation of the terms of this Agreement
shall be valid and /or binding unless made in writing and signed by both parties. There
are no oral understandings or agreements between the parties.
15. Breach/Sanctions. If, through any cause, EMPLOYER violates any of the terms and
conditions of this Agreement, or if EMPLOYER reports inaccurately or if any Audit
Report makes disallowances, EMPLOYER shall promptly remedy its acts or omissions
and/or repay CITY all amounts due CITY as a result of EMPLOYER's violation. For any
such failures or violations, CITY shall also have the right at its sole discretion to either:
(1) discontinue program support until such time as EMPLOYER fulfills its obligations or
remedies all violations of this agreement or prior agreements; and/or (2) collect
outstanding amounts as determined by CITY due CITY by offsetting or debiting from
current claims or invoices, if after thirty (3 0) days' written notice EMPLOYER has failed
to repay same or a repayment schedule has not been made; and/or (3) terminate this
Agreement by giving written notice to EMPLOYER of such termination in accordance
the notice provision in Paragraph XVIII herein below.
16. Termination. Either party may terminate this Agreement upon thirty (30) days prior
written notice to the other parry. However, the CITY may immediately terminate this
Agreement at such time as funds are not made available to CITY through the United
States Department of Labor or the State of California Employment Development
Department for the purpose of carrying out this Agreement.
17. Independent Contractor. The EMPLOYER, and any agents and employees of the
EMPLOYER, in the performance of this Agreement, shall act in an independent capacity
as independent contractors and not as officers, employees, or agents of the CITY. This
Agreement is not intended nor shall it be construed to create an employer - employee
relationship between EMPLOYER and CITY, nor a joint venture relationship. The
EMPLOYER shall not subcontract in the name of the CITY.
18. Equal Employment Opportunities. The EMPLOYER warrants that it will comply with
Title VI of the Civil Rights Act of 1964, and the requirements relating to equal
employment opportunities set forth in Executive Order No. 11246, as amended by E.O.
5
11375 and supplemented by the requirements of 41 CFR Part 60. EMPLOYER will also
comply with all applicable federal and state laws and regulations, and particularly those
assurances and certifications set forth in Exhibit B attached hereto and by this reference
incorporated herein.
19. Prohibitions. The EMPLOYER shall not use any of the training funds provided under
this Agreement for political or sectarian activities.
20. Grievance Procedure. The EMPLOYER shall continue to operate, or shall establish and
maintain a grievance or complaint handling procedure relevant to the terms and
conditions of employment and the EMPLOYER's activities and programs, which shall
meet at a minimum the requirements set forth in Section 101(31) of the Act and 663.700-
710 and regulations promulgated by the State or Federal Government. Employers that do
not have a grievance or complaint handling procedure shall use the procedures prescribed
by the CITY.
21. Guidelines. The CITY shall make the WIA applicable federal regulations and policy
guidelines available to EMPLOYER at CITY — W /O /R/K Center, 1000 E. Santa Ana
Blvd., Suite 200, Santa Ana, California 92701. The CITY shall also inform the
EMPLOYER of changes in the WIA regulations or policy guidelines if such changes
affect the operation of this Agreement.
22. Drug Free Workplace. The EMPLOYER agrees to provide a drug -free work place and to
execute a certification as set forth in Exhibit D attached hereto and incorporated herein by
this reference.
23. Notices. All notices, reports and correspondence between the parties hereto respecting
this Agreement shall be in writing and deposited in the United States mail, postage
prepaid, addressed as follows:
CITY:
City of Santa Ana — Santa Ana WORK Center
1000 E. Santa Ana Blvd., Suite 200
Santa Ana, CA 92701
Attention: WORK Center Director
EMPLOYER:
Best Medical Enterprise
1420 Ritchey St., Suite A
Santa Ana, CA 92705
(949) 457 -8280
Robert Castillo
11
24. Debarment. To protect the public interest and ensure the integrity of Federal programs,
CITY may only conduct business with responsible persons and may not make any award
or permit any award to any party which is debarred or suspended or is otherwise excluded
from or ineligible for participation in Federal assistance programs under Executive Order
12549, "Debarment and Suspension ". See also 29 CRF Parts 97.35 and 98.510.
EMPLOYER must review and sign Exhibit E "Debarment ", which is attached hereto and
incorporated herein by this reference.
24. Merger. This Agreement, together with the attachments hereto, expresses the total
understanding of the parties. There are no oral understandings of the parties or terms and
conditions other than as stated herein.
25. Validity. The invalidity in whole or in part of any provision of this Agreement shall not
void or affect the validity of any other provision of this Agreement.
26. 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:
Mana D. Huizar
Clerk of the Council
APPROVED AS TO FORM:
Sonia R. Carvalho
City Attorney
T337 Lisa Storck
Assistant City Attorney
RECOMMENDED
Community Development Agency
L:
11
CITY OF SANTA ANA
David Cavazos
City Manager
EMPLOYER:
Robert Castillo
Owner
Tax ID#
State: 023-9758-6
Fed: 452509801
Agreement # Exhibit A
TRAINING PLAN
I. GENERAL
Name of OJT Employer: Best Medical Ente rise
2. Address of OJT Work -site: 1420 Ritchey St. , Suite A
Phone Number: 949 457 -8280
4. Training Supervisor: Robert Castillo
5. Name of OJT Trainee: Michael F. Alter
6. Application Number of Trainee: 1022864
Proportion of trainees /employees: (at time Agreement entered into)
a. Total number of employer's regular employees 2
C. Cumulative number of trainees currently in OJT 0
IL OCCUPATION AND ON -THE -JOB TRAINING OUTLINE:
Program/Grant #: WIA Adult 201
2. Job Title /Occupation: Biomed Technician/Medical Equipment Repairer
3. Length of Time in Business: 13 years
4. ONET Code: 49- 9062.00 SVP Level 6.0 to <7.0
5. Hourly Starting Wage: $13.00
Start Date: 11/04/2013 End Date: 05/30/2014
Hours 693
6. State and Federal Tax I.D.: State 023 - 9758 -6
Federal 452509801
Basic Work Week Hours: 32 -40
Outline of On- the -Job Training Plan and Method of Assessment:
ELEMENTS OF TRAINING
HOURS OF TRAINING
1. Objective 1
80
Familiarization with medical devices and equipment; vendors /
manufacturer name and recognition of equipment used in medical
facilities serviced by Best Medical Enterprise
Measurement Method: Q & A, task observation and inspection. Goal is to achieve rate
of proficiency within first Month and a half of training.
2. Objective 2
Learn warehouse inventory control and receiving process. Maintain status
100
of equipment from receipt, to repair, shipping and warehouse
organization
Measurement Method: Q & A, task observation and inspection. Goal is to achieve rate
of proficiency within subsequent three and a half months.
3. Objective 3
Inspection and calibration of equipment, safety and testing protocol -
280
Biomedical Technology concentrate on electronics fundamentals,
human anatomy and biomedical instrumentation function and
troubleshooting.
Measurement Method: Q & A task observation and inspection. Goal is to achieve rate of
proficiency within subsequent three and a half months.
4. Objective 4
Shadow trainer delivering and servicing equipment at medical offices /
233
clinics and various locations serviced by Best Medical Enterprise
providing excellent customer services to clients, marketing services
as needed.
Measurement Method: Q & A task observation and inspection. Goal is to achieve rate of
proficiency within subsequent three and a half months.
RATING LEVELS:
Measurement method: how will it be determined if OJT participant acquired the skill? Q &A, observation, product review /inspection,
etc.
PROFICIENT MODERATE
II. COST COMPUTATION
Example: Hourly Reimbursement $ 6.50
= $ 4,504.50
MARGINAL
Hours 693 cost Per Trainee
III. Person(s) authorized to sign payment invoices for EMPLOYER:
Robert Castillo Owner 10/29/2013
Print Name Signature Title Date
Print Name
Signature
Title
Date
3
IT.Y.YI1s71a[aI&I
A. The EMPLOYER assures that:
It will comply with the requirements of the Workforce Investment Act (WIA), the California
Unemployment Insurance Code, as amended, and the regulations and policies promulgated
thereunder.
2. No OJT participant displaces a regular employee nor shall an OJT participant fill a position of a
person who has been laid off from the same or similar position.
3. No current employees are receiving unemployment insurance benefits as a result of layoffs or
work reductions.
4. No person in the United States shall on the grounds of race, color, sex, religion, national origin,
age, disability, sexual orientation, or marital status be excluded from participation in, be denied
the benefits of, or be otherwise subjected to discrimination under any program or activity for
which the applicant receives federal financial assistance and will immediately take any measure
necessary to effectuate this Agreement.
5. It will comply with provisions of the Hatch Act, if applicable, which limits the political activities
of employees.
6. Individuals receiving training on the job shall be compensated by the EMPLOYER at such rate,
including periodic increases, as may be deemed reasonable under regulations prescribed by the
Secretary of Labor, but in no event at a rate less than that specified in Section 6 (a) (1) of the Fair
Labor Standards Act of 1938 or, if higher, under the applicable State or local minimum wage
law.
Services and activities provided under this Agreement will be administered by or under the
supervision of the EMPLOYER.
8. No relative by blood, adoption or marriages of the EMPLOYER may be trained under this
Agreement.
9. Appropriate standards for health and safety in work and training situations will be maintained.
10. Conditions of employment or training are appropriate and reasonable with regard to the type of
work, the geographical region, and the proficiency of the trainee.
11. Training will not be for any occupation which requires less than six weeks of training according
to the Specific Vocational Preparation Table (SVP Code).
12. Training will, to the maximum extent practicable, be consistent with every individual's fullest
capabilities and lead to employment possibilities.
13. The program will, to the maximum extent feasible, contribute to the occupational development
or upward mobility of individual participants.
14. Training will be in accordance with the training plan, which plan incorporates documentation
that must be completed by EMPLOYER before end of contract.
EXHIBIT B
15. *Dot and * *SVP code books will be used to determine length of OJT period. The training time
may not be longer than the SVP Code allows; however, contractors are encouraged to negotiate
shorter training periods whenever applicable.
16. OJT trainees shall not number more than 40% of the EMPLOYERS work force.
17. All EMPLOYER training payments (reimbursements) must be exclusive of any and all
EMPLOYER fringe benefits, paid holidays, paid sick days and overtime compensation.
18. The participating EMPLOYER must keep an accurate and up -to -date time sheet for the OJT
trainee.
19. Payroll records, time and attendance records and job duties retained on file by the participating
EMPLOYER for each OJT trainee are subject to review.
Employer Signature Date
EXHIBIT B
,4COR& CERTIFICATE OF LIABILITY INSURANCE
°ATE'"11 /20Y3
1 0 11 112 01 3
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT
AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES
NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions
of the policy, certain policies may require an endorsement. A statement on this certlFlCate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER
CS &S /AAA CLUB SERVICES LLC
PO BOX 946560
CONTACT
NAME:
PHONE
PHONE
(AIC, Na. Exq:
Fax
IAIC, No):
E -MAIL
ADDRESS:
MAITLAND, FL 32794 -6580
Phone - 877. 724.2669
GENERAL LIABILITY
Fax - 877. 763-5122
INSURER(S) AFFORDING COVERAGE
NAIC M
INSURER A; Continental Casualty Company
20443
$1,006,000
INSURED
BEST MEDICAL ENTERPRISE
INSURER B
Y
N
4030636771
22962 CAVANAUGH RD
INSURER C:
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$366,666
E (An one Person)
LAKE FOREST, CA 92630
INSURER D:
— 04125/2"4—
PERSONAL &ADV INJURY
$1,000,000
INSURER E
GENERAL AGGREGATE
INSURER F,
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE
AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID
CLAIMS
IN SR
LTR
TYPE OF INSURANCE
ADOL
INSR
SUER
WVO
POLICY NUMBER
POLICY
MWDDNYYY
MMIUOIYYYY
LIMITS
GENERAL LIABILITY
EACHOCCURRENCE
$1,006,000
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ® OCCUR
- --
Y
N
4030636771
04/2512013 -
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$366,666
E (An one Person)
$10,000
A --
— 04125/2"4—
PERSONAL &ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
POLICY PRO LOG
ECT
PRODUCTS - COMPIOP AGO
$2,000,000
COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY
(Ea attitlenn
BODILY INJURY (Per person)
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
HIRED AUTOS NON-OWNED
AUTOS
BODILY INJURY (Par accident)
PROPERTY DAMAGE
(Per aCtitlent)
UMBRELLA UAB
EXCESS CIAO
HCLAIMS-MADE
OCCUR
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—
EACH OCCURRENCE
GGREGATE
DED1 RETENTIONS
FIPPR
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNEREXECUTIVE YIN
OFFICEWMEMBER EXCLUDED?
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( "1 I "
If yes,
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STATU-
TORY LIMITS
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E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L. DISEASE- POLICY LIMIT
DESCRIPTION OF
DESCRIPTION OF OPERATIONSbdlow
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Almch ACORD 101. Ack itional Remarks Schedule. if more space is ra,Amd)
City of Santa Ana it's officers, agent and employees are added as an additional insured as provided in the blanket additional insured
endorsement Insurance Primary and Non Contributory, as per the blanket additional insured endorsement.
Cancellation per policy provisions SB147082
This certificate supersedes all previously issued certificates. All previously issued certificates have been rescinded and considered
null and void.
rcoTlnr ATP unl nFR reNrP[ I CTinm
City of Santa Ana
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Attn: Purchasing Department
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
20 Civic Center Plaza
ACCORDANCE WITH THE POLICY PROVISIONS.
Santa Ana, CA 92701
AUTHORIZED REPRESENTATIVE
-. -- - - - -1988 -2010 ACORD CORPORATION.- All rights reserved. --
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 0190050
Exhibit C
ADDITIONAL INSURED ENDORSEMENT
Insurance Company CS &s /AAA CLUB SERVICES LLc
This endorsement modifies such insurance as is afforded by the provisions of Policy
# 4030636771 relating to the following:
1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California
92702; its officers, employees, agents and volunteers are named as additional insureds
( "additional insureds ") with regard to liability and defense of suits arising from the
operations and uses performed by or on behalf of the named insured.
2. With respect to claims arising out of the operations and uses performed by
or on behalf of the named insured, such insurance as is afforded by this policy is
primary and is not additional to or contributing with any other insurance carried by or for
-- the benefit of the additional insureds.
3. This insurance applies separately to each insured against whom claim is
made or suit is brought except with respect to the company's limits of liability. The
inclusion of any person or organization as an insured shall not affect any right which
such person or organization would have as a claimant if not so included.
4. With respect to the additional insureds, this insurance shall not be
canceled, or materially reduced in coverage or limits except after thirty (30) days written
notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana,
California 92702.
(Completion of the following, including countersignature, is required to make this
endorsement effective.)
Effective
Policy # 4030636771 - SB147082
Issued to Best Medical Enterprise
Named Insured
this endorsement form as a part of
Countersigned by sbiccsrna cna.com
Authorized Representative
APPROVED )is 'PO FORM
-TL KK �yy_,
Exhibit C Assistant City AflorneY d�
CNA
SB- 147082 -D
(Ed. 04/10)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BUSINESSOWNERS COMMON POLICY CONDITIONS
All Coverage Parts included in this policy are subject to the following conditions:
A. Cancellation (b) Pay property taxes that are owing
1. The first Named Insured shown in the
Declarations may cancel this policy by mailing
or delivering to us advance written notice of
cancellation.
2. We may cancel this policy by mailing or
delivering to the first Named Insured written
notice of cancellation at least:
a. 5 days before the effective date of
cancellation if any one of the following
conditions exists at any building that is
Covered Property in this policy.
(1) The building has been vacant or
unoccupied 60 or more consecutive
days. This does not apply to:
(_a) Seasonal_unoccupancy; or
(b) Buildings in the course of
construction, renovation or addition.
Buildings with 65% or more of the rental
units or floor area vacant or unoccupied
are considered unoccupied under this
provision.
(2) After damage by a covered cause of
loss, permanent repairs to the building:
(a) Have not started, and
(b) Have not been contracted for,
within 30 days of initial payment of loss.
(3) The building has:
(a) An outstanding order to vacate;
(b) An outstanding demolition order; or
(c) Been declared unsafe by
governmental authority.
(4) Fixed and salvageable items have been
or are being removed from the building
and are not being replaced. This does
not apply to such removal that is
necessary or incidental to any
renovation or remodeling.
(5) Failure to:
and have been outstanding for
more than one year following the
date due, except that this provision
will not apply where you are in a
bona fide dispute with the taxing
authority regarding payment of such
taxes.
b. 10 days before the effective date of
cancellation if we cancel for nonpayment of
premium.
c. 30 days before the effective date of
cancellation if we cancel for any other
reason.
3. We will mail or deliver our notice to the first
Named Insured's last mailing address known to
US._ -
4. Notice of cancellation will state the effective
date of cancellation. The policy period will end
on that date.
5. If this policy is cancelled, we will send the first
Named Insured any premium refund due. If we
cancel, the refund will be pro rata. If the first
Named Insured cancels, the refund may be less
than pro rata. The cancellation will be effective
even if we have not made or offered a refund.
6. If notice is mailed, proof of mailing will be
sufficient proof of notice.
B. Changes
This policy contains all the agreements between you
and us concerning the insurance afforded. The first
Named Insured shown in the Declarations is
authorized to make changes in the terms of this
policy with our consent. This policy's terms can be
amended or waived only by endorsement issued by
us and made a part of this policy.
C. Concealment, Misrepresentation Or Fraud
(a) Furnish necessary heat, water,
sewer service or electricity for 30
consecutive days or more, except
during a period of seasonal
unoccupancy; or D
SB- 147082 D Exhibit C
(Ed. 04/10)
This policy is void in any case of fraud by you as it
relates to this policy at any time. It is also void if you
or any other insured, at any time, intentionally
conceal or misrepresent a material fact concerning:
1. This policy;
2. The Covered Property;
3. Your interest in the Covered Property; or
4. A claim under this policy.
Examination Of Your Books And Records
Aniff3avEb As TO 1 o f
Page 1 of
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---LISA
Assistant Citv vity,
CNA
We may examine and audit your books and records
as they relate to this policy at any time during the
policy period and up to three years afterward.
E. Inspections And Surveys
We have the right but are not obligated to:
1. Make inspections and surveys at any time;
2. Give you reports on the conditions we find; and
3. Recommend changes.
Any inspections, surveys, reports or
recommendations relate only to insurability and the
premiums to be charged. We do not make safety
inspections. We do not undertake to perform the
duty of any person or organization to provide for the
health or safety of workers or the public. And we do
not warrant that conditions:
1. Are safe or healthful; or
2. Comply with laws, regulations, codes or
standards.
This condition applies not only to us, but also to any
rating, advisory, rate service or similar organization
which makes insurance inspections, surveys,
reports or recommendations.
F. Insurance Under Two Or More Coverages
If two or more of this policy's coverages apply to the
same loss or damage, we will not pay more than the
actual amount of the loss or damage.
G. Liberalization
If, during your policy period, we adopt any revision
that would broaden the coverage under this policy
without additional premium the broadened coverage
will immediately apply to this policy. The broadened
coverage will also apply to the renewal of this policy
if such renewal was in process or was mailed prior
to the date we adopted such revision.
H. Other Insurance
1. If you have other insurance covering the same
loss or damage, we will pay only for the amount
of covered loss or damage in excess of the
amount due from that other insurance, whether
you can collect on it or not. But we will not pay
more than the applicable Limit of Insurance.
2. Business Liability Coverage is excess over:
a. Any other insurance that insures for direct
physical loss or damage; or
b. Any other primary insurance available to
you covering liability for damages arising
out of the premises for which you have
been added as an additional insured by
attachment of an endorsement.
SB- 147082 -D
(Ed. 04/10)
3. When this insurance is excess, we will have no
duty under Business Liability Coverage to
defend any claim or "suit" that any other insurer
has a duty to defend. If no other insurer
defends, we will undertake to do so; but we will
be entitled to the insured's rights against all
those other insurers.
I. Premiums
1. The first Named Insured shown in the
Declarations:
a. Is responsible for the payment of all
premiums; and
b. Will be the payee for any return premiums
we pay.
2. The premium shown in the Declarations was
computed based on rates in effect at the time
the policy was issued. On each renewal,
continuation or anniversary of the effective date
of this policy, we will compute the premium in
accordance with our rates and rules then in
effect.
3. With our consent, you may continue this policy
in force by paying a continuation premium for
each successive one -year period. The premium
must be:
a. Paid to us prior to the anniversary date; and
b. Determined in accordance with Paragraph
2. above.
Our forms then in effect will apply. If you do not
pay the continuation premium, this policy will
expire on the first anniversary date that we have
not received the premium.
4. Undeclared exposures or change in your
business operation, acquisition or use of
locations may occur during the policy period that
are not shown in the Declarations. If so, we may
require an additional premium. That premium
will be determined in accordance with our rates
and rules then in effect.
J. Premium Audit
SB- 147082 -D
(Ed. 04/10) Exhibit C
1. This policy is subject to audit if the Declaration
shows subject to audit. We will compute the
final premium due when we determine your
actual exposures.
2.
Premium shown in this policy as advance
premium is a deposit premium only. At the close
of each audit period we will compute the earned
premium for that period. Audit premiums are
due and payable on notice to the first Named
Insured. If the sum of the advance and audit
premiums paid for the policy period is greater
than the earned premium w will r9tyrC)Jt9
excess to the fipt)N1 m051r r 1Ar
P ?ge2bf 3-
Assistant City L��S-
CNA
3. The first Named Insured must keep records of
the information we need for premium
computation, and send us copies at such times
as we may request.
K. Transfer Of Rights Of Recovery Against Others
To Us
1. Applicable to Businessowners Property
Coverage:
If any person or organization to or for whom we
make payment under this policy has rights to
recover damages from another, those rights are
transferred to us to the extent of our payment.
That person or organization must do everything
necessary to secure our rights and must do
nothing after loss to impair them. But you may
waive your rights against another party in
writing:
a. Prior to a loss to your Covered Property
b. After a loss to your Covered Property only if,
at time of loss, that party is one of the
following:
(1) Someone insured by this insurance;
(2) A business firm:
(a) Owned or controlled by you; or
(b) That owns or controls you; or
SB- 147082 -D
(Ed. 04110) Exhibit C
SB- 147082 -D
(Ed. 04/10)
(3) Your tenant.
You may also accept the usual bills of lading or
shipping receipts limiting the liability of carriers.
This will not restrict your insurance.
2. Applicable to Businessowners Liability
Coverage:
If the insured has rights to recover all or part of
any payment we have made under this policy,
those rights are transferred to us. The insured
must do nothing after loss to impair them. At our
request, the insured will bring "suit" or transfer
those rights to us and help us enforce them.
This condition does not apply to Medical
Expenses Coverage.
L. Transfer Of Your Rights And Duties Under This
Policy
Your rights and duties under this policy may not be
transferred without our written consent except in the
case of death of an individual Named Insured.
If you die, your rights and duties will be transferred
to your legal representative but only while acting
within the scope of duties as your legal
representative. Until your legal representative is
appointed, anyone having proper temporary custody
of your property will have your rights and duties but
only with respect to that property.
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LI A pttcPag`a 3 of 3
Assistant (;�tV
Certification Regarding Drug -Free Workplace Requirements
The certification set out below is a material representation upon which reliance is
placed by the U.S. Department of Housing and Urban Development in awarding the
grant. If it is later determined that the contractor knowingly rendered a false
certification, or otherwise violates the requirements of the Drug -Free Workplace
Act, the U.S. Department of Housing and Urban Development, in addition to any
other remedies available to the Federal Government, may take action authorized
under the Drug -Free Workplace Act.
CERTIFICATION
A. The contractor certifies that it will provide a drug -free workplace by:
(a) Publishing a statement notifying employees that the unlawful
manufacture, distribution, dispensing, possession or use of a
controlled substance is prohibited in the contractor's workplace and
specifying the actions that will be taken against employees for
violation of such prohibition;
(b) Establishing a drug -free awareness program to inform employees
about —
(1) The dangers of drug abuse in the workplace;
(2) The contractor's policy of maintaining a drug -free workplace;
(3) Any available drug counseling, rehabilitation, and employee
assistance program; and
(4) The penalties that may be imposed upon employees for drug
abuse violations occurring in the workplace;
(c) Making it a requirement that each employee who will be engaged in
the performance of the grant be given a copy of the statement
required by paragraph (a);
(d) Notifying the employee in the statement required by paragraph -(a)
that, as a condition of employment under the contract, the employee
will -
(1) Abide by the terms of the statement; and
(2) Notify the employer of any criminal drug statute conviction for
a violation occurring in the workplace no later than five days
after such conviction.
1 *3:114Noa]
Pg. 2
(e) Notifying the U.S. Department of Housing and Urban Development
within ten days after receiving notice under subparagraph (d)(2) from
an employee or otherwise receiving actual notice of such conviction;
(f) Taking one of the following actions, within 30 days of receiving notice
under subparagraph (d)(2), with respect to any employee who is so
convicted -
( 1) Taking appropriate personnel action against such an employee,
up to and including termination; or
(2) Requiring such employee to participate satisfactorily in a drug
abuse assistance or rehabilitation program approved for such
purposes by a Federal, State, or local health, law enforcement,
or other appropriate agency;
(g) Making a good faith effort to continue to maintain a drug -free
workplace through implementation of paragraphs (a), (b), (c), (d), (e)
and (f).
B. The contractor shall insert in the space provided on the attached "Place of
Performance" form the site(s) for the performance of work to be carried out
with the grant funds (including street address, city, county, state, and zip
code) the contractor further certifies that, if it is subsequently determined
that additional sites will be used for the performance of work under the
contract, it shall notify the U.S. Department of Housing and Urban
Development immediately upon the decision to use such additional sites by
submitting a revised "Place of Performance" form.
Dated:
Employer Signature
W/CII 3119]
DIVISION OF EMPLOYMENT SERVICES
PLACE OF PERFORMANCE
FOR CERTIFICATION REGARDING DRUG -FREE WORKPLACE
REQUIREMENTS
Name: Best Medical Enterprise
Name of Contractor
Contractor Number:
Date:
Robert Castillo
The Contractor shall insert in the space provided below the site(s) expected to be
used for the performance of work under the contract covered by the certification:
Place of Performance (include street address, city, county, state, zip code for each
site):
1420 Ritchey St. , Ste A
Santa Ana, CA 92705
s :e,
Certification Regarding
Debarment, Suspension, Ineligibility and Voluntary Exclusion
Lower Tier Covered Transactions
This certification is required by the regulations implementing Executive Order 12549, Debarment and
Suspension, 29 CFR Part 98, Section 98.510, Participants' responsibilities. The regulations were published
as Part VII of the May 26,1988 Federal Register (pages 19160 - 19211).
(BEFORE COMPLETING CERTIFICATION, READ INSTRUCTIONS FOR CERTIFICATION -
Attached)
(1) The prospective recipient of federal assistance funds certifies, by submission of this proposal, that
neither it nor its principals are presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from participation in this transaction by any federal department or
agency.
(2) Where the prospective recipient of federal assistance funds is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation to this
proposal.
Robert Castillo Owner
Name and Title of Authorized Representative
9 : t -'L 1
Signature Date
EXHIBIT E
INSTRUCTIONS FOR CERTIFICATION
By signing and submitting this proposal, the prospective recipient of federal assistance funds is
providing the certification as set out below.
2. The certification in this clause is a material representation of fact upon which reliance was placed
when this transaction was entered into. If it is later determined that the prospective recipient of
federal assistance funds knowingly rendered an erroneous certification, in addition to other remedies
available to the Federal Government, the Department of Labor (DOL) may pursue available
remedies, including suspension and/or debarment.
3. The prospective recipient of federal assistance funds shall provide immediate written notice to the
person to which this proposal is submitted if at any time the prospective recipient of federal
assistance funds learns that its certification was erroneous when submitted or has become erroneous
by reason of changed circumstances.
4. The terms "covered transaction," "debarred," "suspended," "ineligible," "lower tier covered
transaction," "participant," "person," "primary covered transaction," "principal," "proposal," and
"voluntarily excluded," as used in this clause, have the meanings set out in the Definitions and
Coverage sections of rules implementing Executive Order 12549. You may contact the person to
which this proposal is submitted for assistance in obtaining a copy of those regulations.
5. The prospective recipient of federal assistance funds agrees by submitting this proposal that, should
the proposed covered transaction be entered into, it shall not knowingly enter into any lower tier
covered transaction with a person who is debarred, suspended, declared ineligible, or voluntarily
excluded from participation in this covered transaction, unless authorized by the DOL.
6. The prospective recipient of federal assistance funds further agrees by submitting this proposal that
it will include the clause titled "Certification Regarding Debarment, Suspension, Ineligibility and
voluntary exclusion - Lower Tier Covered Transactions," without modification, in all lower tier
covered transactions and in all solicitations for lower tier covered transactions.
A participant in a covered transaction may rely upon a certification of a prospective participant in a
lower tier covered transaction that it is not debarred, suspended, ineligible, or voluntarily excluded
from the covered transaction, unless it knows that the certification is erroneous. A participant may
decide the method and frequency by which it determines the eligibility of its principals. Each
participant may, but is not required to check the List of Parties Excluded from Procurement or Non -
Procurement Programs.
8. Nothing contained in the foregoing shall be construed to require establishment of a system of
records in order to render in good faith the certification required by this clause. The knowledge and
information of a participant is not required to exceed that which is normally possessed by a prudent
person in the ordinary course of business dealings.
9. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a
covered transaction knowingly enters into a lower tier covered transaction with a person who is
suspended, debarred, ineligible, or voluntarily excluded from participation in this transaction, in
addition to other remedies available to the Federal Government, the DOL may pursue available
remedies, including suspension and/or debarment.
EXHIBIT E
MEMO
To: Clerk of the Council Date: October 30, 2013
From: Sylvia Vazquez
Subject: Workforce Investment Act - On The Job Training Agreements
On- the -Job Training (OJT) is a Workforce Investment Act training program in which an OJT
contract is designed for a particular individual and employer. An employer which hires a trainee
may be reimbursed up to 50 percent of the wages paid for the extraordinary cost of lower
productivity in participants, providing the training, and additional supervision.
OJT contracts are conducted through noncompetitive negotiations. Per State of California
Employment Development Department Directive 12 -10, "Customized Training and On- The -Job
Training are exempt from Federal and State competitive procurement ".
Please call me with any questions. Thank you.
Sylvia Vazquez X 2654