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HomeMy WebLinkAboutARC MERCURY-2015WURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES Opt '020 -//o CLERK OF COUNCIL R 1 2 2015 DATE:: Agreement No. ON-THE-JOB TRAINING AGREEMENT UNDER THE WORKFORCE INVESTMENT ACT N-2015-033 THIS AGREEMENT is made and entered into this 10th day of March, 2015 between the City of Santa Ana, a charter city and municipal corporation duly organized and existing under the Constitution and laws of the State of California (hereinafter "CITY") and Are Mercury (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 March 10, 2015, and ending September 11, 2015. 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. 1 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. Funding. CITY shall reimburse the EMPLOYER an amount not to exceed $6,300 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, e. 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. 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. 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. 9. 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 Keening. 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, 1 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 party. 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: Are Mercury 1942 E. Blair Ave. Santa Ana, CA 92705 ATT: Andrew Wolf, CEO 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 herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify CITY 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 I). Huizar Clerk of the Council APPROVED AS TO FORM: Sonia R. Carvalho City Attorney By: Lisa Storck Assistant City Attorney RECOMMENDED FOR APPROVAL: wlhAglml Kelly Ree ei Executiv irect r Community De opment Agency David Cavazos City Manager I vwllf Andrewolf CEO Tax ID# 3401236 TRAINING PLAN I. GENERAL 1. Name of OJT Employer: 2. Address of OJT Work -site: 1942 East Blair Ave. Santa Ana, CA 92705 3. Phone Number: 949-216-8192 4. Training Supervisor: Simon Vakili 5. Name of OJT Trainee: Rochelle S. Burch 6. Application Number of Trainee: 43274536 7. Grant/Program: 8. Proportion of trainees/employees: (at time Agreement entered into) a. Total number of employer's regular employees 3 C. Cumulative number of trainees currently in OJT 0 II. OCCUPATION AND ON-THE-JOB TRAINING OUTLINE: 1. Occupation: Administrative Support Agent/Executive Administrative Assistant 2. Length of Time in Business: 4 years 3. ONET Code: 43-6011.00 SVP Level: (6.0 to < 7.0) 4. Hourly Starting Wage: $ 15/hour Start Date: 03/10/2015 End Date: 09/11/2015 Hours 840 5. State and Federal Tax LD.: State: 3401236 Federal 45-3807443 6. Basic Work Week Hours: 35 7. Outline of On -the -Job Training Plan and Method of Assessment: Exhibit A 1 ELEMENTS OF TRAINING HOURS OF TRAINING Objective 1- Virtual administration work (internal / external as customer support): 80 Tools / Software: Google Drive Google Voice Google Hangouts Intuit QuickBooks online Adobe Suite Scanning Software Open office WORD Open office EXCEL Open Office IMPRESS (same as Microsoft PowerPoint) Impacts: Filing / administrative support / supporting our project managers / supporting client requests Objective 2-Light accounting: Tools / Software: 360 Google Drive Intuit QuickBooks online Objective 3-Updating Web content / Social network marketing administration. 200 Tools / Software: Website Site Manager (WHM) cPanel Manager (cPanel) WordPress Facebook Google Plus LinkedIn Bing Webmaster tools Google Webmaster tools byectrye, 4 Pur" 'f(UL ' i%Agevtg�t A oIler� �tao 200 Tools / Software: Google Drive Intuit QuickBooks online Various Vendor online portals Open office WORD Open office EXCEL RATING LEVELS: Measurement method: how will it be determined if OJT participant acquired the skill? -Q&A, observation, product review/inspection, etc. PROFICIENT MODERATE MARGINAL II. COST COMPUTATION Hourly Reimbursement: $ 7.50 (50% of $15.00) Training Hours: 840 Cost Per Trainee (Hourly Reimbursement X Training Hours) _ $ 6,300 III. Person(s) authorized to Andrew Wolf `f Print Name Print Name invoices for EMPLOYER: CEO Title �r00 Title 03/05/2015 Date Date ASSURANCES 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. 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. 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. It. 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 A EMPLOYER for each OJT trainee are subject to review. Signature EXHIBIT B 03/05/2015 Date CERTIFICATE OF LIABILITYINSURANCE DATE (MMIDDIYYYY):: 1 3/4i2015 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder Is an ADDITIONAL INSURED,. the policy(los) must: be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions ofthe policy; certain policies may require an endorsement, A statement on this certificate does not Confer rights to the certificate holder in Ileo of such endorsement(s), PRODUCER The Empire CompanyPHONERRa, 550 North Park ,Center Drive Suite 20.5 Santa Ana CA 92705 CNAME:OMIACT SuSen Remeike FA[ N.. A -MAIL. .sre'maika@empire-.co.00m, INSURER$ AFFORDING COVERAGE NAIL INSURERA Sentinel insurance CoMany, LTD 11000.. INSURED ARC Mercury .1942 Blair Ave Santa Ana CA 92705, INSURERS: INSURER C':. INSURE...O: :INSURER&6 INSURERP:; COVERAGES CERTIFICATE NUMBER:15/16 Master REVISION NUMBER:: THIS 1S TO CERTIFY'THATTHE POLICIES OF INSURANCE LISTED BELOA 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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S: SUBJECT TO ALL. THE TERMS,; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. .LIMITS SHOWN. MAY HAVE BEEN REDUCED BY PAID. CLAIMS: ITR TYPE OF INSURANCE ADDLISUBR POLICY NUMBER MMIOQIYYYY+ (MM/DD/YY 'I LIMITS' AUTHORIZED REPRESENTATIVE GENERAL LIABILITY ,Santa Ana, CA. 92701 Michael Condy/SUSAN „'"„�1-.<.e.-y+l. cep-✓-"'"'" EACH OCCURRENCE $ 1.,000,000 PREMISES EO- nee $ 1,000,000 A. COMMERCIAL GENERAL LIABILITY CLAIMS -MADE aOCCUR 72SBAAQ6956 [20/2015 /20/2016 MED FOR (Ary one persen-.: $ 10y OQQ PERSONAL .& ANY INJURY, $ 1,000,00,0 GEN P,$- AOGRCGATE $ 2,000,000 GENL AGGREGATE LIMIT' APPLIES: PER: PRADUCTS-COMP/OPAGG. $ 2.,000,000 $ x POLICY 7 PRO. LOG AUTOMOBILE LIABILITY f LIMIT Ea am ant, 1,000,000 : BODILY INJURY (Per parson) $ A X ANY AUTO ALL OWNED SCHEDULED:. WIRED AUTOS iC Al0iTOQVNNED 72SBAAQ6956 /20/2015 /20/2016 - BODILY IN;IURY IPs=Ident) :PR P :Y DAMAGE $ P., d. RRh X UMBRELLA LIAB ,(OCCUR EACH OCCURRENCE $ 1, 000,DQQ' AGGREGATE $ 1,000,000'. A EXCESS LIAR CLAIMSNADE DED I $:: RETENTION$. 10,000 $ 72SHAAO,6956. /20/2015 /20/2016 WORKERS COMPENSATION. AND EMPLOYERS LIABILITY ANY PROM ETORIPARTNERIEXECUTIVE YIN OPFICERIMEMBER EXCLUDED? (Msnd.tory In MR) N. /A STAT I 0E H-. EL EACH ACCIDENT $ E L DISEASE -EA EMPLOYE_ $ EL.DISEASE- POLICY LIMIT $ If yes desorlree Under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101 Additional Remarks Schedule, If more space Is required) Those usual to the Insured's Operations.. City of Sana Ana, Its Officers, Employees„ Agents, and Representative are an Additional Insured. per the Business: ,Liability Coverge form SS000B attached. Waiver of Subrogation and Primary Non -Contributing wording per farm S$0008 attached.,np�e Ilk,�"'U 1 CERTIFICATE HOLDER CANCELLATION ACORD25(2010105) 01888-2010ACORD CORPORATION. All rights reserved. INS025 (201005),01: The ACORD: name andlogo are registered marks of ACORD Exhibit C SHOULD ANY OF THE ABOVE. DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL Be' DELIVERED IN. ACCORDANCE WITH THE POLICY PROVISIONS. City of Santa Ana 20 Civic Center Plaza AUTHORIZED REPRESENTATIVE ,Santa Ana, CA. 92701 Michael Condy/SUSAN „'"„�1-.<.e.-y+l. cep-✓-"'"'" ACORD25(2010105) 01888-2010ACORD CORPORATION. All rights reserved. INS025 (201005),01: The ACORD: name andlogo are registered marks of ACORD Exhibit C BUSINESS LIABILITY COVERAGE FORM This Paragraph f. applies separately to you and any additional Insured. 3. Financial Responsibility Laws a. When this policy Is certified as proof of financial responsibility for the future under the provisions of any motor vehicle financial responsibility law, the insurance provided by the policy for "bodily injury" liability and "property damage" liability will comply with the provisions of the law to the extent of the coverage and limits of insurance required by that law. b. With respect to "mobile equipment" to which this Insurance applies, we will provide any liability, uninsured motorists, underinsured motorists, no-fault or other coverage required by any motor vehicle law. We will provide the required limits for those coverages. 4. Legal Action Against Us No person or organization has a right under this Coverage Form: a. To join us as a party or otherwise bring us Into a "suit" asking for damages from an Insured; or b. To sue us on this Coverage Form unless all of Its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured; but we will not be liable for damages that are not payable under the terms of this Insurance or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claimant's legal representative. 5. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this policy to the first Named Insured, this Insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom a claim is made or "suit" Is brought. 6. Representations a. When You Accept This Policy By accepting this policy, you agree: (1) The statements in the Declarations are accurate and complete; (2) Those statements are based upon representations you made to us; and (3) We have issued this policy in reliance upon your representations. b. Unintentional Failure To Disclose Hazards If unintentionally you should fall to disclose all hazards relating to the conduct of your business at the inception date of this Coverage Part, we shall not deny any coverage under this Coverage Part because of such failure. 7. Other Insurance If other valid and collectible Insurance is available for a loss we cover under this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is primary except when b. below applies. If other insurance Is also primary, we will share with all that other Insurance by the method described in c. below. b. Excess Insurance This insurance is excess over any of the other insurance, whether primary, excess, contingent or on any other basis: (1) Your Work That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work"; (2) Premises Rented To You That is fire, lightning or explosion Insurance for premises rented to you or temporarily occupied by you with permission of the owner; (3) Tenant Liability That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occupied by you with permission of the owner; (4) Aircraft, Auto Or Watercraft If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Section A. — Coverages. (5) Property Damage To Borrowed Equipment Or Use Of Elevators If the loss arises out of "property damage" to borrowed equipment or the use of elevators to the extent not subject to Exclusion k. of Section A. — Coverages. Page 16 of 24 Form yS900 O$ 04 05 Exhibit C UN (6) When You Are Added As An Additional Insured To Other Insurance That is other insurance available to you covering liability for damages arising out of the premises or operations, or products and completed operations, for which you have been added as an additional insured by that Insurance; or (7) When You Add Others As An Additional Insured To This Insurance That is other insurance available to an additional insured. However, the following provisions apply to other Insurance available to any person or organization who is an additional insured under this Coverage Part: (a) Primary Insurance When Required By Contract This insurance is primary If you have agreed in a written contract, written agreement or permit that this insurance be primary. If other Insurance Is also primary, we will share with all that other insurance by the method described in c. below. (b) Primary And Non -Contributory To Other Insurance When Required By Contract If you have agreed in a written contract, written agreement or permit that this Insurance is primary and non-contributory with the additional Insured's own insurance, this Insurance Is primary and we will not seek contribution from that other Insurance. Paragraphs (a) and (b) do not apply to other insurance to which the additional Insured has been added as an additional insured. When this insurance is excess, we will have no duty under this Coverage Part to defend the Insured against any "suit" if any other insurer has a duty to defend the Insured against that "suit". 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. Form SS 00 08 04 05 Exhibit C BUSINESS LIABILITY COVERAGE FORM When this insurance is excess over other Insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self- insured amounts under all that other Insurance. We will share the remaining loss, if any, with any other Insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Method Of Sharing If all the other insurance permits contribution by equal shares, we will follow this method also. Under this approach, each insurer contributes equal amounts until it has paid its applicable limit of Insurance or none of the loss remains, whichever comes first. If any of the other Insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share Is based on the ratio of Its applicable limit of insurance to the total applicable limits of insurance of all Insurers. 8. Transfer Of Rights Of Recovery Against Others To Us a. Transfer Of Rights Of Recovery If the Insured has rights to recover all or part of any payment, Including Supplementary Payments, we have made under this Coverage Part, 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. b. Waiver Of Rights Of Recovery (Waiver Of Subrogation) If the insured has waived any rights of recovery against any person or organization for all or part of any payment, Including Supplementary Payments, we have made under this Coverage Part, we also waive that right, provided the Insured waived their rights of recovery against such person or organization In a contract, agreement or permit that was executed prior to the Injury or damage. Pagi BUSINESS LIABILITY COVERAGE FORM F. OPTIONAL ADDITIONAL INSURED COVERAGES If listed or shown as applicable In the Declarations, one or more of the following Optional Additional Insured Coverages also apply. When any of these Optional Additional Insured Coverages apply, Paragraph 6. (Additional Insureds When Required by Written Contract, Written Agreement or Permit) of Section C., Who Is An Insured, does not apply to the person or organization shown in the Declarations. These coverages are subject to the terms and conditions applicable to Business Liability Coverage in this policy, except as provided below: 1. Additional Insured - Designated Person Or Organization WHO IS AN INSURED under Section C. is amended to include as an additional Insured the person(s) or organlzabon(s) shown in the Declarations, but only with respect to liability for 'bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing operations; or b. In connection with your premises owned by or rented to you. 2. Additional Insured - Managers Or Lessors Of Premises a. WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organizations) shown in the Declarations as an Additional Insured - Designated Person Or Organization; but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Declarations. b. With respect to the insurance afforded to these additional Insureds, the following additional exclusions apply: This insurance does not apply to: (1) Any 'occurrence" which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. 3. Additional Insured - Grantor Of Franchise WHO IS AN INSURED under Section C. is amended to Include as an additional Insured the person(s) or organization(s) shown in the Declarations as an Additional Insured - Grantor Of Franchise, but only with respect to their liability as grantor of franchise to you. 4. Additional Insured - Lessor Of Leased Equipment a. WHO IS AN INSURED under Section C. is amended to Include as an additional Insured the person(s) or organization(s) shown in the Declarations as an Additional Insured — Lessor of Leased Equipment, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising Injury" caused, In whole or In part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). b. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any 'occurrence" which takes place after you cease to lease that equipment, 5. Additional Insured - Owners Or Other Interests From Whom Land Has Been Leased a. WHO IS AN INSURED under Section C. Is amended to Include as an additional insured the person(s) or organization(s) shown in the Declarations as an Additional Insured — Owners Or Other Interests From Whom Land Has Been Leased, but only with respect to liability arising out of the ownership, maintenance or use of that part of the land leased to you and shown in the Declarations. b. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: (1) Any 'occurrence" that takes place after you cease to lease that land; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. 6. Additional Insured - State Or Political Subdivision — Permits a. WHO IS AN INSURED under Section C. is amended to include as an additional insured the state or political subdivision shown in the Declarations as an Additional Page 18 of 24 Exhibit C Form SS 00 08 04 06_.,, Payroll Alliance Center 3600 WISEMAN BIND.. SAN ANTONIO, TX 78251 1"NE HARTFORD Jung 16, 2011 ooeoss ARC MERCURY INC 1942 BLAIR AVE SANTA ANA CA 92705 RE: Policy Number 76 tkTG GF,1653 Door Paychex Client: On be+half of our partnership with,Paychvx, Nvo would like to thank you for choosing The Hartford to provide your Workers' Compensation insurance, We are pleased to welcome you to The Hartford and look forward to servicing your figure needs. In an effort to ensure that your coneorn� tarc3 u+ddrescsed ran efficiently a� poaeihlr, we are providing the fallowing toll-free numhera: Service Assistaneu To contact a licons ed insurance professional garding current coverage inquiries, changeslendoreemonlo to your policy, roquesb for certificates of insurance or salesinquirie.8 regarding quotes for additional lines ofinaurance, please contact: The Hartrord'6 CustomerService f Sales Dapartment Phone; 1 (877) 287-1312 Monday - friday, 8:00 AM - 6:00 PM PST Claims Assistance To report a chum or leas, please cull the TcleChurn line directly: The liartford's 24 -flour `PeloClsim line Phone: 1(877)383-7022 Please keep a ropy of this letter for future roference. Thank you, The Itnrtt'ard's Payroll Alliance Center Exhibit C Billing Inquiries A- our partnership with Paychex offers two primary billing methods, it 6 necessary to direct specific billing inquiries to the appropriate resource, dependent on your specirru billing mothod. It' you're currently a Workers' Cominnsation Payment Service client, whereby your workers' compensation premium is deducted with each payroll cycle*, billing inquiries should be directed to; tPayehoxInsurance Age-acy, Inc Phone: 1(800) 472.0072 fax: 1 (585) 664-3145 Monday- Friday, 8:00 AM n 6:00 PM EST' If you're currently receiving trills directly from The Ilurtford, billing inquiries should be directed to: The Hertford's Billing Department Phone: 1 (800) 382.6170 Monday - friday, 8:00 AM » 6:00 PM EST i Payroll Allinnee Center 3604 WISEMAN BLVD, SAN ANTONIO, TX 78261 Monday . Friday, 8:00 AM • 6:00 PM EST 1 (877)287.1312 FOR A,SSISTANCG WITH A CLAIM CALL 1(877)'383;7422 , 76 WEG GF4653 INSTRUC`T`IONS FOR REmowNG Y IIS Ill CARD, CUT ,ALONG DOTTED LINE WITH A PAIR OF SCISSORS. Your wallet aizad Ill eards are included on this sheet. This Bard list.,rill appropriate phone numbers you may, need to service your business or, in the event of a J; aim, The Hartford's tall frea= 24 hour PoleGlnim hotline phone number, Payroll Alliance Center 3600 WISFMAN BLVD. SAN ANTONIO,, TX 78201 Monday- Friday, 8:00 AM - 6:00 PAI ESN' 1 (877) 287-1812 + FOR ASSiSTANCP WITH A CLAIM CALL 1 (,877)583-7422 + 78WEG W4053 e Exhibit Ci V f1,n0 I..�r 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. EXHIBIT D a 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). 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 Performi Dated: 03/05/2015 571.91 DIVISION OF EMPLOYMENT SERVICES PLACE OF PERFORMANCE FOR CERTIFICATION REGARDING DRUG-FREE WORKPLACE REQUIREMENTS Name: Name of Contractor: Andrew Wolf Contractor Number: 949-216-8192 Date: 03/05/2015 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): Are Mercury 1942 East Blair Ave. Santa Ana, CA 92705 EXHIBIT D 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 Linable to certify to any of the statements in this certification, such prospective participant shall attach an explanation to this proposal. Andrew Wolf -CEO e and Title of Authorized Representative Date 03/05/2015 EXHIBIT E INSTRUCTIONS FOR CERTIFICATION 1. 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. 7. 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 '1 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. A EXHIBIT E