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HomeMy WebLinkAboutSASSOON, DR. MAUREEN 2 -2015Qtr Ifillp, N-2015-176 –1A' CLERK Of' CUUM tL DAMe DEC 0 9 2ti 5 f-LN-81JINANT AUkEEMENT '11119 AGREBM'RNT is mide and entered into this I?a' (lay of Novombox, 2015 by and between Dr, Maureen Samoon, MS, MPH C'COMultant") and the City of Santa Ana, a charter city and municipal corporation organized. and existing onder the Constitution and laws Of the State of Califeriijr ( "City'), RE-1 C Y —p/Ij I IS, A. Tice City c1ceircs to retain a coaaaltant haying special skill and knowledge in the fleld of occupational and environmental health and sivfety consulting servioos. 13, Consultant represents that Consultant is able and willing to provide such services to the City. C In uadartaktag the porfortuanoo of Oils Agreement, Consolumt represents that she is knowledgeable in her field and that any services peribmuxt by Consultant trader this Agreement will be perimined in compliance; with auch standards as inay reasonably be expected from a professional consulting firm in the field, NOW `RI$FREi+gRU3 in consideration OF the mutual and respective promises, and artbiect w the terms and conditions hereinafter set foilth, the parties agree is follows: 1. SCOPE OF 9ERVICE 8 Causultam shall Perform those services relating to Occupational and envirmutricatal health and s,Xety consulting services fircl-ading but not hynited to those services set forth in Exhibit "A", attached hereto and juQurporated heroin by roterenco. 21 COMPENSAXION a. City agrees to pay, and Consultant agrees to accept is total payment for its services, the rites and charges identified In Exhibit B. The total sum to be expended under this Arfooment, shall , not exceed $25,000,00 during the term of this Agreement, b, Payment by Citystuill be rnade witifin thirty (30) (lays following receipt of proper invoice evidencing work porfortned, subject to City accounting procedures. Paytirentneed not be made for work which fails to meat the standards of perfornimn set forth in the Recitals whien nuty reasonably be expected by City, 3. TERM This Agreement shall commence on January 4, 2016 and terminate on De"i aber 31, 2016, unless terminated earlier piusuant to Section 12, below. The term of this Agreement may be extended upon a writing executed by the City Manager and the City Attorney, 4. INDEPE NDENT CONTRACTOR C(TISVIltallf, shall, daring the entire term of thisAgrwinent, be cons(rued to be an it-rdepondent contractor and iiot in employee of the City, This Agrmmiout is not intended nor shall it beconstraed to create an elnployor crnployee rclation'qhip, ajoint venture relationship, or to allow the City to oxereiqe diserotion or control over the professional nuicoer in wI-aoh Consultant performs the services which are the subject 1111tterr of this Apreerrient; however, the services to be provided by Consultant shall be pzo-OdDd ill a nialurer consistent with all applicable standards and regulations governing such services. Consultant shall pay all salaries and wages, employer's soaial security taxoo, unemployment insurance and similar taxes relating to its employees and sh all be responsible for all applicable withholding taxes. s INSURANCE Uior / �� u xa work under this Agreement, Consultant shall /ouiotoiw and shall require, its subcontractors, ifany, to obtain and zou6d*in insurance wo described below: � u.I)ont9 the uuWreufthe `oonprovided, Cooz"�rcu{a1(3no�n]ljahiDtylusnmu:*iohot mg�e& b. Worker's ComponsatioT, &i accordance with the yro«toinuouf Section 3300nfthe Labor Code, Consultant, if Consultant has any employm, is required to be insured against liability for n/o6m�'o�mnpm�v�iu/�o�touudur,o��o����oo,mommPrior tocommencing tkopexttoouw^ooftbnvodc under this Agreement, Consultant agrees k/ obtain and maintain any employer's liability ioouzmoo*6b limits not lox^ than $1,0OV,00O per accident, c, Automobile liability insurluce, or equivalent, fun.n, with a combined single limit of not less t6au$l,009'UOW per occurrence, such iomo/nuee shall include coverage for owned and hired automobiles. d, Professional liability (errors sud omissions) finurance, whb. q combined si�uule1izu{tvfnot less than $l'V00,000 per /lxic"^ `� 6. INDEMNIFICATION Consultant agrees to and shall indemnify, defend, and bold harmless the Uty, its officers, agents, employees, congultalits, legal counsel, and representatives from liability for pex3oual injury, damages, just compensation, restitution, judicial or cqn1table relief arising out of claims: �1) for personal injury, including death, and claims for properly damage, arising from the direct Or indirect operations oftho Colaultant of its conLractors, subcontractors, agents, employees, or other pumons acting on its behaff which relates to the services described in Section I of this Agreement; and (2) from any claim that personal injiny, damages,just compensation, restitution, i t.idicial or equitable relief is due by reason af effects arising from this Agreement. This indemnity and hold haralloss agreement applios to all claims for damages, just judicial or equitable relief suffered, or alleged to have been suffered,, by reason of thp cvents referred to in this Section, The Consultant further agrees to indemnity, hold hartaless, and pay all costs for the defense of the City, incinding fees and costs for legal counsel to be selected by the City, regardiagany action by a third party asserting that peTsonM injary, chunages, just compensation, rostRution, judicial or equitable rchef due to POI Sound OF property rights arises by reason of City may make all reasonable decisions with respect to its representation in any legal proceeding, ?^ CONFIDEy0OAlWY TY Consultant texoivndfIVU1 the City information which dnoto8,uuxh,roof such info,nmGuui^ reasonably understood t^ be confidential and/or proprietary, Consultant agrees Lhat it shall not use or disclose x^6hizdi,tuxduu except in the performance of this Agreement, and farther agrees tn*m*.tix*the game degree of care it, uses to protect its own infomiation of like importance, but iuoo event less than reasonable care, "Confidential Byffiuuu6un» hall include all nonpublic {oCortoutiou.Confidential inforroition includes not only written h1ormalJon, but also information transferred orally, visually, electronically, or by other means, Confidential information disclosed to eithey party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non -use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Consultant disclosed in a Publicly available source; (c) is in rightful possession of the Consultant and disclosed without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (o) is indepeudently developed by the Consultant without reference to information disclosed by the City. 81 CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interest mid shall not have interests, direct or indirect, which would conflict in any mancer with performance of services specified under this Agreement, 91 NOTICE Any notice, tender, demand, delivery, or other conatineicdion pursuant to this Agreement shall be in writing and shelf be deemed to be properly given if delivered in ,person or inailed by first class or certified triail, postage prepaid, or sent by facainailo or other telegraphic connnunicatiol, in the re aver provided in this Section, to the follown-1g, persons: To City; Clerk of the City Council City of Santa Ana 20 Civic Center Ptaza (M-30) I"C' Box 1988 Santa Ana, California 92702-1988 Facsimile (714) 647-6956 Copies to: 'Executive Director ofPersonnel Services City of Santa Ana 10 Civic Center Plaza (M-29) P.O' Box 1988 Santa Ana, California 92,702-1988 rnesimile (714) 647-5414 and City Attorney City of Smita Ana 20 Civic Contar Plaza (M-29) P'0. Box 1,988 Santa Ana, California 92702-1988 Facsimile (719 ) 647-6515 To Consultant; Dr. Maureen Sagsoon, MS, MPB P.O. Box 2028 Palos hordes Peninsula, CA 90274 A party may change its address by giving notice in writing to the other patty. Thereafter, any conurnmicatiaa shall be addressed and transmitted to the new ackhess, If sort by mail, comainnioation shall be effective or deemed to have been given three (3) days after it has been deposited in the 1,Tafted States mail, duly registered or certified, with postage prepaict, and addressed as set forth abovo. If sent: by facsimile, communication shall be effective or deenied to have been given twenty-four (24) hours after the tbne.set forth oil the transmission report issued by the transmitting fausiraile machine, addressed as set forth above, For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be exoluded. 10, E XCLUSIVITY AND This Agrcorracut represents the complete and oxclusive stademen t between the City and Consul tant regarding the subject matter heroin, and supersedes any and all oral or written, between thapgrtics. In the event of tr conflict betwoon, the; tenns of this Agreementand aikyrattachraents, hereto, the terms of this Agreement shall prevail and wiII serve to fidly supersede existing Agreement. This Agreement may not be modified except by written instrument signed by the CiTyand by an authorized representative of Cousulteart. The parties agree that any terni% or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terras or conditions hereof, shall hot bind or obligate Consultant nor die City, Each party to this Agreement acknowledges that no representations, inducements, prormsm5 or ' agrecanents, orally or otherwise, have been made by any party, or anyone acting on belialf of any party, which are not embodied heroin, 11, 6SS2GI{MFN7p 1ousou*;b as this AgToamont is intended to seoure the specialized. saryioos of Consuftan� Consultant may not assign, transfer, delegate, or suboontract any interest herein without the prior written consent vY8e City and any m/^b assignment, transfer, delegation orstibcvn8rwotwithout the City's prior written cmrunot shall be, considered null and void. Nothing iutbio Agreement shall beconstrued to limit the City's ability to have any off6n services which are the ^v6|ecttv this A8r=u/s4y*rthoun8hyCity personnel orby other consultants retained hyCity. 12. '11,M0INAXION This Agtoement /nay botoruduated by (he City with thirty (30 days written notice of termination tu the Consultant, u.Asu*ou8ikun^f such payment, the Executive Director may r =Cuum8tauttudu|ivextu the City all the work product completed uooI such date, and insuch n0000unb work product shall bVthe property of the City onloss prohibited by law, and Consultant conaents to the City's uss thereof for such purposes xx fire City deems upponprlute, 6. Payment need not bo made for work that thi}ato meet tbaokondu/i[of performance, xyeuif led in the Recitals of this Agreement. 13^ NON DISCREWINM0WN CVuou]twot shall not dio:rizojuuto because uf race, color, crend. Marlon, sox, marital status, sexual orientation, age, national origin, ancestry, or disability, uodefiuwJ and prohibited by applicable law, iothe recruitment, oo!ooLbx4traiuiu8' `P,ozmduo,lecmluutioaor other employment related udiviUen o, any activities under this Agreement Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state aad local laws and regulations. 14. JURISDICITON - VENUE This Agreement, has boon executed and delivered in the State, of California slid the validity, interprotation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California, Both parties fortlier agree that Om, ngo County, California, shall be the venue for tiny notion or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 15, PROFESSIONAL LICENSES Consultant shall, throughout the torn of this Agreement., maintain all necessary licenses, permits, qprovats, waivers, and exemptions necessary to" the Provision of the services hereunder and required by the laws and regulations ofthe United Sates, the State of California, the City of Santa Ann and all other governmental agencies, Consultant shall notify the City immediately and in writing of in; inability to abtein or ixunisatnin such front nits, heenses, approvaSa, watvcrrv, staid exaonptions. Said "arability ahallbe cause for termination of this Aipecairni. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written, ATTEST� I IkLIP�A_ I? M , �ARTA D 1,10IZUR. - Clork of Orc Council APPROVED AS TO FORM: Sonia R. Carvalho City A .... oy "an Set warznmn iorAssistant City A[lorney RECOMMENDED FOR APPROVAL, --- UA�INJL"�, EbWARD RA�XAT"T­—- Executive Direntor of Personnel Services CITY OF 5AFYA ANA 5TVid—cavaz s City Manager CONSULTANT 5R. MATO3EN SASSO(YN, MS, mphi Soloproprictor Exy.mn'A SOO T-6 005—Orde—es, 1. Condooting the City Safiaty Coracsittee Meetings pursuant too, a City I I b:JI. Illness Prevention program Tipp approximately six time per year, Iry 2. Employee Health qafaty 'Fraining (ix Cal-OSEA mandated LTairduF) for City omployors cuvoriag such topics HR respiratory protoction hwing wnsmitatioft, emergency action/fireresponse, hazard cornirurnioution, hazardous waste, confined Space, lockout/block out supervisor safety inspections and accident investigaions and hands-on defensive driving on private property, I Inspection services as needed bya Certified Asbestos Consultant, per the Stat© of California. 4, Inspection sorVicca as needed from Lead-Certified CaliIbvJa'j)qptvtrnsut of public Realth Conslattud, S. A City-Widq, Safety laspoctiou. 6, Advising iho City axed in issues involving Cal-OSCHA. 7. Othor thiM-party health and safety se.171008 on a 40 necdod/required basis (i. 0., employee Work station ergonomic evaluations, indoor air quality surveys and noise surveys) as requested by Risk Management x(Vor Stu man Td osocroo-,% 8, Conduct an atlitit of tho existing loss control programs wit h rc hc changes, as doetned iiecossary. comniondoos for 9. Other taslca as requested by the Uxewavo Diroctor of Personnot Services or hig designee. lI,XflfBrC B Fees f , Occu 7atu icmat & Ertv_iroiunekzt<l,I3ealtlt & Saf''ety C ". nsultiixc Services DR. MAI.WIFN SASSOON, MS, MPR Certified hiduatrial hygiene Fees: 310/544-2912 1, General industrial hygiene services (excluding Iegal cases) are charged at rate of $150/hour, portal -to- portal, witlr a 4 -hour nvnlutum. Additional charges, such as but not limited to: equipment and laboratory fees, printing and duplicating 'fees, data fees (i.e., such as are associated with Phase I rosvarch), and travel related fooq (i,e,, airfare, hotel, our rental) are charged to the client per assoolated incurred cost, if the client pays them direct or up front, otherwise there is a 1.0% mark -up, 2. General office work, report writing and research are charged at $150 /hour, 3. Legal cases, includingprepara #ion, doctmzent review, research, industrial hygiene surveys and all other related work including court time (with or without testimony) at id deposftigns are charged at a rate of $450/hour, with a 4 -hour mininxum, plus expenses if outside the greater Los Angeles area SOLE PROPMETOR DECLARATION WDRKU0 QQZI IES -M. —A 1 11,2� &L px6reby of tinder penalty ol'perjury, the following declaration; I certify on bobalf of '.'0 1 1) that during the torm of my cOntlaot for services with the City of Santa Ana, I will not employ any person in any mamierso as to become snlrjuct to the worke"', con,I)e1isatiot laws of California, and agree that if I should become subject to the workers, compensation provisions of Sortion 3700 of the Labor Code, I shall fbilliwitIl comply with those provisions and provide proof of workers' comVensanoft covomga. DATE; t i– i%r t By: 14,, Name: ------ L 01 Title: Telephone: -z— WARNING FM LURE TO SECURE WOE1( lEmS, COMpENqATION COVERA(Iri IS UNLAWFUL, AND SHALL RTBJECTAN EMPLOYERTO CRIMINAL PENALTIES AND CIVIL FINESUPTO ONE HUNDREDTI-IOUSAND DOLLARS ($100,000), IN ADDITION TO THE COST' OF COMPENSATION, DAMAGES AS PROVIDE'D FOR IN SECTION 3706 OFTITELABOR CODE, INM-MEST, AND ATTOMY'S FEES, DRMAU -1 OP ID: C6 w., . CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDONM) 06/09/2015 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(les) 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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Brakke, Schafnitz Ins. Brokers License #0428915 100 Wilshire Blvd. 111940 Santa Monica, CA 90401 CONTACT NAME: Carole S. Mitchell PHON o - 0.310- 524 -1357 �� c Nea: 949- 313.3323 A" Og carole.mitchsII sig.us ADDRESS^ �i.. Darla Gray INSURERS AFFORDING COVERAGE W INSURER A:Westchester Surplus Lines Ins _NAIC ..,.__ X INSURED Dr. Maureen SassOOn ...._. P O Box 2028 Palos Verdes Peninsula, CA 90274 INSURER B: 0710112018 INSURER G: $ 50,000 X Add'I Insured INSURER D: INSURER_E; _ _ $ 5,000 INSURER F Prof & Pollut -CLM PERSONAL & ADV INJURY COVERAGES CERTIFICATE NUMBER: 1 REVISION NUMBER: THIS IS TO CERTIFY THA -r 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 R TYPEOFINSURANCE Tft L POLICY NUMBER MOCROYEFF PDMLLIICOYEYP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE. $ 1,006,000 CLAIMS -MADE L�_"J OCCUR X X G24270427004 07/6112015 0710112018 PREMISES Eao curmnce $ 50,000 X Add'I Insured MED EXP (Any one Demon) $ 5,000 _ X Prof & Pollut -CLM PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,00 X POLICY ❑JE4 LOG PRODUCTS- COMP/OPAGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY _ COMBINED SINGLE (Ea acelden0 $ BODILY INJURY (Par parson) $ ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (per accident) $ NON -OWNED HIREDAUTOS q AUTOS PR PERTYDAMA 'E_ Peraccident' $ UMBRELLA LIAO OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOMPARTNERIEXECUTIVE O OPROERIMEMBER EXCLUDED? NIA I PER - STATUTE ER E.L. EACH ACCIDENT $ EL. DISEASE-EA EMPLOYE $ (Mandatary ho NN} It yes, describe under DESCRIPTION OF OPERATIONS bar. E.L DISEASE -POLICY LIMIT $ • Professional Liab. 624270427004 0710112015 0710112016 Prof.Liab 1,000,000 • Contractors Poll, G24270427004 0710112015 0710112016 Pollution 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be apaehed If more space la required) Policy Provides 30 days notice of cancellation except 10 days for nonpayment Applicable ndorsements Attached where required by Written Contract. Emailed @santa- ana.org CSANTAA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City f Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN V Attn: Briza Morales ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza Santa Ana, CA 92701 AUTHORIZED REPRESENTATIVE ©1988 -2014 ACORD CORPORATION. All ri�ghAtsReSoryg4l.. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD tr'" L�� Named Insured Endorsement Number Dr. Maureen Sassoon Policy Symbol Policy Number Policy Period ERecllve Date of Endorsement ECP G24270427004 07101/2015 to 07/0112016 07/01/2015 Issued By (Name of Insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number. The remainder of the Information is to be completed only when this endorsement Is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT OWNERS, LESSEES OR CONTRACTORS — SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE CONTRACTOR'S POLLUTION LIABILITY COVERAGE SCHEDULE: Name of Person or Organization: Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specificwritten request of such person or organization to you, wherein such request Is made prior to commencement of operations. (If no entry appears above, information required to complete this endorsement will be shown In the Declarations as applicable to this endorsement.) A. SECTION II - WHO IS AN INSURED is amended. to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured, B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to bodily injury or property damage occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work`, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2) That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. ENV -3100 (08 -04) Includes copyrighted material of Insurance Services Office, Inc. with Its permission Page 1 of�1 (fit Named Insured Endarsement Number Dr. Maureen Sassoon Policy Symbol Policy Number Policy Period Effective Date of Endorsement ECP G24270427 004 07/01/2015 to 07/01/2016 07101/2015 Issued By (Name of Insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number, The remainder of the Information Is to be completed ontywhen this endorsement is issued subsequentto the preparation of the ptley, THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT - OWNERS, LESSEES OR CONTRACTORS (PRIMARY AND NON - CONTRIBUTORY) This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE CONTRACTOR'S POLLUTION LIABILITY COVERAGE SCHEDULE., Name of Person or Organization: Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you, wherein such request is made prior to commencement of operations, (It no entry appears above, Ini applicable to this endorsement.) SECTION II - WHO IS AN INSURED Is amended to Include: as A. SECTION it - WHO IS AN INSURED is amended to Include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that Insured, B. With respect to the Insurance afforded to these additional insureds, the following exclusion is added: 2, Exclusions This Insurance does not apply to bodily injury or property damage occurring after: (1) All work, including materials, pans or equipment furnished In connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2) That portion of your work out of which the Injury or damage arises has been put to Its Intended use by any person or organization other than another contractor or subcontractor engaged In performing operations for a principal as a part of the same project, C. The coverage provided hereunder shall be primary and not contributing with any other insurance available to those designated above under any other third party liability policy. ENV -3101 (08 -04) Includes copyrighted material of Insurance Services Office, Inc. with Its permission Page I f 1 Named Insured Endorsement Number Dr. Maureen Sassoon Policy Symbol Policy Number Policy Period Effective Date of Endorsement ECP 624270427 004 07/01/2015 to 07101/2016 07/0112015 Issued By (Name of Insurance Company) Westchester Surplus Lines Insurance Company Intent the policy number. The remainder of the information is to be completed only when this endorsement Is Issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Person or orcanizetion: Any person or organization that Is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you, wherein such request is made prior to commencement of operations. If no entry appears above, Information required to complete this endorsement will be shown in the Declarations as annlirahla to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition Is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown In the Schedule above because of payments we make for Injury or damage arising out of your ongoing operations or your work done under a contract with that person or organization and Included in the products•completed operations hazard. This waiver applies only to the person or organization shown in the Schedule above. All other terms and conditions remain the same. ENV -3143 (03 -05) Includes copyrighted material of Insurance Services Office, Inc. with its permission Pagel of I q I�' ADDITIONAL INSURED ENDORSEMENT — PRODUCTS - COMPLETED OPERATIONS HAZARD Named Insured Endorsement Number Dr. Maureen Sassoon Policy Symbol Policy Number Policy Period Effective Date of Endorsement ECP 624270427 QQ4 07/01/2015 to 0710112016 07/01/2015 Issued By (Name of Insurance Company) Westchester Surplus Lines Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTOR'S POLLUTION LIABILITY COVERAGE PART SCHEDULE Any person or organization that Is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you, wherein such request Is made prior to commencement of operations. (If no entry appears above, Information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II — Who Is An Insured Is amended to Include as an additional insured the person(s) or organization(s) shown In the Schedule, but only with respect to liability for bodily injury or property damage Caused, in whole or in part, by your work performed for that additional Insured and Included In the products- completed operations hazard. All otherterms and conditions remain the same. ENV -3225 (10 -08) Copyright 0 2008N Page 1 of1� ADDITIONAL INSURED ENDORSEMENT — PRODUCTS - COMPLETED OPERATIONS HAZARD PRIMARY R NON - CONTRIBUTORY Named Insured Endorsement Number Dr. Maureen Sassoon Policy Symbol Policy Number Policy Period Effective Date of Endorsement ECP G24270427004 07/0112015 to 07/01/2016 07/01/2015 Issued sy (Name of Insurance Company) Westchester Surplus Lines Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTOR'S POLLUTION LIABILITY COVERAGE PART SCHEDULE Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organlzatlon to you, wherein such request is made prior to commencement of operations. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) Section II— Who Is An Insured is amended to include as an additional Insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for bodily Injury or property damage caused, In whole or in par[, by your work performed for that additional insured and included in the products - completed operations hazard. Furthermore, the coverage provided hereunder shall be primary and not contributing with any other Insurance available to those designated above under any other third party liability policy. All otherterms and conditions remain the same. ENV -3226 (10 -08) Copyright ©20088 Page 1 of 1 3"" —" REPRINTED FROM THE ARCHIVE. THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS -- SMInsurance,,, POLICY NUMBER: A2074142 A Liberty Mutual. Cbmpany SAFECO INSURANCE COMPANY OF AMERICA AUTOMOBILE POLICY DECLARATIONS NAMED INSURED: MAUREEN SASSOON PO BOX 2028 PALOS VERDES PEN CA 90274 -8028 AGENT: NHC INSURANCE SERVICES INC 796 W 9TH ST SAN PEDRO.CA 90731 -3602 POLICY PERIOD FROM: SEPT 1 2015 TO: SEPT 1 2016 at 12:01 A.M. standard time at the address of the insured as stated herein. AGENT TELEPHONE: 1- 310 -221 -0917 RATED DRIVERS MS MAUREEN SASSOON 2008 BMW 328I SULEV 4 DOOR SEDAN ID# WBAVC53578FZ84867 2014 HONDA CR -V EX 4 DOOR ID# 2HKRM3H59EH548165 Insurance is afforded only for the coverages for which limits of liability or premium charges are indicated. COVERAGES 2008 BMW LIMITS I PREMIUMS 2014 HOND LIMITS1 PREMIUMS LIABILITY: Actual Cash Value 40.30 BODILY INJURY $500,000 $ 177.00 $500,000 $ 197.70 Each Person $500,000 Each Occurrence PROPERTY DAMAGE $100,000 Each Occurrence MEDICAL PAYMENTS $5,000 UNINSURED AND UNDERINSURED MOTORISTS: BODILY INJURY $500,000 Each Person $500,000 Each Accident COMPREHENSIVE Actual Cash Value Less $250 Deductible COLLISION Actual Cash Value Less $500 Deductible WAIVER OF COLLISION DEDUCTIBLE ADDITIONAL COVERAGES: LOSS OF USE $50 Per Day /$1200 Max ANTI FRAUD FEE ROADSIDE ASSIST ORIGINAL PARTS REPLACEMENT ENDORSEMENT Each Person $500,000 Each Occurrence 103.30 $100,000 131.30 Each Occurrence 23.80 $5,000 24.50 102.10 $500,000 113.60 Each Person $500,000 Each Accident 69.20 Actual Cash Value 40.30 Less $250 Deductible 233.50 Actual Cash Value 283.10 Less $500 Deductible 14.60 18.10 34.80 $50 Per Day /$1200 Max 34.80 1.74 1.74 5.80 5.80 30.30 32.30 TOTAL $ 796.14 TOTAL EACH VEHICLE PREMIUM SUMMARY VEHICLE COVERAGES -CONTINUED - P 0 BOX 515097, LOS ANGELES, CA 90051 SA- 1697/EP 9/90 11� Page 1 of 2 TOTAL $ 883.24 2008 BMW $ 796.14 2014 HOND 883.24 PREMIUM $ 1,679.38 -1 �'^\ DATE PREPARED: AUG. 18 2t�YV "" REPRINI ED FROM TI IS ARCHIVE. THE ORIGINAL. IRANSACTiON MAY INCLUDE ADDITIONAL FORMS '"" Me Insurance,. :A ub""y hl ,en ltlI Camrmnu POLICY NUMBER: UA3442004 SAFECO INSURANCE COMPANY OF AMERICA PERSONAL UMBRELLA POLICY DECLARATIONS INSURED: AGENT: MAUREEN SASSODN N11C INSURANCE SERVICES INC PO BOX 2028 796 W 9TH ST PALOS VERDES PEN CA 90274 -8028 SAN PEDRO CA 90731 -3602 1- 310 - 221 -0917 SCHEDULE OF UNDERLYING INSURANCE: You, as defined in the policy contract, agree: 1) that insurance policies providing the coverages specified on the back of these declarations, if applicable, are in force and will be maintained in force as collectible insurance for at least the required minimum limits stated. 2) to insure all motor vehicles owned, leased by or used by you. 3) to insure all residence premises owned, leased by or leased to you. 4) to insure all recreational vehicles owned, leased by or used by you. 5) to insure all watercraft owned by you. COVERAGES I PREMIUM Basic premium - includes one automobile and primary residence $ 218,00 In Home Business Coverage $ 30.00 1 Additional automobile in the household $ 83.00 2 Rental units $ 26.00 TOTAL ANNUAL PREMIUM $ 357.00 You may pa your premium in full or in installments. There is no installment fee for the following billing plans: Full Pay, Annual 2 -Pay. Installment fees for all other billinec�� pplans are listed below. If more than one policy is billed on the installment bill, only the highest fee is charged. The fee is: $0.00 per installment for recurring automatic deduction (EFT) $0.00 per installment for recurring credit card or debit card $5.00 per installment for all other payment methods ENDORSEMENTS APPLICABLE TO THIS POLICY: In -Home Business Liability Coverage PLEASE SEE REVERSE OR:I:CINAL DATE PREPARED 5EPT 0 2015 P-i075 /EP 3 /14 qjA fn POLICY PERIOD FROM: JUNE 27 2015 RESIDFNrF PRFMtRFR� TO: JUNE 27 2016 RCH PALOS VRD CA 90275 -2228 CHANGED AS OFSEPT 1 2015 at 12:01 A.M. Standard time at the address of the insured as stated herein. RETAINED LIMIT: $250 LIMIT OF LIABILITY: $1,000,000 SCHEDULE OF UNDERLYING INSURANCE: You, as defined in the policy contract, agree: 1) that insurance policies providing the coverages specified on the back of these declarations, if applicable, are in force and will be maintained in force as collectible insurance for at least the required minimum limits stated. 2) to insure all motor vehicles owned, leased by or used by you. 3) to insure all residence premises owned, leased by or leased to you. 4) to insure all recreational vehicles owned, leased by or used by you. 5) to insure all watercraft owned by you. COVERAGES I PREMIUM Basic premium - includes one automobile and primary residence $ 218,00 In Home Business Coverage $ 30.00 1 Additional automobile in the household $ 83.00 2 Rental units $ 26.00 TOTAL ANNUAL PREMIUM $ 357.00 You may pa your premium in full or in installments. There is no installment fee for the following billing plans: Full Pay, Annual 2 -Pay. Installment fees for all other billinec�� pplans are listed below. If more than one policy is billed on the installment bill, only the highest fee is charged. The fee is: $0.00 per installment for recurring automatic deduction (EFT) $0.00 per installment for recurring credit card or debit card $5.00 per installment for all other payment methods ENDORSEMENTS APPLICABLE TO THIS POLICY: In -Home Business Liability Coverage PLEASE SEE REVERSE OR:I:CINAL DATE PREPARED 5EPT 0 2015 P-i075 /EP 3 /14 qjA fn "" REPRINTED FROM THE ARCHIVE, THE ORIGINAL TRANSACTION MAY INCLUDE ADDITIONAL FORMS "" Type of Policy Required Minimum Limits Automobile /Motor Vehicle Liability Bodily Injury 500,000 each person/ (Including motor homes) and 500,000 each occurrence Property Damage 100,000 each occurrence Comprehensive Personal Liability Single Limit 300,000 each occurrence Premises Liability Single Limit 300,000 each occurrence Motorcycle Liability Single Limit 500,000 each occurrence or Bodily Injury - 250,000 each person/ and - 500,000 each Occurrence Property Damage - 100,000 each occurrence Recreation Vehicle Liability Single Limit - 300,000 each occurrence or Bodily Injury - 250,000 each person/ and - 500,000 each occurrence Properly Damage - 100,000 each occurrence Watercraft Liability 1. a. Powerboats 32 feet or more in length; or b. Sailing vessels (with or without auxiliary power) 26 feet or more in length Single Limit - 500,000 each occurrence 2. All other watercraft Single Limit - 300,000 each occurrence or Bodily Injury - 250,000 each person/ and - 500,000 each occurrence Property Damage - 100,000 each occurrence Incidental Farm Coverage Single Limit - 300,000 each occurrence jv-Zo /s=I ?� DRMAU -1 OP ID: C6 A . OF LIABILITY INSURANCE 16 DATE(M as11712o7120 1 6 I 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 Wan 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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Brakke Schafnitz Ins. Brokers License #OK07568 Wilshire Blvd. 94 NAMECT Carole S. Mitchell PHONE 310- 524 -1357 aie, No :949- 313 -3323 Arc Na E E -MAIL ADDRESS: Carole.mitchell @sig.us 9 4401 1 Sa nta Monica, CA 9 Santa Darla Gray INSURERS) AFFORDING COVERAGE NAIC # INSURER A: Westchester Surplus Lines Ins INSURED Dr. Maureen Sassoon P O Box 2028 Palos Verdes Peninsula, CA 90274 INSURERB: EACH OCCURRENCE INSURERC: CLAIMS -MADE OCCUR X X INSURER D: 0710112016 INSURER E : PREMISES Ea occurrence INSURER F; X COVERAGES CERTIFICATE NUMBER: 1 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 CONTRACTOR 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. INSR LTR TYPE OF INSURANCE DL UBR WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR X X 624270427005 0710112016 0710712077 PREMISES Ea occurrence $ 50,000 X Add'I Insured MED EXP (Any one person) $ 5,00 X Prof & Pollut -CLM PERSONAL &ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY 1 PRO- 71 LOG JECT $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANYAUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS NON -OWNED HIREDAUTOS AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE UED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE PER TH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ OFFICER/MEMBER EXCLUDED? ❑NIA (Mandatory in NH) E.L. DISEASE - POLICY LIMIT $ It yes, describe under DESCRIPTION OF OPERATIONS below A Professional Liab. G24270427005 07/01/2016 07101/2017 Prof.Liab 1,000,00 A Contractors Pall. G24270427005 0710112016 07/0112017 Pollution 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1a1, Additional Remarks Schedule, may be attached if more space Is required) Policy Provides 30 days notice of cancellation except 10 days for nonpayment Applicable Endorsements Attached where required by Written Contract -E mailed to: SMorales5@santa- ana.org CERTIFICATE HOLDER CANCELLATION CSANTAA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana Y ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Briza Moraies,Risk Mngr P.O. BOX 1988 AUTHORIZED REPRESENTATIVE Santa Ana, CA 92702 ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD� Darned insured > ndorsement Number Dr. Maureen Sassoon Policy Symbol Policy Number Policy Period Effective Date of Endorsement ECP 07/0112016 to 0710112017 0710112016 Issued By (Name of insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT - OWNERS, LESSEES OR CONTRACTORS (PRIMARY AND NON - CONTRIBUTORY) This endorsement modifies insurance provided under the following: COMMERCIAL_ GENERAL LIABILITY COVERAGE CONTRACTOR'S POLLUTION LIABILITY COVERAGE SCHEDULE: Name of Person or Organization: Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you, wherein such request is made prior to commencement of operations. no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) SECTION 11 - WHO IS AN INSURED is amended to include: A. SECTION 11 - WHO IS AN INSURED is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that Insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to bodily injury or property damage occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2) That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. The coverage provided hereunder shall be primary and not contributing with any other insurance available to those designated above under any other third party liability policy. ENV -3101 (08 -04) Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 1 Named Insured EndarsementNumber Dr. Maureen Sassoon Policy Symbol Policy Number Policy Period Effective Rate of Endorsement ECP 07/09/2096 to 07/0112017 07/01/2016 Issued By (Name of insurance Company) Westchester Surplus Lines Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: Any person or organization that is an owner of real property or personal property on which you are performing operations, or a contractor on whose behalf you are performing operations, and only at the specific written request of such person or organization to you, wherein such request is made prior to commencement of operations. (If no entry appears above, information required to complete Mis endorserent Will De snown in We ueciarauUcr5 ct5 cIPP,Llir�- .v Ll� endorsement_) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or your work done under a contract with that person or organization and included in the products - completed operations Lazard. This waiver applies only to the person or organization shown in the Schedule above. All other terms and conditions remain the same. A3 ENV -3143 (03 -05) Includes copyrighted material of Insurance Services Office, Inc_ with its permission Page 1 of 1 ?i>-01