The URL can be used to link to this page

Home My WebLink AboutHERNANDEZ, FELICE STINSON (2)-2017CC m PIE FraP 9/2311Y i0dRANCE L0 ON FILE , _ N-2017-077-01 WORK MAY NOT PROCEED., — ®CLERK OF COUNCIL (a� DATE: XT1 a zoii FIRST AMENDMENT TO AGREEMENT TO PROVIDE O: SAPD (B COUNSELING SERVICES AND INSTRUCTIONAL SERVICES Fiscal TO INMATES AT THE SANTA ANA JAIL THIS FIRST AMENDMENT to the above referenced agreement is entered into this 21" day of August, 2017, between Felice Stinson Hernandez (hereinafter "Consultant") and the City of Santa Ana, a charter city and municipal corporation of the State of California ("City"). RECITALS A. The parties entered into an agreement N-2017-077, dated July 1, 2017, ("Agreement") by which Consultant agreed to provide counseling and instructional services to inmates at the Santa Ana Jail. B. The original compensation of the Agreement for services provided by the Consultant was listed with a total not -to -exceed amount of $10,000. C. In accordance with the terms and conditions of the Agreement, the parties wish to amend the compensation amount to reflect an increase in expected inmates during the term of the Agreement so that services may continue to be provided. No other terms will be amended. The Parties therefor agree: 1. Section 2a, Compensation, is amended to read as follows: City agrees to pay, and Consultant agrees to accept as total payment for services an hourly rate of thirty seven dollars ($37.00) for all scheduled instructional and counseling sessions. The total sum to be expended shall not exceed $25,000 during the term of the Agreement. 2. Except as hereinabove modified, all terms and conditions of said Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Amendment to Agreement on the date and year first written above. ATTEST: 0-11 a I MW CITY OF SANTA ANA Raul Godinez II City Manager --signatures continued on next page-- First Amendment to Agreement N-2017-077 Signature Page APPROVED AS TO FORM.: SONIA R. CARVAL City JAomeyBy: Tamogosian Assistant City Attomey APPROVED AS TO CONTENT: _ DaYAAALntin Acting Chief of Police N-2017-077-01 L HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP (Certifli of Inqurflure OCCURRENCE POLICY FORM Print Date: 9/13/2017 Producer Branch Prefix Policy Number Policy Period 018098 970 HPG 0619799393 from 09/23/17 to 09/23/18 at 12:01 AM Standard Time Named Insured and Address: Program Administered by: Felice R Hernandez Healthcare Providers Service Organization 320 S Pixley St 159 E. County Line Road Orange, CA 92868-4030 Hatboro, PA 19040-1218 1-800-982-9491 www.hpso,com Medical Specialty: Code: Insurance is provided by: Rehabilitation Counselor 80723 American Casualty Company of Reading, Pennsylvania 333 S. Wabash Avenue, Chicago, IL 60604 Excludes Cosmetic Procedures Professional Liability $1,000,000 each claim $ 3,000,000 aggregate Your professional liability limits shown above include the following, * Good Samaritan Liability * Malplacement Liability * Personal Injury Liability Sexual Misconduct Included in the PL limit shown above subject to $ 25,000 aggregate sublimit Coverage Extensions License Protection $25,000 per proceeding $25,000 aggregate Defendant Expense Benefit $ 1,000 per day limit $ 25,000 aggregate Deposition Representation $ 10,000 perdepusition $ 10,000 aggregate Assault $ 25,000 per incident $ 25,000 aggregate Includes Workplace Violence Counseling Medical Payments $ 25,000 per person $ 100,000 aggregate First Aid $ 10,000 per Incident $ 10,000 aggregate Damage to Property of Others $ 10,000 per incident $ 10,000 aggregate Information Privacy (HIPAA) Fines and Penalties $ 25,000 per incident $ 25,000 aggregate Workplace Liability Workplace Liability Included in Professional Liability Limit shown above Fire & Water Legal Liability Included in the PL limit shown above subject to $150,000 aggregate sublimil Personal Liability $1,000,000 aggregate Total: $ 124.00 Base Premium $124.00 Premium reflects Self Employed , Part Time l C��^ ^ 10_ ( 1 Policy Forms & Endorsements (Please see attached fist for a general description of many common policy forms and endorsements.) G -121500-D G -121503-C G -121501-C1 G -145184-A G -147292-A GSL15563 GSL15564 GSL15565 GSL17101 GSL13424 CNA80051 CNA80052 G -123846-D04 CNA81753 CNA81758 ONA82011 CNA79575 Keep this document in a safe place. It (� p and proof of payment are your proof \� Ij�'",Vp_/�V, II"�V C11• tv1 �` coverage. There is no coverage in force v unless the premium is paid in fuX in order to activate your coverage, please remit Chairman of th Board Secretary premium in full by the effective date of this Certificate of insurance. Master Policy # 188711433 G -141241-B (03/2010) Coverage Change Date: Endorsement Change Date: P-Q-LSC_Y_FORMS . & ENDORSEMENTS The following are the policy forms and endorsements that apply to your current professional Ilability insurance policy COMMON POLICY FORMS& ENDORSEMENTS FORM # QE$CRIPTION G-1 21500-1) Common Policy Conditions G -121503-C Workplace Liability Form G421501-01 Occurrence Policy Form - California G -145184-A Policyholder Notice - OFAC Compliance Notice G -147292-A Policyholder Notice - Silica, Mold & Asbestos Disclosure GSL15563 Information Privacy Coverage Endorsement HIPAA Fines, Penalties & Notification Costs GSL15564 Sexual Misconduct Sublimits of Liability Professional Liability & Sexual Misconduct Exclusion GSL15565 Healthcare Providers Professional Liability Assault Coverage GSL17101 Exclusion of Specified Activities Reuse of Parenteral Devices and Supplies GSLI3424 Services to Animals CNA80051 Amended Definition of Personal Injury Endorsement CNA80052 Distribution or Recording of Material or Information in Violation of Law Exclusion Endorsement G -123846-D04 California Cancellation and Non -Renewal ONA81753 Coverage & Cap on Losses from Certified Acts Terrorism CNA81758 Notice - Offer of Terrorism Coverage & Disclosure of Premium CNA82011 Related Claims Endorsement CNA79575 Exclusion of Cosmetic Procedures PLEASE REFER TO YOURCERTIFICATE OF INSURANCE FOR THE POLICY FORMS & ENDORSEMENTS SPECIFIC TO YOUR STATE AND YOUR POLICY PERIOD. For NJ residents: The PLIGA surcharge shown on the Certificate of Insurance is the NJ Property & Liability Insurance Guaranty Association, For KY residents: The Surcharge shown on the Certificate of Insurance Is the KY Firefighters and Law Enforcement Foundation Program Fund and the KY LGPT is the KY Local Government Premium Tax which includes charges at a municipality andlor county level. For WV residents: The surcharge shown on the Certificate of Insurance is the WV Premium Surcharge, For FL residents: The FIGA Assessment shown on the Certificate of Insurance is the FL Insurance Guaranty Association - 2012 Regular Assessment. Form#: G-141241-8 (03/2010) Named Insured:Felice R Hernandez Master Policy#:188711433 Policy#:0619799393