HomeMy WebLinkAboutBOSCH, WESLEY A., M.A. MFT-2017INSURANCE NOT ON FILE
WORK MAY NOT PROCEED N-2017-246
CLERK OF COUNCIL
DATE; AGREEMENT TO PROVIDE ASSESSMENTS OF
d-. coA (o) SKILL LEVELS AND SERVICES
THIS AGREEMENT is made and entered into this 27 day of November, 2017, by and between
Wesley A. Bosch, MA MFT ("Consultant'), and the City of Santa Ana, a charter city and
municipal corporation organized and existing under the Constitution and laws of the State of
California ("City").
RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
comprehensive and specialized assessments of skill levels and service needs of adults,
youth, and dislocated workers, such as diagnostic testing and use of assessment tools; and
in-depth interviewing and evaluation to identify employment barriers and appropriate
employment goals.
B. Consultant represents that Consultant is able and willing to provide such services to the
City.
C. In undertaking the performance of this Agreement, Consultant represents that it is
knowledgeable in its field and that any services performed by Consultant under this
Agreement will be performed in compliance with such standards as may reasonably be
expected from a professional consulting firm in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the
terms and conditions hereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
Consultant shall perform during the term of this Agreement, the tasks and obligations,
including all labor, materials, tools, equipment, and incidental customary work, required to fully
and adequately complete the services described and set forth in Exhibit A, attached hereto and
incorporated by reference.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services,
the rates and charges for 2017-2018 identified in Exhibit B, attached hereto and
incorporated by reference. The total amount of the Agreement shall not exceed
$25,000.
b. Payment by City shall be made within forty-five (45) days following receipt of proper
invoice evidencing work performed, subject to City accounting procedures. Payment
need not be made for work which fails to meet the standards of performance set forth
in the Recitals which may reasonably be expected by City.
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3. TERM
This Agreement shall commence on the date first written above and continue for a one
(1) year period, unless terminated earlier in accordance with Section 15 below.
4. INDEPENDENT CONTRACTOR
Consultant shall, during the entire term of this Agreement, be construed to be an
independent contractor and not an employee of the City. This Agreement is not intended nor
shall it be construed to create an employer-employee relationship, a joint venture relationship, or
to allow the City to exercise discretion or control over the professional manner in which
Consultant performs the services which are the subject matter of this Agreement; however, the
services to be provided by Consultant shall be provided in a manner consistent with all
applicable standards and regulations governing such services. Consultant shall pay all salaries
and wages, employer's social security taxes, unemployment insurance and similar taxes relating
to employees and shall be responsible for all applicable withholding taxes.
5. OWNERSHIP OF MATERIALS
This Agreement creates a non-exclusive and perpetual license for City to copy, use,
modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property
embodied in plans, specifications, studies, drawings, estimates, and other documents or works of
authorship fixed in any tangible medium of expression, including but not limited to, physical
drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared
or caused to be prepared by Consultant under this Agreement ("Documents & Data").
Consultant shall require all subcontractors to agree in writing that City is granted a non-exclusive
and perpetual license for any Documents & Data the subcontractor prepares under this
Agreement. Consultant represents and warrants that Consultant has the legal right to license any
and all Documents & Data. Consultant makes no such representation and warranty in regard to
Documents & Data which were provided to Consultant by the City. City shall not be limited in
any way in its use of the Documents and Data at any time, provided that any such use not within
the purposes intended by this Agreement shall be at City's sole risk.
6. INSURANCE
Prior to undertaking performance of work under this Agreement, Consultant shall
maintain and shall require its subcontractors, if any, to obtain and maintain insurance as
described below:
a. Commercial General Liability Insurance. Consultant shall maintain commercial
general liability insurance naming the City, its officers, employees, agents,
volunteers and representatives as additional insured(s) and shall include, but not
be limited to protection against claims arising from bodily and personal injury,
including death resulting therefrom and damage to property, resulting from any
act or occurrence arising out of Consultant's operations in the performance of this
Agreement, including, without limitation, acts involving vehicles. The amounts
of insurance shall be not less than the following: single limit coverage applying to
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bodily and personal injury, including death resulting therefrom, and property
damage, in the total amount of $1,000,000 per occurrence, with $2,000,000 in the
aggregate. Such insurance shall (a) name the City, its officers, employees, agents,
and representatives as additional insured(s); (b) be primary and not contributory
with respect to insurance or self-insurance programs maintained by the City; and
(c) contain standard separation of insureds provisions.
b. Business automobile liability insurance, or equivalent form, with a combined
single limit of not less than $1,000,000 per occurrence. Such insurance shall
include coverage for owned, hired and non -owned automobiles.
C. Worker's Compensation Insurance. In accordance with the provisions of Section
3700 of the Labor Code, Consultant, if Consultant has any employees, is required
to be insured against liability for worker's compensation or to undertake self-
insurance. Prior to commencing the performance of the work under this
Agreement, Consultant agrees to obtain and maintain any employer's liability
insurance with limits not less than $1,000,000 per accident.
d. If Consultant is or employs a licensed professional such as an architect or
engineer: Professional liability (errors and omissions) insurance, with a combined
single limit of not less than $1,000,000 per claim with $2,000,000 in the
aggregate.
C. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section:
i. Consultant shall maintain all insurance required above in full force and
effect for the entire period covered by this Agreement.
ii. Certificates of insurance shall be furnished to the City upon execution of
this Agreement and shall be approved by the City.
iii. Certificates and policies shall state that the policies shall not be canceled
or reduced in coverage or changed in any other material aspect without
thirty (30) days prior written notice to the City.
iv. Consultant shall supply City with a fully executed additional insured
endorsement.
f If Consultant fails or refuses to produce or maintain the insurance required by this
section or fails or refuses to furnish the City with required proof that insurance
has been procured and is in force and paid for, the City shall have the right, at the
City's election, to forthwith terminate this Agreement. Such termination shall not
affect Consultant's right to be paid for its time and materials expended prior to
notification of termination. Consultant waives the right to receive compensation
and agrees to indemnify the City for any work performed prior to approval of
insurance by the City.
7. INDEMNIFICATION
Consultant agrees to defend, and shall indemnify and hold harmless the City, its officers,
agents, employees, contractors, special counsel, and representatives from liability: (1) for
personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of
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claims for personal injury, including death, and claims for property damage, which may arise
from the negligent operations of the Consultant, its subcontractors, agents, employees, or other
persons acting on its behalf which relates to the services described in section 1 of this
Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution,
judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement.
This indemnity and hold harmless agreement applies to all claims for damages, just
compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered,
by reason of the events referred to in this Section or by reason of the terms of, or effects, arising
from this Agreement. The Consultant further agrees to indemnify, hold harmless, and pay all
costs for the defense of the City, including fees and costs for special counsel to be selected by the
City, regarding any action by a third party challenging the validity of this Agreement, or
asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief
due to personal or property rights arises by reason of the terms of, or effects arising from this
Agreement. City may make all reasonable decisions with respect to its representation in any
legal proceeding. Notwithstanding the foregoing, to the extent Consultant's services are subject
to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by
Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence,
recklessness, or willful misconduct of the Consultant.
8. INTELLECTUAL PROPERTY INDEMNIFICATION
Consultant shall defend and indemnify the City, its officers, agents, representatives, and
employees against any and all liability, including costs, for infringement of any United States'
letters patent, trademark, or copyright infringement, including costs, contained in the work
product or documents provided by Consultant to the City pursuant to this Agreement.
0101ENORDIR&I
Consultant shall keep records and invoices in connection with the work to be performed
under this Agreement. Consultant shall maintain complete and accurate records with respect to
the costs incurred under this Agreement and any services, expenditures, and disbursements
charged to the City for a minimum period of three (3) years, or for any longer period required by
law, from the date of final payment to Consultant under this Agreement. All such records and
invoices shall be clearly identifiable. Consultant shall allow a representative of the City to
examine, audit, and make transcripts or copies of such records and any other documents created
pursuant to this Agreement during regular business hours. Consultant shall allow inspection of
all work, data, documents, proceedings, and activities related to this Agreement for a period of
three (3) years from the date of final payment to Consultant under this Agreement.
10. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Consultant agrees
that it shall not use or disclose such information except in the performance of this Agreement,
and further agrees to exercise the same degree of care it uses to protect its own information of
like importance, but in no event less than reasonable care. "Confidential Information" shall
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include all nonpublic information. Confidential information includes not only written
information, but also information transferred orally, visually, electronically, or by other means.
Confidential information disclosed to either party by any subsidiary and/or agent of the other
party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure
shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is,
through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful
possession of the Consultant without an obligation of confidentiality; (d) is required to be
disclosed by operation of law; or (e) is independently developed by the Consultant without
reference to information disclosed by the City.
11. CONFLICT OF INTEREST CLAUSE
Consultant covenants that it presently has no interests and shall not have interests, direct
or indirect, which would conflict in any manner with performance of services specified under
this Agreement.
12. DISCRIMINATION
Consultant shall not discriminate because of race, color, creed, religion, sex, marital
status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited
by applicable law, in the recruitment, selection, training, utilization, promotion, termination or
other employment related activities. Consultant affirms that it is an equal opportunity employer
and shall comply with all applicable federal, state and local laws and regulations.
13. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and
Consultant, and supersedes any and all other agreements, oral or written, between the parties. In
the event of a conflict between the terms of this Agreement and any attachments hereto, the
terms of this Agreement shall prevail. This Agreement may not be modified except by written
instrument signed by the City and by an authorized representative of Consultant. The parties
agree that any terms or conditions of any purchase order or other instrument that are inconsistent
with, or in addition to, the terms and conditions hereof, shall not bind or obligate Consultant or
the City. Each party to this Agreement acknowledges that no representations, inducements,
promises or agreements, orally or otherwise, have been made by any party, or anyone acting on
behalf of any party, which is not embodied herein.
14. ASSIGNMENT
Inasmuch as this Agreement is intended to secure the specialized services of Consultant,
Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior
written consent of the City and any such assignment, transfer, delegation or subcontract without
the City's prior written consent shall be considered null and void. Nothing in this Agreement
shall be construed to limit the City's ability to have any of the services which are the subject to
this Agreement performed by City personnel or by other consultants retained by City.
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15. TERMINATION
This Agreement may be terminated by the City upon thirty (30) days written notice of
termination. In such event, Consultant shall be entitled to receive and the City shall pay
Consultant compensation for all services performed by Consultant prior to receipt of such notice
of termination, subject to the following conditions:
a. As a condition of such payment, the Executive Director may require Consultant to
deliver to the City all work product(s) completed as of such date, and in such case
such work product shall be the property of the City unless prohibited by law, and
Consultant consents to the City's use thereof for such purposes as the City deems
appropriate.
b. Payment need not be made for work which fails to meet the standard of
performance specified in the Recitals of this Agreement.
16. WAIVER
No waiver of breach, failure of any condition, or any right or remedy contained in or
granted by the provisions of this Agreement shall be effective unless it is in writing and signed
by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or
right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether
or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies.
17. JURISDICTION - VENUE
This Agreement has been executed and delivered in the State of California and the
validity, interpretation, performance, and enforcement of any of the clauses of this Agreement
shall be determined and governed by the laws of the State of California. Both parties further
agree that Orange County, California, shall be the venue for any action or proceeding that may
be brought or arise out of, in connection with or by reason of this Agreement.
18. PROFESSIONAL LICENSES
Consultant shall, throughout the term of this Agreement, maintain all necessary licenses,
permits, approvals, waivers, and exemptions necessary for the provision of the services
hereunder and required by the laws and regulations of the United States, the State of California,
the City of Santa Ana and all other governmental agencies. Consultant shall notify the City
immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals,
waivers, and exemptions. Said inability shall be cause for termination of this Agreement.
19. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this
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Agreement shall be in writing and shall be deemed to be properly given if delivered in person or
mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic
communication in the manner provided in this Section, to the following persons:
To City:
Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Fax: 714- 647-6956
With courtesy copies to:
Executive Director,
Community Development Agency
City of Santa Ana
20 Civic Center Plaza (M-27)
P.O. Box 1988
Santa Ana, California 92702
Fax:
To Consultant:
Wesley A. Bosch, MA, MFT
24001 Muirlands Blvd., #331
Lake Forest, CA 92630
Fax: 949-829-4368
Sonia R. Carvalho
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, California 92702
Fax: 714- 647-6515
A party may change its address by giving notice in writing to the other party. Thereafter,
any communication shall be addressed and transmitted to the new address. If sent by mail,
communication shall be effective or deemed to have been given three (3) days after it has been
deposited in the United States mail, duly registered or certified, with postage prepaid, and
addressed as set forth above. If sent by fax, communication shall be effective or deemed to have
been given twenty-four (24) hours after the time set forth on the transmission report issued by the
transmitting facsimile machine, addressed as set forth above. For purposes of calculating these
time frames, weekends, federal, state, County or City holidays shall be excluded.
20. 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
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year hist
above written.
ATTEST:
Maria D. Huizar.
ei Clerk of the Council
APPROVER AS TO FORM:
SONIA R. CARVALHO
City Attgtigy ri
By:
Ryan
RECOMMENDER FOR APPROVAL:
ROBERT ZUR S H IED
Interim Executive rector
Community Development Agency
CITY OF SANTA ANA
Raul Godinez II
City Manager
CONSULTANT:
Wesley A. Bosch, MA, MFT
Page 8 of 10
_SCOPE OF SERVICES
A. Description
Comprehensive and specialized assessments of skill levels and service needs of adults,
youth, and dislocated workers, such as diagnostic testing and use of assessment tools; and
in-depth interviewing and evaluation to identify employment barriers and appropriate
employment goals.
Assessment means an examination of a customer's basic skills, occupational skills, prior
work experience, employability interests, aptitudes, supportive service needs, level of
commitment to gaining and retaining employment and/or reaching and maintaining economic
self-sufficiency.
Individuals referred to assessment will be enrolled into the WIOA program and receive
Career Services as prescribed by the WIOA, established by SAWC procedures, and
determined by SAWC staff.
B. Deliverable
Completed assessment packages may lead to the development of individual employment
plans to identify the employment goals, appropriate achievement objectives, and appropriate
combination of services to achieve the goals, In addition to hard copies of assessment
materials/tools employed, assessment packages must include a summary of assessment
results clearly identifying test scores, highlighting skill sets, and ranking program commitment
level and employability.
C. Type of Contract and Method of Payment
Cost reimbursement based on individual referrals will be the type of contract and method of
payment determined at the time of final selections of contractors.
II. aQOPE OF WORK
The comprehensive skills assessment for participants must:
• Examine the capabilities, needs and vocational potential of participants;
• As a process, be useful to ascertain an individual's skill levels and needs for
referrals to appropriate training and educational programs leading to employment;
• Be a source of information and a foundation to develop the client specific individual
employment plan;
• Be client centered and, at a minimum, take into account the participant's:
City of Santa Ana WORK Center
Request for Qualifications for Assessment Services
Page 11
o Family situation;
o Education;
o Basic educational skill;
o Prior work experience and skills;
a Occupational skills;
o Life circumstances of barriers to participation in training and/or work;
o Employability (attitude towards work, motivation, work maturity skills, financial
resources and needs;
o Interest, career goals and aptitudes (including non-traditional jobs);
0 Supportive service needs; and
o Personal employment information relating to the local labor market.
Both the assessment system and personnel providing the services must be capable of serving a
diversified population and their particular needs.
City of Santa Ana WORK Center
Request for Qualifications for Assessment Services
Page 12
WATIi
PROPOSERS STATEMENT Atm FEE SCHEDULE
CERTIFICATION
I certify that I have read, understand and agree to the terms and conditions of this Request for
Proposals. I have examined the Scope of Services (Exhibit A) and I am familiar with the scope of work
requirements. I am familiar with all of the existing conditions and limitations that may Impact work
requests. I understand and agree that I am responsible for reporting any errors, omissions or
discrepancies to the City for clarification prior to the submission of my proposal.
PEE SCHEDULE
Please provide a description of vocational evaluation or assessment services that the company has provided
and can provide to the City, along with a proposed fee schedule.
LEGAL NAME OF
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AUTHORIZED AGENT
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SIGNATURE OF/AUTHOiZIZED AGENT DATE E-MAILADDRESS
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FEDERAL ID NO. (IF APPLICABLE) CONTRACTOR LICENSE NO. (IF APPLICABLE)
City of Santa Ana WORK Center
Request for Qualifications for Assessment Services
Page 13
Wesley Bosch, MA, MFT
EXHIBIT B
Fee Schedule
Vocational Assessment fees:
The 2 -day full objective, assessment cost per person:
2017-2018 -- $240
2018.2019 ,- $241
2019-2020 -- $242
The modified assessment cost per person:
2017-2018 •- $175
2018-2019 -- $176
2019-2020 -- $177
Basic Skills -only testing when requested by case manager: $40 - $80, depending on partial or
hull testing.
Although not requested in this RPQ, in the outside possibility of a request by the Work Center
director for miscellaneous additional activities, the fee would be: $45 per hour.
Certificate of Insurance (Proof of Coverage) Date Issued: 11/09/2017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,
THIS CERTIFICATE DOES NOT AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Insured Name and Mailing Address*
Cancellation
Program Administrator
Wesley A Dosch
Employees
Administered By:
24331 Muirlands Blvd #D4-123
notice will be delivered in accordance with the policy provisions.
CPH and Associates
N-2017-246
Holder has also been added to the policy as an additional insured:**
[ 3� Yes/No ]
711 S. Dearborn, Suite 205
Lake Forest, CA 92630
/Y
' P
Chicago, IL 60605
P.312-987-9823 F.312-987-0902
endorsed. A statement on this certificate does not confer rights to the certificate holder
*Additional insured locations are often requested by individual business owners who have more than
'nL fql< hius com
one office. Your coverage is portable, meaning that you are covered at any location for practice under
Underwritten By:
he occupation(s) listed on your policy.
Philadelphia Indemnity Insurance
Company
Coverage
Policy #:081041 IEffective Date: 08/21/2017
[Expiration Date: 08/21/2018
HE 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 BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Limits of Liability
EACH OCCURRENCE AGGREGATE
Coverage Part
(Per individual claim) (Total amount per policy year
$1,000,000 $3,00 000
Professional Liability
Commercial General Liability
$1,000,000 $3,000,000
Includes: General Liability, Fire & Water Legal Liability
and Personal Liability
N/A N/A
Pr2gerty Coverage
$1000,000 $3,000,000
Supplemental Liabili
Unlimited Unlimited
Defense Expense Coverage
$35,000 $35,000
State Licensing Board Investigation Defense Coverage
$15,000 $15,000
Assault Coverage
$10,000 $35,000
Deposition Expense Benefit
$5,000/person $50,000
Medical Ex ense Coverage
$15,000 $15,000
First Aid Coverage
Description/Special Provisions:
General Liability Insured Location(s):
25283 Cabot Rd., Ste. 204 Lacuna Hills, CA 92653 : 1000 E. Santa Ann Blvd.. Ste. 200 Santa Ana, CA 92701
Certificate Holder
Cancellation
City of Santa Ana, its Officers, Agents, and
Employees
Should any of the above described policies be cancelled before the expiration date thereof,
0 Civic Center Plaza
notice will be delivered in accordance with the policy provisions.
Santa Ana, CA 92702
Holder has also been added to the policy as an additional insured:**
[ 3� Yes/No ]
t
j
wore
/Y
' P
**If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be
endorsed. A statement on this certificate does not confer rights to the certificate holder
Authorized Representative
in lieu of such endorsement(s).
C. Philip Hodson
DISCLAIMER:The Certificate of Insurance does not constitute a contract between the issuing Insurer(s), authorized representative or producer, and
the certificate holder, nor does It affirmatively or negatively amend, extend, or alter the coverage afforded by the policies listed thereon.
Additional Insured - Lessor Endorsement
This endorsement modifies insurance provided under the following:
ALLIED HEALTHCARE PROVIDERS PROFESSIONAL
AND SUPPLEMENTAL LIABILITY POLICY
In consideration of the premium paid, this policy is amended as follows
Section III. Insured is amended to include the following entity or entities as an additional Insured, but only
with respect to their liability arising of the Insured's use, operation, or maintenance of the premises listed (if
different from mailing address in the Declarations).
Additional Insured Name and Mailing Address:
City of Santa Ana, its Officers, Agents, and Employees
20 Civic Center Plaza
Santa Ana, CA, 92702
Premises Address (if different from mailing address shown on the Declarations)
"Revised, effective 11/08/2017, at no additional premium. at the premium of $0.00
All other terms and conditions of this policy remain unchanged. This endorsement is part of your policy and
takes effect on the effective date of your Policy, unless another effective date is shown below.
Policy: 081041
Effective on and after: 11/08/2017
Issued to: Wesley A Bosch
Expiration date: 08/21/2018
PI-PHCP-03 (07/10)
By: Robert O'Leary, Authorized Representative
UO
Lic No: LMFI' 16179 Wesley A. Bosch, MA, MFT
24001 Muirlands Blvd., #331
Lake Forest, Ca 92630
November 9, 2017
City of Santa Ana
Santa Ana WORK Center
1000 E. Santa Ana Blvd., Suite 200
Santa Ana, Ca 92701
To Whom It May Concern:
WboschMFT(@Emaii.com
(949) 357-4207
I, Wesley A. Bosch, certify that I will immediately notify the City of Santa Ana of any
changes in or cancellation of my professional liability insurance policy. My policy
number is 081041. The policy is underwritten by Philadelphia Indemnity Insurance
Company and administered by CPH and Associates.
Wesley A. Bosch, MA, MFT