HomeMy WebLinkAboutCOUNSELING TEAM INTERNATIONAL, THE (2) - 2017COMPL t E
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Fiscal AGREEMENT TO PROVIDE PSYCHOLOGICAL EVALUATIONS
FOR THE CITY OF SANTA ANA POLICE DEPARTMENT
N-2017-251
THIS AGREEMENT is made and entered into this 1st day of October, 2017 by and between
Counseling Team International, ("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
providing psychological evaluations for the City's Police Department.
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
terns 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 fiilly
and adequately complete the psychological evaluation services described and set forth in Scope of
Services - 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 for
City, the rates and charges identified in Compensation - Exhibit A. The total sum to
be expended under this Agreement shall not exceed $18,882.
b. Payment by City shall be made within 45 days (forty-five) 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.
3. TERM
This Agreement shall commence on the October 1, 2017 for a six (6) month term, unless
terminated earlier in accordance with Section 15, below.
4. INDEPENDENT CONTRACTOR
Consultant shall, during the entire tern 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. 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
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 perfonnance 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.
e. 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 'inured
endorsement.
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.
6. 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 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 I 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 terns 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 terns 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.
7. RECORDS
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.
8. 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 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.
9. 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.
10. 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.
11. 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 terns
of this Agreement shall prevail. This Agreement may not be modified exceptby 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.
12. 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.
13. TERMINATION
This Agreement may be tenninated 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.
14. 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.
15. 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.
16. 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.
17. 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 terns 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.
18. NOTICE
Any notice, tender, demand, delivery, or other communication pursuant to this 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 maturer 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:
Chief of Police
Santa Ana Police Department
20 Civic Center Plaza (M-97)
P.O. Box 1981
Santa Ana, California 92702
Fax: 714-245-8090
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
N-2017-251
To Consultant:
Nancy K. Bold, Inc. dba The Counseling Team International
1881 Business Center Drive, Ste. I 1
San Bernardino, CA 92408
Fax: 909-384-0734
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, com nunication 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.
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first
above written.
ATTEST:
Maria D. Huizar
Clerk of the Council
APPROVED AS TO FORM:
SONIA R. CARV
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
__ZA-V L1FrCrA ENTIN
Acting Chief of Police
Santa Ana Police Department
CITY OF SANTA ANA
y , �
Raul Godinez�tIJ
City Manager
CONSULTANT:
EXHIBIT A
SCOPE OF SERVICES and COMPENSATION
EXHIBIT A
SCOPE OF SERVICES
Comolete Pre-emnlovment Psychological Evaluation
Consultant agrees to perform a complete pre-employment psychological evaluation for City's
Police Department applicants. Said psychological evaluation shall comply with the California
Peace Officer's Standards and Training (P,O.S.T,) Psychological Screening Manual, as well as
any additional psychological suitability criteria specified by City's Police Department and agreed
to by Consultant.
a. For the purpose of this Agreement, a complete pre-employment psychological evaluation
includes, but is not limited to a clinical interview, administration of necessary tests,
scoring of tests and preparing verbal and written recommendations for employment.
b, Consultant agrees to provide City's Police Department with verbal recommendation of
the candidate's psychological suitability for the classification of Police Officer as well as
other classifications within the Police Department within two (2) working days of said
candidate's clinical interview.
Consultant agrees to provide City's Police Department with a written report of the
candidate's psychological suitability for the classification of Police Officer as well as
other classifications within the Police Department within five (5) working days of the
candidate's clinical interview.
d. Consultant ,agrees to complete required continuing professional education (CPE)
requirements.
Complete Post -Traumatic Psychological Incident Evaluation
Consultant agrees to give City's Police Department Employees involved in violent incidents,
such as a life-threatening situation and/or serious injury or death to any person, complete post-
traumatic psychological evaluation.
a. A complete post-traumatic psychological incident evaluation includes, but is not
limited to, clinical interview and post-traumatic counseling.
b. Initial psychological service contact with Involved officers) shall be made
immediately if possible, but no later than forty-eight (48) hours following the
incident.
C. A minimum of three (3) follow-up counseling sessions shall follow, if the Consultant
deems those sessions necessary. Such follow-up sessions shall, whenever possible
and practical, be scheduled by Consultant at Consultant's Orange County office
locations, unless otherwise agreed by involved officer(s).
d. If Consultant deems immediate follow-up counseling sessions are not indicated,
Consultant shall schedule one (l) follow-up session within a period of not less that
fourteen (14) days and not more than thirty (30) days following the traumatic incident
with the involved officer(s) to assess whether additional sessions shall be deemed
necessary. Such sessions shall, whenever possible and practical, be scheduled at
Consultant's Orange County office locations unless otherwise agreed by involved
officer(s), Following such sessions Consultant shall provide City's Police
Department with verbal recommendation as to the necessity of additional sessions
and an assessment of officer(s) recommended duty status within forty-eight (48)
hours. A written psychological assessment of the officer(s) evaluated shall be
submitted within five (5) calendar days to the City's Police Department upon
completion of such follow-up counseling session(s).
e. Consultant shall provide City's Police Department with a verbal recommendation for
return of said officer(s) involved in traumatic incidents to full or modified duty status
as soon as possible and in no case later than forty-eight (48) hours following the
incident,
Consultant shall provide City's Police Department with a written psychological
assessment of officer(s) in question and a recommendation as to their suitability to
return to active duty, Rill or modified, and need for follow-up treatment within five
(5) days following the post-traumatic counseling session.
g, At the direction and with the consent of City's Police Department, Consultant shall
provide similar post traumatic incident counseling services to immediate family
members of involved officer(s) adversely impacted by the incident. The goal of such
services shall be to stabilize external factors which might otherwise affect officer(s)
return to duty or recovery and to determine if referral to other private service
providers is warranted. Verbal consultation with City's Police Department is
recommended but no written reports of family member counseling sessions are
required unless otherwise indicated or where the fitness for duty of the offrcer(s)
comes in doubt.
Crisis Interview Counselini
Consultant agrees to conduct crisis intervention counseling with authorization and approval of
City's Police Department when a Department employee(s) is believed to be gravely disabled as a
result of psychological disorder or emotional disturbance and unable to perform any or all of the
fall range of duties of an employee's classification,
a. Consultant agrees to obtain authorization from City's Chief of Police or designate
prior to conducting crisis intervention counseling of City's Police Department
employee(s). Should intervention be requested by employee and not Department,
Consultant agrees to obtain authorization from City's Chief of Police or designate
prior to conducting crisis intervention counseling.
SWAT Consultation
Consultant agrees to be on-call and to respond to SWAT call -outs as requested.
a. Consultant will provide consulting with the SWAT commander regarding
psychological profiles and recommended approach to specific suspects.
b. Consultant will assist in interpreting intelligence data in reference to SWAT call -out
and/or suspect.
COMPENSATION
In consideration for Consultant services, City shall pay Consultant an hourly rate as follows:
I. For complete pre-employment psychological evaluation, City agrees to pay
Consultant three hundred dollars ($300.00) per applicant.
2. For complete post-traumatic psychological incident review, and crisis intervention,
City agrees to pay Consultant the hourly rate of one hundred seventy-five dollars
($175.00).
3. Initial consultation for post -trauma incidents will be billed at a rate of ninety-five
dollars ($95.00) per hour.
4. For SWAT consultation and training, City agrees to pay Consultant the hourly rate of
one hundred seventy -fifty dollars ($175.00).
The total sum to be expended pursuant to this Agreement shall not exceed eighteen
thousand eight hundred and eighty-two dollars ($18,882) during the term of this
Agreement.
to
Certificate of Insurance(Proof of Coverage) Date Issued: 08/21/2017
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*
Program Administrator
Vaney K. BohlInc. dba The Counseling Teaminlernational
Administered By:
Vancy KBold -
CPH and Associates
1881 Business Center Drive h N
711 S. Dearborn, Suite 205
'an Bernardino. CA 92408
Chicago, IL 60605
P. 312-987-9823 F. 312-987-0902
*Additional Insured locations are often requested by individual business owners who have more than one
Infa gphin9:eom
office. Your coverage isportable, meaning thntyou are covered at any locationforpractice under life
Underwritten By:
occupation(s) listed on your policy.
Philadelphia Indemnity Insurance Company
Coverage
Polic #: 025826 lEffective Date: 08/31/2017
lExeiration Date: 08/31/201.4
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 CONTRAC-r 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
Coverage Part
EACHOCCURRENCE
AGGREGATE
(Per individual claim)
(Total amount per policy ear)
$1,000,000
$5,1100 000
Professional Liability
Commercial General Liability
N/A
N/A
Includes: General Liability, Fire & Water Legal Liability
and Personal Liability
N/A
N/A
Property Coverage
S 1.000,000
$5,000,000
Supplemental Liabilit
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
Dep ositton Exec se Benefit
S5,0001person
$50,000
Medical Expense Coverage
$15,000
$15,000
First Aid Coverage
U Civic Center Plaza SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Santa Ana, CA 92702 EXPIRATION DATE'rHEREOF, NOTICE WILL BE DELIVERED 1N ACCORDANCE WITH TH
POLICY PROVISIONS.
Bolder has also been added to the policy as nn additional insured:—
[ X Yes/Nu ] � f%
-*If the certificate holder is an ADDITIONAL. INSURED, the polleydes) must be t ice"
endorsed. A statement on this certificate does not confer rights to the certificate holder in Authorized Representative
lieu of such endersement(s). C. Phill e Hodson
DISCLAIMER:The Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and
the certilicate holden, nor does it affirmatively or negatively amend,, extend, at, alter the coverage afforded by the policies listed thereon.
ee.0!✓ary
G9 fJe/®7
THIS ENDORSEMENT CHANGED THE POLICY. PLEASE READ tT CAREFULLY
Additional Insured 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:
Santa Ana Police Department is hereby added as an Additional Insured, solely for Damages arising out
of a Professional Incident covered under this policy. The Professional Incident must arise out of
services provided by the Insured, under contract with Santa Ana Police Department.
Additional Insured Name and Mailing Address:
Santa Ana Police Department
60 Civic Center Plaza
Santa Ana, CA, 92702
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: 025826
Effective on and after: 08/31/2017
Issued to: Nancy K. Bohl Inc. dba The Counseling Team International
Expiration date: 08/31/2018
PI-PHCP-05 (03/01)
O
By: Robert O'Leary, Authorized Representative
CERTHOLDER COPY
P.O. BOX 8192, PLEASANTON, CA 94588
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 08-12-2017
SANTA ANA POLICY DEPARTMENT
ATTN: TAYLOR GEIL-CHIEFS OFFICE M-97
60 CIVIC CENTER PLZ
SANTA ANA CA 92701-4060
SP
GROUP:
POLICY NUMBER: 0702761-2017
CERTIFICATE ID: 38
CERTIFICATE EXPIRES: 08-12-2018
08-12-2017/08-12-2018
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named. below for the oolicv Deriod indicated.
This policy is not subject tocancellation by the Fund except upon 80 days advance written notice to the employer.
We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document
with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance
afforded by the
/policy
ydedescribed
�herein is subject to all the terms, exclusions,
and conditions, of such policy.
Authorized Representative% President and CEO
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2015-08-12 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED:
SANTA ANA POLICY DEPARTMENT
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-12-2011 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
NANCY K BOHL INC DBA: THE COUNSELING TEAM SP
INTERNATIONAL _
1881 BUS CTR DR STE 11
SAN BERNADINO CA 92408
M0408
IREv.7-20141 PRINTED : 07-17-2017
SP