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HomeMy WebLinkAboutREACH11151MIGE IWT fill FILE INORK MAY KT PROCEED CLERK OF CR4NCIL • t 201 REACH EMPLOYEE A-2017-241 ASSISTANCE PROGRAM SERVICES AGREEMENT 0`. vi-i-5 0 k`r ®(_ I4� his Employee Assistance Program Services Agreement is made and entered into as of _ day of August, 2017, between REACH Employee Assistance, Inc. (hereinafter referred to as "REACH"), a California corporation, 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 (hereafter referred to as "City".) Whereas REACH is engaged in the Employee Assistance Program Services business and desires to service City; and Whereas City desires to obtain the Employee Assistance Program Services of REACH. It is therefore agreed as follows: This is a contract for service outlining the duties and responsibilities of REACH Employee Assistance, Inc„ to the City of Santa Ana. 1. Below are listed the Scope of Services provided by the REACH: 1. Assessment/CounselinalReferral for Emolovees and Dependents. A total assessment will be administered for a well-rounded analysis of the client's problem. Employees and humediate family members are entitled to up to three (3) sessions per incident every six (6) months. REACH provides professional assessment/counseling to the point of referring the client to an outside counseling professional or agency. In addition, REACH provides follow-up consultation. The number of sessions offered, within this limit, will be at the sole discretion of the REACH counseling staff. The City will be assigned a REACH liaison person. REACH provides quality, experienced counselors knowledgeable in assessment skills to provide personal counseling to employees and immediate family members. REACH also provides qualified and experienced staff to assist management on all aspects of Employee Assistance Program. Dr Marcus Dayhoff is administratively, operationally and clinically responsible for REACH. A. Confidentiality and Release of Information As a general rule REACH shall not disclose to the City the identity of City employees or inunediate family members of City employees who elect to participate in the REACH Program offered under this Agreement. Exceptions Notwithstanding the above, REACH shall release to the City in writing the following information on employees who have been referred into the REACH Program as a condition of employment with the City: A) Whether employee bas agreed to participate in the Assistance Program. B) List of all appointments of employee kept and missed, together with reason, if any, for missing the appointment. C) Submission of the employee's anticipated treatment plan as a participant in the Program. This plan shall consist of the following: 1) The anticipated number of visits, appointments, or sessions requested of the employee. 2) The typo of therapeutic procedures in general terms that the employee is to receive during the employee's participation with the REACH Program or the treatment provider(s). 3) Description of the treatment service provider the employee is referred to by REACH. 4) Any other information not contained in the employee's treatment service provider medical record deemed appropriate by the City to evaluate the employee's participation in the Assistance Program. D) Any conclusion or opinion of REACH or employee's treatment service provider that the employee is limited or restricted in his/her ability to perform the employee's job duties, such limitation may be, but not necessary, limited to physical, psychological, or medical reasons. E) Any conclusion or opinion of REACH or employee's treatment service provider that employee's participation may necessitate employee's absence fi-om the City. F) That employee has failed, refused, or otherwise has discontinued to proceed with the REACH Program or any treatment service provider. G) Report consisting of the following: 1) Diagnosis 2) Summary of treatment or therapeutic procedures 3) Disabilities, limitations, or restrictions of employee 4) Recormnendation on further treatment. The above information shall be considered confidential information not subject to disclosure by REACH unless the City employee has on file with REACH and any treatment service provider in the REACH Program an irrevocable authorization(s), RELEASE OF INFORMATION to the City. On receipt of the City's request for the above information, REACH shall notify in writing, the City employee of the City's request. NOTE: The City agrees that in cases where an employee agrees to be referred by management to REACH, the Supervisor will seek written permission from the employee to inform REACH of the circumstances leading up to the referral. The City agrees to in no way insist or demand confidential information from the REACH program on specific individuals who do not want their information released to the City. Service Providers: Exceptions will also be made in cases when the employee and/or immediate family members sign a written release authorizing the release of information by REACH to one or more agreed upon service providers. 2. Definitions a. "Client" shall mean an employee or his/her immediate family member participating in the REACH EAP program. b. "Treatment Service Providers" or "Service Providers" shall mean an outside counseling professional or agency, referred by REACH, whose services will be paid by the client. 3. CounselinQ Hours REACH provides counseling hours from 8:00 a.m. to 8:00 p.m. Monday through Thursday, Friday 8:00 to 5:00 p.m. and will respond appropriately and effectively to employee needs. Every attempt will be made to see management referrals and employees in crisis as early as possible to the time of call and no later than 24 hours (during business hours) of the call being made. All other clients will be seen within 48 hours of the call being made. The City agrees to provide REACH with names and telephone numbers of liaison individual(s) at the City who can be contacted in cases of emergencies and keep REACH appraised of changes in contacts and telephone numbers. 4. 24-Hour Availability. 7 days a week REACH provides confidential intake and psycho -social assessment and counseling to the point of referral to employees and their irmrrediate family members with a 24 hour telephone service. REACH assures that no calls go unanswered and that all crisis callers receive courteous and prompt service. During non -business hours, all calls answered by the REACH answering service will be connected to the on -call counselor. The REACHline number is 1-800-273-5273. 5. Location Employees and family members will have a choice of counseling either at one of our several conveniently located offices or at one of our service provider's office. 3 6. Referral Network When necessary, REACH will refer employees and dependents to appropriate, cost effective, geographically convenient and high quality services provided by individuals and agencies which have been screened by our staff. Monitoring/Pollow-up REACH will monitor and follow-up as long as appropriate all people referred by the REACH program to outside individuals and community resources to assure the problem is resolved and that the person is satisfied with the quality of referrals. In cases of management referrals, REACH will also follow-up regularly with the City on status of job performance. 8. Service Utilization Reports REACH will provide quarterly confidential reports on service utilization, aggregate client profiles, assessed problems and outcome at case closure. Customer satisfaction reports will be available upon request by the City. 9. Benefits The City agrees to provide REACH with copies of all the City employee benefit plans and appraise REACH of all changes as they occur. 10. Avoiding Conflict of Interest REACH agrees to avoid conflict of interest by providing up to three (3) referrals to clients based on competency, geography and the most cost effective modality to deal with the client's problem(s). No referrals will be made to the private practices of REACH counseling staff members or to any private practitioner and/or agency with whom a REACH counselor has an economic relationship. Only the City can make exceptions to this rule. 11. Alcoholism and Chemical Dependency Intervention Services REACH provides job related alcoholism and chemical dependency intervention services as required. 12. Policy and Procedure The City agrees to consider implementing a policy and procedure statement on employee assistance when appropriate. REACH will provide technical assistance to the City staff in writing a policy and procedure statement on employee assistance. 0 13. Training REACH will provide Management and Supervisory training sessions annually. It is recommended that no more than 25 managers/supervisors attend each session. The purpose of these training sessions is to make managers and supervisors aware of City employee assistance program policy and procedures, of how to identify poor job performance as it relates to personal problems and to familiarize them with the processes of referrals and follow-up. The effectiveness of each training session will be evaluated. 14. Management Guidelines REACH supplies on request Management and Supervisor Employee Assistance Program guidelines for inclusion in City personnel management guidelines. 15. Manager/Supervisor Consultation and Assistance REACH will assist managers and supervisors calling REACHIine for consultation on how to deal with specific employee incidents or problems, which may require EAP intervention. The City agrees to encourage managers and supervisors to take advantage of this consultation service. 16. Program Promotion The City agrees to support REACH in developing a yearly EAP program promotion plan. a. EAP orientation classes for employees in groups of up to 50 will be available to the City as a means of introducing City EAP policy and procedures and utilization of REACH services. b. "Munch & Learn" presentations will be conducted periodically upon request by the City, at City locations to maximize utilization of REACH services. C. REACH brochure & REACHIine cards will be supplied to the City for distribution to all employees. d. REACH Frontline will be electronically supplied to the City quarterly for distribution to all supervisors. e. REACHline.eom will be available for online use to all employees and family rnembers. Employees will be supplied a password as mentioned on REACH employee brochure for online secure area access. f. REACHIIne Posters will be supplied from time to time to the City for posting on official staff bulletin boards. 5 g. Originals of promotional materials for inclusion as short articles in internal staff newsletter or as check stuffers will be supplied upon request by the City. h. REACH staff will participate at the City's employee benefit fair upon request. L REACH will assist with drafting of any EAP related materials to announce REACH services to employees. 17, Ouali REACH conducts on -going quality assurance audits on all aspects of the program from inception to end of the contract year. REACH will supply the City with quarterly reports. II. THE CITY OF SANTA ANA REALIZES AND UNDERSTANDS Top management support and commitment is essential to the success of the REACH Employee Assistance Program at the City of Santa Ana. 2. REACH is a totally confidential program. The City will only be aware of employees referred officially by management and information about that employee will not be released without written consent of the employee. 3. REACH will not, in all cases, be able to resolve the employee's or dependent's problem(s) in the set number of counseling sessions. In such cases the employee or family member will be referred to quality, cost effective resources available within the community. 4. Employees and dependents will not be charged for the services provided by REACH. If referrals are necessary, those referrals may result in additional cost to the City's benefit plan and may result in added costs to the employee or family member. The REACH program is made available to all fall- and part-time employees and their dependents. The REACH benefit starts on the first day of employment. 6. It is anticipated that the yearly employee utilization rate will be a minimum of 6-8%. The REACH promotional program will aim at achieving at least this utilization rate. III. TERMS AND CONDITIONS The Agreement period will be from January 1, 2018 to December 31, 2020, 2. The total cost to the City for the services to be provided to the City and its employees by REACH under this Agreement shall be $1.85 per full time employee per month, and $1.25 per part time employee per month, While the number of persons employed by the City may fluctuate fiom time to time during the term of this Agreement, the City agrees the amount of compensation payable to REACH during the tern of the Agreement shall be based on the number of persons employed by the City at the beginning of the month invoiced for. The beginning employee count will be 970 full time and 490 part time. The City will be invoiced on the first of each month for that month's installment. Checks will be made payable to REACH Employee Assistance, Inc. and mailed to 650 N. Rose Drive, 9350, Placentia, CA 92870 - Attn.: Accounts Receivable. 4. The City will make payment within 30 days from the date of the receipt of the invoice from REACH Employee Assistance, Inc. 5. REACH Employee Assistance, Inc. agrees to indemnify, defend, and hold harnless the City, its officers, employees, agents and representatives, from any and all claims, demands, purported liability, or consequential damages of any kind or nature arising out of or in connection with REACH's acts or omissions in carrying out the terns of this Agreement or exercising the rights herein granted; excepting those claims, demands, purported liability, or consequential damages which arise out of the sole negligence of City. 6. REACH agrees to maintain during the course of this Agreement the following insurance coverage: a) Comprehensive general liability insurance coverage, including personal injury and contractual liability coverage, in an amount equal to One Million Dollars ($1,000,000.00) per occurrence, combined single limit; b) Worker's Compensation insurance as required by State of California statutes; c) Professional liability insurance with a One Million Dollar ($1,000,000.00) limit, per occurrence. REACH agrees to keep such policy in force and effect for at least five (5) years from the date of completion of this Agreement. Also, the City of Santa Ana, its officers, agents and employees will be narned as additional insured on the above referred comprehensive general liability coverage and REACH will provide an endorsement to that effect. Such insurance shall (a) name the City, its officers, employees, agents, volunteers 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 (e) contain standard separation of insured's provisions. Such insurance will be evidenced by certificate and issued by companies licensed to do business in California and acceptable to the City. Before REACH performs any work, it will furnish certificates of insurance and endorsements, as required by City, evidencing the aforementioned general liability, and professional liability insurance coverages on forms acceptable to the City which shall provide that the insurance in force not be canceled or modified without 30 days prior written notice to the City. In the absence of satisfactory insurance coverage, City may, at its option: (a) procure insurance with collection rights for premiums, attorney's fees and costs against REACH by way of set-off or recoupment from the sums due REACH, at City's option; (b) immediately terminate this Agreement; or (c) self insure the risk, with all damages and costs incurred, by judgment, settlement or otherwise, including attorney's fees and costs, being collectible from REACH, by way of set-off or recoupment from any sums due REACH. 7. NO ASSIGNMENT. REACH shall not assign or transfer this Agreement or any rights hereunder without the prior written consent of the City and approval by the City's City Attorney, which may be withheld in the City's sole discretion. Any unauthorized assigned or transfer shall be null and void and shall constitute a material breach by REACH of its obligations under this Agreement. No assigmnent shall release the original parties or otherwise constitute a notation. 8 COMPLIANCE WITH LAWS. REACH shall comply with all Federal, State, County and City laws, ordinances, riles and regulations, which are, as amended from time to time, incorporated herein and applicable to the performance hereof. 9. ATTORNEY FEES. If any action at law or in equity is brought to enforce or interpret the terns of this Agreement, the prevailing party shall be entitled to reasonable attorney's fees, costs and necessary disbursements in addition to the relief to which such party may be entitled. 10, INTERPRETATION. (a) Applicable Law, This Agreement, and the rights and duties of the parties hereunder (both procedural and substantive), shall be governed by and construed according to the laws of the State of California, with venue in Orange County. (b) Entire Agreement. This Agreement, including any exhibits attached hereto, constitutes the entire agreement and understanding between the parties regarding its subject matter and supersedes all prior or contemporaneous negotiations, representations, understandings, correspondence, documentation and agreements (written or oral), To the extent there is any conflict or inconsistency between the terns and provisions of this Agreement and the exhibits attached hereto, the terms and provisions of this Agreement shall govem the rights and obligations the parties hereto. (c) Written Amendment. This Agreement may only be changed by written amendment signed by REACH and the City Manager of the City or other authorized representative of the City, subject to any requisite authorization by the City Council. Any oral representations or modifications concerning this Agreement shall be of no force or effect. N (d) Severability. If any provisions of this Agreement is held by any court of competent jurisdiction to be invalid, illegal, void, or unenforceable, such portion shall be deemed severed from this Agreement, and the remaining provisions shall nevertheless continue in full force and effect as fully as though such invalid, illegal, or unenforceable portion had never been part of this Agreement. (e) Order of Precedence. In case of conflict between the terms of this Agreement and the terms contained in any document attached as an exhibit or otherwise incorporated by reference, the terns of this Agreement shall strictly prevail. (f) Choice of Forum. The parties hereby agree that this Agreement is to be executed in accordance with the applicable laws of the State of California, is entered into and is to be performed in the City of Santa Ana and that all claims or controversies arising out of or related to performance under this Agreement shall be submitted to and resolved in a forum within the City of Santa Ana at a place to be determined by the rules of the forum. 11. TIME OF ESSENCE. Time is strictly of the essence of this Agreement and each and every covenant, tern and provision hereof. 12. AUTHORITY OF REACH. REACH hereby represents and warrants to the City that REACH has the right, power, legal capacity and authority to enter into and perform its obligations under this Agreement, and its execution of this Agreement has been duly authorized. 13. NOTICES. Any notice or demand to be given by one party to the other shall be given in writing and by personal delivery or prepaid first-class, registered or certified mail, addressed as follows. Notice simply to the City of Santa Ana or any other City department is not adequate notice. 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 Copies to: Executive Director of the Personnel Services Agency City of Santa Ana 20 Civic Center Plaza (M-24) P.O. Box 1988 Santa Ana, Califorva 92702 Fax 714- 647-6930 City Attorney City of Santa Ana 20 Civic Center Plaza (M-29) F.O. Box 1988 Santa Ana, California 92702 Fax 714- 647-6515 If to REACH: REACH Employee Assistance, Inc. 101 East Lincoln Avenue, Suite 230 Anaheim, CA 92805 Attn.: Dr. Marcus Dayhoff Fax:714-533-5700 Any such notice shall be deemed to have been given upon delivery, if personally delivered, or, if mailed, upon receipt or upon expiration of three (3) business days from the date of posting, whichever is earlier. Either party may change the address at which it desires to receive notice upon giving written notice of such request to the other party. 14. TERMINATION FOR CONVENIENCE (Without Cause). The City or REACH may terminate this Agreement in whole or in part at any time, for any cause or without cause, upon sixty (60) calendar days' written notice to the other. If the Agreement is thus terminated by the City for reasons other than REACH's failure to perform its obligations, the City shall pay REACH a prorated amount based on the services satisfactorily completed and accepted prior to the effective date of tenmination. Such payment shall be REACH's exclusive remedy for termination without cause. 15. DEFAULT. In the event either party materially defaults in its obligations hereunder, the other party may declare a default and terminate this Agreement by written notice to the defaulting party. The notice shall specify the basis for the effective date of termination stated in such notice, which date shall be no sooner than ten (10) days after the date of the notice. Termination for cause shall relieve the terminating party of further liability or responsibility under this Agreement, including the payment of money, except for payrnent of services satisfactorily and timely performed prior to the service of the notice of termination, and except for reimbursement of (1) any payments made by the City for service not subsequently performed in a timely and satisfactory manner, and (2) costs incurred by the City in obtaining substitute performance. 16. EQUAL EMPLOYMENT OPPORTUNITY. During the performance of this Agreement, REACH agrees as follows: a. REACH shall not discriminate against any employee or applicant for employment because of race, color, religion, sex, national origin or mental or physical disability. REACH will ensure that applicants are employed and that employees are treated during employment, without regard to race, color, religion, sex, national origin or mental or 10 physical disability. Such actions shall include, but not limited to the following: employment, upgrading, demotion or transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms of compensation and selection training, including apprenticeship. REACH agrees to post in conspicuous places, available to all employees and applicants for employment, a notice setting forth provisions of this non- discrimination clause. b. REACH shall, in all solicitations and advertisements for employees placed by, or on behalf of REACH, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or mental or physical disability. c. REACH shall cause the foregoing paragraphs (a) and (b) to be inserted in all subcontracts for any work covered by this Agreement, provided that the foregoing provisions shall not apply to subcontracts for standard commercial supplies or raw materials, 19. CONFLICT. REACH hereby represents, warrants and certifies that no member, officer or employee of REACH is a director, officer or employee of the City, or a member of any of its boards, commissions or committees, except to the extent permitted by law. (Signatures on Following Page) 11 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: CITY OF SANTA ANA .��oz _- Maria D. Ftuizar Clerk of the Council Raul Manager eII r City Manager APPROVED AS TO FORM: SONIA R, CARVALHO City Attorney Laura Rossini Senior Assistant City Attorney RECOMMENDED FOR APPROVAL: Ellen Smiley Acting Director of P rsonnel 12 REACH Employee Assistance, Inc, By: /u/ Marcus bayhoff CEO & Clinical Director A� ®® CERTIFICATE OF LIABILITY INSURANCE 2/DATE(M DDmYv) 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(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 endorsements . PRODUCER CONTNAMEACT Patti Kenn The Van Group a Division Wagnera erlGroupk 135 Crossways Park Drive, P.O. Box 9017 PHONE 516-719-8760 FAX .888-290-0302 E-MAIL ADDRESS. pkenny@sterlingrisk.com INSURERS AFFORDING COVERAGE NAIC # Woodbury NY 11797 INSURERA:Great American Assurance Company 26344 INSURED REACEMP-01 INSURER B : Reach Employee Assistance, Inc 101 E Lincoln Ave, #230 Anaheim CA 92805 INSURER Ci INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 134747264 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 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. INSR R TYPE OF INSURANCE INSD WVD POLICVNUMBER POLICY EFF MDDIYYYY POLICY EXP MWDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y GLP 47&88-02-01 2/17/2017 2/17/2018 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X❑ OCCUR PREMI ETORENTED PREMISES RENT rrence $100,000 MED EXP(Any one person) $5,000 PERSONAL &ADV INJURY $1,000,000 AGGREGATE LIMIT APPLIES PER: PNOLICY JEa LOG GENERAL AGGREGATE $3,000,000 GEN'L X PRODUCTS - COMP/OP AGG $3,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE L Ea accident $ BODILY INJURY (Par person) $ ANY AUTO AUTOS NED ALTOSULED BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION OTH- ANDEMPLOYERVLIABILITY Y/N SPER TATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNEWEXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DE SCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Professional Liability Y Y GLP 478-88-02-01 2/17/2017 2/17/2018 Each Incident $1,000,000 Aggregate $3,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Santa Ana is included as an additional insured as required by written contract but only as respects to the operations performed by the named insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana 20 Civic Center Plaza THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana CA 92701 AUTHORIZEDREPRESENTATIVE @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD saw Ro® CERTIFICATE OF LIABILITY INSURANCE OATE(MMDDMYY) 2/13/2020 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(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 Van Wagner Agency 135 Crossways Park Drive P.O. BOX 9017 CONTACT NAME PHONE FAX 11-800-735-1588 l888-29"302 EWAIL ADDRESS INSURE S AFFORDING COVERAGE NAIC• Woodbury NY 11797 INSURER A: Great American Assurance Company 26344 Licensall: BR-14185 8 REACEMP-01 Assistance, Inc EAnaheA SURER B: INwREac: INSURERD: e, #230 INSURER E 05 INSURER F: COVERAGES CERTIFICATE NUMBER: 2056513644 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 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. INSR T TYPE OF INSURANCE ADDL SUB POLICY NUMBER MM ICY EFF MOLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILIIj GLP 478-88-02 V17CO20 V172021 EACH OCCURRENCE $I'"." CLAIMS -MADE M OCCUR / PREMISES E $10DDDO MED EXP (Myme person) $ 5.000 PERSONAL 8 ACV INJURY $1.000.000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 %( POLICY �J�� �LOC PRODUCTS - COMP/OP AGG $3,000,000 $ OTHER: AUTOMOBILE LIABILITY M INEDt SINGLE LIMIT (Ea acc,der $ BODILY INJURY (Per person) E ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY( Per awdwi) $ PROPERTY D E (Per accidentl $ NON -OWNED HIRED AUTOS AUTOS E UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER TH- STATUTE ANY PROPRIETOR/PARTNERIEXECUrIVE E.L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ If yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Rofassional Liability / GLP 47888-248 V172020 2/172021 Each Incident $1900,000 Aepegate $3,000.0D11 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is regWred) REVIEWED & APPROVED By Risk MANACIEMENT DIVISION JU 4 2020 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE / THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Employee Benefits M-34 / Attn: Carrie Hanes AUTHORIZED REPRESENTATIVE P.O. BOX 1988 Santa Ana, CA 92702-1988 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CERTHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 03-27-2020 CITY OF SANTA ANA SP BENEFITS DEPARTMENT 20 CIVIC CENTER PLZ SANTA ANA CA 92701-4058 GROUP POLICY NUMBER: 1555105-2020 CERTIFICATE ID: 32 CERTIFICATE EXPIRES: 03-01-20211/ 03-01-2020/03-01-2021 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 policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 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 dbby the pololliiicccyyy ddees(cr/libbeeedd] 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 #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 03-01-2000 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. — ENDORSEMENT #1651 - LETICIA A. DAYHOFF SEC,TRES - EXCLUDED. ENDORSEMENT N1851 - MARCUS D. DAYHOFF PRESIDENT - EXCLUDED. REVIEWED & APPROVED By Risk MANAGEMFNT DIVISION EMPLOYER Jl" 4 2020 ANgiE ACEVEdo REACH EMPLOYEE ASSISTANCE INC SP 650 N ROSE DR PLACENTIA CA 92870 [JCJ,CNI (Rev.7-2014) PRINTED : 03-27-2020