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HomeMy WebLinkAboutNANCY K. BOHL, INC., DBA: THE COUNSELING TEAM INTERNATIONALINSURANCE NOT ON FILE N-20`19-12T WORK MAY -NOT PROCEED-- -� CLERK OF COUNCIL DATEAUL 2 2 2019 AGREEMENT TO PROVIDE PSYCHOLOGICAL EVALUATION SERVICES FOR THE CITY OF SANTA ANA POLICE DEPARTMENT 1_ a Mwr\C d✓APHIS AGREEMENT is made and entered into this 12th day of June, 2019 by and between Nancy K. Bohl, Inc., a California corporation dba The 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. On April 8, 2019, the City issued a Request for Proposal ("RFP") No. 19-040 for the purpose of retaining a consultant having special skill and knowledge in the field of providing psychological evaluation and counseling services for the City's Police Department, B, The City received numerous responses to the RFP. Consultant is one of the three parties selected by the City. Consultant represents that it 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: 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 psychological evaluation 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 for City, the rates and charges identified in Exhibit B. The total sum to be expended under this Agreement shall not exceed $32,522, This amount is comprised of a base amount of $29,565 and a contingency amount of $2,957 for services to be provided at the sole discretion of the City. b. Payment by City shalt 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 July I, 2019 and continue for a three (3) year term through June 30, 2022, unless terminated earlier in accordance with Section 13, 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. 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 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. 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. Where the amounts or coverage provided by the certificates of insurance provides coverage greater than those listed by this Agreement, the amounts provided by the certificates of insurance shall be incorporated by reference into the Agreement. v. Consultant shall supply City with a fully executed additional insured 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 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 terns 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. 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. 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 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. 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 assigmnent, 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 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. 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 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 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 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: 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 To Consultant: Nancy K. Bohl, Inc. dba The Counseling Team International 1881 Business Center Drive, Ste. I t 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, 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 timeframes, 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: CITY OF SANTA ANA a Norma Mitre Kristine Ridge Acting Clerk of the Council City Manager APPROVED AS TO FORM: SON [A R. CARVALHO CONSULTANT: City Attorney Tamara Bogosian aanK. Bohl- prod, Ph.D. Assistant City Attorney RECOMMENDED FOR APPROVAL: (_-.,1;�.6v- 1 VALENTIN Chief of Police Santa Ana Police Department EXHIBIT A SCOPE OF SERVICES EXHIBIT A SCOPE OF WORK The City of Santa Ana is seeking a professional and experienced company to pre -employment psychological evaluation services, peer support training, and crisis counseling. Specific responsibilities include, but are not limited to: A. Complete Pre -Employment Psychological Evaluations Perform a complete pre -employment psychological evaluation for the City's Police Department applicants. Said psychological evaluation shall comply with the California Peace Officer's Standards and Training (POST) Psychological Screening Manual, as well as any additional psychological suitability criteria specified by the City's Police Department. 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 recommendation for employment. Consultant shall Provide the City's Police Department a list of available appointment times for psychological evaluations; the appointment times must be provided 24 hours prior to pre -scheduled Commander oral interviews. The psychological evaluations shall be administered within seven business days of the Commander oral interviews. 2. Provide the City's Police Department with verbal recommendation of the candidate's psychological suitability for the classifications of Police Officer as well as other classifications within the Police Department within two (2) working days of said candidate's clinical interview. 3. Provide the 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. This report must be received by the PD within five working days via US Mail, or may be sent in a pdf document via e-mail. 4. Complete the necessary Police Officer Standards and Training (POST) Continuing Professional Education (CPE) required for psychologists conducting pre -employment peace officer evaluations. The initial CPE requirement of six hours must be completed by May 6, 2019. Evaluators will need to complete 12 hours of POST -approved CPE every two years. The CPE Tracking System will calculate the required hours based on the effective date of this requirement (September 1, 2014) and the date the psychologist began conducting peace officer evaluations. B. Complete Post -Traumatic Psychological Incident Evaluation Provide City's Police Department employees involved in violent incidents, such as a life -threatening and/or serious injury or death to any person, complete post -traumatic psychological evaluation. A complete post -traumatic psychological incident evaluation includes, but is not limited to, clinical interview and post -traumatic counseling. City of Santa Ana - RFP 19-040 for Psychological Services Page 1 Consultant shall provide: Initial psychological service contact with involved officer(s) shall be made immediately if possible, but no later than forty-eight (48) hours following the incident. 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 office location, unless otherwise agreed by involved officer(s). 3. One (1) follow-up session within a period of not less than 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. Following such sessions, 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). 4. A verbal recommendation to the City's Police Department 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. 5. A written psychological assessment to the City's Police Department of officer(s) in question and a recommendation as to their suitability to return to active duty, full or modified, and need for follow-up treatment within five (5) days following the post - traumatic counseling session. 6. At the direction and with consent of City's Police Department, similar post -traumatic incident counseling services may be requested for 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 officer(s) comes into doubt. C. Crisis Intervention Counseling Conduct crisis intervention counseling with authorization and approval of City's Police Department when a Department employee(s) is believed to be suffering from a psychological disorder or emotional disturbance and unable to perform any or all of the full range of duties of an employee's classification. Consultant shall: 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. City of Santa Ana - RFP 19-040 for Psychological Services Page 2 D. Critical Incident Stress Management The work of law enforcement professionals exposes them to significant incidents that can have a lasting effect on their mental health and well-being. The Santa Ana Police Department recognizes the importance of routine and post -incident debriefings to assist employees in processing events in a healthy and productive manner while minimizing the risk of post incident stress that can lead to physical and psychological disorders. Therefore, at the request of the Chief of Police or his/her designee, the consultant shall: 1. Conduct routine group debriefings with units that are regularly exposed to high levels of stress (i.e. child abuse investigators, crime scene investigators, and dispatchers) to ensure the group's ongoing well-being. 2. Hold a post -critical incident meeting ahead of a formal debriefing to discuss normal reactions to stress and healthy methods to process stress. When necessary, such meetings shall be conducted prior to the affected employee's end of watch. 3. Facilitate post -incident group debriefings with affected employees following a critical incident. Such debriefings should ideally be held within 24-72 hours of the incident but, given the need to coordinate varying work schedules, shall be conducted as close in time to the incident as practical. E.Consultation Services On -call status is required to respond to criminal incidents such as SWAT call -outs or major investigations as requested. Consultant shall: Consult with the Department's management regarding psychological profiles and recommended approach to addressing specific suspects. 2. Assist in interpreting intelligence data in reference to criminal incidents and/or suspect. F. Psychological Training Services Provide City's Police Department employees with relevant psychological training to assist in the providing organizational wellness services. Consultant shall: Provide training to members of Police Department including, but not limited to, peer support services, crisis intervention stress management, and suicide intervention/prevention training. Provide Testimony In Court And Court Preparation City of Santa Ana — RFP 19-040 for Psychological Services Page 3 IW'.ififil7:. COMPENSATION (RATES) CITY OF SANTA ANA REQUEST FOR PROPOSALS FOR PSYCHOLOGICAL SERVICES PROPOSERS CERTIFICATION AND PROPOSAL ITEM PRICING 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 am familiar with the services being requested. 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. Proposal Item Price - Pricing shall be all inclusive and based on the scope of services described in Exhibit A. Cost proposal shall include all costs for a three-year psychological services agreement. Service _ Pricing Anticipated No. Subtotal A. Pre -employment psychological $ 300 Per applicant of Units Per Yr. TBD $TBD _ evaluations ®• Complete Post -Traumatic $200 Per hour — ------------ TBD '$TBD-------- Psychological Incident Evaluation C. Review of Fitness for Duty $ N/A Per hour -- N/A N/A — D. Crisis Intervention Counseling $105 Per hour TBD y $TBD E. pCritical Incident Stress $200 Per hour TBD $TBD I Management I FJG. Consultation Services $105 Per hour TBD — $TBD Psychological Training Services $ Per hour IT BD $TBD _ 187.50 Testimony in court and court $ NyA Per hour N/A $ N/A — _qreparation _ w_— One -Year Total Three -Year Total�- City of S0 for P anta Ana — Rf p 19-04sychologlcai Services Page 20 J V. CONTRACT #: L- 201q--1-2-:-1 /Ag-c-"«' CERTIFICATE OF LIABILITY INSURANCE DATEI IDDNYYY) ~"� 02/03/2020 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 have ADDITIONAL INSURED provisions or 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 endersannenwAL PRODUCER "Osd+.".LP-CTrn; C INSURED SKALA INSURANCE AGENCY INC GENE SKALD. AGENT LIC. 0587032 4214 N SIERRA WAY SAN BERNARDINO, CA 92407 NANCY K BOI IL INC DBA THE COUNSELING TEAM INTERNATIONAL AND DBA THE ORGANIZATIONAL NFTA/ORK 'CONTACT NAMel __ .PHONE LAIC No $Ye' 909-B83-8861 E-MAIL APpRe}s: _ GENE GENESKALA.COM @ INSURERS) AFFORDING COVI INSURERA: INSURER B: State Farm General Insurance State Farm Mutual Automobile INSURER C : _ INSURER D: covFaer.Fc rvorlvlrar� _— __. - "" cvIJIV1Y IY W1Y16r,-{(: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 13ELOW HAVE BEEN ISSUED TO THE INSURED NAMED A8OVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAN) CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR A LSUeR LTR TYPE OF IN5URANCE POLIDYEFF P C ERP POLICY NUMBER MN110D/YYYY MMnrvvYW LIMITS COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE 1,000,000 RF101270-ITFRT neeca 3 S 30g000 CLAIMSMADE®OCCUR HIRED AUTO MED EX= n( lie Una pu,surd 5 5 000 A ENOL Y Y 92LE14261 & 92YD04220 07112/2019 (0711212020 PRsDNat. sAnV-NUURy s GEN'L AGGREGATE LIMITAPrrPLIEIIS PER PDLICY ❑ AGCRECA.TE 5 2,000,OOD PRODUCTS-COMPIOP AGG ` lea u LOG (GENERAL OTHER'. — a AUTOMOBILE LIABILITY Y Y 4414187F2475 12/24/2019 06/24/2020 COMBwEDs1NGlE cltalT Eu r"Cldent 3 BODILY INJURY IPmpe see) S 1.000.000 B ]ANYAUTO AUTOSSCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accitlunl) 3 10AIRED NON -OWNED AUTOS CALTOE ONLY PV[J-0.4GE palrr"P, a „ —'I---' 1000,000 3 UMBRELLA LIAO OCCUR -• EACH OCCURRENCE -___:..�.. 5 -EXLESsi O-AIMS-NADE AGGREGATE § 'QED RETENTIONS ^i - WORKERS FftN I ION PER OTH.. s AND EMPLOYERS' LIABILITY YIN Ee ANv PROPRIETORIPARTNEIR EXECUTIVE OFFICERMEMBER EXCLUDED? �. MIA F I EACH ACCIDENT _HACCI s " IMandatery in NH) - If yee, descdbe under El. DISEA.SE-EA EMPLOYE-5 EL DISEASE-POLIOYLIYt" 3 -T_- DESCRIPTION Of OFERATION$below t DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD tat, Amfiflm al Remarks Schedule, maybe aeached if mare space is required) ' Business Office Policy Property Locations: 1881 Business Center Dr, San Bernardino, CA 92408 39755 Murriete Hot Springs Rd, Ste D160, Murrieta, CA 92563 1545 Anacapa Rd Ste 7C, Victorville, CA 92392 135 S State College Blvd Ste 200, Brea, CA 92821 444 Camino Del Rio Ste 2015,San Diego, CA 92108 701 Palomar Airport Rd, #300, Carlsbad, CA 92011 74075 El Pasco Ste A9, Palm Desert, CA 92260 232 I-lanisor Ave Ste D, Claremont: CA 91711 270 E Hwy 246. Ste 11, Buellton, CA 9342' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF SANTA ANA O ANCE WITH THE POLICY PROVISIONS. RISK MANAGEMENT DIVISION 20 CIVIC CENTER PLAZA 4th FLOOR A Tu D EPRESEN Alive - "— SANTA ANA, 8 Fc Y 7, ^ t"-70'VED y .CiDk ; te,;. ,=. �: o-,�;.-'I'I ©1988-20 Dft0 GORP A 10 . ht eserved. ACORD 25 (2016103) 4D: TheORD ame ogq are E�gistered marks of ACORD4RF 132849,12 031G2�1c BIE SC�.1 r_m ijz 4 TCTI January 15, 2020 City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4t1i Floor Santa Ana, CA 92701 To Whom it May Concern, THE COUNSEuNG TEAx INTERN.ATIQNAI, In regards to the insurance requirements for automobile liability which states, contract requires any auto or owned, hired autos, non -owned autos and only scheduled be covered under our policy at $1,000,000 per occurrence with no annual aggregate limit for each bodily injury & property damage, we are unable to satisfy these requirements. Nancy K. Bohl Inc., dba The Counseling Team International only has one vehicle under the company which is covered on our automobile policy..'All contractors that provide services on behalf of The Counseling Team are required to have their own auto insurance policies. If you have any additional questions, please contact me directly at 909-884-0133 x 225. S' cerely2 �- Julte Casto Koot Chief Financial Officer The Counseling Team International RE°�1To"'r & APPROVED -F r DEBBity u_I.LFl:;, P.O. Box 10427 • San Bernardino, CA 92423 • (909) 884-0133 • Fax (909) 384-0734 Satellite Offices in the Counties of: Los Angeles • Orange • Riverside • San Bernardino • San Diego • Ventura www.thecounselingteam.com Policy No. 92 LS1426 CMP-4766.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 LB1426 Named Insured: -NA_CCY K. FO .L I,dC D3A THE COOTNSELI:\G TEAM IN."TERNATIONAL AND CBA TEE. 0-GAIN:ZATIONA.L SET✓dORX. PO BOX 10423 S" 3ERNRI)NO CA .92423 C1123 Name And Address Of Additional Insured Person Or Organization: CITY OF SANTA A`:A ITS OFFICERS EMPLOYEES AGENTS VOL-IiNTE-ERS & RE3RESENTATIV S 20 CIVIC CENTER PLZ SANTA ANA CA 92301 40—zB SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured: any person or organization shown in the Schedule, but only with respect to liability for "bodily injury', "property damage", or "personal and advertis- ing injury" caused, in whole or in part, by; a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products —Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". However, Paragraph 1, above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; b. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured; and c. If the contract or agreement between you and the additional insured is governed by California Civil Cade Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tional insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit" is tendered to us. O, Copyright. State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of In uran UEpces Office, Inc., with its permission. 2, Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit' brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION 11— LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations, Thisendorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION 11— GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an 'occurrence" or an of- fense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the 'occur- rence" or offense took place; (2) The names and addresses of any in- jured persons and witnesses; and CMP-4786.1 CMP-4786.1 Page 2 of 2 (3) The nature and location of any injury or damage arising out of the 'occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit' to us and to all other insur- ers who may have insurance potentially available to the additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION Il — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II --LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION It — COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. 1007033 148011 08-21-2014 9:, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ��-tL4-0 Policy No. 92 :,BI426 CMP-4767 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP-4787 WAIVER OF TRANSFER OF RIGHTS OR RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 L31426 Named Insured: NANCY K BORL INC DBA THE CCUSS'ELING 'TEAM INTERSATICNAL AND DBA THE O ISAKIZATIONAL _NETWORK PO BOX 1C427 SIN BERNRDNO CA 92423 0427 Name And Address Of Person Or Organization CITY OF SANTA AAA ITS OFFICERS SMPL•OY, ES AC3ZNT'S VOLU\TEERS a REPRESE1N PATE `,?ES 20 CIVIC CENTER PLZ SA_NTA AL:A CA 92701 105€9 The following is added to Paragraph 10.b. of SECTION I AND SECTION 11 — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4767 1006225 137715.1 11-19-2013 CU, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Policy No. 42 YD0922 .^, CMP-4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 i'1)0422 Cl Named Insured: \A'_<CY i< BO!=L INC L'3A T�E COUNSELNC 'T'EAM I\TE..<!NA"_ICNAL AN0 D3A TI' CRGAi:IZATIONA L iRE^_4;i0-..Z PO BOY `0427 S`i 3E N-RDNO CA 92423 0427 Name And Address Of Additional Insured Person Or Organization: CITY O1 SANTA A.NA ITS OFFICE-RS EM2LOYLES AGENTS VOLUNTEERS & RE_PRESENTATIV:S 20 CIVIC C!,NT R PLL SANTA ANA CA 92701 4058 SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury", "property damage", or "personal and advertis- ing injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional Insured; or b. Products —Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". However, Paragraph 1. above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; b. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured; and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tionaf insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit" is tendered to us. ;?.), Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of In urancr.�ug Serices, Office, Inc., with its permission. CONTI 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit' brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION 11— LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION 11— GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an 'occurrence" or an of- fense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the 'occur- rence" or offense took place; CMP-4786.1 Page 2 of 2 (3) The nature and location of any injury or damage arising out of the 'occur- rence' or offense; b. Tender the defense and indemnity of any claim or "suit' to us and to all other insur- ers who may have insurance potentially available to the additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION II — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other Insurance of SECTION 1 AND SECTION II — COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named 'in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CMP-4786,1 1007033 148011 08-21-2014 C. Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. � a-kl,�-o Policy No. 92 YD0422 0 CMP-4787 Page I of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY" CMP-4787 WAIVER OF TRANSFER OF RIGHTS OR RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 YD0122 0- Named Insured: NANCY k 3G L INC D3A TF COJ-NSSLING '1'ELM 1\TERt`,1A'110NAL AND DBA HE CRGA.S_ZATI0N!A.L S TVMRF 10 30X 10927 SN 3?_`3L'3G CA 92423 C92. Name And Address Of Person Or Organization CITY OF SAtNTA ANA ITS OFFICnnS SM'LOYEr S AGENIS VGL-'rd'rL' 2S & ?iE_P_R SSiNTATIVES 20 CIVIC PLC: ANTA A\A CA 92701 �1058 The following is added to Paragraph 10.b. of SECTION I AND SECTION Il — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 1006225 137715.1 11-19-2013 �s Copyright, 51ais farm Mutual Automrhile Insurance Company, 2008 Includes copyriighted material of Insurance SeMces Office, Inc., with its permission. State&M STATE FARM in. PO box 653922 Richardson, 7X 75005-3922 66A AT1 23 on0939 0093 CITY OF SANTA ANA, ISAOA 20 CIVIC CENTER PLZ FL 4TH SANTA ANA CA 92701-405B I'll 111111111111111'Il11111 �1ui�'loll. 11111 DATE OF NOTICE: DEC 04 2019 CODE: NOTE: PLEASE NOTIFY STATE FARM AT THE ADDRESS LISTED AT THE TOP, LEFT CORNER OF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. rADDITIONAL INSURED'S NOTICE OF COVERAGE - - - -- j State Farm Mutual Automobile Insurance Company 7501-FA48-A NAMED INSURED: POLICY NO: 4414187-F24-75W COVERAGE: NANCY K BOHL INC YR/MAKE/MODEL: 201713MW SPORT:WG ON AND Ph LIABILITY N DBA THE COUNSELING TEAM VIN/CAMPER: 5UXKR6C36N0U13705 $ i MIL IS 1 MIL 41 MIL INTERNATIONAL AGENT NAME: SKALA INSURANCE AGENCY INC %10e10DEO.CDMP 4 PO BOX 10427 AGENT PHONE: (909)883-8861 $100 DEO. Mt, 9 SN BERNRDNO CA 92423-0427 ENDORSEMENT NO:-:60266U POLICY EFFECTIVE OCT 31 2019 UNTIL TERMINATED POLICY MESSAGES: This policy $flown Above supersedes policy# 4414187.75V. The policy includes a lass payable clause protecting the additional insured's interest in the described car to the extent of the insurance o provided and subject to all policy provisions. The additional insured will be given 20 days notice if the policy is ternimatedUnul such notice m is provided. It shag be presumed that the required renewal premiums have been pald.The additional insured must notify us within 10 days of S any change of interest or ownership coming to their attentien.Failure to do so will render this policy null and void. MT 86698.4-P MATCH 00534 MUTL VOL Statelerm State Farm Mutual Automobile Insurance Company B PO Box 853922 Richardson, TX 75085-3922 NAMED INSURED 00534 75-7501-4 P Dose NANCY K COUNSELING IoNGu DNA THE COUNSELILI NG TEAM INTERNATIONAL PO BOX 10427 SN BERNRDNO CA 92423-0427 DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. IF AN AMOUNT IS DUE, THEN A SEPARATE STATEMENT IS ENCLOSED. DECLARATIONS PAGE PAGE 1 OF 2 POLICY NUMBER 4414187-F2475W POLICY PERIOD) 11 OCT 31 2019 to JUN 24 2020 12 01 A M Standard Time AGENT SKALA INSURANCE AGENCY INC — 4214 N SIERRA WAY SN BERNRDNO, CA 92407-3896 _ PHONE: (909)883-8861 rvun UAn YEAR MAKE MODEL BODY STYLE VEHICLE ID, NUMBER 2017 BMW X5 SPORT WG 5UXKR6036HOU13705 600HCV11 SYMBOLS COVERAGE 6 LIMITS PREMIUMS A Liability Coverage $702.61 Bodily Injury Limits Each Person, Each Accident $1,000,000 $1,000,000 Property Damage Limit Each Accident $1,000,000 D Comprehensive Coverage-$1,000 Deductible $139.21 G Collision Coverage-$1,000 Deductible $508.25 R1 Car Rental and Travel Expenses Coverage $44.33 Limit - Car Rental Expense Each Day, Each Loss $50 $1 A00 U Uninsured Motor Vehicle Coverage $75.91 Bodily Injury Limits Each Person, Each Accident $100,000 $300,000 Ut Uninsured Motor Vehicle Property Damage Coverage $10.37 Additional Use of Non -Owned Car Coverage BIPD Liability $5.18 Physical Banner- S25 88 Total Premium for OCT 31 2019 to JUN 24 2020,- $1 511.74 Thls is not a bill. IMPORTANT MESSAGES Replaced policy number 4414187-75V. Your total renewal premium for DEC 24 2019 to JUN 24 2020 is $1,160.84. Location used to determine rate charged-36442 WILDWOOO CANYON RD, YUCAIPA CA 92399.5274. CONTINUED 06813/07236 See Reverse Side I5 W66C 2 %2002 IoinWW-) II S%ON Ia1.M.) ,6W91J-k) StateFarm State Farm Mutual Automobile Insurance Company PO Box 853922 Richardson, TX 75085-3922 00534 NAMED INSURED 000s9s Dose 75-7501-4 P A NANCY K COINC DNA THE COUNSELING SELILI NG TEAM INTERNATIONAL PO BOX 10427 5N BERNRDNII CA 92423-0427 86698-4-P MATCH 00534 MUTL VOL DECLARATIO NS PAGE 2 OF 2 POLICY NUMBER 4414187-F2475W POLICY PERIOD OCT 31 2019to JUN 24 2020 12:01 A.M. Standard Time EXCEPTIONS, POLICY BOOKLET & E DNDOppRSEMENTS (See policy booklet & individual endorsements for coverage details.) i WITHYOUR POLICY ANDSppINYSENDORS1EM€€NTSLTHATIAPPLY, INCLUDINGLTHOSEOISSUED TO YOU ANo5S0B5ept1ENT RENEWAL N TICE OOgj ryry60pp28BU ADDITIONAL INSURED -THE ORGANIZATIONAL NETWORK, PO BOX 10427, SN 02R6028BUCAOOI4IONAL42INSURED-CITY OF REDLANDS ATTN: RISH M ANAGEMENT, PO BOOgX 3pp005 R€DLANDSgCA 92373-1505. ��,,qq UU AGTS0EMPL ANO VOLO.HNTEERSUATTNCIIRISX�MNGTR0112220ACAOIA PKWY�EOARDENIGROVE CA 0486DAE8 DDITIONAL INSURED -RIVERSIDE CITY POLICE, 4102 ORANGE ST, nywr6c1nC PA a9Cn1—OC71 COUNTY FIRE AUTHORITY ISAOA, 1 FIRE y „ UhtIUEHS, LMP49Y.t:kS AND AGENTS777 N F STREET, SN BERNRONO"CA 'ITIONAL INSURED -CITY OF RIVERSIDE IT'S OFFICERS & EMPLOYEES, DITIONALIOINSURED�COUNTYOOF ORANGE ISAOA, 1055 N MAIN ST, SANTA -3601. DITJONAL INSURED -BEST BASIN MUNICIPAL WATER DISTRICT ISAOA, BRIT ONAIT.EINSUREDATHRENCOUNTY7DISTRICTS OF SAN BERNARDINO, ISAOA )IITIONA2 5 INSURED--CCITTYMOF4CO7 ONA2 O -101 B AVE, CORONADO CA HTIONAL INSURED -CITY OF HUNTINGTON BEACH IT'S OFFICER'S, ISAOA, ITIONALTINSUREDACAL STATE2POLYTECHNIC UNIV, POMONA, 3801 W '0M0NA CA 91768-255 )ITIONAL_INSUREP-CITY OF.SAN_BERNARDINO,.IT'S OFFICERS'. ISAOA HI HUI SPRINGS POLICE DEPARTMENT, 65900 240. OFELSEGUNDO OFFICERS, OFFICIALS, CCSpOpP CARSONUAND ISAOA24ATTENTION PURCHASING t�1TY9OF4VENTURA C/O EXIGIS INSUR NEW YORK NY 10163-4668. OF SANTA ANA, ISAOA, 20 CIVIC CENTER PLZ CITY OF ONTARIO, 303 E B ST, ONTARIO CA 60SOGF BUSINESSFNAMEDDINSUREDUNDER THE LIABILITY COVERAGE. (6g(gp12BAC 49CB USE 4AMENOATDRYEENDORSEMENTRSONAL VEHICLE SHARING. SQ388L USENQP NON -OWNED CARS-COMPREHENSIVEAR$- LIABILITY D MEDCOVERAGE ICAL MAND SCOLLISION S COVERAGE; NANCY K BOHL•V 30 000 LIMIT. CITY OF CARSONAISAOAORCIITYSOF SANTA ANANIDSAOAHCITYAOF RIVER IDE. FOR:: Agent: SKALA INSURANCE AGENCY INC Telephone: (909)883-8861 -) jiqI C\Y�—J 7 \ 06814107236 Prepared DEC 042019 7501-A48 15'WN C42 %2002 02s, )cIn025.) 139%0 10025vd) e,� This policy is issued by State Farm Mutual Automobile Insurance Company. MUTUAL CONDITIONS 1. Membership, While this policy is In force, the first insured shown on the Declarations Page is entitled to vote: at all meetings of members and to receive dividends the Board of Directors in Its discretion may declare In accordance with reasonable classifications and groupings of policyholders established by such Board. 2. No Contingent Liability. This policy is non -assessable. 3. Annual Meeting. The annual meeting of the members of the company shall be held at its home office at Bloomington, Illinois, on the second Monday of June at the hour of 10:00 A.M., unless the Board of Directors shall elect to change the time and place of such meeting, in which case, but not otherwise, due notice shall be mailed each member at the address disclosed in this policy at least 10 days prior thereto. In Witness Whereof, the State Farm Mutual Automobile Insurance Company has caused this policyto be signed by Its President and Secretary at Bloomington. Illinois. secwary °iesi2enl IMPORTANT NOTICE: California law requires us to provide you with information for filing complaints with the State Insurance Department regarding the coverage and service provided under this policy. Your agent's name and contact information are provided on the front of this document. Another option is to reach out by mail or phone directly to: Slate FarmO Executive Customer Service PO Box 2320 Bloomington IL 61702 Phone # 1-800-STATEFAHM {1-800-782-8332) Department of Insurance complaints should be filed only after you and State Farm or your agent or other company representative have failed to reach a satisfactory agreement on a problem. California Department of Insurance Consumer Services Division 300 South Spring Street Los Angeles, CA 90013 Phone # 1-800-927-HELP (4357) or visit www.insutan2e oa covi0l.consumera NOTICE We are required to furnish you with the tollowing information: 1 An automobile liability insurance company ma yy cancel a policy before the end of the currentpolicy :period for reasons described in the provision titled Cancellation which is located in the General Terms -section of your policy (refer to the Contents in the beginning of your policy for the page number). 2. An automobile liability insurance company may increase the premium or refuse to renew the policy for any of to following reasons: a. Accident involvement by an insured, and whether an insured is atfault in the accident. b. A change in, or an addition of, an insured vehicle. c. A change in, or addition of, an insured underthe policy. d. A change in the location of garaging of an insured vehicle. e. A change in the use of the insured vehicle. I. Convictions for violating any provision of the Vehicle Code or the Penal Code relating to the operation of a motor vehicle, g. The payment made by an insurer due to a claim filed by an insured or a third parry. 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BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 01-14-2020 CITY OF SANTA ANA, ATTN: RISK MANAGEMENT SP 20 CIVIC CENTER PLZ FL 4 SANTA ANA CA 92701-4058 GROUP: POLICY NUMBER: 0702781-2019 CERTIFICATE ID: 107 CERTIFICATE EXPIRES: 08-12-2020 08-12-2019/08-12-2020 THIS CERTIFICATE SUPERSEDES AND CORRECTS CERTIFICATE # 105 DATED 01-14-2020 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 by the policy described herein is subject to all the terms, /exclusions, and conditions, of such policy. Authorised Reprosentafive President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2020-01-14 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF SANTA ANA. ATTN: RISK MANAGEMENT ENDORSEMENT #20SS ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-12-2011 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2020-01-14 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF SANTA ANA. ATTN: RISK MANAGEMENT ENDORSEMENT #1651 - NANCY K BOHL P,S,T - EXCLUDED. EMPLOYER NANCY K BOHL INC SP 1881 BUS CTR OR STE 11 SAN BERNADINO CA S2408 [P1X,H01 SP (REV.I-2014) PRINTED : 01-14-2020 �al�l� PHILADELPHIA INSURANCE COMPANIES Certificate of Liability Insurance Date Issued: 01/28/2020 Underwritten by: Philadelphia Indemnity Insurance Company One Bala Plaza, Suite 100 Bala Cynwyd, PA 19004 . NAIC #: 18058 Administered by: CPH & Associates • 711 S. Dearborn St, Ste 205 Chicago, IL 60605 P 800.875.1911 F 312.987,0902 , info@cphins.com DISCLAIMER: This certificate is issued as a matter of information only and confers no rights upon the certificate holder. The Certificate of Insurance does not constitute a contract between the issuing insureds), 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. Insured: Nancy K. Bohl Inc. dba The Counseling Team International policy Number: 025828 Nancy Berl 1881 Business Center Drive #11 San Bernardino, CA 92408 Policy Term: 08/3112019 to 08/31/2020 Covered Locations Professional Liability: Portable coverage, not location specific Coverage Type Per Incident Aggregate (Occurrence Form) (Per individual claim) (Total amount per year) Professional Liability $ 1,000,000 $ 5,000,000 Supplemental Liability $ 1,000,000 $ 5,000,000 Licensing Board Defense $ 35,000 $ 35,000 Commercial General N/A N/A Liability N/A NIA Fire/Water Legal Liability Business Personal Property N/A N/A Vicarious Sexual Misconduct $ 1,000,OOD $ 1,000,000 Cyber Liability (Claims Made Form) $ 25,000 Retroactive Date: $ 25,000 08/31/2018 Comments/Special Descriptions Certificate Holder City of Santa Ana Attn Risk Management 20 Civic Center Plaza, 4th Floor Santa Ana, CA 92702 © Certificate Holder has been added as an additional insured 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 in Ileu of such endorsement(s),. Notice of Cancellation will only be provided to the first named insured in accordance with policy provisions, who shall act on behalf of all additional insureds with respect to giving notice of cancellation. trf)� Authorized Representative C. Philip Hodson �.� - eM Digitallysigned by Francine R. Francine R. Villareal Villareal Date: 1020.09.24 15:30:37-0700' A`6RO® CERTIFICATE OF LIABILITY INSURANCE �(1 �30/2aD 0 YI 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 have ADDITIONAL INSURED provisions or 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 rl hts to the certificate holder in lieu of such endorsements . PRODUCER StaiMlIm SKALA INSURANCE AGENCY INC GENE SKALA, AGENT LIC. B587032 CONE:TACT A PHONE 1, 909-883-8861 FAX ASol! WAIL s, GENE@GENESKALPLCOM INSURI AFFORDING COVERAGE NNCN 4214 N SIERRA WAY INSURER A: State Farm General Insurance Company 25151 SAN BERN.ARDINO, CA 92407 INSURED INSURER B: State Farm Mutual Automobile Insurance Company 25178 INSURER C: NANCY K ROHL INC INSURER 0: ❑BA THE COUNSELING TEAM INTERNATIONAL IN$DkEk E: AND DBA THE ORGANIZATIONAL NETWORK INSURER F COVERAGES CERTIFICATE NUMBER: 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, TA R TYPE OF INSURANCE ADD aUGR POLICY NUMBER MMIDDNY PCIDIV LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE $ 2,000,000 CLAIM ® OCCUR -Fjaop ene $ 300,000 NED EXP (Any we arson $ 5,000 HIRED AUTO I ENOL PERSONAL & ADV INJURY t A Y Y 921-B14261 & 92YD04220 07)12l2020 07/12/2021 LIMIT APPLIES PER: GENT AGGRECATEppCT GENERAL AGGREGATE $ 4,000,000 � POLICY ❑,IELOG PRODUCTS - COMP/OP AGG 5 $ OTHER AUTOMCMLEUABILRY Y Y 4414187F2475 06/24/2020 12/24/2020 eIN OSINGUE MT e ddenl $ BODILY INJURY (Perpsn;an) 5 1,000,ODO ANY AUTO BODILY INJURY(Peracddmt) $ 1,000,000 B OWNED SCHEOULED AUTOS ONLY AUTOS HIRED NDN-0 ED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE f1se, $ 1,000,000 $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE S EXCESS UAB CLFAMSAIAOE CEO I I RETENTION S $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRILTORIPARI NERiEXECUTIVE OFFICERIMEMnER EXCLVDFOY ❑ (Mandatory In NH) NIA T LITE FD.RTM E.L EACH ACCIDENT 5 E L. DISEASE - EA EMPLOYE S II yyes, tlestrMe antler DEECRIPTIONOF OPERATIQN5beha, EL DISEASE -POLICY LIMIT - S DEECWRTION OF OPERATIONSILOCAl10Na 1VENN:LES(ACORD1M,Addklenal Rome 5aadub,maybaeaacfiadSmaaespacearequired) Business Office Policy Property Locations: 41750 Rancho Los Palmas Or Ste D-2, Rancho Mirage, CA 92270 1881 Business Center Dr, San Bernardino, CA 9240E 39755 MUmieta Hot Springs Rd, Ste D160, Murrieta, CA 92563 1545 Anacepa Rd Ste 7C, Vfctorvl4e, CA 92392 135 S State College Blvd Ste 200, Brea, CA 92821 444 Camino Del Rio Ste 2015,San Diego, CA 92108 701 Palomar Airport Rd, #300, Carlsbad, CA 92011 74075 El Peace Ste A9 & A16, Palm Desert, CA 92260 232 Harrison Ave Ste D, Claremont, CA 91711 270 E HWY 246 Ste 11. Buelllon, CA 93427 4160 Temescal Canyon Rd Ste 309, Corona, CA 92883 CITY OF SANTA ANA RISK MANAGEMENT DIVISION 20 CIVIC CENTER PLAZA 4th FLOOR SANTA ANA, CA 92701 AGORD 25 (2016103) The ACORD name and logo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE VALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. `-/ © 1888-`R43d ACORD registered marks of ACORD Ride Managanent Diaisinn REVIEWED & APPROVED BY: faaa.o:.r.e Z vdt,4e '� Risk Management Analyst c� State Farm Dear Certificate Holder, We are pleased to attach a standard ACORD certificate of insurance issued to you on behalf of the captioned client. For the reasons stated within this informational letter, State Farm is unable to comply with your request for one or more of the following changes: Modify the current ACORD form including specific requests on notice of cancellation or statements that purport to modify policy provisions a Issue a prior edition of the ACORD form � Complete a proprietary certificate of insurance A Complete a proprietary coverage form, coverage questionnaire or coverage statement Upon request and if authorized by our insured, we will be happy to provide you with certified copies of all property and/or liability insurance policies in force for our insured that are relevant to you. • Notice of cancellation is a policy provision. A certificate that purports to provide a policy provision different from that provided by the policy itself cannot amend the insurance policy. Adding or modifying language to the certificate regarding coverages or rights may be in violation of laws concerning certificates of insurance in the given state. • State Farm is unable to provide the cancellation notice you request by endorsement. The policyholder can cancel immediately and state laws grant the insurer the right to cancel for reasons such as nonpayment with less notice than you may require. • ACORD forms carry a copyright and their use is licensed. Use of an older edition of any ACORD form without ACORD's permission would violate ACORD's licensing agreement and federal copyright law. • We do not issue certificates of insurance that are not on our forms or on an ACORD form we have licensed for use. Many proprietary certificates include language that may or may not comply with state laws, regulations, and insurance department directives. They may include wording implying coverages or rights violating the law concerning certificates of insurance in the given state. Coverage surveys, questionnaires or statements are often presented as "affidavits" or warranties that the coverages afforded the insured comply with the contract the policyholder has signed with the certificate holder. We can only certify the coverage State Farm offers, but cannot provide you with assurances regarding other coverages mentioned in your surveys, questionnaires or coverage statements. We appreciate your understanding of why we are not able to comply with your request. C01 Response Letter v-M I9.13 US Providing Insurance and Financial Services, Ktk ManagementDMsian REVIEWED&APPROVED By: '� Risk Management Analyst TCTI January 15, 2020 City of. Santa Ana Risk Management Division 20 Civic Center Plaza, 4`I' Floor Santa Ana, CA 92701 To Whom it May Concern, THE COUNSELING TEAM INTERNATIONAL In regards to the insurance requirements for automobile liability which states, contract requires any auto or owned, hired autos, non -owned autos and only scheduled be covered under our policy at $1,000,000 per occurrence with no annual aggregate limit for each bodily injury & property damage, we are unable to satisfy these requirements. Nancy K. Bohl Inc., dba The Counseling Team International only has one vehicle under the company which is covered on our automobile policy. All contractors that provide services on behalf of The Counseling Team are required to have their own auto insurance policies. If you have any additional questions, please contact me directly at 909-884-0133 x 225. S- ice�r�ely�;� �lil ice/ e(/�r��� -66W J lie Casto Koot Chief Financial Officer The Counseling Team International P.O. Box 10427 • San Bernardino, CA 92423 • (909) 884-0133 • Fax (909) 384 Satellite Offices in the Counties of: Los Angeles • Orange • Riverside • San Bernardino • S www.thecounselingteam.com Rule Management DMsinn REVIEWED & APPRDVED BY: Risk Management Analyst Policy No. 92 Lii1426 CMP-4766.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY_ CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 LB1126 Named Insured: NANCY K BOHL INC D3A TEE COUNSELING 'TEAM INTERNATICN'AL AND DriA T"L ORGANI2ZATIONAL NETWOR`4 PO BOXI 10427 SN BERNRDNO CA 92423 0127 Name And Address Of Additional Insured Person Or Organization: CITY OF SANTA ANA ITS OFF'IC-IRS EMPLOYEES AGENTS VOLUNTEERS & REPRESENTATIVT;S 20 CIVIC CENTER PLZ SANTA ANA CA 92-W1 4058 1. SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- ciude, as an additional insured, any person or organization shown In the Schedule, but only with respect to liability for "bodily injury', "property damage", or "personal and advertis- ing injury' caused, In whole or in part, by: a, Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf, in the performance of your ongoing opera- tions for that additional insured; or b. Products — Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard However, Paragraph 1. above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; b. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured; and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability, or (2) You are required by contract or agreement to provide for such addi- tional insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit" is tendered to us. to, Copyrigght, State Farm Mutual Automobile Insurance Company, 2013 Includes copyr'Ighled material cf In nce CONTINUED services Office, Inc., with its permission. Risk Martag madDiuisian REVIEWED&APPROVEDBY: �� Risk Management Analyst 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit' brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION II — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION If — GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an 'occurrence" or an of fense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occur- rence" or offense took place; (2) The names and addresses of any in- jured persons and witnesses, and CMP-4786A CMP-4786.'1 Page 2 of 2 (3) The nature and location of any injury or damage arising out of the "occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit' to us and to all other insur- ers who may have insurance potentially available to the additional insured: and c, Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION 11 — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. 1007033 148011 08-21-2014 (Q, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Rime hi ttagmad Diaisinn REVIEWED&APPROVED BY: faaa.o:.r.e R. Mnebd '� Risk Management Analyst PolicyN92 �B142o CMP-4787 o. Page 1 of THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP-4787 WAIVER OF TRANSFER OF RIGHTS OR RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following. BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 L31426 Named Insured: NANCY 3 ROLL INC DBA THE COUNSELING TEAM INTE3NATIONAL AND DBP. TH7 ORGANIZATIONAL NETWORE PO 3GX IC427 SN BERNRDNO CA 92423 0427 Name And Address Of Person Or Organization CITY OF SANTA ANA ITS OFFICERS EMPLOYEES P.GEiaTS VO-UNTEERS L RERRRSENTATTW S 20 CIVIC CENTER PLZ SANTA ANA CA 92701 4055 The following is added to Paragraph 10.b. of SECTION 1 AND SECTION 11 — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations, or b. "Your work" done under contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 1 Wfi225 137715.1 11-19-2013 (0, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Rime Management Diuisian REVIEWED&APPROVED BY: Faa.o:.r.e R. Mnebd '� Risk Management Analyst Policy No, 92 YD0422 D CMP-4788.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following. BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 YD0422 D Named Insured: NANCY X 3OHL INC DBA THE COUNSELING 'TEAM _N 1'ERNATICNAL AND DBA THE ORGA T—ZA^IGNAL NE"_'WORR 20 3OX 10427 SN BERNRDNO CA 92423 0427 Name And Address Of Additional Insured Person Or Organization: CITY OF SANTA ANA ITS OFFICERS EMPLOYEES AGENTS VOLUNTEERS 6 REPRESEN^_ATIVES 20 CIVIC CENTER PLZ SANTA ANA CA 92701 4058 1_ SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown In the Schedule, but only with respect to liability for "bodily injury', "property damage", or "personal and advertis- ing injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products — Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". However, Paragraph 1. above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; b. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured, and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tional insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit" is tendered to us. @, Copyright, Slate Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED Ride Management Diuisian REV EWED & APPROVED BY: °1„ill la l;' Fw� R. M'Ad '� Risk Management Analyst 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit' brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION 11— LIMITS OF INSURANCE: If coverage provided to the additional insured Is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION 11— GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence" or an of- fense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occur- rence" or offense took place; (2) The names and addresses of any in- jured persons and witnesses, and CMP-4786.1 CMP-4786.1 Page 2 of 2 (3) The nature and location of any injury or damage arising out of the 'occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit' to us and to all other insur- ers who may have insurance potentially available to the additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION II — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION 11— COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional Insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. 1007033 148011 08-21-2014 (0, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance services Office, Ina, with its permission. Ride Managxmad Diaisian REVIEWED&APPRDVEDBY: faaa.o:.r.e R. Mnebd '� Risk Management Analyst Policy No. 02 YD0422 0 CMP-4787 Page 1 of 'I THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP-4787 WAIVER OF TRANSFER OF RIGHTS OR RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the fohowing. BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 YD0422 0 Named Insured: iNANCY 3 3OHL INC D2A TEE COUi\SELING TEAM I1\TERNA1'10NZ11— AND DEA 'THE ORGAN-ZATIONAI. NETWORK PO SOX 10427 SN 3ER.NRDNO CA 92423 0427 Name And Address Of Person Or Organization: CITY OF SANTA ANA ITS OFFICERS EMPLOYES AGENTS VOLUNTEERS & REPRESENTATIVES 20 CIVIC: CENTER PLZ SANTA ANA CA 92701 4058 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 1pp6225 137715.1 11.19-2013 0, Copyright. Slate Fame Mutual Automobile Insurance Company, 2008 Includes uupyrighted material of Insurance services Office, Inc., with its permission. Rime Managanad Division REVIEWED&APPROVED BY: faaa.o:.r.e R. Mnebd '� Risk Management Analyst StateFarm STATE FARM PO Box 853922 Richardson, TX 75085-3922 66A ATi 23 0009M 0093 CITY OF SANTA ANA, ISAOA 20 CIVIC CENTER PLZ FL 4TH SANTA ANA CA 92701-4058 Itr111111111111111[[1111111.1111111111 IgDll 4111, 1111 1111 111111 DATE OF NOTICE: DEC 04 2019 CODE: NOTE: PLEASE NOTIFY STATE FARM AT THE ADDRESS LISTED AT THE TOP, LEFT CORNER OF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. ADDITIONAL INISURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 7501.FA4&A NAMED INSURED: POLICY NO: 441 4187-F24-75W COVERAGE: NANCY K BOHL INC YRIMAKEIMODEL: 2017 BMW SPORT WG B'AND PD Will LOY DBA THE COUNSELING TEAM VINICAMPER: SUXKROC36HOU13705 $I MIL IS i MIL Is 1 MIL 10 OED. COMP. INTERNATIONAL AGENT NAME: SKALA INSURANCE AGENCY INC $00 10e4 DED. COLL PO BOX 10427 AGENT PHONE: (909)683-8861 SN BERNRDNO CA 92423-0427 ENDORSEMENT NO: 6026BU POLICY EFFECTIVE OCT 31 2019 UNTILTERMINATED POLICY MESSAGES: This policy shown above supersedes policyY 4414187-75V The policy includes a loss payable clause protecting the addi tonal insured's Interest In the described carts the extent of the insurance provided and subject to all policy provisions. The additional Insured will be given 20 days notice If the policy is terminatedLlntil such notice is provided, it shall be presumed that the required renewal premiums have been paid.The additional insured must notify us within 10 days of any change of interest or ownership coming to their atlenlion.Fallure to do so will render this policy null and void, FRT REsI M91agYmnll DLwsl an REVIEWED &APPROVED BY: '� Risk Management Analyst 86698-4-P MATCH 00534 MUTL VOL StafeFarm State Farm Mutual Automobile Insurance Company ^ PO Box 853922 Richardson, TX75085-3922 NAMED INSURED 00534 75-7501-4 P 000sas ocse NANCV k BOHL INC DBA THE COUNSELING TEAM INTERNATIONAL PO BOX 10427 SN BERNRDNO CA 92423-0427 DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. IF AN AMOUNT IS DUE. THEN A SEPARATE STATEMENT IS ENCLOSED. DECLARATIONS PAGE PAGE 1 OF 2 POLICY NUMBER 441 4187-F24-75W — POLICY PERIOD OCT 31 2019 to JUN 24 2020 12:01 A.M. Standard Time AGENT SKALA INSURANCE AGENCY INC 4214 N SIERRA WAY SN BERNRDNO, CA 92407-3896 PHONE. (909)883-8861 YOUR CAR YEAR MAKE MODEL BODY STYLE VEHICLE ID, NUMBER CLASS 2017 BMW X5 SPORT WG 5UXKR6C36HOU13705 600HCV1I SYMBOLS COVERAGE & LIMITS PREMIUMS A Liability Coverage $702.61 Bodily Injury Limits Each Person, Each Accident $1,000,000 $1,000,000 Property Damage Limit Each Accident $1,000,000 D Comprehensive Coverage-$1,000 Deductible $139.21 G Collision Coverage-$1,000 Deductible $508.25 R1 Car Rental and Travel Expenses Coverage $44.33 Limit - Car Rental Expense Each Day, Each Loss $50 $1.200 U Uninsured Motor Vehicle Coverage $75.91 Bodily Injury Limits Each Person, Each Accident $100,000 $300,000 U1 Uninsured Motor Vehicle Property Damage Coverage $10.37 Additional Use of NonaDwried Car Coverage BIPD Liability $5.18 Physical Damece $25.88 Total pramilum for OCT 312019 to JUN 24 2020. $1,511.74 This is not a bill IMPORTANT MESSAGES Replaced policy number 4414187-75V Your total renewal premium for DEC 24 2019 to JUN 24 2020 is $1,160.84. Location used to determine rate charged-36442 WILDWOOD CANYON RD, YUCAIPA CA 92399-5274. CONTINUED 06813/07236 See Reverse Side 15 3366 C .2 052002 Io,e02610 H S%ON (o1e0251e1 Risk Managanmt DlAsicn REVIEWED & APPROVED BY: - Risk Management Analyst 86698-4-P MATCH 00534 MUTL VOL Staterbrin State Farm Mutual Automobile Insurance Company A• PO Box 853922 Richardson, TX 75085.3922 00534 NAMED INSURED aze 75-7501-4 P A aD NANCV K COINC DNA THE COUNSELING SELILI NG TEAM INTERNATIONAL PO BOX 1D427 SN BERNRDNO CA 92423-0427 DECLARATIONS PAGE PAGE 2 OF 2 POLICY NUMBER 441 4187TF24-75W POLICY PERIOD OCT 31 2019 to JUN 24 2020 12:01 A.M. Standard Time EXCEPIiON% POLICY BOOKLET & ENDORSEMENTS (See policy booidet & individual endorsements for coverage details.) YOUR POLICY COpQpNSISTS OrypF�ERWTHIS DECLARATIONS PAGE THE POLICY BOOKLET - WW1I1RN6NO2NBUBAGDITpIpONALANY W77INSUREDNTHECORGANIZATIONAEMENTS THAT APPLY, LtCNEOING TWORKTHPOEBONS1D4270 YOU 02R6D $BUCADDIONAL2IRSURED-CITY OF REDLANDS ATTN: RISH M ANAGEMENT, PC BO3N 553202 5 REO NOS NpCA 92373-1505. AOTSDEMPL ANO VO UNTEERSUATTNCRISK MNGT, 11222DACACIA PKWY, GARDENIGROVE CA 92840-5208. 04„60288U ADDITIONAL_IN$URED-RIVERSIDE CITY POLICE, 4102 ORANGE ST, COUNTY FIRE AUTHORITY ISAOA, 1 FIRE ERS,((��EMPpPLCOYEES AND AOENTS777 iN -F STREET, SN BERNRDNO'CA I INSCAE92522YORF RIVERSIDE IT'S OFFICERS & EMPLOYEES, INSURED -COUNTY OF ORANGE ISAOA, 1055 N MAIN ST, SANTA INSURED -WEST BASINMUNICIPALWATER DISTRICT ISAOA, E 210 INSURED -THE COUNTY DISTRICTS OF SAN BERNARDINO, ISAOA S7. IRSURED-CITYMOF4CORONADO, 101 B AVE, CORONADO CA TN NBCHED-CITY BEACH IT'S OFFICER'S, ISAOA, 121. 1NS(U15RR5EpO-CAL STATE NDIIP UNIV, POMONA, 3801 W 5qq}1}N29DC55N20IST OppSNSBERNRDNORCAN9M1-1704FICERS', ISAOA DINSUREDFCITY2DFHEL SEGUNDO DPFICERSEPOFFICIAL565900 DA 350 MAIN $7 EL SEGUNDO CA 90245-3895. I �JSURED-CITY P CARSON AND ISAOA, ATTENTION PURCHASING N ST CARSON CA 90745-2257. PONBb%E4668UI N�EW YYORK VENTURA C/O INSUR INSURED-CItY OF SANTA ANA, ISAOA, 20 CIVIC CENTER PLZ 9270I-4058. INSURED -THE CITY OF ONTARIO, 303 E B ST, ONTARIO CA UNDER THE LIABILITY COVERAGE. RSONAL VEHICLE SHARING. BILITY AND MEDICAL PAYMENTS COVERAGES REHENSIVE COVERAGE AND COLLISION CITY OF 06814/07236 tzzazaz cn,z mzora lot.oaae) totaozs4c) �� lot.u[5uq FOR: Agent: SKALA INSURANCE A� Telephone. (909)883-8861 Prepared DEC 04 2019 75( Rime Manager erdDivisinn REVIEWED&APPROVEDBY: �� Risk Management Analyst This policy is issued by State Farm Mutual Automobile Insurance Company. MUTUAL CONDITIONS 1. Membership. While this policy is in force, the first insured shown on the Declarations Page is entitled to vote at all meetings of members and to receive dividends the Board of Directors in its discretion may declare in accordance with reasonable classifications and groupings of policyholders established by such Board. 2. No Contingent Liability. This policy is ran -assessable. 3. Annual Meeting. The annual meeting of the members of the company shall be held at its home office at Bloomington, Illinois, on the second Monday of June at the hour of 10:00 A.M., unless the Board of Directors shall elect to change the time and place of such meeting, in which case, but not otherwise, due notice shall be malted each member at the address disclosed in this policy at least 10 days priorthereto. In Witness Whereof, the State Farm Mutual Automobile Insurance Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. *a rn.)1 .� Secretary Prc�dem IMPORTANT NOTICE: California law requires us to provide you with information for filing complaints with the Slate Insurance Department regarding the coverage and service provided under this policy. Your agent's name and contact information are provided on the front of this document. Another option is to reach out by mail or phone directly to State Ferri Executive Customer Service PO Box 2320 Bloomington IL 61702 Phone a 1-800STATEFARM (1-800-782-8332) Department of Insurance complaints should be filed only after you and Slate Farm or your agent or other company representative have failed to reach a satisfactory agreement on a problem. California Department of Insurance Consumer Services Division 300 South Spring Street Los Angeles, CA 90013 Phone q 1-800-927-HELP (4357) or visit www.insurance.camovM1-consumers NOTICE We are required to furnish you with the following information: 1. An automobile liability insurance company may cancel a policy before I end of the current policy period for reasons described in the provision Titled Cancellation which is located in the General Terms section of your policy (referto the Contents in the beginning of your policy forthe page number). 2. An automobile liability insurance company may increase the premium or refuse to renew the policy for any of the following reasons: a. Accident involvement by an insured, and whether an insured isatfaultinthe accident , h. A change in, or an addition of, an insured vehicle. v. A change in, or addition of, an insured underthe policy. d. A change in the location of garaging of an insured vehicle. e. A change in the use of the insured vehicle. f. Convictions for violating any provision of the Vehicle Code or the Penal Code relating to the operation of a motor vehicle. g. The payment made by an insurer due to a claim filed by an insured or a third parry. An automobile liability insurance company may increase the premium or refuse to renew the polic reasons that are not listed above but which are lawful and not unfairly discriminatory. uvh7 1310 REA Mrrnaganent Division REV EWED & APPROVED By: faar.o:.r.e R. Mnebd OWYHEE I Risk Management Analyst PLEASE ATTACH TO YOUR POLICY BOOKLET poll Nm ber: 441 4187-F24-75W Sheet 1 of 2 9 > _ � C iJ 9 as 0 11 m n = b m cm oy .. �a>• Yr 2- a Sr ip, R'j f T d�' O Q R R _m 1T% q .jTT P V !sl o- � o• Cv _ v •�A � � R ?' 97 �nC C C 'x1 'h'. y � onRi ? m 4 9'2Sj' o �_❑ O'7<'F `�+CiY ;t �;n f;0„7e,c H C � Zci, •- D 'A ?i '1 b7 f`b n � =m opo ��m ay'4 �Nv - D 2� n m. 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'd ' �• y C n� n is �winzz z y tY 6 G q j FL ' 61 no n O [L Fr O6 I1 7236 E01 PLEASE A 1"FACII TO YOUR POLICY BOOKLET Policy Number: 441 4187-F24-75W S N y rv^ ❑ � 7 S � — 7 �. % n ...3 n. — o -a m �� ❑ ti s �m <6 O, n a n l n. m 7 D c m N 06815;07236 PLI, ASL ATTACH TO YOUR POLICY BOOKLET policy Number: 441 4187-F24.75W Sheet 2 of 2 c w n� T pz v' .b. w CSo qg c �nmo favH M�'� �4°Ot'°c�. m�A��'�^gRos^gym°`°`'N ° y 4c no..y�Vd'`CZ'�2`7 rnh and 1omo £n u D �� aT •v$ aW �. 3. ny=='aGi ,b'C�Ci�' �=•m c'$ ,°a"'p'0��'8•� .mcw h3 a'o' �e m m�a Maa bApC O _. � � °��, `w_ac �Lj� •-7 i'e'=off a+q ? s n i ox m-u � $'m o� � °'.-°�w��', '°OO'r,s aD_.i ayy�ac••ca V ° A> �nN.tiq S'� J � M C � m+ n o'er v Ny�J nn="mem''<ioNoiCmn°ara < 0ws: n 2oO on Yo �cy�n am O X n Cl 'iy �j1O O' m zoo am c`'"va.' z _ ina •yaw b`p m v��cy`e<o^�.nao bNGi,y :O'1Z 8 AC 4='<aa'-''mp.c ao�4'_'PnH$'0j3a ,`Z A.- nZ mwmm y m<Coy w �nO�' ,bC a wso°w 5'ge jv ,g on 'rt''m'�a'':s a�rro •gn IJ o.=y 7y hb YK °=y Eo 2.m � Kl7Tai � ^•o� S'A a. �.�?� �"?' a tg b H tm 3 S n - .`L"- as w o w A oc o'er c � m e o n b n e ;2 n D S-'00 (j N y " A 0601G 36 E01 POLICYHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 08-12-2020 CITY OF SANTA ANA, ATTN: RISK MANAGEMENT SP 20 CIVIC CENTER PLZ FL 4 SANTA ANA CA 92701-4058 GROUP POLICY NUMBER: 0702781-2020 CERTIFICATE ID: 107 CERTIFICATE EXPIRES: 08-12-2021 08-12-2020/08-12-2021 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 by the policy /described 7,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 2020-08-12 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF SANTA ANA. ATTN: RISK MANAGEMENT ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-12-2011 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION .EFFECTIVE 08-12-2011 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF SANTA ANA, ATTN: RISK MANAGEMENT ENDORSEMENT #1651 - NANCY K BOHL P,S,T - EXCLUDED. EMPLOYER NANCY K BOHL INC 1881 BUS CTR OR STE 11 SAN BERNADINO CA S2408 SP PRINTED : Risk Mrxnagnnent Divielan REVIEWED & APPROVED BY: f � R. V: l - Risk Management Analyst IRE V.7- 20'14) ® PHILADELPHIA CPH INSURANCE COMPANIES Certificate of Liability Insurance Date Issued: 07/22/2020 Underwritten by: Philadelphia Indemnity Insurance Company - One Bale Plaza, Suite 100 - Bala Cynwyd, PA 19004 NAIC 4: 18058 Administered by: CPH & Associates 711 S- Dearborn St Ste 205 Chicago, IL 60605 P 800.875.1911 F 312.987.0902 - info@cphins.com DISCLAIMER: This certificate is issued as a matter of information only and confers no rights upon the certificate holder, 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. Insured: Nancy K. BON Inc. dba The Counseling Team International Policy Number: 025826 Nancy Bohl Policy Term: 08/31/2019 to 08/31/2021 1881 Business Center Drive #11 San Bernardino, CA 92408 Covered Locations Professional Liability: Portable coverage, not location specific Coverage Type Per Incident Aggregate (Occurrence Form) (Per individual claim) (Total amount per year) Professional Liability $ 1,000,000 $ 5,000,000 Supplemental Liability $ 1,000,000 $ 5,000,000 Licensing Board Defense $ 35,000 $ 35,000 Commercial General NIA NIA Liability N/A NIA Fire/WaterLegal Liability Business Personal Property N/A NIA Vicarious Sexual $ 1,000,000 $ 1,000,000 Misconduct Cyber Liability (Claims Made Form) $ 25,000 $ 25,000 Retroactive Date: 08/3112018 Comments/Special Descriptions Certificate Holder City Of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana, CA 92702 ® Certificate Holder has been added as an additional insured 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 in lieu of such endorsement(s), Notice of Cancellation will only be provided to the first named insured in accordance with policy provisions, who shall act on behalf of all additional insureds with respect to giving notice of cancellation. Authorized Representative RiA Managanent Diviaian REVIEWED & APPROVED By: i;.Vl - Risk Management Analyst PI-PHCP-05 (3-01) THIS ENDORSEMENT CHANGED THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured Endorsement This endorsement modifies insurance provided under the following: ALLIED HEALTHCARE PROVIDERS PROFESSIONAL AND SUPPLEMENTAL LIABILITY INSURANCE POLICY In consideration of the premium paid, this policy is amended as follows: Citv Of Santa Ana 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 City Of Santa Ana. Additional Insured Name and Mailing Address: City Of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana, CA, 92702 All other terms and conditions of this policy remain unchanged. Policy M 025826 Endorsement #: PI-PHCP-05 (3 -01) Effective on or after: 08/31/2020 Issued to: Nancy K. Bohl Inc. dba The Counseling Team International Expiration date: 08/31/2021 Page 1 of 1 Rime Management DMsion REVIEWED&APPRDVEDBY: '� Risk Management Analyst Francine R. Digitally signed by Francine R. Villareal Villareal Date: 2021.07.01 17:15:15 -07'00' DATE (MWDDIYYYY) ` �� CERTIFICATE OF LIABILITY INSURANCE � 06121 /2021 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 have ADDITIONAL INSURED provisions or 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 State Farm SKALA INSURANCE AGENCY INC GENE SKALA, AGENT LIC. 0587032 CIST CT NAME: PHONE . 909-883-8861 IL GENE@GENESKALA.COM II' 4214 N SIERRA WAY ftbURER S AFFOROfNG COVERAGE NAILS INSURER A: State Farm General Insurance Company 25151 SAN BERNARDINO, CA 92407 INSURED INSURER B : State Farm Mutual Automobile Insurance Company 25178 NANCY K BOHL INC INSURER C : INSURER D: DBA THE COUNSELING TEAM INTERNATIONAL INSURER E: AND DBA THE ORGANIZATIONAL NETWORK INSURER F : COVERAGES CERTIFICATE NUMBER: 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. MSR LTR TYPE OF INSURANCE At7S7L U POLICY NUMBER POLICY EFF IPOWLDi D E7fP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE ® OCCUR REAI - en S 300,000 $ 5,000 RED AUTO kENOL MED EXP hA one raon A Y Y 92LB14261 & 92YD04220 07/12/2021 07/12/2022 PERSONAL &ADV INJURY $ GEWL AGGREGATE LIMIT APPLIES PER: POLICY a jE LOC GENERAL- AGGREGATE S 4.W0,000 PRODUCTS- COMPfOP AGO $ $ OTNER: AUTOMOBILE LIABILITY Y Y 4414187F2475 06/24/2021 12/24/2021 COs xeWg!M MBINED SINGLE LIMir $ BODILY INJURY (Per person) $ 1,0f10,000 ANY AUTO B OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ PROPER7YDAMAGE Per acc $ 1,000,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE S 4 AGGREGATE 5 EXCESS LIAB CLAIMS -MADE DED RETENTION $ S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETORIPARTNERIEXECU-nVE ❑ OFFIC ERIMEM BER E7CCL U DEO? ( Mandatotyln NH) NIA I PTEAR T OTH- 1~.L. EACH ACCIDENT S E.L. DISEASE- EA EMPLOYEE S If yes, deserlbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT S DESCRIPTION OF OPERATIONS] LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is mqulred) Business Office Policy Property Locations: 41750 Rancho Los Palmas Dr Ste D-2, Rancho Mirage, CA 92270 1881 Business Center Dr, San Bernardino, CA 92408 39755 Murrieta Hot Springs Rd, Ste D160, Murrieta, CA 92563 1545 Anacepa Rd Ste 7C, Victorville, CA 92392 135 S State College Blvd Ste 200, Brea, CA 02821 444 Camino Del Rio Ste 2015,San Diego, CA 92108 701 Palomar Airport Rd, #300, Carlsbad, CA 92011 74075 EI Paseo Ste A9 & Al6, Palm Desert, CA 92260 232 Harrison Ave Ste D, Claremont, CA 91711 4160 Temesoal Canyon Rd Ste 309, Corona, CA 92883 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 CCORDANCE WITH THE POLICY PROVISIONS. RISK MANAGEMENT DIVISION 20 CIVIC CENTER PLAZA 4th FLOOR Ur REPR T SANTA ANA, CA 92701 RiskMarWmerdDMsian #88-2.015 ACO C °,$ REVIEWED & APPROVED BY.- ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Risk Management Analyst A State Farm " Dear Certificate Holder, We are pleased to attach a standard ACORD certificate of insurance issued to you on behalf of the captioned client. For the reasons stated within this informational letter, State Farm is unable to comply with your request for one or more of the following changes: i, Modify the current ACORD form including specific requests on notice of cancellation or statements that purport to modify policy provisions Issue a prior edition of the ACORD form Complete a proprietary certificate of insurance 1 Complete a proprietary coverage form, coverage questionnaire or coverage statement Upon request and if authorized by our insured, we will be happy to provide you with certified copies of all property and/or liability insurance policies in force for our insured that are relevant to you. • Notice of cancellation is a policy provision. A certificate that purports to provide a policy provision different from that provided by the policy itself cannot amend the insurance policy. Adding or modifying language to the certificate regarding coverages or rights may be in violation of laws concerning certificates of insurance in the given state. • State Farm is unable to provide the cancellation notice you request by endorsement. The policyholder can cancel immediately and state laws grant the insurer the right to cancel for reasons such as nonpayment with less notice than you may require. Is ACORD forms carry a copyright and their use is licensed. Use of an older edition of any ACORD form without ACORD's permission would violate ACORD's licensing agreement and federal copyright law. • We do not issue certificates of insurance that are not on our forms or on an ACORD form we have licensed for use. Many proprietary certificates include language that may or may not comply with state laws, regulations, and insurance department directives. They may include wording implying coverages or rights violating the law concerning certificates of insurance in the given state. Coverage surveys, questionnaires. or statements are often presented as "affidavits" or warranties that the coverages afforded the insured comply with the contract the policyholder has signed with the certificate holder. We can only certify the coverage State Farm offers, but cannot provide you with assurances regarding other coverages mentioned in your surveys, questionnaires or coverage statements. We appreciate your understanding of why we are not able to comply with your request. COI Response Letter v.10 19 13 US Providing Insurance and Financial Services, �oRaN 3 RiskMmVmerdDMaian REVIEWED & APPROVED SY.- r p P1. M44441 Risk Management Analyst TCTI JOW 9BVi20al City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana, CA 92701 To Whom it May Concern, THE COUNSELING TEAK INTERNATIONAL In regards to the insurance requirements for automobile liability which states, contract requires any auto or owned, hired autos, non -owned autos and only scheduled be covered under our policy at $1,000,000 per occurrence with no annual aggregate limit for each bodily injury & property damage, we are unable to satisfy these requirements. Nancy K. Bohl Inc., dba The Counseling Team International only has one vehicle under the company which is covered on our automobile policy. -'All contractors that provide services on behalf of The Counseling Team are required to have their own auto insurance policies. If you have any additional questions, please contact me directly at 909-884-0133 x 225. S' cerely, Julie Casto Koot Chief Financial Officer The Counseling Team International P.O. Box 10427 • San Bernardino, CA 92423 • (909) 884-0133 • Fax (909) 3 Satellite Offices in the Counties of: Los Angeles • Orange • Riverside • San Bernardino - www.thecounselingteam.com �oRaN RiskMmagrnedDMsian REVIEWED & APPROVED BY.- 3 z Risk Management Analyst Policy No. 92 LB1426 CMP-4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 LB1426 Named Insured: NANCY K BOHL INC D3A THE COUNSELING TEAM INTERNATIONAL AND DBA THE ORGANIZATIONAL NETWORK. PO BOX 10427 SN BERNRDNO CA 92423 0427 Name And Address Of Additional Insured Person Or Organization: CITY OF SANTA ANA ITS OFFICERS EMPLOYEES AGENTS VOLUNTEERS & REPRESENTATIVES 20 CIVIC CENTER PLZ SANTA ANA CA 92701 405E SECTION If — WHO IS AN INSURED of SECTION If — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury", "property damage", or 'personal and advertis- ing injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products — Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". However, Paragraph 1. above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; b. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured; and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tional insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit" is tendered to us. ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED �oRaN Risk Mwag merdDMsian REVIEWED & APPROVED BY. - Risk Management Analyst CMP-4786 1 Page 2 of 2 2. Any insurance provided to the additional in- (3) The nature and location of any injury sured shall only apply with respect to a claim or damage arising out of the "occur - made or a "suit" brought for damages for rence" or offense; which you are provided coverage. b. Tender the defense and indemnity of any 3. With respect to the insurance afforded to the claim or "suit" to us and to all other insur- additional insured, the following is added to ers who may have insurance potentially SECTION If — LIMITS OF INSURANCE: available to the additional insured; and If coverage provided to the additional insured c. Agree to make available any other insur- is required by contract or agreement, the most ance the additional insured has for de - we will pay on behalf of the additional insured fense or damages for which we would will be the lesser of the amount of insurance: provide coverage under SECTION It -- a. Required by the contract or agreement; or LIABILITY. b. Available under the applicable Limits Of 5. With respect to the insurance afforded the ad - Insurance shown in the Declarations_ ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other This endorsement shall not increase the ap- Insurance of SECTION I AND SECTION II — plicable Limits Of Insurance shown in the COMMON POLICY CONDITIONS: Declarations. a. This insurance is primary to and will not 4. With respect to the insurance afforded to the seek contribution from any other insurance additional insured, the following is added to available to the additional insured, provided Paragraph 3. Duties In The Event Of Occur- that the additional insured is a named in- rence, Offense, Claim Or Suit of SECTION sured under such other insurance. II — GENERAL CONDITIONS: b. Regardless of any agreement between The additional insured must: you and the additional insured, this insur- ance is excess over any other insurance a. See to it that we are notified as soon as whether primary, excess, contingent or on practicable of an 'occurrence" or an of- any other basis for which the additional in- fense which may result in a claim. To the sured has been added as an additional in - extent possible, notice should include: sured on other policies. (1) How, when and where the 'occur- There will be no refund of premium in the event rence" or offense took place; this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply_ CMP-4786.1 1007033 148011 08-21-2014 Cc Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. oRaN Risk Mwag merdDivisian REVIEWED & APPROVED SY.- Risk Management Analyst Policy No. 92 LB1426 -age 78 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP-4787 WAIVER OF TRANSFER OF RIGHTS OR RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 LE1426 Named Insured: NAN,CY K BOHL INC DBA THE COUNSELING TEAM INTERNATIONAL AND DBA THE ORGANIZATIONAL NETWORK PO BOX 10427 SN BERNRDNO CA 92423 0427 Name And Address Of Person Or Organization: CITY OF SANTA ANA ITS OFFICERS EMPLOYEES AGENTS VOLUNTEERS & REPRESENTATIVES 20 CIVIC CENTER PLZ SANTA ANA CA 92701 4058 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 1006225 137715 1 11-19-2013 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. �oRaN RiskManagzmerdDivisian REVIEWED & APPROVED BY. - Risk Management Analyst Policy No. 012 YD0422 0 CMP-4786.1 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following. BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 YD0422 0 Named Insured: NANCY K BOHL INC DBA THE COUNSELING TEAM INTERNATIONAL AND DEA THE ORGANIZATIONAL NETWORK PO BOX -10427 SN BERNRDNO CA 92423 0427 Name And Address Of Additional Insured Person Or Organization: CITY OF SANTA ANA ITS OFFICERS EMPLOYEES AGENTS VOLUNTTEERS & REPRESENTATIVES 20 CIVIC CEINTER PLZ SANTA ANA CA 92701 4058 SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury", 'properly damage", or "personal and advertis- ing injury" caused; in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products — Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". However, Paragraph 1, above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; b. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured; and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tional insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit' is tendered to us. ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED oRaN Riskhtwag:merdDMsian REVIEWED & APPROVED BY. - Risk Management Analyst CMP-4786 1 Page 2 of 2 2. Any insurance provided to the additional in- (3) The nature and location of any injury sured shall only apply with respect to a claim or damage arising out of the "occur - made or a "suit" brought for damages for rence" or offense; which you are provided coverage. b. Tender the defense and indemnity of any 3. With respect to the insurance afforded to the claim or "suit" to us and to all other insur- additional insured, the following is added to ers who may have insurance potentially SECTION 11— LIMITS OF INSURANCE: available to the additional insured; and If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION II — GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an 'occurrence" or an of- fense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occur- rence" or offense took place; c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION 11 — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. (2) The names and addresses of any in- jured persons and witnesses; and All other policy provisions apply. CMP-4786 1 1007033 148011 08-21-2014 C. Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. oRaN 3 Risk Mwag merdDMsian REVIEWED & APPROVED SY.- z a p R. V Risk Management Analyst CMP Policy No. 92 YD0422 0 Page -4787 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP-4787 WAIVER OF TRANSFER OF RIGHTS OR RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 YDO422 0 Named Insured: NANCY K BOHL INC DBA THE COUNSELING TEP.M INTERNATIONAL AND DBA THE ORGANIZATIONAL NETWORK PO BOX 10427 SN BERNRDNO CA 92423 0427 Name And Address Of Person Or Organization: CITY OF SANTA ANA ITS OFFICERS EMPLOYEES AGE.vTS VOLUNTEERS & REPRESENTATIVES 20 CIVIC CENTER PLZ SANTA ANA CA 92701 4058 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 1006225 137715.1 11-19-2013 ©: Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. �oRaN 3 RiskMaaganerdDMsian REVIEWED & APPROVED SY.- z a p R. V Risk Management Analyst StateFarm STATE FARM M. PO Box 853922 Richardson, TX 75085-3922 66A AT1 23 000939 0093 CITY OF SANTA ANA, ISAOA 20 CIVIC CENTER PLZ FL 4TH 13, SANTA ANA CA 92701-4058 Inllllllll�I���II��III��I!'�Ill�l����nlnll'I�liuil�l" �'I���� DATE OF NOTICE: DEC 04 2019 CODE: NOTE: PLEASE NOTIFY STATE FARM AT THE ADDRESS LISTED AT THE TOP, LEFT CORNER OF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. ADDITIONAL INSURED'S NOTICE OF COVERAGE State Farm Mutual Automobile Insurance Company 7501-FA48-A NAMED INSURED: POLICY NO: 441 4187-F24-75W COVERAGE: NANCY K BOHL INC YRIMAKEfMODEL: 2017 8MW SPORT WG Bi AND PD LIABILITY ' DBA THE COUNSELING TEAM VINiCAMPER: 5VXKR6C36H0U13705 5 3 (30 DE 1 h COMP. S MIL o $1000 DED. LL 't' INTERNATIONAL AGENT NAME: SKAtA INSURANCE AGENCY INC r100@i]Ed. CALL PO BOX 10427 AGENT PHONE: (909)883-8861 o SN BERNRDNO CA 92423-0427 ENDORSEMENT NO: 60285U POLICY EFFECTIVE c OCT 31 2019 UNTIL TERMINATED m POLICY MESSAGES: This policy shown above supersedes policy# 4414187-75V. The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance o, provided and subject to all policy provisions. The additional insured will be given 20 days notice if the policy is terminatedUntil such notice is provided, it shall be presumed that the required renewal premiums have been paid.The additional insured must notify us within 10 days of g any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void, FRT RAManagement Dtwalan REVIEWED & APPROVED BY. - Risk Management Analyst 86698-4-P MATCH 00534 MUTL VOL StateFarm State Farm Mutual Automobile Insurance Company ® PO Box 853922 Richardson, TX 75085-3922 NAMED INSURED 00534 75-7501-4 P 000535 0058 NANCY K BOHL INC DBA THE COUNSELING TEAM INTERNATIONAL PO BOX 10427 SIN BERNRDNO CA 92423-0427 DO NOT PAY PREMIUMS SHOWN ON THIS PAGE. IF AN AMOUNT IS DUE, THEN A SEPARATE STATEMENT IS ENCLOSED. YOUR CAR DECLARATIONS PAGE PAGE 1 OF 2 POLICY NUMBER 441 4187-F24-75W POLICY PERIOD OCT 31 2019 to JUN 24 2020 12:01 A.M. Standard Time AGENT SKALA INSURANCE AGENCY INC 4214 N SIERRA WAY SIN BERNRDNO, CA 92407-3896 PHONE: (909)883-8861 YEAR MAKE MODEL BODY STYLE VEHICLE ID. NUMBER CLASS 2017 BMW X5 SPORT WG 5UXKR6C36HOU13705 600HCV11 SYMBOLS COVERAGE & LIMITS PREMIUMS A Liability Coverage $702.91 Bodily Injury Limits Each Person, Each Accident $1 ,000,000 $1,000,000 Property Damage Limft Each Accident $1,00.0,000 D Comprehensive Coverage - $1,000 Deductible $139.21 G Collision Coverage-$1,000 Deductible $508.25 R1 Car Rental and Travel Expenses Coverage $44.33 L m.A - Car Rental Expense Each Day, Each Loss $50 $1,200 U Uninsured Motor Vehicle Coverage $75.91 Bodily Injury Limits Each Person, Each Accident $1001OQQ $300n0.00 U1 Uninsured Motor Vehicle Property Damage Coverage $10.37 Additional Use of Nop-0wried Car Coverage BIPD Liability $5. 18 Physical Damage $25 , 88 Total Premium for OCT 312019 to JUN 24 2020. $1,511,74 This is not a bill IMPORTANT MESSAGES Replaced policy number 4414187-75V Your total renewal premium for DEC 24 2019 to JUN 24 2020 is $1,160.84. Location used to determine rate charged-36442 WILDWOOD CANYON RD, YUCAIPA CA 92399-5274. CONTINUED 06813/07236 See Reverse Side 155-3866 CA 05-2002 (ot 025tc) 115X0N (o1 a0251e) �oRaN IZAManagmerdl)Msian REVIEWED & APPROVED BY. - Risk Management Analyst 86698-4-P MATCH 00534 MUTL VOL StdeFwmState Farm Mutual Automobile Insurance Company PO Box 853922 Richardson, TX 75085-3922 00534 NAMED INSURED 75.7501.4 P A 000s3s oose NANCY K BOHL INC DBA THE COUNSELING TEAM INTERNATIONAL PO BOX 10427 SN BERNRDNO CA 92423-0427 DECLARATIONS PAGE I PAGE 2 OF 2 POLICY NUMBER 441 4187-F24-75W POLICY PERIOD OCT 31 2019 to JUN 24 2020 12:01 A.M. Standard Time EXCEPTIONS, POLICY BOOKLET & ENDORSEMENTS (See policy booklet & individual endorsements for coverage details.) FORM POLICY AND ANYSENDORSEMENTSLTHATIAPPLY, IACLUDINGLTHOSE0IISSUED TO YOU WITH ANY SOBSEIUENT RENEWAL NOTICE. 01 6029SU ADDI IONAL INSURED -THE ORGANIZATIONAL NETWORK, PO BOX 10427, SN BERNRDNO CA 92423-0427. 02 6028BU ADDITIONAL INSURED -CITY OF REDLANDS ATTN: RISH M ANAGEMENT, PO 033X602886 ADDITIONALAINSURED-CITY OF GARDEN GROVE ITS OFFICERS OFFICALS AGTS EMPL AND VOLUNTEERS ATTN RISK MNGT, 11222 ACACIA PKWY, GARDEN GROVE CA 92840-5208. 04 6028BU ADDITIONAL INSURED -RIVERSIDE CITY POLICE, 4102 ORANGE ST, RIVERSIDE CA 92501-3671. 05 6028BU ADDITIONAL INSURED -CITY OF GLENDALE AND ITS OFFICERS AGENTS 5P6028BU ADDITIONALEINSURED-NE3CITYIOFBMORENO VALLEYLISAOA91PD6BOX188005, M©RENO VALLEY CA 92552-0805. 07 6028BU ADDITIONAL INSURED-SAN MANUEL BAND OF MISSION INDIANS AND ITS AFFILIATES ENTITIES INSURANCE COMPLIANCE PO BOX 100085-M9 DULUTH GA 30096. 08 6028BU ADDITIONAL INSURED -COUNTY OF RIVERSIDE ISAOA, 29$0 WASHINGTON ST, RIVERSIDE CA 92504-4647. 09 6028BU ADDITIONAL INSURED -ORANGE COUNTY FIRE AUTHORITY ISAOA, 1 FIRE AUTHORITY RO IRVINE CA 92602-0125. OFFFICERSU AGENTSON&EMPLOYEES,T211CST1SOFSTLHAMBAM$RA CAT91801-3706. 11 6028BO ADDITIONAL INSURED-SAN BERNARDINO CITY UNIFIED SCHOOL DISTRICT, ITS TRUSTEES,, OFFICERS, EMPLOYEES AND AGENTS777 N F STREET, SN BERNRDNO CA 92410. 12 6028BU ADDITIONAL INSURED -CITY OF RIVERSIDE IT'S OFFICERS & EMPLOYEES, 13060 8BU AMITIONALIINSURED�COUNTY0OF ORANGE ISAOA, 1055 N MAIN ST, SANTA ANA CA 92701-3601. 14 6028BU ADDITIONAL INSURED -WEST BASIN MUNICIPAL WATER DISTRICT ISAOA, 17140 AVALON BLVD STE 210 CARSON CA 90746-1242. 15 6028BU ADDITIONAL INSURED -THE COUNTY DISTRICTS OF SAN BERNARDINO, ISAOA ATTN: EBIX PO BOX 257 PORTLAND MI 48875-0257. 16 6028BU ADDITIONAL INSURED -CITY OF CORONADO, 101 B AVE, CORONADO CA 92118-1510. 17 6028BU ADDITIONAL INSURED -CITY OF HUNTINGTON BEACH IT'S OFFICER'S, ISAOA, 200 MAIN ST HUNTINGTN BCH CA 92648-8121. 18 6028BU ADDITIONAL INSURED -CAL STATE POLYTECHNIC UNIV, POMONA, 3801 W 19M6028BUEADDPIOTIONNALAINSURED-CITY OF SAN BERNARDINO IT'S OFFICERS', ISAOA ATTN: HUMAN RESOURCES 290 N D ST SN BERNRDNO CA 92401-1734. 206028BU ADDITIONAL SPGSDCAE92240HOT SPRINGS POLICE DEPARTMENT, 65900 PIERSON 21 6028BU ADDITIONAL INSURED -CITY OF EL SEGUNDO OFFICERS, OFFICIALS, 22P60028BUAADDITIONALOINSURED-CITYSAP CARSONUAND ISAOA24ATTENTION PURCHASING DIVISION 701 E CARSON ST, CARSON CA 90745-2257. COMPLLIANCEASSERVICCESLPONBOX 4668UINTW YORKENYU10I63-4668IGIS INSUR 24 6028BU ADDITIONAL INSURED -CITY OF SANTA ANA, ISAOA, 20 CIVIC CENTER PLZ 25 5 2ABUAADDITIONAL INSURED -THE CITY OF ONTARIO, 303 E B ST, ONTARIO CA 91764-4196. 6028BU ADDITIONAL INSURED. 6196AA WAIVER OF SUBROGATION UNDER THE LIABILITY COVERAGE. 603OGF BUSINESS NAMED INSURED. 6126MO EXCESS COVERAGE FOR PERSONAL VEHICLE SHARING. 612BAC AMENDATORY ENDORSEMENT. [6[049CB USE OF NON -OWNED CARS- LIABILITY AND MEDICAL PAYMENTS COVERAGES 6©333BL USSEMO� NON-OWNEDOCARS-COMPREHENSIVE COVERAGE AND COLLISION COVERAGE; NANCY K BOHL 30 000 LIMIT. 6196AA WAIvv R N SUBROGATION UNDER THE LIABILITY COVERAGE FOR: CITY OF CARSON ISAOA; CITY OF SANTA ANA ISAOA;CITY OF RIVERSIDE. 0681 /07236 155 7 66 CA 2 05-2002 (o1 a0251c) (o1 a0254c) 13SX0 (ola025vd) Agent: SKALA INSURANCE AC Telephone: (909)883-8861 Prepared DEC 04 2019 750 a N_oaa Risk Managzmerd'Divisian REVIEWED & APPROVED BY.- 4 f R. Vj&wd ® Risk Management Analyst This policy is issued by State Farm Mutual Automobile Insurance Company. MUTUAL CONDITIONS 1. Membership. While this policy is in force, the first Insured shown on the Declarations Page is entitled to vote at all meetings of members and to receive dividends the Board of Directors in its discretion may declare in accordance with reasonable classifications and groupings of policyholders established by such Board. 2. No Contingent Liability. This policy is non -assessable. 3. Annual Meeting. The annual meeting of the members of the company shall be held at its home office at Bloomington, Illinois, on the second Monday of June at the hour of 10:00 A.M., unless the Board of Directors shall elect to change the time and place of such meeting, in which case, but not otherwise, due notice shall be mailed each member at the address disclosed in this policy at least 10 days prior thereto. In Witness Whereof, the State Farm Mutual Automobile Insurance Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. Ser retaryyj IMPORTANT NOTICE: California law requires us to provide you with information for filing complaints with the State Insurance Department regarding the coverage and service provided under this policy. Your agent's name and contact information are provided on the front of this document. Another option is to leach out by mail or phone directly to: State Farm® Executive Customer Service PO Box 2320 Bloomington IL 61702 Phone # 1-800-STATEFARM (1-800-782-8332) Department of Insurance complaints should be filed only after you and State Farm or your agent or other company representative have failed to reach a satisfactory agreement on a problem. California Department of Insurance Consumer Services Division 300 South Spring Street Los Angeles, CA 90013 Phone # 1-800-927-HELP (4357) or visit www.insurance_ca.g*vt01-consumers NOTICE We are required to furnish you with the following information: 1. An automobile liability insurance company may cancel a policy before the end of the current policy period for reasons described in the provision tined Cancellation which is located in the General Terms section of your policy(referto the Contents in the beginning of your policy forthe page number). 2. An automobile liability insurance company may increase the premium or refuse to renew the policy for any of the following reasons: a. Accident involvement by an insured, and whether an insured is at fault in the accident. b. A change in, or an addition of, an insured vehicle. c. A change in, or addition of, an insured under the policy. d. A change in the location of garaging of an insured vehicle. e. A change in the use of the insured vehicle. f. Convictions for violating any provision of the Vehicle Code or the Penal Code relating to the operation of a motor vehicle. g. The payment made by an insurer due to a claim filed by an insured or a third party. An automobile liability insurance company may increase the premium or refuse to renew the policy reasons that are not listed above but which are lawful and not unfairly discriminatory Risk Mattagemad Division REVIEWED & APPROVED BY. - Risk Management Analyst 103 9£ZL0/91990 Cw7 o v �b O O .b �WF �r L •-y' �1 W z � ce ^ � C N° ti U vC q U U•--' L C�cW7C,a C' O L Z y > CD ��QU� A c `o ° o o�U U o ��C>z cvi?• Cc) v a] J o �• s> c cCU O 2�02�<W c L H G%i c3 L F-� U U d U � U � •� Y. T '/. w � � r M U v J O •� > c° `c - C� ° �OwQgw F-� M i 0-F�ti�OJc�O� O'"gWwm OFaU�" C78`U zw'JF�' W po�ya4Oxgr��kFO[�i�q p0 x gCawq> W U�W�gwO y,W� Uuz~ WG¢U U u U u J��u� O Q adUZO�Q E~aCC)< ri O w C O .ami � 'iWj W U .W-1 z -C U °z�xZW'� �S z ; —N'�•N �= N o0F o T U'^y G U bD L a, �b U O r >>.p U w% v] v L O U O i U Ca uNi U ; . •� 'O U Y L b 'C 2 C cE C)iE C cn C ^ E ca C o v n _- 5 o = �° e, ° r = c Lo > W O `�•'+ p�� d ti w A rr �l VI 0 N Z 3O I 10;IgS ,I IIIIN008 ADI IOd HAOA O.L IIDd.L.LV 'HWHIld M9L-bZ3-L8Ib Ibb :JNUMN ADlfnd Cw7 cw7 C m c �oRaN RiskMmRgzmerdDMslan REVIEWED & APPROVED BY.- o r Risk Management Analyst 9CU0/91990 ^y W zz E C U 0�� '. G7 OTCc•,'-�`"^"^co". �3WH v c° 4 0 ' r D FRO 4" ~ U U ZI o o M W a+ W x o d a 'w _ ^ f� 4' O �, ° a fx V v � U _ o 7 °-' s x > O V N a� r ° HwoQ z��a'o� ^ � W U y o ^ 2. r = � � N 02 o¢ U W_ c p_ v 0. y •-- �1] Q rJ L S o ,+_, •., o o .^O [z' zLg�QNUCF" L ^� V U �y ��� FU a 0-0 0 on U I/ Fly C.] d r 1 C a. = o O W w % o^ ,o c C .o_'' o o cCz u g v WCl Z o � �uQ���U��vo °r Fyn o aF-� O o� x W o w a o � a •' b �? c�? `a U i 0. c U C U Y ti cc y U 0 U o 2 � o^ Q O G •v y % a C, y O U w W ;� U F •: � a ° �� a .= e,y 0-0 i� ��c❑ a y o 3 z e°m ��y� �� Q F •C E.p� `o t� w on v �_ d> .� r O ^E °air > a v d h z Ow 7 MSL-bZd-L8117 Ibb _zaqumN AoAod .LN'IN009 AJII'IOd HAOA O.L IIDVLJV :11S` H Id 0 O 9 ��oRaN Risk MmRgemerdDMaian REVIEWED & APPROVED BY. - Risk Management Analyst 103 9EZLO91990 O v I v i r° ti N U r y >' C U O a M, a w 0 0 rr, C �n d i n o F U M �� y j cr c •_ �• U U a y G-10 N 0= R W 3 fG t u O > �. ►�i O F-� U p eco— >OCR. ° ti = >' m JO O C y ,ur.- U�-O C a, '7 c ^U�U��i' Q.-. v �• V 4 I ` Q T d W Z' LS• f- �; W q 4=� !y" y Cp•Y-'—' '...: �b V'J. VCJ O .rn ""' � cC Q' r O OU .-. U o J. 'y bu= q �>-_- - r= 'o- o 0�U7 µ?3 �,'xs�-'�'=°` °' ��5 .a c �•� F wC�O v�.��cvo� �° �wL1�DU'var° a M, o � O o y \\ ^ 80 It R ,6i d2 d O '- -Up N +Ci �' s. .= a bq S W OU ,3 zf N y M 7J �, ^• y ` ° vUi i1U�i U C,14 t,.., y. �? p L a `�'•' >. .p C i -• '� C. T�C. o. tco�� O Q >.c�.rDR F" ACE- c°�ocn °' c d� ay �� �.r�� rp �� � � O?.�oo5.6 o u o 7,2, o � �E 3 d � c � „ �o.EO�cz >o=c°�W� �..vWi�o��� �E r Hc�3c�u.� L° o�3�`oy° 4+lq�c czo>= zo U r woRaN RiskMwagemerdDMslan m r ^ coG< REVIEWED & APPROVED BY.- Z 3o Z aaGS IU r-400g A3I'I0d HI iOA O•L I3)V.L.LV INVU 1d MSL-bZ3-L8ib Ibb :�agmnN���od ' �� Risk Management Analyst POLICYHOLDER COPY SP P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 08-12-2020 CITY OF SANTA ANA, ATTN: RISK MANAGEMENT 20 CIVIC CENTER PLZ FL 4 SANTA ANA CA 92701-4058 SP GROUP: POLICY NUMBER: 0702761-2020 CERTIFICATE ID: 107 CERTIFICATE EXPIRES: 08-12-2021 08-12-2020/08-12-2021 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 by the policy described 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 2020-08-12 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF SANTA ANA, ATTN: RISK MANAGEMENT ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-12-2011 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION .EFFECTIVE 08-12-2011 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF SANTA ANA, ATTN: RISK MANAGEMENT ENDORSEMENT #1651 - NANCY K BOHL P,S,T - EXCLUDED. EMPLOYER NANCY K BOHL INC 1881 BUS CTR DR STE 11 SAN BERNADINO CA 92408 (REV.7-2014) SP PRINTED : Risk MmWmentDivisian REVIEWED & APPROVED BY: Risk Management Analyst CPH H PHILADELPHI INSURANCE COMPANIESS & ASSOCIATES Certificate of Liability Insurance Date Issued: 07/22/2020 Underwritten by: Philadelphia Indemnity Insurance Company • One Bala Plaza, Suite 100 • Bala Cynwyd, PA 19004 • NAIC #: 18058 Administered by: CPH & Associates 711 S. Dearborn St Ste 205 Chicago, IL 60605 P 800 875 1911 F 312 987 0902 info@cphins.com DISCLAIMER: This certificate is issued as a matter of information only and confers no rights upon the certificate holder. 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 Insured: Nancy K. BON Inc. dba The Counseling Team International Nancy BOW 1881 Business Center Drive #11 San Bernardino, CA 92408 Policy Number: 025826 Policy Term: 08/31 /2019 to 08/31 /2021 Covered Locations Professional Liability: Portable coverage, not location specific Coverage Type Per Incident Aggregate (Occurrence Form) (Per individual claim) (Total amount per year) Professional Liability $ 1,000,000 $ 5,000,000 Supplemental Liability $ 1,000,000 $ 5,000,000 Licensing Board Defense $ 35,000 $ 35,000 Commercial General N/A N/A Liability N/A NIA o Fire/Water Legal Liability Business Personal Property N/A N/A Vicarious Sexual $ 1,000,000 $ 1,000,000 Misconduct Cyber Liability (Claims Made Form) $ 25,000 $ 25,000 Retroactive Date: 08/31 /2018 Comments/Special Descriptions: Certificate Holder City Of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana, CA 92702 ® Certificate Holder has been added as an additional insured 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 in lieu of such endorsement(s) Notice of Cancellation will only be provided to the first named insured in accordance with policy provisions, who shall act on behalf of all additional insureds with respect to giving notice of cancellation (' P)A� Alft'- Authorized Representative r' Dhinn I-I-4— Q N_oaa RAManagmentDMsian REVIEWED & APPROVED BY.- 4F R. VSA44a ® Risk Management Analyst PI-PHCP-05 (3-01) THIS ENDORSEMENT CHANGED THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured Endorsement This endorsement modifies insurance provided under the following: ALLIED HEALTHCARE PROVIDERS PROFESSIONAL AND SUPPLEMENTAL LIABILITY INSURANCE POLICY In consideration of the premium paid, this policy is amended as follows: City Of Santa Ana 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 City Of Santa Ana. Additional Insured Name and Mailing Address: City Of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana, CA, 92702 All other terms and conditions of this policy remain unchanged. Policy #: 025826 Endorsement #: PI-PHCP-05 (3 -01) Effective on or after: 08/31 /2020 Issued to: Nancy K. Bohl Inc. dba The Counseling Team International Expiration date: 08/31/2021 Page 1 of 1 HortaN } z Risk MmRgementDMsian REVIEWED & APPROVED BY.- f R. Vj&'Wd Risk Management Analyst