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HomeMy WebLinkAboutGRUVER, ERIC, PH.D.INSURANCE NOT ON FILE N-2019-128 WORK MAY NQTpPRNOCEED CLERWF � 2U ffi DAT . AGREEMENT TO PROVIDE PSYCHOLOGICAL EVALUATION SERVICES D` Y d(.1i FOR THE CITY OF SANTA ANA POLICE DEPARTMENT i—co ,Ack(ktl," i THIS AGREEMENT is made and entered into this 12th day of June, 2019 by and between Eric Gruver, Ph.D., ("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 9, 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 he 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 consultingfirm in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES Consultant shall perform during the term of this Agreement, the tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately complete the 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 $14,190. This amount is comprised of the base amount of $12,900 and contingency amount of $1,290 for services to be provided at the sole discretion of the City. b. Payment by City shall be made within 45 days (forty-five) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. 3. TERM This Agreement shall commence on July 1, 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 51,000,000 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 orchanged 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 terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing, to the extent Consultant's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Consultant. 7. RECORDS Consultant shall keep records and invoices in connection with the work to be performed under this Agreement. Consultant shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Consultant under this Agreement. All such records and invoices shall be clearly identifiable. Consultant shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours. Consultant shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Consultant under this Agreement. 8. CONFIDENTIALITY If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential an&or proprietary, Consultant agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Consultant without reference to information disclosed by the City. 9. CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 10. DISCRIMINATION Consultant shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 11. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the 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 assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other consultants retained by City. 13. TERMINATION This Agreement may be 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: Eric Gruver, Ph.D. 2021 E. 4`h Street Suite 116 Santa Ana, CA 92705 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 elTective 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: 10 �� Norma Mitre Acting Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attomey Bv: Tamara bogosian Assistant City Attorney RECOMMENDED FOR APPROVAL: r___ ED-F�'VCD VALENTIN Chief of Police Santa Ana Police Department CITY OF SANTA ANA .c` Kri ine Ridge City Manager 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 (as needed) 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 1. 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: 1. 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. 2. 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. Review of Fitness for Duty Review background investigations, clinical interviews, administrative reports and/or other relevant documents to determine an employee's psychological fitness for duty, when so directed by the City. Fitness for duty review includes, but is not limited to, clinical interviews, administration of necessary tests, scoring of tests, and preparation of verbal and written recommendations for employment. Consultant shall: 1. Outline all psychological concerns resulting from that review and submit to City's Police Department a recommendation concerning further testing and or evaluation which may be deemed appropriate. 2. Provide City's Police Department with verbal notification as to the above within forty - City of Santa Ana — RFP 19-040 for Psychological Services Page 2 eight (48) hours, and with a complete written report concerning reviews of fitness for duty within ten (10) working days following receipt of documents or the last clinical interview of employee(s) in question. Note: The City may elect to enter into two agreements to allow for a separate psychologist to conduct fitness for duties. D. 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: 1. 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. E. 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. F.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. Assist in interpreting intelligence data in reference to criminal incidents and/or suspect. City of Santa Ana — RFP 19-040 for Psychological Services Page 3 G. 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. City of Santa Ana — RFP 19-040 for Psychological Services Page 4 EXHIBIT B COMPENSATION (RATES) EXHIBIT 8 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. of Units Per Yr. Subtotal A. Pre -employment psychological evaluations $ 400 Per applicant TBD $ TBD B. Complete Post -Traumatic Psychological Incident Evaluation $ 150 Per hour TBD $ TBD C. Review of Fitness for Duty $ 1 so Per hour TBD $ TBD D. Crisis Intervention Counseling $ 1so Per hour TBD $ TBD E. Critical Incident Stress Manaciement $ 15o Per hour i TBD $ TBD F. Consultation Services $ 15o Per hour TBD $ TBD G. Psychological Training Services $ 150 Per hour TBD ii $ TBD Testimony in court and court Preparation $ 200 Per hour ;TBIi $ TBD � YI City of Santa Ana — RFP 19- 440 for Psychological Services Page 20 15.08. 2019 15:22 17145444996 #0217 P 4/19 Account Number: CA GRUE 1440 Date: 8/15/19 Initials: KB CERTIFICATE OF INSURANCE ALLIED WORLD INSURANCE COMPANY C/O: American Professional Agency, Inc. 95 Broadway, Amityville, NY 11701 800-421-6694 This is to certify that the insurance policies specified below have been issued by the company indicated above to the insured named herein and that, subject to their provisions and conditions, such policies afford the coverages indicated insofar as such coverages apply to the occupation or business of the Named Insured(s) as stated. THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE(S) AFFORDED BY THE POLICY(IES) LISTED ON THIS CERTIFICATE. Name and Address of Named Insured ERIC WAYNE GRUVER, PH.D. 2021 E 4TH STREET SUITE 116 SANTA ANA CA 92705 Type of Work Covered: PROFESSIONAL PSYCHOLOGIST Location of Operations: N/A (If diffarent than addrese listed above) Claim History: Rwl-rnari-i I,r A. . nIInI /+000 krer-JRwrownw-• & APPROVEC 1GEMENT DIVISION 212019 M. LAMBERT Coverages Policy Number Effective Date Expiration Date Limits of Liability PROFESSIONAL/ LIABILITY 5010-7473 3/01/19 3/01/20 2,000,000 4,000,000 NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED, WHO SHALL ACT ON BEHALF OF ALL INSUREDS WITH RESPECT TO GIVING OR RECEIVING NOTICE OF CANCELLATION. Comments: Defense Reimbursement Proceedings Limit is CITY OF ANAHEIM CITY OF SANTA ANA RISK MANAGEMENT DIVISION 20 CIVIC CENTER PLAZA ANAHEIM, CA 00000 SANTA ANA, CA 92702 This Certificate Issued o Name: ERIC WAYNE GRUVER, PH.D. 2021 E 4TH STREET Address: SUITE 116 _ SANTA ANA CA 92705 $75,000. 3 ADDL.INS.BELOW: CITY OF GARDEN GROVE, IT'S OFFICERS, OFFICIALS EMPLOYEES, AGENTS, AND VOLUUZS,tRS 00000 orized Representative APA 00138 00 (06/2014) 15.08.2019 15:22 17145999996 #0217 P 5/19 WORKERS' COMPENSATION_ DECLARATION (4V16Qxrcby affirm under penalty of perjury, the (Nwnerntle) following declaration T ec ' If of 1 that during the term of my (C01130ent/Company Nan contract for services with the City of Santa Ana, I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall I forthwith comply with�thoos provisions and prod prao workers' compensation coverage. DATE: ii Name: Title: Telephone: 1 �{ ��''� l qL4�/ GI WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. 15-03.2019 15e22 17145444996 #0217 P 6/19 Eric W. Gruver, Ph.D. PSY 5246 PSYCHOLOGY August 15, 2019 City of Santa Ana, To Whom It May Concern: RP,: C ac with Eric W. Gruvor, Ph.D.- AUTOMOBILE LIABILITY not be i ig my or y vehicle for the City of Santa Ana. Therefore AUTOMOBILE LIABILITY not perl in.p SJ �k %, �� Fellow -American College Of Forensic Psychology - Fellow-Oiplomote The International Academy OfMedlclne And Psychology. 2021 E. Fourth Street, Suite 116. Santa Ana, CA 92705 Office (714) 544-4434 • Fax (714) 544.4996 • E-mail. drgruver39@gmoil.com 15.08.2019 15:22 17145999996 #0217 P 7/19 W es FARMERS INSURANCE California Offer of Terrorism Coverage Namedlnsured;ERIC GRUVER AgentNumber:97-15-520 Address; 2021 E FOURTH STE 116 Policy Number:01504-40-07 SANTA ANA CA 92705 Q� Read Carefully Before Signing DearValued Customer, (V v Our records indicate that you a pre iously declined coverage for "Certified Acts of Terrorism." Effectivejanuary1,2015th deralTerr rismRisk insurance Act defines a"certified act of terrorism" as an act that is certified eSecretar ftheTreasury,inaccordance with the provisions ofthe Act tobe an act of terrorism. a criteria co tained in the Terrorism Risk Insurance Act for a "certified act of terrorism"inclu hefollowing: 1. The act,rofulted in insured losses in excess of $5 million in the aggregate, attributable to all types of insupricesubjecttotheTerrorismRiskInsuranceAct;and 7_yRe act is a violent act or an act that is dangerous to human life, property or infrastructure and is committed by an Individual or Indlvlduals as part of an effort to coerce the civilian population of the United States or to influence the policy or affect the conduct of Its government bycoercion. You should know that coverage for losses caused by "certified acts of terrorism" is partially reimbursed by the United States government under a formula established by federal law. Under this formula, the U.S. government pays a percentage of covered terrorism losses exceeding the statutorily established deductible paid by the insurer providing the coverage. The Act contains a $100 billion cap that limits government reimbursement and insurer liability for losses resulting from Certified Acts of Terrorism when the amount of such losses in anyone calendar year exceeds S100 billion. If the aggregate insured losses for all insurersexceed $100 billion, terrorism coverage may be reduced. The premium charged for this coverage does not include any charges for the portion of loss covered by the federal government under the Act. The premium cost for such coverage for "certified acts of terrorism" Is calculated as a percentage of our final premium for certain coverages, per the following schedule: Coverage Los Angeles, Orange and All OtherCountles San Francisco Counties Property 1.5% 1.0% General Liability 1.5% 1.0% Umbrella 1.0% 1-0% In no event will the premium be greater than 1.5%of your property/ Iiabillty premium. You have the right to Include this coverage for "certified acts of terrorism." If you choose to do so, you must sign this form and return It In the enclosed envelope within 30 days of the effective date of this policy. No Reply Is Necessary To Decline This Offer. I ACCEPT "Certified Acts of Terrorism" coverage. Signatu Date UA. 14 A 25-6301 1-15 Sign And Keep This Copy With Your policy A6301301 page I of 1 15.08.2019 15r23 17145eee996 #0217 P 8/19 FARMERS INSURANCE Important Notice Subscription Agreement Notice (Please keep foryour records) Bypoyment of the policypremium, you acknowledge Char you have received and read the buck Insurance Exchange Subscription Agreement (the terms ofwhich orerprovlded below) and that you agree to be bound to all of the rermsond conditions of the Subscription Agreement. Under the Subscription Agreement, you appoint Truck Underwriters Association (the "Association") to act as the attorney -In -fact. The Association has acted in this capacity since 1935, The Subscrfptfon Agreementprovides for paymant of compensation to the Association for Its becoming and acting as attorney -in -fact. This compemotlon consists of o membership fee and a percentage of premiums on all policies of insurance or reinsurance issued or effected by the Exchange. These feesore included In yourpolicypayment and are not on additional fee. We reserve the right to requestthat you provide us with n slgned5ubscriptionAgreement and if you fall to do so, your coverage maybe terminated. Subscription Agreement For and inconsideration of the benefits to be derived therefrom the subscriber covenants and agrees with Truck Insurance Exchange and other subscribers thereto through their and each of their attorney -in -fact, Truck Underwriters Association, to exchange with all other subscribers' policies of insurance or reinsurance containing such terms and conditions therein as may be specified by said attorney -in -fact and approved by the Board of Governors or its Executive Committee for any loss insured against, and subscriber hereby designates, constitutes and appoints Truck Underwriters Association to be attorney -in -fact for subscriber, granting to it power to substitute another in its place, and In subscriber's name, place and stead to do all things which the subscriber or subscribers might or could do severally or Jointly with reference to all policies issued, including cancellation thereof, collection and receipt of all monies due the Exchange from whatever source and disbursement of all loss and expense payments, effect reinsurance and all other acts Incidental to the management of the Exchange and the business of interinsurance; subscriber further agrees that there shall be paid to said Association, as compensation for Its becoming and acting as attorney -In -fact, the membership fees and twenty per centum of the Premium Deposit for the insurance provided and twenty per centum of the premiums required for continuance thereof. The remaining portion of the Premium Deposit and of additional term payments made by or on behalf of the subscriber shall be applied to the payment of losses and expenses and to the establishment of reserves and general surplus. Such reserves and surplus maybe invested and reinvested by a Board of Governors duly elected by and from subscribers In accordance with provisions of policies issued, which Board or Its Executive Committee or an agent or agency appointed by written authority of said Executive Committee shall have full powers to negotiate purchases, sales, trades, exchanges, and transfers of investments, properties, titles and securities, together with full powers to execute all necessary instruments. The expenses above referred to shall include all taxes, license fees, attorneys' fees and adjustment expenses and charges, expenses of members' and governors' meetings, agents' commissions, and such other specified fees, dues and expenses as may be authorized by the Board of Governors, All other expenses incurred In connection with the conduct of the Exchange and such of the above expenses as shall from time to time be agreed upon by and between the Association and the Board of Governors or i is Executive Committee shall be borne by the Association. The principal office of the Exchange and its attorney -in -fact shall be maintained in the City of Los Angeles, Countyof Los Angeles, State of California. This agreement can be signed upon any number of counterparts with the same effect as if the signatures of all subscribers were upon one and the same Instrument, and shall be binding upon the parties thereto, severally and ratably as provided in policies issued. Wherever the word "subscriber" is used the same shall mean members of the Exchange, the subscriber hereto, and all other subscribers to this or any other like agreement. Any policy issued hereon shall be non -assessable. 25-3037CI 2-1e 15.08.2019 15123 17145999996 00217 P 9/19 FARMERS INSURANCE Important Notice- Regarding Additional Insured Endorsements Dear Farmers Customer, Thank you for choosing Farmers for your insurance needs. We appreciate your business and want to keep you informed of any updates related toyour policy. We recently updated the following Additional Insured endorsements, and one or more of them has been attached to your renewal policy: Endorsement Title New Form Number _ Additional insured- Managers Or Lessors of Premises J7231 J7232 Additional Insured -Controlling Interest Additional insured -State Or Governmental Agency Or Subdivision Or Political Subdivision• 17233 Permits Or Authorizations Relating To Premises Additional Insured - Mortgagee, Assignee, Or Receiver J7234 J7235 Additional Insured -Owners Or Other Interests From Whom Land Has Been Leased Additional Insured - Lessor Of Leased Equipment J7236 17237 Additional Insured -Vendors Additional Insured - Designated Person Or Organization J 7238 Addltlonallnsured - Owners, Lessees Or Contractors- Scheduled Person Or Organization J7239 Addltlonallnsured - owners, Lessees Or Contractors- With Additional Insured Requirement In _ j7240 Construction Contract Additional Insured -State Or Political Subdivisions - Permits J 7241 The updated versions of the Additional Insured endorsement(s) Included with this renewal replace the versions previously attached to your policy. Please review all of the revised endorsements Included with your renewal and provide them to the Additional Insured entities. Should any of these entities no longer need to be Included as an Additional Insured on your policy, please contact your Farmers agent to have them removed. This notice is not a substitute for reviewing your policy and the endorsements Included with your policy. Please take a moment to review your policy carefully to better understand the terms and conditions of your coverage. If you have questions, please contact your Farmersagen t. 259356 02.19 O 259356•EDI Pa e 10 1" � 3561 1 15-08.2019 15:29 17145999996 *0217 P 10/19 FARMERS INSURANCE Notice to Policyholders New Marijuana Exclusion As you review the enclosed renewal policy, you will notice that an endorsement entitled Marijuana Exclusion has been added to your policy contract. Marijuana has historically been excluded from coverage due to its classification as contraband. Due to changes in the legal status of marijuana and marijuana related products at the state level, this new endorsement clarifies that your policy does not provide coverage for loss, damage or injury related to theownership, sale or distribution of marijuana. This notice is for informational purposes only; it is not a part of your insurance contract. It is not a substitute for reviewing your policy and the endorsements included with your policy. Please take a moment to carefully review your pol icy to better understand the terms and conditions of your coverage. If you have anyquestions about this changetoyour insurance coverage, please contact your Farmerfagent 25-9319E D 1 2-19 25-9319 j /� 1 f Page o II A931 of I 15.08.2019 15:24 17145999996 #0217 P 11119 FARMER$ INSURANCE Important Notice - Regarding Supplementary Payments Coverage Dear Farmers Customer, Thank you for choosing Farmers ° for your Insurance needs. We appreciate your business and want to keep you Informedoran update relating to your policy. Your commercial Insurance policy now contains endorsement J7230-EDI Supplementary Payments. This endorsement provides updated policy language in line with current industry standards as provided by Insurance Office Service (ISO) forms. This change may result in a reduction of coverage on your policy with regard to coverage for opposing party s attorney fees. This notice is not a substitute for reviewing your policy and the endorsements Included with your policy. Please review your policy to better understand the terms and condl tions of your coverage. If you have questions, please contact your Farmers agent. 25-9342 12-t8 1't Page 1 of 1 25-9302-EDI A93a2101 15.08.2019 15:24 17145444996 #0217 F 12/19 FARMERS INSURANCE Named ERIC GRUVER Insured Truck Insurance Exchange (A Reciprocal Insurer) Member Of The Farmers Insurance Group Of Companies'e Home Office: 6301 Owensmouth Ave., Woodland Hills, GA 91367 COMMON POLICY DECLARATIONS Mailing 2021E FOURTH STE 116 Address SANTA ANA, CA 92705 Form of ©Individual ❑joint Venture Business ❑Corporation ❑Partnership F005238941.001.00001 Account No. prod. Count 97-15-520 015041-40-07 Agent No. Policy Number ❑ Limited Liability Co. Business Description: ❑ Other Organization Health Practitioners Policy From 08.25.2019 (not priorto time applisd for) Period To 08-25.2020 12:01A.M, Standard time atyour mallingaddress shown above. If this policy replaces other coverage that ends at noon standard time of the same day this policy begins, this policy will not take effect until the other coverage ends. This policy will continue for successive policy periods as follows: If we elect to continue this Insurance, we will renew this policy if you pay the required renewal premium for each successive policy period subject to our premiums, rules and forms then In effect. The attorney -in -fact (AIF) or management fee foryour renewed policy will never exceed 20%of the policy's premiums and will be paid out of the premiums. You may wish to consider this Information In deciding whether to accept or decline this offer to renew your policy. This policy consists of the following coverage parts listed belowand for which a premium Is indicated. This premium may be subject to change. uoverage rarra Premium After Discount And Modification Buslnessowners $702.00 Employment Practices Liability $74,00 Cyber LIabilityAnd Data Breach Expense Coverage $80,00 Total (See Additional Fee l nformatlon Below) $856.00 56-2406 1-17 �r C2406201 Page 1 0} 3 55-240 iO3 `f�11 15.08.2019 15:24 17145444996 #0217 P 13/19 Policy Number101504-40-07 Additional Fee Information The following additional fees apply on an account, not per policy, basis. Effective Date:08-25.2019 • A service fee will be assessed on every installment invoice and will be included in the minimum amount due. However, If you choose to pay the entire account balance In full upon receipt of the first Installment, the fee will be waive 1. In addition, for accounts fullyenrolled In online billing and scheduled for recurring Electronic Funds Transfer (EFT) payments the fee will be waived. State Installment Fee All states except Alaska, Florida,Maryland, NewJersey And West Virginia $6.00 Alaska and Maryland Not applicable Florida $3.00 NewJersey $7.00 West Virginia $5.00 • Areturned payment fee applies per check, electronic transaction or other remittance which is not honored by your financial Institution for any reason Including but not limited to Insufficient funds or a closed account. NOTE: If the refumedpayment Is In response to a Notice of Cancellation, coverage still cancels on the cancellation effective date setforth In the notice. state NSF Fee All States Except Alaska, Florida, Indiana, Maine, Nebraska, New Jersey, North Dakota, Oklahoma, Virginia And West Virginia $30.00 North Dakota And Oklahoma $25.00 Nebraska And Indiana $20 00 Florida And West Virginia $15.00 Maine $10,00 Alaska, NewlerseyAnd Virginia Notapplicable • A late fee will be assessed on each Notice of Cancellatlon that is issued and will be included In the minimum amount due. state late Fee All States Except Alaska, Florida, Maryland, Missouri, Nebraska, New Jersey, Rhode Island, Vlrglnla, South Carolina And West Vlrglnla $20.00 Nebraska, Rhode Island And South Carolina $10,00 Alaska, Florlda, Maryland, Missouri, NewJersey, Virginia And West Vlrglnla Not applicable The following applies o n a per•pollcy basil a. ' A relnstatetnentfee of S25.00 will be assessed if the policy is reinstated over 30 days but under 6 months from the cancellation date. This fee does not applyto Florida, Indiana & Maryland orto Workers Compensation policies. One or more of the fees or charges described above may be deemed a part of premium under applicable state law. 56.2406 1.17 C2406203 page 3 of 3 ��IPA��°� 15.03.2019 15:24 17145444996 #0217 P 14/19 Ah Truck Insurance Exchange (A Reciprocal Insurer) Member Of The Farmers Insurance Group Of Companless FARMERS INSURANCE Home Office: 6301 Owensmouth Ave., Woodland Hills, CA 91367 POLICY DECLARATIONS - SERVICE OR OFFICE PRIMARY POLICY Named ERICGRUVER Insured Mailing 2021 E FOURTH STE 116 Address SANTA ANA, CA 92705 PollcyNumber 01504-40.07 ❑Audltable Policy From 08.25.2019 Period To 08-25-2020 12:01A.M. Standard time at your mailing address shown above. In return for the payment of premium and subject to all the terms of this policy, we agree with you to provide insurance as stated in this policy. We provide insurance onlyfor those Coverages described and forwhich a specific limit of Insurance is shown. Your Agent Bob Davis Po Box 3847 Tustin, CA 92781 (714)5053893 56.2407 1.15 562407-IDI A%I//111 1 Page 1 of s 15-08.2019 15:25 17145994996 #0217 F 15/19 Polley Number: 01504.40.07 effective Date: 08.25.2019 PROPERTY, INLAND MARINE AND CRIME COVERAGES AND LIMITS BUILDING Option: eV- BlanketValue(see Base Coverage& Extensions for the total limit) Valuation: ACV -Actual Cash Value;AV-AgreedValue; RC- Rep acementCost; ERC- Extended RC; FRC- FunctionalRC;GRC- Guaranteed RC Abbreviation: ALS = Actual Loss Sustained; 81=Business income; EE=Extra Ex ense Premises Bldg. Number No. Covered Premises Address Mortgage& Name And Address 001 001 2021 E Fourth Ste 116 Santa Ana, CA 92705 Coverage Business Personal Property(813P) Option lValuation I LImlt Of Insurance RC I $23,900 Deductible/ Welting Period $500 96Q407 1-15 --- a62407-EIA �/)A � � Pape 2 of 8 15.08.2019 15:25 17145444996 00217 P 16/19 PollcyNumber: 01504-40-07 Fffartlanal.: no-ic inin PROPERTY, INLAND MARINE AND CRIME COVERAGES AND LIMITS CONTINUED PREMISES tp FW119,11 q Premises Bldg, Number Covered Premises Address 001 All 2021 E Fourth Ste 116, Santa Ana, CA9Z705 Coverage Limit Of Insurance Deductible Waiting Period Accounts Receivables - On -Premises $9,000 $500 Debris Removal 25% Of Loss + 10,000 Personal Effects $2,600 $500 Pollutant Clean Up And Removal Aggregate $10,000 $500 Valuable Paper And Records - On -Premises $5,000 $500 5644w 1_0 V \l Page 3 of 9 15.08-2019 15:25 17145444956 #0217 P 17/19 PollcyNumber: 01504.40-07 Fffoetivanga. AA-ICIA10 PROPERTY, INLAND MARINE AND CRIME COVERAGES AND LIMITS OF INSURANCE .. . ... 9000d'11.9106W V. 'k Olt. 96WROW0 c ana pram ea bp; dY bvlld(p40� P W 1 0 j0jW* lie Base Coverages And Extensions Urnit Of Insurance Deductible/ Waiting Period Accounts Receivables - Off -Premises $2,500 $500 Arson Conviction Reward $5'000 None Business Income & Extra Expense- Civil Authority 3 WaAks 72 Hours - 9 1 Business Income (B 1) & Extra Expense (EE) 1BMon the -ALS 72 Hours BPP Seasonal Increase 25% DroneAlrcraft - Direct Damage (per occurrence) $10,000 $500 DroneAlrcraft- Direct Damage (per item) $2,500 $500 Drone Aircraft - B I & EE $10,000 72 Hours Electronic Data Processing Equipment $10,000 $500 Electronic Data Processing Media And Records $2,500 $500 Employee Dishonesty $5,000 $500 Extended Business Income 30 Days Fire Department Service Charge $1,000 None Fire Extinguisher Systems Recharge Expense $2,500 None Forgery And Alteration $2,500 $500 Limited Cov. - FungI Wet Rot Dry Rot& Bacteria- Aggregate $15,000 $500 Money And Securities - Inside Premises $5,000 $500 Money And Securities - Outside Premises $5,000 $SOO Money Orders And Counterfeit Paper Currency $1,000 $500 N6wlyAcqulred Or Constructed Building $250,000 $500 Outdoor Property $2,500 $500 Outdoor Property - Trees, Sh rubs & Plants (Per item) $500 $500 Outdoor Signs $2,500 $500 Personal Property At Newly Acquired Promises $100,000 $500 Personal Property Off Premises $5,000 $500 Premises Boundary 100 Feet Preservation Of Property 30 days Valuable Paper And Records- Off -Premises $2,500 $500 56-2407 1-15 562407-EIC Page 4 of 8 15.08.2019 15:25 17145444996 90217 P 18119 PollcyNumber. 01504-40.07 EffectiveDe[ee OR-95.7019 15.08.2019 15:26 17145444996 #0217 P 19/19 Policy Number: 01504.40.07 EffectiveDate: 08.25.2019