HomeMy WebLinkAboutSTIPKOVICH, ELISA (2)INSURANCE ON FILE WORK MAY PROCEED N-2019-204
UNTIL INSURANCE EXPIRES
CL1ERK 0! CO CIUN L CONSULTING AGREEMENT
DATE: OCT
1TIIS CCONSULTING AGREEMENT ("Agreement") is made and entered into this
Q .COAL day of 6LIUv , 2019, by and between Elisa Stipkovich ("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 ("Client").
RECITALS
A. Client and Consultant desire to create an independent contractor relationship in
connection with the services that Consultant may perform for Client, as described below.
B. In undertaking the performance of this Agreement, Consultant represents that she is
knowledgeable in her field and that any services performed by Consultant under this
Agreement will be performed in compliance with such standards as may reasonably be
expected from a professional consulting firm in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the
terms and conditions hereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
Consultant shall perform those services as set forth in Exhibit A attached to this
Agreement and incorporated herein by reference.
2. COMPENSATION
a. As full consideration for all services to be rendered by Consultant pursuant this
Agreement, Client shall pay Consultant one -hundred and fifty dollars ($150.00)
per hour of service. Consultant expressly acknowledges that she shall receive no
other compensation for services rendered pursuant to this Agreement, and
specifically acknowledges that she shall not receive medical, life or other
insurance, vacation, sick days or holiday benefits, or any other benefits. In
connection with payment of Compensation hereunder, Client shall provide both
Consultant and the IRS with IRS form 1099. The total sum to be expended under
this Agreement shall not exceed twenty-five thousand dollars ($25,000,00) during
the term of this Agreement.
b. Consultant shall be reasonably reimbursed by Client for extraordinary costs and
expenses incurred in connection with the performance of her duties under this
Agreement. The parties expressly acknowledge and agree that Compensation as
defined above does not encompass reimbursement for extraordinary costs and
expenses, such as travel, parking, overnight delivery, photocopying, postage,
entertaining others on behalf of Client, etc. Costs of travel using Consultant's
personal car shall be reimbursed at the IRS rate, and all other extraordinary costs
and expenses shall be reimbursed at actual cost. As used herein, the term "travel"
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specifically excludes commuting to/from Client's offices, and therefore shall not
be reimbursable. Client shall not be obligated to reimburse Consultant for
extraordinary costs and expenses greater than $50.00 per occurrence, unless
Client shall have specifically agreed in advance, prior to the time such
extraordinary costs and expenses are incurred, to reimburse Consultant for same.
C. Payment by Client shall be made within forty-five (45) days following receipt of
proper invoice evidencing work performed, subject to Client 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 Client.
3. TERM
This Agreement shall be effective as of the date first written above, and shall continue for
two (2) years, unless terminated earlier as provided in section 14 below. The City shall also have
the discretion to exercise two (2) one-year extensions upon a writing executed by the City
Manager and City Attorney. Thereafter, the term of this Agreement may be further extended
upon a writing executed by the City Manager and City Attorney.
4. RESPONSIBILITIES OF THE PARTIES
a. Consultant shall determine the method, details, and means of performing the
services described herein.
b. Consultant agrees to accept exclusive liability for the payment of payroll taxes,
self-employment taxes, and social security and other contributions that are based
on the Compensation paid to Consultant hereunder or on the wages, salaries, or
other remuneration paid to Consultant, if any. Consultant further promises and
agrees to reimburse and to defend and hold harmless Client for any such taxes or
contributions that Client may be compelled to pay.
C. Consultant shall supply at her own expense all office space, office supplies, and
all other tools and instrumentalities required to perform services under this
Agreement.
d. The parties agree, and Client expressly acknowledges, that Consultant may select
Consultant's own specific time or period of time to perform the services set forth
in this Agreement, and that Consultant may perform services under this
Agreement at Client's facilities during hours that Client is not open to the general
public for business. Client expressly acknowledges that Consultant may refuse to
perform services under this Agreement for any time or period of time, even if so
requested to perform such services by Client.
C. The parties agree that Consultant shall be subject to no restraint in performing
Consultant's contractual services, other than federal, state and local laws.
F
Consultant shall act in a manner that will not detrimentally affect the operation or
reputation of Client at any time in which Consultant is performing services
pursuant to this Agreement. The parties agree, and Consultant expressly
acknowledges, that Client will not provide Consultant with any training
whatsoever as to the methods or techniques to be used by Consultant in
performing the services contemplated hereunder.
5. INDEPENDENT CONTRACTOR
Consultant acknowledges that the services rendered pursuant to this Agreement
are for a specified price for a specified result and that Consultant is under the control of
Client as to the result of the Scope of Work only, and not as to the means by which such
result is accomplished. As such, Consultant acknowledges that she is an independent
contractor within the meaning of California law and accepts the legal consequences of
such status. Consultant acknowledges that these consequences include, but are not limited
to, the following:
a. Client will not incur liability for gross negligent or fraudulent acts of
Consultant solely on the basis of their relationship.
b. Consultant is excluded from the benefits of state workers compensation
insurance. Hence, to the extent desired by Consultant, adequate levels of
medical and disability insurance coverage should be maintained by
Consultant to provide benefits in the event that Consultant sustains injuries
while performing services pursuant to this Agreement which are not the
fault, or due to the negligence of, Client.
C. Consultant is excluded from receiving state unemployment and disability
insurance benefits.
d. Client shall not deduct from the Compensation of Consultant any amount
for: (1) federal or state income tax withholding; (2) the "employees'
portion" under the Federal Insurance Contribution Act (FICA); or, (3)
"employee contributions" to any state disability funds; nor is Client
required to make payments on Consultant's behalf for the "employer's
portion" under FICA or under the Federal Unemployment Tax Act.
Consultant acknowledges that Consultant is self-employed and that
Consultant's earnings are self-employment earnings and, as such, are
subject to self-employment tax.
e. Consultant is excluded from state and federal labor laws that regulate the
payment of wages, including, but not limited to, minimum wage and
overtime provisions promulgated by state agencies and/or the regulations
promulgated by the Department of Labor pursuant to the Fair Labor
Standards Act.
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6. NO LIMITATIONS ON OUTSIDE ACTIVITIES
The parties agree, and Client expressly acknowledges, that Consultant is free to offer
professional advisory services to any other corporation, person or entity, whether engaged in the
same business as Client or not. This Agreement is only intended to create an exclusive
contractual relationship between Consultant and Client for the purpose of negotiations with
Caribou Industries, Inc. Client expressly acknowledges that Consultant is free to engage in any
other business or employment during the term of this Agreement so long as Consultant provides
the services contemplated hereunder in a timely manner.
7. OWNERSHIP OF MATERIALS
This Agreement creates a non-exclusive and perpetual license for Client to copy, use,
modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property
embodied in plans, specifications, studies, drawings, estimates, and other documents or works of
authorship fixed in any tangible medium of expression, including but not limited to, physical
drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared
or caused to be prepared by Consultant under this Agreement ("Documents & Data").
Consultant shall require all subcontractors to agree in writing that Client is granted a non-
exclusive and perpetual license for any Documents & Data the subcontractor prepares under this
Agreement. Consultant represents and warrants that Consultant has the legal right to license any
and all Documents & Data. Consultant makes no such representation and warranty in regard to
Documents & Data which were provided to Consultant by the Client. Client shall not be limited
in any way in its use of the Documents and Data at any time, provided that any such use not
within the purposes intended by this Agreement shall be at Client's sole risk.
8. INDEMNIFICATION
Client agrees to indemnify, hold harmless and defend Consultant from and against any
and all claims, causes of action, suits, legal or administrative proceedings, and any resulting
damages, losses, penalties, fines or liabilities, including reasonable attorney fees and litigation
costs, to the extent to have resulted from Client's negligence.
Consultant agrees to indemnify, hold harmless and defend Client from and against any
and all claims, causes of action, suits, legal or administrative proceedings, and any resulting
damages, losses, penalties, fines or liabilities, including reasonable attorney fees and litigation
costs, to the extent to have resulted from Consultant's negligence.
9. CONFIDENTIALITY
All reports, documents and materials prepared by Consultant or provided to Consultant in
the course of Consultant's performance of services hereunder shall be considered Confidential
Information, and shall be the exclusive property of Client. Confidential Information may not be
shared with or divulged to others by Consultant without the permission of Client. Consultant
shall treat all Confidential Information with at least the same degree of care Consultant accords
Consultant's own secret, proprietary information.
rd
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 Client.
10. 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.
11. 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 Client: 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:
and
Executive Director — CDA
City of Santa Ana
20 Civic Center Plaza (M-25)
P.O. Box 1988
Santa Ana, CA 92702
Fax 714-647-6515
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, CA 92702
Fax 714- 647-6515
5
To Consultant: Elisa Stipkovich
500 High Drive
Laguna Beach, CA 92651
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 piuposes of calculating these
time frames, weekends, federal, state, County or City holidays shall be excluded.
12. ENTIRE AGREEMENT
This Agreement constitutes the entire Agreement between the parties respecting the
rendering of services by Consultant to Client, and there are no representations, warranties or
commitments, except as set forth herein. Only an instrument in writing executed by the parties
may amend this Agreement.
13. ASSIGNMENT
The rights and obligations of Client under this Agreement shall inure to the benefit of and
shall be binding upon the successors and assigns of Client. The rights and obligations of
Consultant are personal in nature and may not be assigned without Client's prior written consent.
14. TERMINATION
Client and consultant may terminate this Agreement upon twenty-four (24) hours written
notice. The parties agree that, other than the contractual payments and obligations specifically set
forth in this Agreement, as well as those requirements set forth in section 15 below, neither party
shall have any obligation or duty as to the other party following the termination or expiration of
this Agreement or any renewals thereof.
15. COOPERATION WITH CLIENT AFTER TERMINATION OF AGREEMENT
Following any notice of termination of this Agreement given pursuant to Section 14
above, or the expiration of this Agreement pursuant to Section 2 above, and at the request of
Client, Consultant shall fully cooperate with Client in all matters relating to the winding up of
Consultant's pending work on behalf of Client and the orderly transfer of any such pending work
to such other persons as may be designated by Client prior to termination. Client shall
compensate Consultant for time spent in winding up and transferring pending work at the same
rate and under the same terms of this Agreement as if it had not been tenninated.
j
16. 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.
17. GOVERNING LAW
This Agreement, including all matters of construction, validity, effect, performance, and
remedies, shall in all respects be governed by and construed and enforced in accordance with the
laws of the state of California, as if applied to contracts executed in such state by residents
thereof and to be performed entirely in such state, and without reference to rules governing
conflicts of law.
18. SECTION HEADINGS
Section and other headings contained in this Agreement are for reference purposes only
and shall not affect in any way the meaning or interpretation of this Agreement.
19. COUNTERPARTS
This Agreement may be executed in counterparts, each of which shall be deemed to be an
original.
(Signature Page Follows)
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
rDpr
DAISY GOMEZ,1/i-
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Attorp"
By: ' [(,
RYAN O
Assistant
RECOMMENDED FOR APPROVAL:
STEVEN A. MENDOZA
Executive Director
Community Development Agency
[:
CITYY OF SANTA ANA
s
KRISTINE RIDCS
City Manager
CONSULTAN
r
ELISA ST PKO H
Tax ID#1�1-A-3 - 0 / �IS
EXHIBIT A
SCOPE OF SERVICES
Scope of Work
YMCA DDA
Consultant will:
1) On behalf of City of Santa Ana, conduct lead negotiations during the preparation of the
Disposition and Development Agreement (DDA) for the redevelopment of the former
YMCA Building.
2) Coordinate the preparation of a Disposition and Development Agreement (DDA) with
City's Attorneys, Community Development Agency, Planning and Building Agency, Public
Works Agency and other City Departments in accordance with the terms of the DDA.
3) On behalf of City of Santa Ana, conduct lead negotiations for the proposed project
scope as defined in the DDA and coordinate the entitlement process and CEQA clearance
with the Planning Department;
4) Conducts or participates in negotiations for the disposition of land, easements and
rights -of -way and interacts with the developer and city staff in negotiating final terms of
the DDA;
7) Upon approval of the DDA, provide oversight as needed during the implementation of
the DDA;
8) May be required to attend City Council and/ or Council Committee meetings to present
information.
AC-4;�;i'' CERTIFICATE OF LIABILITY INSURANCE
�
DATE(MM/DD/YYYY)
1 nm9nnl G
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(les) must be endorsed. If SUBROGATIONIS 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 hostler in lieu of such endorsement(s).
PRODUCER
CONTACT
NUTMEG INS AGENCY INCIPHS
78210781
The Hartford Business Service Center
NAME,
PHONE (888) 925-3137
INC, No, Eaq:
FAX (888) 443-6112
(Arc, No):
3600 Wiseman Blvd
E-MAIL
San Antonio, TX 78265
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAICX
INSURED
INSURERA: Sentinel Insurance Company Ltd.
11000
ELISA STIPKOVICH
INSURER B:
500 HIGH DR
INSURERC:
LAGUNA BEACH CA 92651-1525
INSURER D:
INSURER E:
INSURER F I
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
INOICATED.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.
INSF
TYPE OF INSURANCE
ADDL
S BR
POLICY NUMBER
POOCYEFF
POLICY EXP
LIMITS
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$1,000,000
CLAIMS-MADE[flOCCUR
General Liability
ty
X
DAMAGE TO RENLED
PREMISES a er rcel
$1,000,000
MED EXP (Any meperean)
$10,000
A
X
76 SBU BC5868
08/14/2019
08/1412020
I
PERSONALAADVINJURY
$1.000,000
GENL AGGREGATE UNIT APPLIES PER:
GENERAL AGGREGATE
$2.000,000
POLICY ❑ PRO- E] LOC
JECT
PRODUCTS-COMP/OPAGG
$2,000,000
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
fFeamiftall
$1,000,000
ANY AUTO
BODILY INJURY (Par Parson)
A
ALL OWNED SCHEDULED
AUTOS AUTOS
76 SBU BC5868
08/14/201g
08/1412020
60DILY INJURY(Perac dent)
X
HIRED NON-0yVNEO
AUTOS X AUTOS
PROPERTY DAMAGE
(Per accident)
UMBRELLA UAB
OCCUR
EACH OCCURRENCE
EXCESS UAB
CLAIMS.
MADE
AGGREGATE
RETENTION $
WORKERS COMPENSATION
PER OTH-
AND EMPLOYERS' LIABILITY
TATUTE I ER
E.L EACH ACCIDENT
ANY YIN
PROPRIETOR/PARTNEWEXECUTIVE
OFFICER/MEMBER EXCLUDED?
NIA
EL DISEASE -EA EMPLOYEE
(Mandatory In NH)
11 yea, desalbe under
E L DISEASE -POLICY LIMIT
DESCRIPTION OF OPERATIONS
A IDATA
BREACH - BUS INC & EX
76 SBU BC5868
08114/2019
08/14/2020
Limit$10,000
EX
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Rwaft w.dule, may be ahachad Wrnme space H required)
Those usual to the Insured's Operations. CITY OF SANTA ANA is an additional insured per the Business Liability Coverage Form SS0008 attached to
this policy.
UIIY UI-SAN IA ANA By Risk MANAGEMENT DivisioN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
20 CIVIC CENTER PLZ BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED
SANTA ANA CA 92701-4058 IN ACCORDANCE WITH THE POLICY PROVISIONS.
T03 2019 AUTHORED REPRESENTATIVE
weana- Ctrafizi c�
no 1nAA.90d5 ACrTRD cnlxanwerinu eu .L.ta�.m�e..,va
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
THE At
HARTFORD
Select Customer Insurance Center
3600 WISEMAN BLVD.
SAN ANTONIO TX 78251
Policyholder, please callusat: (877) 287-1316
Agent, please callus at: (888) 925-3137
INSURANCE ENDORSEMENT
ATTACHED
*** PLEASE REVIEW THE CHANGE ***
Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have
questions or need to make further changes:
Policyholder, please callus at: (877) 287-1316
Agent, please callus at: (888) 925-3137 between 7 A.M. and 7 P.M. CST.
The premium billing will be mailed to you separately. You can expect to receive it soon.
Thank you for allowing us to service your business needs.
NUTMEG INS AGENCY INC/PHS
THE HARTFORD SELECT CUSTOMER INSURANCE CENTER
REVIEWED & APPROVED
By Risk MAnAgEylENT Division
J �1NT 3 20�
FRANCINE R. VILLAREAL
The Hartford
Hartford Fire Insurance Company and its Affiliates
One Hartford Plaza, Hartford, Connecticut 06155
�i
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
POLICY CHANGE
This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated
below:
Policy Number: 76 SBU BC5868 DW
Named Insured and Mailing Address; ELISA STIPKOVICH
500 HIGH DR
LAGUNA BEACH CA 92651
Policy Change Effective Date: 10/02/19 Effective hour is the same as stated in the
Declarations Page of the Policy.
Policy Change Number: 001
Agent Name: NUTMEG INS AGENCY INC/PHS
Code: 210781
POLICY CHANGES:
SENTINEL INSURANCE COMPANY, LIMITED
ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING
STATEMENT.IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK
ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS.
THIS IS NOT A BILL.
NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE
BUSINESS LIABILITY OPTIONAL COVERAGES ARE REVISED
ADDITIONAL INSURED(S) ARE ADDED
THE FOLLOWING ARE ADDITIONAL INSURED FOR BUSINESS LIABILITY COVERAGE IN
THIS POLICY.
LOCATION 001 BUILDING 001
PERSON/ORGANIZATION: SEE FORM IH 12 00
FORM NUMBERS OF ENDORSEMENTS ADDED AT ENDORSEMENT ISSUE:
PRO RATA FACTOR: 1.000
THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN.
RgEVIEWM D & APPROVED
iVisoD
RiskForm SS 12 11 04 05 T Page 001 (CONTINUED ON NEXT PAGE)
Process Date: 10/02/19*FRAN'Cl
6EAVILLAREAL
19 Policy Effective Date: 08/14/19
Policy Expiration Date: 08/14/20
POLICY CHANGE (Continued)
Policy Number: 76 SBU 9c5868
Policy Change Number: 001
IH12001185 ADDITIONAL INSURED - PERSON -ORGANIZATION
REVIEWED & APPROVED
By Risk MANAGEMENT DIVISION
Form SS 12 1104 05 T T 03 2 19 ) Page 002
Process Date: 10/02/19
FRANCINE R. VILLAREAL
Policy Effective Date: 08/14/19
Policy Expiration Date: 08/14/20
POLICY NUMBER: 76 SBU 13C5868
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - PERSON -ORGANIZATION
CITY OF SANTA ANA
20 CIVIC CENTER PLZ
SANTA ANA, CA 92701-4058
REVIEWED & APPROVED
By Risk MANAC{EMENT DIVISION
0 T 0 3 2019
M
F ANCINE R. VILLAREAL
Form IH 12 00 11 85 T SEQ. NO. 001 Printed in U.S.A. Page 001
Process Date: 10 / 02 / 19 Expiration Date: 0 8 / 14 / 2 0
THE HARTFORD
BUSINESS SERVICE CENTER
THE 3600 WISEMAN BLVD
HARTFORD SAN ANTONIO TX 78251
CITY OF SANTA ANA
20 CIVIC CENTER PI 7
SANTA ANA CA 92701-4058
Account Information:
Policy Holder Details : IELISA STIPKOVICH
October 2, 2019
vQ Contact Us
Business Service Center
Business Hours: Monday - Friday
(7AM - 7PM Central Standard Time)
Phone: (888) 925-3137
Fax: (888) 443-6112
Email: agency.servicesCcbthehartford.com
Website: httos://business.thehartford.com
Enclosed please find a Certificate Of Insurance for the above referenced Policyholder. Please contact us if you have any
questions or concerns.
Sincerely,
Your Hartford Service Team
REVIEWED & APPROVED
By Risk MANAGFMENT DhdsiON
OC 0 3 2019
FRANCINE R. VILLAREAL
WLTRO05