HomeMy WebLinkAboutTRAN, AMANDA (3)INSURANCE ON FILE N-2024-258
WORK MAY PROCEED
UNTIL INS RANCE EXPIRES
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CITY CLERK
DATE` AG 0 6 2024
o. GMoL� COUNCIL AME PROFESSIONAL SERVICES AGREEMENT
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THIS AGREEMENT is made and entered into on this 15th day of July, 2024 by and between Amanda
Tran ("Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and
existing under the Constitution and laws of the State of California ("City").
RECITALS
A. The City desires to obtain the services of a Consultant to provide administrative, constituent, and
legislative support for a member of the Santa Ana City Council.
B. Consultant represents that Consultant is qualified to perform these services.
C. In undertaking the performance of this Agreement, Consultant represents that Consultant 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 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
a. 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 provide administrative, constituent, and legislative support services for Mayor Pro
Tern Phan ("Councilmember") as provided in this Agreement and in the Scope of Services as
described in subsection b below.
b. At the direction of Councilmember, Consultant shall perform a variety of administrative,
constituent, and legislative functions and tasks, including but not limited to, conducting
complex administrative studies, researching and responding to constituents' inquiries, drafting
written communications involving strategy, policies, and/ or procedures, coordinating assigned
project activities, preparing creative projects, and serving as a liaison, where necessary.
c. As may be required for services performed while at City Hall, the City may provide access to
the Councilmember's office space — consistent with City procedures — should Consultant
require limited access to perform services required by the Councilmember. Consultant shall
maintain a business location separate from City and Consultant understands that such access
to office space is not required by the City but provided to the Consultant on an as -needed basis
and should only be used when City Hall is open to the public or while the Councilmember is
present.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services for City,
the hourly pay rate of $35.00 for services rendered pursuant to this Agreement. Consultant
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agrees and understands that no changes to this pay rate shall be made during the term of this
Agreement and that monthly billing pursuant to this Agreement, shall not exceed a total sum
of five thousand dollars ($5,000.00) per month. The total sum to be expended under this
Agreement shall not exceed ten thousand dollars ($10,000.00) during the term of this
Agreement.
b. Consultant agrees and understands that the not -to -exceed amount, provided above, includes
reimbursement for all out-of-pocket expenses, including but not limited to, mileage, copying
costs, and mail services authorized at the sole direction of the Councilmember in comiection with
the performance of duties under this Agreement. The City shall not make any separate payments
for any of the above expenses.
c. Consultant shall submit monthly invoices to City for work performed during the billing period.
Payment by City shall be made within thirty (30) days following receipt of proper invoice
evidencing work performed, subject to City accounting procedures. Monthly invoices shall be
in substantially the form attached hereto as Exhibit "A."
3. TERM
This Agreement shall commence on July 15, 2024 and terminate on June 30, 2025, unless
terminated earlier in accordance with Section 19, below. City shall recognize and compensate Consultant
for any services performed beginning July 1, 2024.
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, benefits, employer's social security taxes, unemployment insurance, and
similar taxes relating to employees and shall be responsible for all applicable withholding taxes.
5. POLITICAL CAMPAIGN ACTIVITIES
a. Consultant is prohibited from the following political campaign activities while this
Agreement is in place:
1) Acting as campaign treasurer/manager or a campaign consultant for any candidate
for Santa Ana City Council or Mayor;
2) Campaigning for any candidate for Santa Ana City Council or Mayor and at the
same time, working pursuant to this agreement and/or charging the City for the time
spent campaigning pursuant to this agreement;
3) Using City equipment, supplies or resources to campaign for any candidate for
Santa Ana City Council or Mayor;
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4) Accepting any campaign contributions on behalf of any candidate for Santa Ana
City Council of Mayor;
5) Campaigning while wearing any attire or logo that identifies you as a Consultant
for the City of Santa Ana;
6) Campaigning while using any City room, building, or location that has not been
specifically designated for political speech;
7) Receiving any payment or reimbursement from a campaign candidate for Santa
Ana City Council or Mayor or their campaign account; and/or
8) Opening a campaign committee or pulling nomination papers to run as a candidate
for Santa Ana City Council or Mayor.
b. Consultant will sign the declaration attached hereto as Exhibit B acknowledging said
prohibitions.
6. PROHIBITION AGAINST APPOINTMENT TO CITY BOARD OR COMMISSION
Consultant is prohibited from accepting appointment or continuing with any prior appointment to
any City Board or City Commission set forth in Chapter 2 of the Santa Ana Municipal Code while this
Agreement is effective.
BACKGROUND CHECK
Consultant agrees to submit to a background check including, but not limited to, a live scan and
records check to City's satisfaction. Failure to do so is grounds for termination of this Agreement.
8. OWNERSHIP OF MATERIALS
This Agreement creates a non-exclusive and perpetual license for City 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 City 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 City. City 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 City's sole risk.
9. INSURANCE
Prior to undertaking performance of work under this Agreement, Consultant shall maintain and
shall require any subcontractors to obtain and maintain insurance as described below for the entire Term
of this Agreement against claims for injuries to persons or damage to property which may arise from or
in connection with services, products and materials supplied to City. Total cost of such insurance shall be
borne by Consultant.
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Minimum Scope and Limit of Insurance.
Automobile Liability: Insurance Services Office Form CA 00 01 covering Code 1 (any
auto), with limits no less than $1,000,000 combined single limits. In the event Consultant
does not maintain commercial automobile liability insurance, City will accept evidence of
personal automobile insurance.
Workers' Compensation: as required by the State of California, with Statutory Limits,
and Employer's Liability Insurance with limit of no less than $1,000,000 per accident,
policy or employee, for bodily injury or disease. Coverage is not required if Consultant has
no employees and signs request to waive such insurance.
If Consultant maintains broader coverage and/or higher limits than the minimum
requirements for each line of coverage shown above, City requires and shall be entitled to
the broader coverage and/or the higher limits maintained by Consultant. Any available
insurance proceeds in excess of the specified minimum limits of insurance and coverage
shall be available to City.
Other Insurance Provisions. The above required insurance policies are to contain or be endorsed
to contain the following provisions:
• City, its City Council, its officers, officials, employees, agents, and volunteers are to be
covered as additional insureds, under Consultant's CGL, Professional Liability, and
Automobile Liability policies, with respect to any liability arising out of work or operations
performed by or on behalf of the Instructor including materials, parts, equipment, and
personnel furnished in connection with such work or operations.
• Consultant's Insurance company(ies) agrees to waive all rights of subrogation against City,
its City Council, its officers, officials, employees, agents, and volunteers for losses paid
under the terms of any policy which arise from work performed by Consultant under this
Agreement.
• For any claims related to this contract, Consultant's insurance coverage shall be primary
and any insurance maintained by City, its City Council, its officers, officials, employees,
agents, or volunteers shall not contribute with it.
• A severability of interest provision must apply for all the additional insureds, ensuring that
Consultant's insurance shall apply separately to each insured against whom a claim is made
or suit is brought, except with respect to the insurer's limits of liability.
• Insurance policies required herein shall provide that coverage shall not be canceled,
suspended, voided, reduced in coverage or in limits, non -renewed by the carrier, or
materially changed except after thirty (30) days prior written notice has been given to City.
Ten (10) days prior written notice shall be provided to City for policy cancellation or non -
renewal due to non-payment of premium.
• Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa Ana,
Attention: (Name of Department Staff Responsible for Agreement), 20 Civic Center
Plaza M-XX (Responsible Staff's Department Mail Box), Santa Ana, CA 92701. The
name and location of project must be included in the Description of Operations section of
each certificate.
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Self -Insured Retentions. Self -insured retentions must be declared to and approved by the City.
The City may require the Consultant to purchase coverage with a lower retention or provide proof of
ability to pay losses and related investigations, claim administration, and defense expenses within the
retention.
Acceptability of Insurers. Insurance is to be placed with insurers authorized to conduct business
in the State of California with a current A.M. Best rating of no less than A: V11, unless otherwise acceptable
to City.
Verification of Coverage. Consultant shall furnish City with original Certificates of Insurance
including all required amendatory endorsements (or copies of the applicable policy language effecting
coverage required by this clause) and a copy of the Declarations and Endorsement Page of the CGL policy
listing all policy endorsements before work begins. However, failure to obtain the required documents
prior to the work beginning shall not waive Consultant's obligation to provide them. City reserves the
right to require complete, certified copies of all required insurance policies, including endorsements
required by these specifications, at any time.
Special Events Coverage. Special events coverage is available and can be purchased by
Consultant. Use this link to learn more: hqs://2sparta.com/selin application.php.
Special Risks or Circumstances. City reserves the right to modify these requirements, including
limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances.
10. 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.
11. INTELLECTUAL PROPERTY INDEMNIFICATION
Consultant shall defend and indemnify the City, its officers, agents, representatives, and employees
against any and all liability, including costs, for infringement of any United States' letters patent,
trademark, or copyright infringement, including costs, contained in the work product or documents
provided by Consultant to the City pursuant to this Agreement.
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12. 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.
13. 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.
14. CONFLICT OF INTEREST CLAUSE
a. Consultant represents that neither it nor any of its officers, partners or employees has a financial
interest, as defined in Section 87103 of the Government Code, in the subject matter of this
Agreement other than the right to receive payment from City for services rendered.
b. Consultant agrees that it shall not make, participate in making, or in any way attempt to use its
position as consultant to influence any decision of City in which Consultant knows, or has
reason to know, that any of its officers, partners or employees has a financial interest as defined
in Section 87103 of the Government Code.
c. Consultant warrants that neither Consultant nor any of its officers, partners or employees, has
any financial interest in any real property, building or structure within 2,500 feet of the location
of any project or assignment to which this Agreement may apply in the City of Santa Ana.
Consultant agrees to disclose to City any financial interest in such property as may be acquired
by its officers, partners or employees during the term of this Agreement.
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d. In accordance with the City's Conflict of Interest Code, if determined by the City Manager to
be a designated position, Consultant shall file a Statement of Economic Interests (Form 700)
with the Fair Political Practices Commission.
15. NON-EXCLUSIVE
Consultant understands and agrees that this is a non-exclusive Agreement and City may enter into
other agreements with other consultants and may use any of the contractors with whom City has contracts
and, therefore, the City cannot estimate nor guarantee the volume or amount of work to be received by
Consultant under this Agreement.
16. NON-DISCRIMINATION
Consultant shall not discriminate because of race, color, creed, religion, sex, marital status, sexual
orientation, gender identity, gender expression, gender, medical conditions, genetic information, or
military and veteran status, age, national origin, ancestry, or disability, as defined and prohibited by
applicable law, in any services provided under this Agreement. Consultant affirms that it is an equal
opportunity employer and shall comply with all applicable federal, state and local laws and regulations.
17. 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.
18. 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.
1.9. TERMINATION
This Agreement maybe 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:
Page 7 of 12
a. As a condition of such payment, Consultant may be required 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.
Consultant's term shall automatically terminate immediately if, at any time, the Councilmember
is no longer an elected member or Mayor of the Santa Ana City Council.
20. 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.
21. .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.
22. 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 hereLmder 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.
23. 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:
City Clerk
City of Santa Ana
Page 8 of 12
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
With courtesy copies to:
City Manager
City of Santa Ana
20 Civic Center Plaza (M-xx)
P.O. Box 1988
Santa Ana, CA 92702
Fax:
To Consultant:
Amanda Tran
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 time frames, weekends, federal, state, County or City holidays
shall be excluded.
24. 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, if any, and attached hereto shall be incorporated as if fully
set forth in the body of this Agreement.
[signatures appear on following page]
Page 9of12
SIGNATURE PAGE TO COUNCIL AIDE PROFESSIONAL SERVICES AGREEMENT
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above
written.
ATTEST
e ifer .
APPROVED AS TO FORM
SONIA R. CARVALHO
City Attorney
B
onathan T. Martinez
Assistant City Attorney
CITY OF SANTA ANA
44,
Alvaro Nunez
Acting City Manager
CONSULTANT
Tax ID#
Page 10 of 12
EXHIBIT A
Street Address Invoice #:
City, ST Zip Code
Phone
Agreement #:
Date:
Bill To:
City of Santa Ana
20 Civic Center Plaza
Hourly Rate:
Santa Ana, CA 92701
Total Billable Hours:
Amount Due:
Page 11 of 12
EXHIBIT B
Acknowledgment Reearding Political Activities Prohibitions
I, Amanda Tran am an independent contractor working as a Council Aide pursuant to this
Agreement.
1. I acknowledge and agree that during the term of this Agreement, I will not participate or conduct
the following political activities:
a) Acting as campaign treasurer/manager or a campaign consultant for any candidate
for Santa Ana City Council or Mayor;
b) Campaigning for any candidate for Santa Ana City Council or Mayor and at the
same time, working pursuant to this agreement and/or charging the City for the time
spent campaigning pursuant to this agreement;
c) Using City equipment, supplies or resources to campaign for any candidate for
Santa Ana City Council or Mayor;
d) Accepting any campaign contributions on behalf of any candidate for Santa Ana
City Council of Mayor;
e) Campaigning while wearing any attire or logo that identifies you as a Consultant
for the City of Santa Ana;
f) Campaigning while using any City room, building, or location that has not been
specifically designated for political speech;
g) Receiving any payment or reimbursement from a campaign candidate for Santa
Ana City Council or Mayor or their campaign account; and/or
h) Opening a campaign committee or pulling nomination papers to run as a candidate
for Santa Ana City Council or Mayor.
2. I acknowledge and understand that failure to abide by any of the above prohibitions are grounds
for immediate termination of this Agreement.
Signed this 16 day of July , 20 24 .
Amanda Tran
(Name of Consultant)
July 16, 2024
Date
Du Ice Wochot,
(Name of Witness)
Page 12 of 12
(Signature of Consultant)
(S gnature of 'Witness)
Rocha, Dulce
From:
Sent:
To:
Subject:
Attachments:
Approved.
RMD
Monday, July 22, 2024 4:01 PM
Rocha, Dulce
RE: Request for COI Review (Amanda Tran)
Amanda Tran 24-25.pdf
Angie Acevedo I Risk Management Technician
City of Santa Ana - Human Resources Department
20 Civic Center Plaza I Santa Ana, CA 92701
Office: 714-647-5470
Email: aacevedo(cDsanta-ana.ora
City Hall hours are 7:30 am to 5:30 pm, Monday through Thursday and 8:00 am to 5:00 pm every other Friday. Click he for a list of observed holidays and Friday closure dates.
The my5antaAna mobile app puts the power of the Santa Ana city government in the palm of your hand The free app allows residents to quickly and easily report issues to the
City, access City services, and find news and events.
0. Wrillial-
Download on Ihr
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Click here to report an issue directly from the City website.
From: Rocha, Dulce <drocha@santa-ana.org>
Sent: Thursday, July 18, 20241:49 PM
To: RMD <rmd@santa-ana.org>
Subject: Request for COI Review (Amanda Tran)
Request Type (check only one):
o Standard COI Review — Risk Management will review and approve insurance documents submitted. This applies to PO,
Event, Reservations, Permit and Agreements.
X New Contractor or New Agreement — Risk Management will request insurance documents from Contractor/Insured Contact in
accordance with agreement.
City Contact
Department:
City Manager's Office
Project Manager Name:
Dulce Rocha
Project Manager Email:
drocha ,santa-ana.or
Contractor/Insured Contact
Business Name:
Amanda Tran
Agreement Number and
Agreement Link:
TBD
Vendor Contact Name:
Amanda Tran
Vendor Contact Phone:
Vendor Email Address:
atran@santa-ana.org
Insurance Contact (may be found at top right of ACORD form)
Contact Name:
N/A
Contact Phone:
N/A
Contact Email Address:
N/A
All fields required to advance the process — do not delete or modify.
.F, PERSONAL AUTOMOBILE POLICY Amended Decfaradon effective
, IF,�� i AMENDED DECLARATION Sep D6, 2024
1175WOWIF Supersedes any previous declaration bearing
the same policy number for this policy period.
ANTHONY H TRAN
KIM LE
WAWANESA INSURANCE
PO BOX 82867
SAN DIECO CA 92138-9492
TELEPHONE: 8 00-640-2920
Policy Number Account Number Polity Period 12:01 A.M. standard time at the address of
]- From Sep 06, 2024 to Mar06, 2925 the Named Insured as stated herein
Named Insured's Phone Number: Named Insured's Email Address.
Your amended 6 month premium Is $4,144.35. Refer to the breakdown of ,premiums below.
The change in premium for the remainder of the policy period is-S4.72.
Description of Owned Vehicle(s)
Vehicle Year I Maker Model Vehicle Identlfleatlon Number Premium per Vehicle($)
1 2023 1-Wta CAMRY SEISE
$1,415,43
Premium Sub+totai for Vehicles
$4,1".35
Insurance is provided only with respect to the coverages for which a Premium is stated, subject to all conditions
of the policy.
Coverage and Limits of Liability
Premiums per Vehicle ISj
See Policy for Coverage Details 1
2 3
4
Bodily Injury Liability
$100.000 per pefsont$300,000 each occurrence
180.90
178.79 342,80
452.94
Properly Damage Liability
100.000 each occurrence
11t_40
110.24 l 198.06
268.711
Medical Payments
$5,000 each person
61.71
57.92 02.23
98.76
Comprehensive
1,000 deductitrie
44.87
35.81 49.911
38.98
Collision
$1,000 deductible
281.95
181.00
387.02
374.23
Roadside: Assistance
T39 5.37'
Rental Expense
$40 dayJ1,200 max each covered loss
40.32
31.07 37.97
38.83
L
APPROVED
By Cynthia Mora at 4:48 pm, Dec 10, 2024
Aug 20, 2024 14:28 es "Wawanesa Insurance" is a trademark o
PERSONAL AUTOMOBILE POLICY ,amended Declaration effective
AIowaMENDED DECLARATION Sep 06, 2024
117SUIVIMP Supersedes any previous declaration hearing
the same policy number far this policy period.
ANTHONY H TRAM
KIM LE
Policy plumber Account Number
Policy Period
From Sep 06, 2024 to Mar06, 2925
WAWANESA INSURANCE
PO BOX 82887
SAN DIEGO CA 02138-2422
TELEPHONE. 800.640.2020
12_01 A.M. standard time at the address of
the Named Insured as stated herein
Information effecting your insurance premium was obtained from a Motor Vehicle Record or CLUE report supplied by
LexisNexisO. The interpretation of the information and decision regarding an increase in premium, however, was made
by Wawanesa Insurance and not LexisNexisO. A copy of this report is available to you at no charge from LexisNexise
if requested within 60 days. You have a Fight to dispute the accuracy andlor completeness of the information contained
in the report directly with LexisNexisO and LexisNexis& Consumer Service Center, P.O.. Box 105108, Atlanta, GA
30348-5108, by phone at 1-800-456-6004 or through their website at httpsJiwww-con sumerdisclosure.ccrm.
You may request additional information about this decision, and the personal information used to make this decision,
by submitting a written request to Wawanesa General Insurance Company, P.O. Box 82867, San Diego, California,
92138-9492, if requested within 90 days. Additional information on your rights can be found in our Primacy Notice at
www.wawanesa.com.
Driver(s)
Driver Name rIncipal Operator of Vehicle Number 4acasionat Operator of Vehicle Number
Antl mny H Tran 1 2
Jonattmn Tran
Kim Le
Amanda Tian
Exclusion of Named Dlrlver(s)
Excluded Driver(s)
THOI TR.AAN
Relationship to Insured
Relative
2 i 1
POLICY AND ENDORSEMENTS THAT ARE PART OF YOUR CONTRACT WITH US.
REMAIN IN EFFECT (Refer to prior Policy Packet(s) for documents not attached.):
California - Designated Additional Person To Receive Notice of Cancellation or Nonrenewal (CA CAPE 09 21), Personal Auto Policy -
California (CAPAP 0 21), Community Service Statement (CSS), Available Coverages & General Coverage Descriptions (CACOV 09
21), California Notice of Designated Additional Person to Receive Notice of Cancellation (CAOAP 09 21), Disclosure of Fees - California
Auto (CADCFA 04 22}, Minimum Liabillty Coverage Limits and Available Discounts (CADIS 09 21 }, California Roadside Assistance
Identity Card (RAIC), Vehicle Identification Cards (VI'O)
ADDED:
California Roadside Assistance Identity Gard (RAID 1)
01
APPROVED
By Cynthia Mora at 4:48 pm, Dec 10, 2024
Aug 20,202414,28cT-Wawanesa Insurance' is a trademark of WAwanesa General Insurance Company
�(/awanesa PERSONAL
AUTOOr t�Ranw
MOBILE POLICY Deuereuon ec«we
IfiSU/dlI/Ce DECLARATION Mar O8, 2025
,1 t2pt AM Pmaama na Pemwm re�,e,-ywrpM�ry r« w parka
slvrvm. II ywn paymamM-ro rewieved aela,e Ma, D6. 2025 nN Oiler la Renee WI M null em veld.
MTHDW H TRAN WAWAN ESA INSURANCE
KIM LE PO BOX 82867
882/
800440-2920
Policy Number Account Number
Policy Period 1201 A M. nand vo Ems m the address of
41895650
Mar 06, 2025 W Sep 06. 2025 ms Named Insured as slaletl herein
Named Ineum- P— Number. 714- I.—d'e Eman Addrv--yhlran8821@9-
6 month premium for four (4) vehicle(.) is Refer to the breakdown of premiums bell
Description of Owned Vehicles)
Vehicle Year Make Motel Vehicle MaMMeatlon Number Premiunw Whlile(S)
1 2D23
Toyota CAMRY
SE/SE
4T1T11AK0PU773811
Subtotal for Vehicles
Insurance is provided only with respect to the coverage. for which a Premium Is stated, subject to all conditions
of the policy.
Coverage and Limits of Liability Premiums per Vehicle (f)
See Policy ter Wvwage Details
1
2
a
4
Bodily Injury Liability
$100000 per must'S300,m0 exhoavmnca
Property Damage Uability
$100.000 eadl oa--
Medical Payments
85.000 each parson
Comprehensive
.1,000 da rotale
Coal
$1,000drouoible
Roadside Assistance
Rental Expanee
$40 day181300 max each revered bee
Unirrsured4)ndminsured Motorists Protection
$30.000 per person/380,000 sad, aaunence
Feb m,—a CT "Wawa.... Insurance' is a trademark of Wawanesa General Insurance Company
Q/ar�rnesa PERSONAL Oee oRemw
AUTOMOBILE POLICY De tenc on aff —
/nSaronce NO DECLARATN Mar 08, 2025
caee,s9a a- 2025, al 12-1 A.M. Pen,wnta Me premium nrewe yw,rparry r«uce pence
nine.. nywr paymmt H „e,aramad e.N,. M.roe,an nn oar to am..:n a nMl sad Vero.
ANT OW H TRAN WAWA N ESA INSURANCE
KIM LE PO BOX 82867
8821 (A
2920
Policy Number Account Number Policy Period 12:01 A.M.-bnoxm timeal theaddress of
41895650 132790791- O6, 2025 to Sep D6, 2D25 ma Named Imuee es -urea herein
Information affecting your insurance premium was obtained from a Motor Vehicle Record or CLUE report supplied by
LexisNexis4). The interpretation of the information and decision regarding an increase in premium, however, was made
by WSwanesa Insurance and not LexaNexis®. A copy of this report Is available to you at no charge from LexisNmrle®
if requested within 60 days. You have a right to dispute the accuracy and/or completeness of the information contahad
in the report directly with LeAshlexil and LexisNexis® Consumer Service Center, P.O. Box 105108, Atlanta, GA
30348-5108, by phone at 1-800456-6004 or through their website at hbps//—coneumordisdos.-com.
You may request additional information about this decision, and the personal information used to make this decision,
by submitting a written request to Wawanesa General Insurance Company, P.O. Box 82867, San Diego, California,
92138-9492, If requested within 90 days. You may also submit a written request to have access to your recorded personal
information, or you may request to correct amend or delete your personal Information. Additional information on your
rights can be found in our Privacy Notice at www.wawa resa.com.
Oriver(s)
Driver Name
Principal Operator of Vehicle Number Occasional Operator of Vehicle Number
Armory H Tren
1 2
Me— Tran
3
Kim La
2
1
Jon -an Trm
4
Exclusion of Named Driver(s)
Excluded Ddvolq Relationship W Insured
THOI TRAN Relative
POLICY AND ENDORSEMENTS THAT ARE PART OF YOUR CONTRACT WITH US.
REMAIN IN EFFECT IReler to prior Policy Packed.) far documents not attached):
Cal9omia - Designated Additional Person To Receive Notice of Cancellaton or Nonrenewal (CADAPE 09 21), Personal Aux, Policy -
CalNomia (CAPAP 09 21), Community Service Statement (CBS), CAN— Notice of Designated Additional Penton to Receive Notice of
Cancellation (CADAP 09 211
ADDED:
Val IdendBcatbn Came (VID 1), California Roadside Assistance Identity Card (RAIL 1), Auto Notice of Coverage Change (MCC
1), Disclosure of Fees - Cal'rfomia Auto (CADCFA 1124), Minimum Liab,idy Coverage Limits and Available Discounts (CADIS 0125),
CalBomla Automobile Amendatory Endorsement (CAE 01 25) AVaiable Coverages S General Coverage 0escnptiom (CACOV 01 25)
Digitally signed
Tu Tran byT.Tran
Nguyen
Nguyen 11501 30-08006
Pee oo 2a25 m.22 ci "WawanesaInsurance" is a trademark of Wawanesa General Insurance Company
APPROVED
By Tu Tran Nguyen at 3:01 pm, Mar 06, 2025
CITY OF SANTA ANA
Risk Management a division of Human Resources
Managing Risk through Awareness and Action
AFFIDAVIT OF EXEMPTION FOR WORKERS' COMPENSATION INSURANCE
I Amanda Tran
(Naive and Title of Vendor Representative)
("Representative"), attest that I am an authorized
representative of Couneilmember Thai Viet Phan
(Consultant/Company Name)
possess the authority to legally bind Company.
("Company"), and
In my capacity as Representative of Company, I represent and confirm the following, as relates to the
agreement between Company and City of Santa Ana, agreement number N-2024-258
("Agreement") to provide
administrative, constituent, and legislative support
(Services to be provided under agreement/contract)
(`'Services"):
During the course and scope of Company's agreement with the City of Santa Ana, Company will
not employ any person in any manner so as to become subject to the workers' compensation laws
of California, and agree that if Company should become subject to the workers' compensation
provisions of Section 3700 of the Labor Code, Company shall forthwith comply with the
provisions and provide proof of workers' compensation coverage immediately.
If at any time it is found that Company is not adhering to any and/or all of the statements in this
document and does not maintain the minimum professional liability insurance coverage as
required in the Agreement, it will be considered a breach of Agreement rendering the Agreement
null and void and Company will be fully liable for any and all damages.
Signature
Amanda Tran
Print Name
Title
Contact Information, i.e., Telephone Number and/or Email Address
03/06/2025
Date
WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL,
AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO
ONE HUNDRED THOUSANT 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.
Affidavit of Exemption for Workers' Compensation Insurance 11.12.2024