HomeMy WebLinkAboutNELSON, KATHLEEN 3
A
AGREEMENT TERMINATION
Please complete this form when the attached agreement is no longer in a_ 27 Nt 9t1t5
Return form to the Deputy Clerk of the Council (M-30). CalI647-523tll:)iJilfiaftt~f~uMfAns.
CLERK OF COUNCil"
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The agreement with ,?r;,t/.ArYn rfn~
No. ,Ij/.-- ~oot; - J /9 was completed on
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and final payment has been made,
Department:
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Signature: -#'~ f2.r
Date: ?-HO I oq
,
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Revised 08-28-06
City of Santa Ana
Clerk of the Council
INSURANCE ON FILE
WORK MAY PROCEED
UNTIL INSURANCE EXPIRES
j- / -,,200 7
CLERK OF COUNCIL
DIifE: I.t: - ;"'7- M
(0) (2) ~, BfeWn
N-2006-119
CONSULT ANT AGREEMENT
THIS AGREEMENT, made and entered intu this 20th day of September, 2006 by and
between Kathleen Nelson, an individual (hereinafter "Consullant"), and the City of Santa Ana, a
charter city and municipal corporation organized and existing under the Cunslitution and laws of
the State urCalifornia (hereinafter "City"),
RECITALS
A The City desires to retain a consultant having special skill and knowledge in the field of
instructing classes on drug education, health education and drug awareness.
B. Consultant represents that Consultant is able and willing to provide such services to the
City.
C. In undertaking the perfonnance of this Agreement. Consultant represents that it is
knowledgeahle in its ficld and that any services perfom1ed by Consultant under this
Agreement wiil he perrOlmed in compliance with such standards as may reasonably be
expected hum a professiunal consulting finn in the field. .
NOW THEREFORE, in consideratiun of the mutu'a] and respective promises, and suhjeet to the
terms and conditions hereinafter set forth, the parties agree as tt..ll1o\\'s:
J. SCOPE OF SERVICES
Consultant shall perform those services as set 10rth in Exhibit A to this Agreement.
2. COMPENSATION
a. City agrees tu pay, and Consultant agrees to accept as total payment for its services,
the rates and charges identified in Exhibit A. The total sum to he expended under this
Agreement shall not exceed $10,000.00 during the term of this Agreement.
h, Payment by City shall he made within thirty (30) days following receipt of proper
invoice evidencing work performed, suhjeet to City accounting procedures. Payment need not
be made lor work which Jails to meet the standards of performance set forth in the Recitals
which may reasonably be expected by City.
3. TERM
This Agreement shall commence 011 the date first written above and terminate on
December 3 I, 2006, unless terminated earlier in accordance with Section 12, below, The parties
agree that services provided from January 1,2006 until the commencement of this Agreement
shall be included within the Scope of Services of this Agreement. The term or this Agreemenl
may be extended upon a writing executed by the Chief of Police and the City Attorney.
4. INDEPENDENT CONTRACTOR
Consultant shall, during the entire tenn ofthis 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, ajoint venture relationship, or
to allo\v the City to exercise discretion or control over the professiunal manner in which
Consultant performs the services which are the subject matter of this Agreement; however, the
services to he 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 10
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 reqllirc its subcontractors, if any. to ohtain and maintain insurance as
described below:
a. Commercial (jent:ral Liability Insurance. Consultant shall maintain commercia!
general liability insurance naming thl: City, its officers, employees. agents, volunteers nnd
representatives as additional insured(s) and shall inelude, but not be limited to protection against
claims arising from hodily and personal injury, including death resulting therefrom and damage
to property, resulting from any aet or occurrence arising oul 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
hodily and personal injury, including death resulting therefrom, and property damage, in the total
amount of $1,000.000 per occurrence. Consultant shall supply City with a fully executed
additional insured endorsement in substantially the form attached hereto as Exhibit B upon
execution ofthis Agreement and shall be approved in form by the City Attorney.
b. Worker's Compensation Insurance. In aeeordance with the provisions of Section
3300 of the Labor Code. Consultant. if Consultant has any employees, is required to be insured
against liability for worker's compensation or lo undertake self-insurance. Prior to comm~ncing
the performance of the work under this Agreement, Consultant agrecs to obtain and maintain any
employer's liability insurance with limits not less than $1,000,000 per accident
c. 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 he furnished to the City upon execotion of
this Agreement and shall be approved in form by thc City Attorney.
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(iii) CC11ificates and policies shall state that the policies shall not be canceled
or reduced in coverage or changed in [lny other material aspect \vithout
thirty (30) days prior written notice to the City.
d. If Consultant fails or refuses to produce or maintain the insurance required by this
section or lai Is orretilses to furnish the City with required proof lhat insurance has been procured
and is in loree and paid for, the City shall have the right, at the City's election, to forthwith
terminate this Agreement. Such termination shall not effect Consultant's right 10 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 tu and shall indemnify and hold harmless the City, its officers, agents,
employees, consultants, special counsel, and representatives from liability: (I) for personal
injury, damages, just compensation, restitution, judicial or equitahle relief arising out of claims
for personal injury, including health, and claims for property damage, which may mise from the
direct or indirect operations of the Consultant or its contractors, subcontractors, agents,
employees. or other persons acting on their behalf which relates to the services described in
scction I of this Agreement; and (2) Irom any claim that personal injury, damages, just
compensation. restitution. judicial or equitable rdief is duc by reason of the terms of or effccts
arising from this Agreement. This indemnity and hold harmless agreement applies to alf claims
It" damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to
have been sulfered, by reason of the events referred to in this Section or by reason uf the terms
of, or e!"!"eets, arising horn this Agreement. The Consultant further agrees to indemnify, hold
harmless, and pay alf costs for the defense u!"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 ur equitable relief due to personal or property rights arises by reason oflhe terms of, or
etTects arising tram this Agreement. City may make alf reasonable decisions with respect to its
representation in any legal proceeding.
7, CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such
information is reasonably understood to he confidential and/or proprietary, Consultant agrees
that it shalf not use or disclose such intormation 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. "ConJidentiallnformation" shall
include all nonpublie information. Confidential information includes not only writlen
inJormation, but also information transferred oralfy, visually, electronically, or by other means.
Confidential inlormation disci used to either party by any subsidiary and/or agent ofthe other
party is covered by this Agreement. The foregoing obligations of non-use and nondiselosllrc
shalf 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; (e) is in rightful
possession of the Consultant without an obligation of confidentiality; (d) is required to be
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disclosed by operation of law: or (c) is independently developed by the Consultant without
reference to information disclosed hy the City.
8. CONFLICT OF INTEIlliST CLAUSE
Consultant covenants that it presently has no interests and shall not have interests, direct
or indirect, which would conflict in any manner with perJormance of services specified under
this Agreement.
9. 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 certilied mail, postage prepaid, or sent by lelefacsimile 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-] 988
tclefacsimi]e (7]4) 647-6956
\\lith courtesy copies to:
Chief of Police
City of Santa Ana
20 Civic Center Plaza (M-97)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 245-8007
and
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana. California 92702
telefacsimile (714) 64 7-65] 5
To Consultant:
Kath leen N c1son
9962 Sunderland Street
Santa Ana, California 92705
^ party may change its address by giving notice in writing to the other party. Thereancr.
communication shall he addressed and transmitted to the nev./ address. If sent by mail,
communication shall be elTeetive or deemed to have been given tluee (3) days after it has been
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deposited in the United States mail, duly registered or certified, with postage prepaid, and
addressed as set forth above. If sent by telefltcsimile, communication shall be effective or
deemed to have heen 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 hames, weekends, federal, state, County or City holidays shall be
excluded.
10. 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 representati ve of Consultant. The parties
agree that any terms or conditions of any purchase order or other instIument that are inconsistent
with, or in addition to, the terms and conditions hereof; shall not bind or obligate Consultant nor
the City. Each party to this Agreement acknowledges that no representations, inducements,
promises or agreements, orally or othenvise, have been made hy any party, or anyone acting on
hehalf of any party, \-vhich are not embodied herein.
11. ASSIGNMENT
Inasmuch as this Agreement is intended tu 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 he 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.
12. TERMINATION
This Agreement may be terminated by the City upon thirty (30) days "Titten notice of
termination, In such event, Consultant shall be entitled to receive and the City shall pay Consultant
compensation for all services perfom1ed by Consultant prior to receipl of such notice of termination,
subject to the following conditions:
a. As a condition of such payment, the Executive Director may require Consultant to dcliver
to the City all work product 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 he made for work which fails to meet the standard of perfOlmance
specified in the Recitals ufthis Agreement.
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13. 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 lav.., in the recruitmt:nt, selection, training, utilization, promotion, termination or
other employment related activities. Cunsultant affirms that it is an eqllal opportunity employer
and shall cumply with all applicable federal, state and local laws and regulations.
14. JURISDICTION - VENUE
This Agreement has been executed and delivered in the Stale of California and the
validity. interpretation, performance, and enforcement of any of the clallses 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 uut of, in connection with or by reasun of this Agreement.
15. PROFESSIONAL LICENSES
Cunsultant shalL throughout the term of this Agreement, maintain all necessary licenses,
permits, approvals. waivers, ~md exemptions necessary lor 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 her inability to ohtain or maintain such permits, licenses,
approvals, \vaivers, and exemptions. Said inability shall be cause for termination ofthis
Agreement.
16. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature hereinbelow has the power,
authority and right to bind their respective paJiies to each of the terms of this Agreemeut, and shall
indemnify City llilly, including reasonable costs and attorney's fees, for any injuries or damages to
City in the event that slIeh 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
l,mh in the body of this Agreement.
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IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year
first above written.
ATTEST:
G~/-
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,,- -
PATRICIA E. HEAL Y
Clerk of the Council
APPROVED AS TO FORM:
JOSFPH W. FLETCHER
City Attorney
/,<'" ,
:;c.,/ " f
By: /C' ,/lflj eU'-;;,
Laut<a Sheedy ,
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
,
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PAUl. M. WALTERS
Chief of Police
1V
CITY OF SANTA ANA
~vd;~
CONSIILTANT
. 7/ .' i:;?
.,,/'. ".. .'". ,'-
/ Ll//rfpJ _ /!-, ~
KA THLEEN NELSON '
Tax mil
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EXHIBIT A
SCOPE OF SERVICES
Consultant \vill conduct dutises on drug and health education and drug awareness for inmates at
the Santa Ana Jail. The topics covered will include those listed in the Teaching Materials
attachcd hereto as Exhibit A-I.
Consultant wilJ instruct said classes at the Santa Ana Jail, eight (8) hours each week, allimes
mulualJy agreed between the parties.
COMPENSATION
City wilJ pay Consultant $24.00 per hour. Total compensation to be paid Consultant for services
pursuanllu this Agreement shall not exceed $10,000, during the term of this Agreement.
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TEACHING MATERL4.L
VIDEOS
I.NOYA- THE HU~gN BODY
A MfRAClE Of LIfE
E_ UN1VERSE WITHlr--:
C UlTIMATE JOIJRNFY
2, HeMAi' BODY SYSTEMS AT WORK
A BR.-\1)( AI'D NERVOUS SYSTEM
B. SKELETAL SYSTEI\1
C CL~
D cr'lATORY SYSTEM
E RESPIRATORY SYST[y!
F ,\!l'SCL'UR SYSTEM
G. DIGESTIVE SYSTEM
3, CHOLESTEROL EXPLAL"ED
4, CONTEMPORARY i'UTRITION
o. FOOD FOR RECOYERY
6. NUTRITIO" FOR LIVING
7. ""UTRITIO,, FOOD LABELS
s, BODY lilT.~DERS 0:-' DIGESTIONS
9. BODy STORY
10. IlRC"'''ATOMY
II. HYPERTENSION- "THE FACTS"
12. PREVE,,'TIXG A HEART A TTACr,:
13. BLOOD SET
14, U~'SAFE SEX AND Irs CONSEQVEII'CES
IS. DIG[fESTlO!"- DiGEST- PART I, 2, 3.
16. Cl'l~ FAT r.UA.~.CE- "'OBESITY"
17, NUTRITION P A TH\H YS-ALL CHAPTERS
18, MOYERS ON ADDICTIOII'-PARTS A, B, C, D.
19, PEOPLE UKE FS-"AlDS"
2", EMERGl'G DRUG EPIDEMICS
21. 20120 - "GI:fB & ALCOHOL"
22. 48 HRS. - "GBB & ALCOHOL"
23. ALCOHOL "BL\'GE DRI,,"KING BLOWOU,..
24. EXTRE~IE DA1'>GERS UF ALCOHOL USE
2S, DRLG DASGER L~' THE BRAL~
26. MEDICAL ASPECTS OF MJi'iD ALTERING DR~GS.
27. ECSTACY FRfED
28. RCINED LIVES - "METH"
29. ATHLETES & DRUGS
30. ECSTACY THE AGONY
31. PRICE OF ECSTACY
31. "1';\1 0," ECSTACP'
33. WALKING DEAHl
34. DRUG BABY
35. AfDS - "HTR\THlSG Y'Otr SHOULD KNOW"
36, AIDS. "SEX DRUGS"
37. AIDS-"CO,'iFFRE;SCE"
38. ,,"AT~RE OF DRUG DEPENDEC>;CY
39, DRL'G PROFILES
40, HAlTE ASllBl;RY METH,
41. .\LCOHOL & COCAf\'E - "SECRETE OF ADDfCTION"
r:'h~j;:'lr~ 11 - t
,..~.."l.' j,~, i "
42. COCAL'iE & HUMAN PUYSroLOGY
43. SMOKAIlIE COCAINE
44. HOOKED lLLEGAL DRUGS~ VOL.] & 2
45. "WASTED" CN" . ALCOHOL
46. DESIG"ER DRUGS
47. HEROIN" ,~BC
48. STANDARD DEVIANT-PART] & 2
49. ICE
50. \IETH
51. "ALL TilE R.AY["
52. ECSTACY ~ DANGER IN A PILL
53. Sl\10KE & MiRROR'S
54. SCENE SMOKING
55. BEHI"D THE S\!OKE SCREEN
56. Si\fOKL\'G &. TOUACCO H\"DUSTRY
57. TRUTH ABOl;T TOBACCO
58. "URGES WITHr,N"
59. BRAr" OVERT!\IE
60. "BRA!N" - DISCOVERY CHANNEL
61. "RAGE TO REVE]';GE"
6:!. DATE RA.PE
fiJ. DA TIj';G nOLENCE
64. RESPO.~SlBrLlTY
65. DE~"l-\L
66. HANGOVER
67. "FffiES OF THE MIND'
68. SrRVIVl'fG OISASn:RS
69. GANGS, GUNS & GRAFFITI
70. HOPKINS "ER"
o\. COOK COUl'TY GENERAL ER
72. "MS" - MBC LOCKUP PRISONS
73. BREAST CANCER
74. pRfTP,nNGA HEART ATTACK
75. FOOD GUiDE PYR-\l\JID
76. "yIATTER OVER MIND"
77. "Irs GOOD TO BE ALIVE"
78. "MY TRIP TO HIE DE~TIST"
79. SHORTCUTS TO HEALTH & FlThESS
80. PI LA TE'S DYNAMIC FlR."'lDiG & fLEXl1'iG
81. TAICHI
82. YOGA MEDITATION
83. YOGA FOR ATHLETES
84. YOGA FOR f,;JDS
85_ TJll: FIRM - B.-\.SICS
86. STRETCHINC ~ BOB ANDERSON
~J
BOOKS
1. NL'RSlSG DRUG GUIDE
2. NURSING DRUG REFERENCE
3. 1lI0LOGY FOR DU~L'f!ES
4. I\t:TRITION Ro-\P
5. NUTRJTIO"AL HEALING
6. LlFR FIT\"ESS CENTER WORh:BOOh:
7. PHYSIOLOGY COLORl,\G BOOK
8. HEALTHY HEALI'G
9. UNDERSTANDfNG YOUR HEALTH
10. PEDS
II. HEALTH - "Sh:ILLS FOR WELLNESS"
12. WO\'DERS OF SCIENCE- "TilE HUMAN BODY
13. HU~L\N IlODY.. VISUAL GUIDE
14. HU~lA\' BODY - DK
15. BODY ATLAS
16. CONCISE ENCYCLOPEDLA OF THE HUMA'" BODY
17. HIOTIO"'AL INTELLIGENCE
18. PRlNClPALS OF HL'MAN ANATOMY
19. PDR HERBAL MEDICI1'iES
20. 6 WORKBOOKS - VARIOUS TOPICS
21. FIRST AID MATERLALS + BOOKS
22. RECOVERY OI'TfO;-.iS
23. St'BSTA.\TE ABUSE
24. CRITICAL rNCIDEi\'T STRESS DEIlRIEFI"'G
25. THE NEW "FlTOR FAT'
26. FIRST 12 MONTHS OF LIFE
27. C:\RL"'.G FOR YOUR UNDORJI.' CHIT..D
28. A CHILD IS BOR:'
29. "HABITS OF HIGHLY EFFECTIVE PEOPLE"
30. "THE HEALING M[ND" -MOYERS
31. WHE.' YOUR KfDNEYS FAIL
32. "WHERE THERE IS NO DOCTOR'
33. HEART
34. BLOOD
35. REFLEXOLOGY
36. HEALI.\G MASSAGE
37. 5 I\HNL!TE IHASSAGE
38. BODY FOR LIFE
39. TAl. BO
40. THREE STEPS TO STRONG FAMILIES
41. TilE HEART OF ADDICTION
42. TEACH11'1G CHILDREN VALUES & RESPONSIBILITIES
43. SYNOPSIS OF PSYCH IATRY
44. LISTENIi'.G TO PROZAC
45. FOODS THAT HARM & FOODS THAT HEAL
46. UNDERSTANDI\G \"UTRITION
--
CHARTS
L THE RESPJRA TORY SYSTEM
2. THE DIGESTIVE SYSTEM
3. THe M1JSCLE SYSTEM
,. SMOKL'iG AND YOUR HEALTH
5. 1L4RIIlFUL EFFEcrs OF:
A. SMOKING
B. STERIODS
C. ALCOHOl.
D. COCAINE
E. ~IAR\JUN'iA
F. INHALENTS
6. V~T>ERSTANDlNG CHOLESTEROL
7. UNDERSTANDING H\1'ERTENSION
8. HEART OlSEASE
9. A.'''TO<'l\' fLlPCHARTS
10. AIDS & AN
11. TRANSIIlISSIO,'i OF AIDS
[2. FIRST AID
13. VARIOTlS EXERCISF Cllo\RTS
COMPUTER PROGRAMS
I. DEATH & DRUGS
2. BOllYWORJ.::S
3. BRIT ANN/CA - "MY BODY SELF"
4. HEALTH QUEST
5. CHILD DEVELOPMENT
6. HUMA..\;" 3-D"
7, INTERACT/I'E HUMAN' BODY
8. SNA1~ "Hlii\'TA;,\- nODY"
9. SNAP "CHlNESE MED"
10. DISCOVERY CIL-\NNEL
A SHARKS
B, HOW ANlMAlS :>IO\'E
C NILE PASS-\GE TO EGYPT
D BEYOND PLA:'>;ET EAR.TH
EXIIIBIT B
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIARII HY POLICY
Insurance Company
This endorsement modifies such insurance as is afforded by the provisions of Policy
# relating to the following:
1. The City of Santa Ana, 20 Civic Ccnter Plaza, Santa Ana, California 92701: its
officers, employees, agents, volunteers and representatives arc named as additional insureds
("additional insureds") with regard to liability and defense of suits arising lrom thc opcrations
and uscs pcrformed by or on behalf of the named insured,
2. \Vith respect to claims arising out of the operations and uses performed by or on
behalf of the named insured, such insurance as is afforded by this policy is primary and is not
additional to or contributing with any other insurance carried h~l or for the benctit of the
additional insureds.
3. This insurance applies separately to each insured against whom claim is made or
suit is brought except with respeelto the company's limits of liability. The inclusion of any
person or organization as an insured shall not affect any right which such person or organization
would have as a claimant if not so included.
4, With respect to the additional insureds, this insurance shall not be cancelled, or
materially reduced in coverage or limits except after thirty (30) days written notice has been
given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701.
(Completion of the following, including countersignature, is required to make this endorsement
effective,)
Effective
Policy #
Issued to
, this endorsement form as a part of
Named Insured
Countersigned by
Authorized Representative
"
FV ANSTON INSURANCE COMPANY
CERTIFICATE NO.:
CERTIFICATE OF INSURANCE
EXCLUDES COVERAGE FOR NOMI:'iEE EVENTS. SEE SEPARATF APPLICATIONS FOR NOMINEE EVENTS.
SPECIAL EVENT LIAlJILlTY PROGRAM
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PRODUCER: PUBLIC ENTITY (ADDlTlONAL INSURED)
City of Santa Ana
Driver AlIiant Insurance Services in conjunction with 20 Civic Center Plaza, M-28
Apex lnsurance Services Santa Ana. CA 92701
P. O. Box 2!S323
Santa Ana, CA 92799.!jJ2J
(949) 660-8163
License No: OC 36~61
:-lA"1ED INSURED (EVENT HOLDER): EVE" r INFURMATHT\:
Kathleen Nelson N -200b-\ ICj TYPE: TnstructionalfSelf-T mprovemcnt
DAI E(S} JanuarY 1 - Decemher 31. 2006
LOCATION. Santa Ana Jail
This is to certify that the policies of insurance listed below have been issued Lo tht: insun:u named above for the policy penod
indicated. Notwithstanding any requiremenls, terms or conditions of any contracl or ulht'T duwment \V1th respect to which tillS
certiflcate may he issued or may pertain, the insurance afforded by the policies described hen:iu is subject to all the terms,
exclusions and conditions of such policies. Limits shown may have been reduced by paid claims.
INSURANCE CARRIER: Evanston Insurance Company
MASTlm POLICY '1IJMBER: 04SEPI00000l
MASTI<:R ..OLlCY OATES: EFFECTIVE: JANUARY 1.2006 EXPIRATION: JA:\CARY 1.2007
COMMERCIAl flENER}\1 I.lABILlTY OCCURRHNCEFORM DEDL:CTlHUi: NONE
CJ~ncral Aggregate Limit $2,000,000
Products & Completed Operation, 1,000,000
Pcrsonal&Advcl,ti,ing Injury 1,000,000
Fac:h Oc(;unence Limit I ,000,000
Fire Damage (AllY One Fire) 50,UUU
Medical I'ayments (Any One Person) 5,000
The limits of insurance apply separately to each event ins::rcd by tlm policy as if a separate poliey or insurance has been issued for that L'venl
"\I,'ho is insured" is amended tu illduJe, as all inslllnl, 111(; person or organization ShOW11 in this schedule, but only with respect to liability arising out of the
0\~11et'ship, mainwnan~L' or llse uCthe pl"lCmiSt~'i lIsed hy the IlOomed in~lIl'cd (event holder), This insurance docs not apply to: Any "oecurren~e" which take~ plalT
:If'1cr the event hohJerCl;,lscs to hlCOl tell<lnt in Ihatprc111iscs.
OTHER ADUlTIONAI. []'(SIJREDS
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CANCr:LLATIO:-.i: Should the UbtlVC described policy III c:lTlcelled before the lO,llpiratiun date Ihnen!: the issuing ~ompuny .will mail 3D (jays writtcn notice to lhe
ccrtitical~ holder and additional insureds listed.
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AUTHORIZED REPRESENTATIVE:
DATE ISSUED:
Januarv 20. 2006
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N - 200 G -\ I 7
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CHE~KLIST FORPFtOCESSING AGREEMENTS AND~JIIIE.Nd8IENTS
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FROM:
CLERK OF THE COUNCIL OFFICE
DEPT.: S~ '(\~f\. ('AT'J ~1Il\L
CONTACT PERSON ~{\l'\0I tS-Ho..do.
MAIL STOP: H..c;<(
EXT t.12.l.P
TO:
THE FOLLOWING ITEMS SHOULD BE PROVIDED IN REQUESTING PROCESSING OF AGREEMENTS FOR THE CITY:
AGREEMENT NUMBER (if amendment): A / ~ -1.00~' 0<-14 (Ol.t> "'l.\fr\~ \
AMENDMENT NUMBER (if applicable): 0 1ST
COUNCIL APPROVAL DATE: Sevy 'Lb,1S:f:L"
AMOUNT: 0 OVER $10,000 0( UNDER $10,000
NAME OF CONSULTANT~"'l'"\-\-~ ~'i:.l)-tJ
TERM OF AGREEMENT: EFFECTiVE DATE:-.)PrN \. '!DO(, TERMINATION DATE:~ 5\ :ZOC~
o 2ND
o 3RD
o
INSURANCE REOUIRED: 0 NO
"&. YES
If yes, 0 ATTACHED
'c3. iN PROGRESS
o AUTO
o PROFESSIONAL liABiliTY
o CGL (Commercial General Liabliity)
o WORKERS COMPENSATION
(INS. APPROVAL REQUIRED BY CAO PRIOR TO SUBMITTING TO COTC)
SIGNATURES REOUIRED:
o VENDOR
o CITY ATTORNEY
o
o
AGENCY (UNDER $10,000)
OTHER
COMMENTS:
1.1 -19 -0 (, rJ/i:t.
ADDITIONAL REMARfl:S: h9?'J
'Y'
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FOR CLER'59FFICE USE ONLY:
~ PROCESS
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