HomeMy WebLinkAboutMAXIMUS FINANCIAL SERVICES, INC. 2 (MAXIMUS, INC.) -2008iNSdRANGE ON FILE
„ORK MAV PROCEED
un i tL INSURANCE EXPIRES
S~i~ok
CLERK CF COUNCIL
DATE: %)~h,D~
0 ,';i~,b,~~.~ ~ I~
m~V~~lyh S'~fG~~AI
AGREEMENT FOR STATE MANDATED
COST REIMBURSEMENT SERVICES
N-2008-149
This Agreement is made and entered into this lit day of October, 2008 by the City of Santa Ana,
municipal corporation and charter City duly organized and existing under the constitution and laws
of the State of California ("City") and MAXIMUS Financial Services, Inc. ("Consultant"), a
California Corporation.
RECITALS
A. The City desires to retain a Consultant having special skill and knowledge in the field of
preparing applicable State Mandate Reimbursement claims in order to maximize revenue to City.
B. Consultant represents that Consultant is an independent contractor that has the knowledge
and experience to prepare and submit such State Mandate Reimbursement claims on behalf of City.
C. In undertaking the performance of this Agreement, Consultant represents that it is
knowledgeable in its field and that any services performed by Consultant under this Agreement will
be performed incompliance 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 and provide those products as set forth in Exhibit A to
this Agreement. The following terms shall apply to the terms and conditions set forth in Exhibit A:
1) City shall approve each claim; 2) Claim shall be filed based upon proof of City costs; 3) Claim
shall not be filed if costs do not exceed One Thousand Dollars ($1,000) per program per year. If
data needed to file applicable claims is not provided by City in a timely manner Consultant cannot
guarantee timely submission of claims.
Information and materials provided by the City:
Consultant will file the claims with information obtained from City. Consultant shall only
file claims for which adequate records or documentation has been provided by City. Claims shall
not be filed for amounts that do not exceed One Thousand Dollars ($1,000).
2. TERM
This Agreement shall commence on the date first written above and terminate on September
30, 2009, with two (2) options to renew for one year at the City's sole discretion, unless terminated
earlier in accordance with Section 76, below. The term ofthis Agreement may be extended upon a
writing executed by the Executive Director of the Finance Department and the City Attorney.
3. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services, the
rates and charges identified in Exhibit A. The total sum to be expended under this Agreement shall
not exceed $12,900.00 during the term of this Agreement.
b. City shall be billed on an annual fixed fee. Consultant agrees to file all eligible annual
fiscal year 2007-2008 actual cost reimbursement claims, and all eligible estimated 2008-2009
reimbursement claims for a fixed fee of 'twelve Thousand Nine Hundred Dollars ($12,900).
Payment by City shall be made within thirty (30) days of the execution of this Agreement.
4. INSURANCE
Consultant shall obtain and maintain for the entire term of this Agreement comprehensive
general liability insurance, with companies acceptable to the City, authorized to issue such
insurance in the State of California. Said insurance shall consist of the following:
a. Worker's Compensation Insurance. In accordance 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 to undertake self-insurance. Prior to
commencing the performance of the work under this Agreement, Consultant agrees to obtain
and maintain any employer's liability insurance with limits not less than $1,000,000 per
accident.
b. Professional Responsibility (Errors and Omissions) insurance with a combined
single limit of not less than $1,000,000.00 per claim.
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 an
effect for the entire period covered by this Agreement.
(ii) Certificates of insurance shall be furnished to the City upon execution
of this Agreement and shall be approved in form by the City Attorney.
(iii) Certificates and policies shall state that the policies shall not be
canceled or reduced in coverage or changed in any other material
aspect without thirty (30) days prior written notice to the City.
5. LIABILITY
Consultant shall be responsible for performing the work pursuant to this Agreement m a
professional manner and shall be responsible for the acts and omissions of its employees as related
to this Agreement. Liability of Consultant to City with regard to all work and services performed or
provided by Consultant for City under this Agreement shall be limited to the total fee actually paid
by City to Consultant. Under no circumstances shall Consultant have any liability to City in excess
of the amount of such fees or compensation. City acknowledges and agrees that but for the above
limitation of liability, Consultant would not be able to provide the services for City under this
Agreement for the prices applicable to this Agreement, and that this limitation of liability is
reasonable.
6, WORK COMPLETION IN A TIMELY MANNER
City agrees to provide information needed to complete the claims two weeks prior to the
established due date or two weeks after the data has been requested by the Consultant, whichever is
first. If information has been received in a timely manner, Consultant agrees to complete and file
the claim(s) on or before the date established for submitting such claims to the State of California.
If data is not provided in a timely manner and Consultant is unable to complete the claims,
the claims shall be submitted late, when allowed by the State. City understands that late claims are
subject to a 10% or One Thousand Dollar ($1,000) per claim penalty (whichever amount is less) up
to one year after the original due date. City understands that the State does not allow claims to be
submitted more than one year after the original due date.
Consultant shall not be responsible for late penalties or for the loss of claiming
opportunities. Consultant shall not be liable for any claims not filed due to incomplete, insufficient,
or late information. Consultant shall be responsible for late penalties or failure to file claims if
caused by mistake or negligence of its employees, officers and agents.
7. CALCULATION OF INDIRECT COST RATE PROPOSALS OR OVERHEAD
RATES
Consultant shall make every reasonable effort to calculate overhead rates when data is
available and provided by the City in a timely manner and where direct costs of a claim exceed Two
Thousand Dollars ($2,000.00).
g. INDEPENDENT CONTRACTOR
Consultant shall, during the entire term of this Agreement, be construed to be an
independent contractor and not an employee of the City. This Agreement is not intended nor shall it
be construed to create an employer-employee relationship, a joint venture relationship, or to allow
the City to exercise discretion or control over the professional manner in which Consultant performs
the services which are the subject matter of this Agreement; however, the services to be provided by
Consultant shall be provided in a manner consistent with all applicable standards and regulations
governing such services. Consultant shall pay all salaries and wages, employer's social security taxes,
unemployment insurance and similar taxes relating to employees and shall be responsible for all
applicable withholding taxes.
9. ASSISTANCE IF AUDITED
In the event an audit is conducted by the State Controller's Office and upon notification by
City, Consultant shall assist City in defending its' claim(s).
10. INDEMNIFICATION
Consultant agrees to and shall indemnify and hold harmless The City, it forfiersonalinjury,
employees, consultants, special counsel, and representatives from liability: (1) p
damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal
injury, including health, and claims for property damage, which may arise from the negligent
operations of the Consultant or its contractors, subcontractors, agents, employees, or other persons
acting on their behalf which relates to the services described in section 1 of 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. 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 sh~llthrou h not ult of the Consultant dasclosedin a
disclosed in publicly available sources; (b) ' , g
publicly available source; (c) is in rightful possession of the Consultant w shnda endentgly developed
confidentiality; (d) is required to be disclosed by operation of law; or (e) ~ P
by the Consultant without reference to information disclosed by the City.
12. 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.
I3. 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 telefacsimile or other telegraphic communication
in the manner provided in this Section, to the following persons:
To City: Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
telefacsimile (714) 647-6956
With courtesy copies to:
Executive Director of Finance
City of Santa Ana
20 Civic Center Plaza (M-17)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714)
and
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647-6515
To Consultant:
MAXIMUS, Inc.
3130 Kilgore Road Suite 400
Rancho Cordova, CA 95670
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 telefacsimile, 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
rransmitting facsimile machine, addressed as set forth above. For purposes of calculating these time
frames, weekends, federal, state, County or City holidays shall be excluded.
14. 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, that 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 otherwise, have been made by any party, or anyone acting on behalf of any
party, which are not embodied herein.
15. 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.
16. TERMINATION
This Agreement may be terminated by the City upon thirty (30) days written notice of
termination.
a. The Executive Director may require Consultant to deliver 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 be made for work which fails to meet the standard of performance
specified in the Recitals ofthis Agreement.
17. 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.
18. 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.
19. PROFESSIONAL LICENSES
Consultant shall, throughout the term of this Agreement, maintain all necessary licenses,
permits, approvals, waivers. and exemptions necessary for the provision of the services hereunder
and required by the laws and regulations of the United States, the State of California, the City of
Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in
writing of her inability to obtain or maintain such permits, licenses, approvals, waivers, and
exemptions. Said inability shall be cause for termination of this Agreement.
20. MISCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature hereinbelow has the power,
authority and right to bind their respective parties to each of the terms of this Agreement, and shall
indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to
City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn.
b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth
in the body of this Agreement.
IN WITNESS WHEREOF, the parties have executed this Agreement the date and year first above
written.
CITY OF SANTA ANA
ATTEST:
P;gA~H~~
Clerk of the Council
Q~
J; DA \rID N. REA
City Manager
~
APPROVED AS TO FORM:
JOSEPH W. FLETCHER
City Attorney
By: i'1(~U ll,~\'-0! ,h
Laurh Sheedy
Assistant City Attorney
MAXIMUS FINANCIAL
SERVICES,INC.
~~~,~
Director of Contract Administration ~
Tax 10# 5~~ I If'Jt'Cl' ...-c'W'
EXHIBIT A
Annual Claims
Annual state mandated cost reimbursement claims are those existing claims which are included in the State
Controller's annual claiming instructions. These claims are to be issued in the fall of2008, and are due no
later than February 15,2009. [n addition, these annual claims include those claims listed in the current
FY2007-2008 State Budget and any other first-time claims that will be, or have been, filed for the first time
during this fiscal year.
. . : .. ~
_ Absentee Ballots
_ Administrative License Suspension
- Animal Adoption
_ Brendon Maguire Act
_ CA Fire Incident Reporting
_ Crime Victim's Domestic Violence Incident Reports
_ Domestic Violence Arrest Policies & Procedures
-Domestic Violence Arrests and Victim Assistance
-DNA Database
-False Reports of Police Misconduct
-Fire Safety Inspections of Care Facilities
_ Firefighters' Cancer Presumption
_ Health Benefits for Survivors of Peace Officers & Firefighters
_ Local Government Employee Relations (PERB)
_ Local Recreation Background Checks
_ Peace Officer's Cancer Presumption
_ Peace Officer Personnel Records: Unfounded Complaints and Discovery
_ Police Officers' Procedural Bill of Rights
_ Photographic Record of Evidence
_ Racial Profiling: Law Enforcement Training
_ Rape Victim Counseling Center Notices
_ Stolen Vehicle Notification
_ Threats Against Peace Officers
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Palacol, Marilyn
From:
Sent:
To:
Subject:
Nicole Koehler/MAXIMUS [nicolekoehler@maximus.comj
Thursday, October 23, 2008 5: 11 PM
Palacol, Marilyn
RE: MAXIMUS Contract
I will request certificates for all of the caoverages and yes, the prof. liability comes separately - from a
different carrier. You should have them tomorrow.
Thanks
***************************************************************
Nicole Koehler
Regional Finance Manager
3130 Kilgore Road, Suite 400
Rancho Cordova, CA 95670
916.471.5525
F 916.366.4838
C 916.206.3253
-----"Palacol, Marilyn" <Moalacol(fusanta-ana.orq> wrote: __n_
To: "Nicole Koehler/MAXIMUS" <nicolekoehler(fumaximus.com>
From: "Palacol, Marilyn" <Moalacol(fusanta-ana.orq>
Date: 10/23/2008 04: 08PM
Subject: RE: MAXIMUS Contract
The agreement provision requires comprehensive general liability insurance which includes Worker's Comp and Prof
Liability. Maximus' agent typically forwards to City the cert for Prof Liability separately.
\;IMilyn Palaeol
City of Santa Ana
714-647-54.'3
email: mvalacol@santa-ana.org-
From: Nicole Koehler/MAXIMU5 [mailto:nlcolekoehler@maximus.comJ
Sent: Thursday, October 23, 2008 3:46 PM
To: Palacol, Marilyn
SUbject: RE: MAXIMUS Contract
They do send them directly to the City and I don't have one. I will request a new one. Do you just need the prof liability?
Thank you
***************************************************************
Nicoie Koehler
1
Palaeol. Marilyn
From:
Sent:
To:
Subject:
Attachments:
ACS Chicago [ACS_Chicago@ars.aon.com]
Wednesday, November 05, 2008 11:03 PM
DonnetteWashington@maximus.com; Palacol, Marilyn; nicolekoehler@maximus.com
MAXIMUS, Inc. - City of Santa Ana [LAX110308069055]
MAXIMUS_lnc_City of Santa Ana_CerCV1.pdf
Attached, please find the Certificate(s) of Insurance that you have requested. Should you have any questions, please
c,lll 866-2H3-7122.
(~ee attached file: MAXIMCS Inc City of Santa Ana Cert_V1.pdf)
Aon Client Services
Aon Risk Services Central, Inc.
dba Aon Risk Insurance Services Central, Inc.
. CA License OD04043
lOOO Milwaukee Ave. I Glenview,IL I 60025
t: 866.283. 7122 I f: 847.953.5390 w: aon.com
1
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CERTIFICATEQF~tJIA.Jll:LiT~,,ffiSURANCE ' 11/06/2008
PRODlICER washington, D.C./ Hunt; THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORJ\'L.\.TlON O;\'LY
Aon Risk services ,Inc. of
200 East Randol ph AND C01WERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
chicago IL 60601 USA CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW,
PHo".(866' 283-7122 FAX- (847, 953-5390 INSVRERS AFFORDING COVERAGE NAIC#
INSURED INSURER A American International specialty Lines 26883
MAXIMUS. Inc. I~SURER B
11419 sunset Hi 115 Road
Reston VA 20190 USA rNSURERC
INSURER D.
INseRER E O"l~
rov E ~,c,:;;;;;.,,:ji!,:t: < ,~:1,~~:,.;< ;;';:SI:lt~~'e'S" er:",terrns:.';an '!il\con ,J.tlonS:<:Q ,:~t e
THE poucms OF \:-JSURAKCE LISTED BELOW HAVE BEEK ISSUED TO THE INSURED NMtED ABOVE FOR ruE POUCY PERIOD iNDICATED. NOTWITIISTANDlNG
ANY REQUIREME!'.i, TER!v1 OR CONDITION OF ANY CONTRACT OR OTHER DOCUME!\'T WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY
PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREll\' lS SUBJECT TO ALL THE TERMS, EXCLUSIO'NS AND CONDlnONS Of SUCH POLICIES
AGGREGATE lIM[TS SHOWN MAY HAVE BEEN REDUCED BY PAID ClAI;...{S. LIMITS SHOWN ARE AS REQUESTED
Il'iSR lAuD' POLICY EFFECTI\' POLICY EXPIRATION
LTR I~SR THE OF INSURA,"'lCE POLICY NUMBER DATE(M1\I\DDlVY) DATE(I\Dt\DDlYY) LIMITS
r"~ EACH OCCURRENCE
COMMERCIAL GENERAL LiABILITY DAMAGE TO RENTED
CLAIMS MADE 0 OCCUR PREMlSES (Ea occurence)
y one person
PERSONAL & ADV INJURY
GENERAl AGGREGATE
GEN'L AGGREGATE LIMlT APPLIES PER
0 PRODUCTS - ('OMP/OP AGO
POLiCY 0 PRO-O LOC
JECT
AIITOMOBILE LIABILITY COMBINED SINGLE awl'
r- ANY AUTO 'I (Eaaccident)
I- AlL OWNED AUTOS iJ&Q
I- BODILY [!"JURY
SCHEDCLED AUTOS I Per person)
r- HIRED AUTOS ..~
r- BODILY I:-lJURY
~ON OWNED Amos (Peraccidenl)
-
- PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT
B ANY AUTO
OTHER THA.'l EAACC
AtrrO ONLY
AGG
EXCESS IUMBRELLA LIABILITY EACH OCCURRENCE
D occeR 0 CLA[MS MADE AGGREGATE
8DEOUCTIBLE
RETE:-ITlO:-.!
WORKERS COMPENSATION Al'iD I~;RV ~;~T~.I I~;H.
EMPLOYERS' LIABILITY
E.L. EACH ACGDENT
ANY PROPRIETUR i PARTNER I EXECUTrYE
OFFICER/MEMBER EXCLL'DED? E,L. DISEASE-EA EMPLOYEE
lfyes, describe under SPECIAL PROVISIONS E.t DISEASE-POLICY UMIT
below
A 007005584 0&/D1/0& ",/01709 Each Calm -
OTIIER 11,000,000
Prof Liability
DESCRIPTWN OF OPERA.llONSIl..OCATIONSIVEHICLESIEXCLUSIONS ADDED BY EKDORSEMENTISPECLAL PROVISWNS
SIR applies per terms and conditions of the poliCY. RE: Division 05-1420, consulting services, project NO.
1047459 09f-a Santa Ana, July 1.2008 to June 30, 2009, Mandated Cost claiming.
~ ~ ~ -
,"b.,i,. . '''':''(f:~#~~i:;;" : ,,"," ":'
City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POUGES BE CANCELLED BEFORE THE EXPlRATLON
20 civic Center plaza M-17 DATE TIIEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
Santa Ana eA 92702 USA 10 DAYS WRITTEN NOTlCE TO THE CERTlFlCATE HOLDER NANlED TO THE LEFT,
BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGATION OR LIABIUTY
OF ANY KlNOUPON THE INSURER, ITS AGENTS OR REPRESENTATIVES
AUTHOR[ZED REPRESENTATIVE ~ ~9"____ ~........,..~
',j~'. CC[', '!":l'''~L:~<:';~,,,;[~~~,,~.f1f~''.,/-~t',;x'['" 'I"
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Palaeol. Marilyn
From:
Sent:
To:
Subject:
Attachments:
Marsh. Certificate@marsh.com
Tuesday, November 04,20088:09 AM
Palacol, Marilyn
CITY OF SANTA ANA CERTIFICATE
cert_5_858156_1.pdf
Attached COI per your request. Copy was emaiIed to cert holder as well.
Reply To: Milae.ros.P.Tiamson@Marsh.com
PLEASE DO NOT REPLY TO THIS EMAIL. USE THE REPLY-TO EMAIL ADDRESS INSTEAD.
THIS [S A POST-ONLY MAILING. MAIL SENT TO THIS ADDRESS CANNOT BE ANSWERED.
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1
ACORO,. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIODNY)
11104/08
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
MARSH USA INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
SUITE 400 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1255 23RD STREET, NW. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
WASHINGTON, DC 20037 COMPANIES AFFORDING COVERAGE
Attn: SHARON HENNING - T-202.263-7600 - -
COMPANY
500625--GAUW-08-09 A Hartford Fire Insurance Co
.-
INSURED COMPANY
MAXIMUS, INC. AND ALL SUBSIDIARIES B Twin City Fire I nsurance Co
11419 SUNSET HILLS ROAD
RESTON, VA 20190 COMPANY
I C N/A
COMPANY
D Hartford Insurance Company Of Midw
COVERAGES This certificate supersedes and replaces any previously issued certificate. 2
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOIfv1\l MAY HAVE BEEN REDUCED BY PAID CLAIMS.
c~ I I POL.lCY EFfECTIVE POL.ICY EXPIRATION
LT' TYPE Of INSURANCE POL.ICY NUMBER DATE (MM/DDNY) DATE (MM/DDNY) L.IM1TS
I GENERAL. UAB1UTY 105/01/08 GENERAL AGGREGATE 1$ 2,000,000
^ ~:t.._,-" 10 UEN TE5891 05/01/09 PRODUCTS - COMPIOP AGG : $ 2,000,000
CLAIMS MADE [8J OCCUR PERSONAL&ADVINJURY 1$ 1,000,000
OWNER'S & CONTRACTOR'S PROT EACH OCCURRENCE 1$ 1,000,000
, - FIRE DAMAGE (Anyone fire) $ 300,000
I -I MED EXP (Anyone person) $ 10,000
L AUTOMOBIL.E L.'ABIUTY COMBINED SINGLE LIMIT I. $ 1,000,000
A ~.' ANY AUTO 10 UUN TE6206 05/01/08 05/01/09
~j ALL O""EO AUTOS I I BODILY INJURY $
\--- SCHEDULED AUTOS (Per person)
H, HIRED AUTOS I BODILY INJURY $
'" NON-O""ED AUTOS (Per accident)
,
PROPERTY DAMAGE $
GARAGE LIABIUTY ~ AUTO ONLY - EA ACCIDENT S
~ ANY AUTO 1/ ,'C7 OTHER THAN AUTO ONLY'
. I EACH ACCIDENT S
I AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
b UMBRELLA FORM I AGGREGATE $
i OTHER THAN UMBRELLA FORM 1 $
WORKERS COMPENSATION ANO 142WBRMG3741 (WI) X I T~,9D'JNs I n~
I ,MPLOYE'" LIABILITY
B 05/01/08 05101/09 EACH ACCIDENT $ 1,000,000
D THE PROPRIETOR! ~INCL 42WNMG3740 (AOS) 05/01/08 05101/09 DISEASE - POLICY LIMIT 1$ 1,000,000
PARTNERS/EXECUTIVE DISEASE - EACH EMPLOYEE I $
OFFICERS ARE EXeL 1,000,000
'"
I I
DESCRIPTION Of OPERATlONSIL.OCATIO NSNEHICL.ES/SPECIAL ITEMS
RE. MANDATED COST CLAIMING
THE CITY OF SANTA ANA AND ITS AGENTS ARE INCLUDED AS ADDITIONAL INSUREDS UNDER THE GENERAL LIABILITY COVERAGE AS REQUIRE!
BY WRITTEN CONTRACT AND ALLOWED BY LAW.
CERTIFICATE HOLDER CLE-001912531-01 CANCELLATION
SHOUL.D ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEfORE THE
EXPIRATION DATE THEREOf, THE INSURANCE COMPANY WILL ENDEAVOR TO MAIL
CITY OF SANTA ANA ~ DAYS WRITTEN NOTICE TO THE CERTifiCATE HOL.DER NAMED TO THE L.EFT,
20 CIVIC CENTER PlAZA, M-17
SANTA ANA, CA 92702 BUT FAIL.URE TO MAIL. SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Of
ANY KIND UPON THE COMPANY, IT, AGENTS 0. REPRESENTATIVES.
AUTHORIZEDREPRESENTAT'VE ~/_.A
ofM...sh USA Inc.
BY: Timothy M. Sasser
ACORD 25.S (1/95) <!l ACORD CORPORATION 1988
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the poiicy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmativeiy or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
Acord 2S-5 (1/95)
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