Loading...
HomeMy WebLinkAboutMARTINEZ, LUIS RAUL (3) INSURANCE NOT ON FILE WORK MAY NOT PROCEED A-2025-211 CITY CLERK DATE, DEC 1 a 2025 �ny� n'�1ti�1�Yc�� NZ) INMATE WITH LUIS RAUL MARTINEZ TO PROVIDE INMATE COUNSELING SERVICES THIS AGREEMENT is made and entered into on this 2'day of December, 2025 by and between Luis Raul Martinez, ("Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. On July 23, 2025, the City issued Request for Proposal No. 25-103 ("RFP") seeking a consultant having special skill and knowledge in the field of counseling and/or instructional services encompassing the fields of anger management, stress reduction, conflict management/resolution, domestic violence avoidance, chemical dependency, life skills/family issues and community resources to the inmates housed at the Santa Ana City Jail. B. Consultant is one of two vendors selected to provide the services pursuant to the Scope of Work in the RFP and attached hereto as Exhibit A to this Agreement. Consultant represents that he is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in its field and that any services performed by Consultant under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional 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: I. SCOPE OF SERVICES Consultant shall perform during the term of this Agreement, the tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately complete the services described and set forth in Exhibit A, attached hereto and incorporated by reference. 2. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services for City, the rates and charges identified in Exhibit B. The total amount to be expended during the term of this Agreement shall not exceed$140,000. b. Payment by City shall be made within forty-five(45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. City and Consultant agree that all payments due and owing under this Agreement shall be made through Automated Clearing House(ACH)transfers. Consultant agrees to execute the City's standard ACH Vendor Payment Authorization and provide required Page I of 8 documentation. Upon verification of the data provided, the City will be authorized to deposit payments directly into Consultant's account(s) with financial institutions. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. 3. TERM This Agreement shall commence on the date first written above and continue for a three (3) year term,unless terminated earlier in accordance with Section 15,below. 4. INDEPENDENT CONTRACTOR Consultant shall, during the entire term of this Agreement, be construed to be an independent Consultant and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer-employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Consultant performs the services which are the subject matter of this Agreement; however, the services to be provided by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services. Consultant shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 5. OWNERSHIP OF MATERIALS This Agreement creates a nonexclusive 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. 6. INSURANCE Insurance requirements are attached hereto as Exhibit C. 7. 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 Page 2 of 8 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, employces, or other persons acting on its behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages,just compensation, restitution,judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages,just compensation,restitution,judicial or equitable relief suffered, or alleged to have been suffered,by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. The Consultant further agrees to indemnify,hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party challenging the validity of this Agreement, or asserting that personal injury, damages, just compensation, restitution,judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding.Notwithstanding the foregoing, to the extent Consultant's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Consultant. 8. 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. 9. 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. 10. 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 fiirther agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than treasonable care. "Confidential Information"shall include all Page 3 of 8 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. 11. CONFLICT OF INTEREST CLAUSE a. 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. b. No immediate family members of either the Mayor, City Council Member, or any appointed City Official, including appointed board and commission members, as defined under the City's Municipal Code, whose position with the City shall award or influence the award of this Agreement, or any competing contract or amendment thereof, shall be employed in any capacity by the Consultant or have any other direct or indirect financial benefit or interest in this Agreement. c. The section also prohibits the awarding of any agreement, contract, grant, or any amendment to those awards, to any former full-time employee for one-year From date of employee separation except for any Ca1PERS retiree as authorized by City Council resolution d. The Consultant must comply with all conflict of interest laws, ordinances, and regulations now in effect or hereafter to be enacted during the term of this Agreement. The Consultant warrants that it is not now aware of any facts which conflict with the prohibitions defined above. If the Consultant hereafter becomes aware of any facts that might reasonably be expected to create a conflict of interest, it must immediately make full written disclosure of such facts to the City. Full written disclosure must include, but is not limited to,identification of all persons implicated and a complete description of all relevant circumstances. Failure to comply with the provisions of this paragraph will be a material breach of this Agreement. e. Consultant covenants that none of its directors, officers, employees, or agents shall participate in selecting or administrating any subcontract supported(in whole or in part) by City funds stemming from the Agreement where the awarding of the subcontract has any direct or indirect financial benefit or interest to any individual, as defined in subsections (b) and(c) above. Page 4 of 8 12. 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 the recruitment, selection, teaching, training, utilization, promotion, termination or other employment related activities or 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. 13. 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. 14. 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. 15. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for all services performed by Consultant prior to receipt of such notice of termination, subject to the following conditions; a. As a condition of such payment, the Executive Director may require Consultant to deliver to the City all work product(s) completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. Page 5 of 8 16. 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. 17. 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. 18. PROFESSIONAL LICENSES Consultant shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 19. 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 20 Civic Center Plaza(M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax: 714- 647-6956 With courtesy copies to: Chief of Police City of Santa Ana 60 Civic Center Plaza Santa Ana, California 92702 Page 6 of 8 To Consultant: Luis Raul Martinez 301 West 2"d Street, #241 Santa Ana, CA 92701 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. 20. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact,held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. [signature page to follow] Page 7 of 8 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: CITY OF SANTA ANA ennifer . Hall � =�� Alvaro Nunez City Manager APPROVED AS TO FORM: SONIA R. CARVALHO CONSULTANT: City Attorney By: Tamara Bogosian Luis aul Martinez Senior Assistant City Attorney RECOMMENDED FOR APPROVAL: Robert Rodriguez Chief of Police Page 8 of 8 EXHIBIT A SCOPE OF SERVICES w ' CITY OF SANTA ANA EXHIBIT I SCOPE OF SERVICES Consultant shall perform services as set forth below. I. SCOPE OF SERVICES The City of Santa Ana is seeking an experienced consultant(s)to provide on-site counseling services for incarcerated persons. Specific responsibilities include, but are not limited to: a. Must be available for at least ten (10) hours per week to perform the following services: i. On-site individual counseling services as needed to incarcerated persons at the Santa Ana Jail. ii. The Consultant(s) shall be trained in trauma-informed practices pertaining to incarcerated individuals. The consultant shall be trained in crisis prevention, de- escalation techniques, crisis intervention and debriefing skills pertaining to incarcerated individuals. iii. Respond to referrals from correctional supervisors, to provide evaluations for mental health conditions including; anxiety, and depression. iv. The consultant shall be trained in the recognition of mental health conditions such as psychosis and suicidal ideation. v. Individual crisis intervention and counseling to incarcerated persons at the Santa Ana Jail. Respond to mental health emergencies, such as illicit drug withdrawal, self-harm and suicide threats. 1. The Consultant(s) must be available 24 hours a day, 7 days a week, including holidays, to respond to emergency call outs within eight (8) hours. vi. Consultant(s) must disclose private information without the consent of the incarcerated person in order to protect themselves or the public from serious harm, e.g., self harm, suicidal ideations, or harm of another person. vii. Consultant(s) must report ongoing domestic violence, abuse or neglect of children, the elderly or people with disabilities, or victims falling within the PREA. viii. Proposers shall be able to provide individual counseling to incarcerated persons dealing with trauma, grief, substance abuse and managing emotions; using therapeutic approaches including but not Iimted to Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), or trauma-informed care and relapse prevention and healthy coping skills. ix. Consultant(s) must prepare treatment planning and case management to ensure the best care for incarcerated individuals. x. Proposers must prepare a treatment plan for incarcerated individuals to address continuous mental health care outside of the Santa Ana Jail. A. Counseling services will only be available to incarcerated persons while they are in custody of the Santa Ana Jail. Once an incarcerated person is released from the facility, all services provided by the Consultant(s) must conclude. City of Santa Ana RFP 25-103 Page 17 of 33 w' CITY OF SANTA ANA xii. Proposers shall provide group counselingltherapy by delivering instructional and/or counseling services in the following program areas to selected inmates: 1. Anger management 2. Stress reduction 3. Conflict management and resolution 4. Domestic violence Avoidence 5. Chemical dependency 6. Life skills 7. Family relationship conseling 8. Community resources xiii. Provide incarcerated persons in attendance with referrals to other agencies and community resources that can provide additional instruction and/or counseling as follow-up to the program material they've received at Santa Ana Jail. xiv. Proposers may include provisions outside of the scope of services deemed necessary to achieve the goals of the RFP. xv. Proposers shall provide an itemized invoice not limited to: unique invoice number, dates of service, hours worked, hourly rate, name of Consultant(s) and services provided on a monthly basis. City of Santa Ana RFP 25-103 Page 18 of 33 EXHIBIT B HOURLY RATES Fee Proposal including hourly rates if applicable ' Page 08 Cost Proposal Description: Rate Per Session Service Individual Mental Hour Session $95 Health Counseling EXHIBIT C INSURANCE REQUIREMENTS Exhibit C—Insurance Requirements 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. MINIMUM SCOPE AND LIMIT OF INSURANCE 1. Commercial General Liability (CGL): Insurance Services Office Form CG 00 01covering COL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence and $2,000,000 aggregate. Required policy limits can be met with primary and umbrella/excess insurance policies. 2. 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. 3. 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. 4. Professional Liability Insurance: with limits no less than$1,000,000 per occurrence or claim, and$2,000,000 aggregate. 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: 1. 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. 2. 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. i Exhibit C—Insurance Requirements 3. 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. 4. 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. 5. 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. 6. Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa Ana, Attention: Santa Ana Police Department, 60 Civic Center Plaza, Santa Ana, CA 92701. The name and location of project must be included in the Description of Operations section of each certificate. 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:VII,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 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. HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP CNA Certificate ltmrance OCCURRENCE PROFESSIONAL LIABILITY POLICY FORM Print Date: 1/21/2026 The application for the Policy and any and all supplementary information, materials, and statements submitted therewith shall be maintained on file by us or our Program Administrator and will be deemed attached to and incorporated into the Policy as if physically attached. PRODUCER BRANCH PREFIX POLICY NUMBER POLICY PERIOD 018098 970 HPG 0697816243 From: 12/10/25 to 12/10/26 at 12:01 AM Standard Time Named Insured and Address: Program Administered by: Luis Martinez Healthcare Providers Service Organization 301 W 2nd St Apt 241 1100 Virginia Drive, Suite 250 Santa Ana, CA 92701-5295 Fort Washington, PA 19034 1-800-982-9491 www.hpso.com Medical Specialty: Code: Insurance Provided by: Alcohol/Drug Counselor 80723 American Casualty Company of Reading, Pennsylvania 151 N. Franklin Street Excludes Cosmetic Procedures Chicago, IL 60606 Professional Liability $ 1,000,000 each claim 3,000,000 aggregate Your professional liability limits shown above include the following: * Good Samaritan Liability * Malplacement Liability * Personal Injury Liability * Sexual Misconduct Included in the PL limit shown above subject to $25,000 aggregate sublimit Coverage Extensions License Protection $25,000 per proceeding $ 25,000 aggregate: Defendant Expense Benefit $ 1,000 per day limit $25,000 aggregate: Deposition Representation $ 10,000 per deposition $ 10,000 aggregate Assault $ 25,000 per incident $25,000 aggregate Includes Workplace Violence Counseling Medical Payments $ 25,000 per person $ 100,000 aggregate First Aid $ 10,000 per incident $ 10,000 aggregate Damage to the Property of Others $ 10,000 per incident $ 10,000 aggregate: Information Privacy (HIPAA) Fines and Penalties $ 25,000 per incident $25,000 aggregate, Media Expense $ 25,000 per incident $ 25,000 aggregate APPROVED General Liability By Tu Tran Nguyen at 10:21 am,Feb 19,2026 General Liability $1,000,000 each claim / $2,000,000 aggregate Fire &Water Legal Liability Included in the GL limit shown above subject to$250,000 aggregate sublimit Personal Liability $1,000,000 aggregate Total $ 465.00 Base Premium $465.00 Premium reflects Self Employed , Part Time Policy Forms and Endorsements (Please see attached list of policy forms and endorsements) Doug Worman, Chief Executive Officer Stathy Darcy, Secretary Keep this Certificate of Insurance in a safe place. It and proof of payment are your proof of coverage. There is no coverage in force unless the premium is paid in full. To activate your coverage, please remit premium in full by the effective date of this Certificate of Insurance. Coverage Change Date: Endorsement Date: Master Policy: 188711433 CNA93692 (11-2018) CALIFORNIA INSURANCE IDENTIFICATION CARD ❑ CALIFORNIA INSURANCE IDENTIFICATION CARD Safeco Safeco COMPANY COMPANY Insurance SAFECO INSURANCE COMPANY OF AMERICA Insurance SAFECO INSURANCE COMPANY OF AMERICA 62 MAPLE AVENUE 62 MAPLE AVENUE KEENE NH 03431 KEENE NH 03431 POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE X60OS321 MAR. 30 2025 MAR. 30 2026 X6005321 MAR. 30 2025 MAR. 30 2026 YEAR MAKE/MODEL VEHICLE IDENTIFICATION NUMBER YEAR MAKEIMODEL VEH ER 2019 TOYOTA JTDKARFP2K3115294 2019 TOYOTA JTDKARFP2K3115294 AGENCY/COMPANY ISSUING CARD NAIC 24740 AGENCY/COMPANY ISSUING CARD NAIC 24740 INSURANCE ANSWER CENTER LLC INSURANCE ANSWER CENTER LLC 1-800-495-6578 1-800-495-6578 4804 LAUREL CANYON BLVD 4804 LAUREL CANYON BLVD I STE 820 STE 820 VALLEY VLG CA 91607-3717 VALLEY VLG CA 91607-3717 ° INSURED LUIS MARTINEZ INSURED LUIS MARTINEZ a 301 W 2ND ST 301 W 2ND ST SANTA ANA CA 92701-8212 SANTA ANA CA 92701-8212 0 0 a CN-7042/CAEP 6/13 SEE IMPORTANT NOTICE ON REVERSE SIDE CN-7042/CAEP 6/13 VEHICLE REGISTRATION COPY U Z_ Y Q z Z O F U a N Z Q K H a Z K O W 2 r uJ U K a W S F O K O r Z K W 2' SEPARATE ID CARD(S) ON THE PERFORATIONS. ONE COPY MUST BE KEPT IN THE INSURED VEHICLE AND PRESENTED UPON DEMAND.THE OTHER COPY SHOULD BE PRESENTED TO THE MOTOR VEHICLE DEPARTMENT CN-7042/CAEPA 6/13 WHEN RENEWING YOUR VEHICLE REGISTRATION. POLICY FORMS & ENDORSEMENTS The following are the policy forms and endorsements that apply to your current professional liability policy. COMMON POLICY FORMS & ENDORSEMENTS FORM # FORM NAME G-121500-D (04-08) Common Policy Conditions G-121501-C1 (07-01) Occurrence Policy Form - California CNA82011 (04-15) Related Claims Endorsement G-145184-A (06-03) Policyholder Notice - OFAC Compliance Notice G-147292-A (03-04) Policyholder Notice - Silica, Mold &Asbestos Disclosure CNA81753 (03-15) Coverage & Cap on Losses from Certified Acts Terrorism CNA81758 (01-21) Notice - Offer of Terrorism Coverage & Disclosure of Premium GSL13424 (05-09) Services to Animals GSL15563 (02-10) Information Privacy Coverage Endorsement HIPAA Fines, Penalties & Notification Costs GSL15564 (10-09) Sexual Misconduct Sublimits of Liability Professional Liability & Sexual Misconduct Exclusion GSL15565 (03-10) Healthcare Providers Professional Liability Assault Coverage GSL17101 (02-10) Exclusion of Specified Activities Reuse of Parenteral Devices and Supplies CNA80052 (09-14) Distribution or Recording of Material or Information in Violation of Law Exclusion Endorsement CNA80051 (09-14) Amended Definition of Personal Injury Endorsement CNA94164 (11-18) Amendment Definition of Claim Endorsement G-123846-D04 (07-01) California Cancellation and Non-Renewal CNA79575 (07-14) Exclusion of Cosmetic Procedures CNA89026 (05-17) Media Expense Coverage CNA89027 (10-17) Entity Exclusion Endorsement G-121504-C (07-01) General Liability Form G-123827-B (07-01)(02) Additional Insured General Liability G-123828-B (07-01) Certificate Holder G-141231-A (07-01) Additional Insured Healthcare Entity PLEASE REFER TO YOUR CERTIFICATE OF INSURANCE FOR THE POLICY FORMS & ENDORSEMENTS SPECIFIC TO YOUR STATE AND YOUR POLICY PERIOD. For NJ residents: The PLIGA surcharge shown on the Certificate of Insurance is the NJ Property &Liability Insurance Guaranty Association. For KY residents: The Surcharge shown on the Certificate of Insurance is the KY Firefighters and Law Enforcement Foundation Program Fund and the Local Tax is the KY Local Government Premium Tax. As required by 806 Ky. Admin Regs. 2:100, this Notice is to advise you that a surcharge has been applied to your insurance premium and is separately itemized on the Declarations page or billing instrument attached to your policy, as required KRS. §136.392. For WV residents: The surcharge shown on the Certificate of Insurance is the WV Premium Surcharge. For FL residents: Form #:CNA93692 (11-2018) Named Insured: Luis Martinez Master Policy#: 188711433 Policy#: 0697816243 HEALTHCARE PROVIDERS GENERAL LIABILITY COVERAGE PART ENDORSEMENT Additional Insured General Liability In consideration of the premium paid, and subject to the General Liability limit of liability shown on the certificate of insurance , it is agreed that the GENERAL LIABILITY COVERAGE PART is amended as follows: The person or entity named below (the "additional insured") is an insured under this Coverage Part but only as respects its liability arising out of named insured's operations, or premises owned by or rented by the named insured and solely to the extent that: 1. a general liability claim is made against the named insured and the additional insured; and 2. in any ensuing litigation arising out of such claim, the named insured and the additional insured remain as co-defendants. In no event is there any coverage provided under this policy for an occurrence that is the direct liability of the additional insured. Additional Insured: City of Santa Ana ATTN: Santa Ana Police Dept. 60 Civic Center Plaza Santa Ana, CA 92701 This endorsement is a part of your policy and takes effect on the effective date of your policy, unless another effective date is shown below. All other provisions of the policy remain unchanged. Must Be Completed Complete Only When This Endorsement Is Not Prepared with the Policy Or Is Not to be Effective with the Policy ENDT. NO. POLICY NO. ISSUED TO ENDORSEMENT EFFECTIVE DATE 02 0697816243 ILuis Martinez 12/10/2025 G-123827-B (07/2001) Page 1 of 1 HEALTHCARE PROVIDERS GENERAL LIABILITY COVERAGE PART ENDORSEMENT Additional Insured General Liability In consideration of the premium paid, and subject to the General Liability limit of liability shown on the certificate of insurance , it is agreed that the GENERAL LIABILITY COVERAGE PART is amended as follows: The person or entity named below (the "additional insured") is an insured under this Coverage Part but only as respects its liability arising out of named insured's operations, or premises owned by or rented by the named insured and solely to the extent that: 1. a general liability claim is made against the named insured and the additional insured; and 2. in any ensuing litigation arising out of such claim, the named insured and the additional insured remain as co-defendants. In no event is there any coverage provided under this policy for an occurrence that is the direct liability of the additional insured. Additional Insured: City of Santa Ana, it's Officers,Offical Employees or Volunteers 20 Civic Cntr P.O. Box 1988 Santa Ana, CA 92702-1988 This endorsement is a part of your policy and takes effect on the effective date of your policy, unless another effective date is shown below. All other provisions of the policy remain unchanged. Must Be Completed Complete Only When This Endorsement Is Not Prepared with the Policy Or Is Not to be Effective with the Policy ENDT. NO. POLICY NO. ISSUED TO ENDORSEMENT EFFECTIVE DATE 01 0697816243 ILuis Martinez 12/10/2025 G-123827-B (07/2001) Page 1 of 1 CNA ADDITIONAL INSURED ENDORSEMENT(General Liability) In consideration of the premium, and subject to the limits of liability applicable to the General Liability Coverage Part, the General Liability Coverage Part is amended as follows: The below-specified person or entity (the "additional insured") is an insured under this Coverage Part for bodily injury or property damage arising out of an occurrence, or personal and advertising injury arising out of an offense, for which the additional insured is vicariously liable solely arising from the named insured's operations, or premises owned by or rented by the named insured; provided that the claim is made and remains asserted against both the additional insured and the named insured. The coverage afforded under this endorsement is subject to all other terms and conditions of coverage and the Limits of Liability stated on the Certificate of Insurance and in this policy. There is no coverage for any claim arising out of the additional insured's own acts, errors or omissions nor for any direct liability of the additional insured. The additional insured shall share limits of liability with all insureds. In no event will this serve to increase the limits of liability as stated on the Certificate of Insurance. Additional Insured: A blanket endorsement that includes any person with a written contract with the City of Santa Ana 6060 Civic Center Plaza Santa Ana CA 92701 All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA101518XX(7-23) Policy No: Page 1 Endorsement No: Effective Date. Insured Name: ©CNA All Rights Reserved. CITY OF SA WT dNd Managing Risk through Awareness and Action AFFIDAVIT OF EXEMPTION FOR WORKERS' COMPENSATION INSURANCE I Luis R. Martinez ("Representative"),attest that I am an authorized (Name and Title of Vendor Representative) representative of Luis R. Martinez ("Company"),and (Consultant/Company Name) possess the authority to legally bind Company. 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 2025-21 1 ("Agreement")to provide Mental Health Counseling ("Services"): (Services to be provided under agreement/contract) 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 workers'compensation 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. f / C a 01-20-26 ignature Late Luis Raul Martinez Print Name Mental Health Counselor Title 714 469-4011 luisraul@martinez.net Contact Information,i.e.,Telephone Number and/or Email Address 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 Nguyen, Tu Tran From: Najera, Luisa Sent: Thursday, February 19, 2026 10:03 AM To: Nguyen, Tu Tran Subject: FW: COI - L. Martinez Hi Tu, Please proceed with the approval. Kindest regards, Lu4ct,Ncyerra. Senior Risk Management Analyst City of Santa Ana I Human Resources Department 20 Civic Center Plaza I Santa Ana, CA 92701 Office: 714-647-6959 Email: Inaiera(a)-santa-ana.org City Hall hours are 8 a.m.to 5 p.m. Monday through Thursday,and 8:00 a.m.to 5:00 p.m.every other Friday. for a list of observed holidays and Friday closure dates. The mySantaAna 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. It is available to download from the Apple App Store and on Google Play. Click here to report an issue directly from the City website. From: Najera, Luisa Sent:Wednesday, February 18, 2026 1:17 PM To: Nguyen,Tu Tran <tnguyen20@santa-ana.org> Subject: RE: COI - L. Martinez Hi Tu, Ok,thank you. I will let you know how to proceed soon. Kindest regards, Lu4alloyiwa, Senior Risk Management Analyst City of Santa Ana I Human Resources Department i 20 Civic Center Plaza I Santa Ana, CA 92701 Office: 714-647-6959 Email: Inaiera(a)santa-ana.org 1 City Hall hours are 8 a.m.to 5 p.m. Monday through Thursday,and 8:00 a.m.to 5:00 p.m.every other Friday. Click her for a list of observed holidays and Friday closure dates. The mySantaAna 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. It is available to download from the Apple App Store and on Google Play. Click here to report an issue directly from the City website. From: Nguyen,Tu Tran <tnguyen20@santa-ana.org> Sent:Wednesday, February 18, 2026 1:13 PM To: Najera, Luisa <Inaiera@santa-ana.org> Subject: RE: COI - L. Martinez Hi Luisa, I hope you are have a great day as well! He is currently missing the following: 1. Waiver of Subrogation endorsement as to the Commercial General Liability a. Blanket endorsement or Specific endorsement with required text: "City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers" 2. Waiver of Subrogation endorsement as to the Professional Liability a. Blanket endorsement or Specific endorsement with required text: "City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers" Attached is the most updated insurance documents. The insurance language for the automobile liability states that the City will accept evidence of personal automobile insurance with no specified requirement of the $1 M policy or the business use endorsement. Due to the language in the agreement, I assumed we can accept his evidence of personal auto without the two requirements. Automobile Liabikity: Insurance Services Office R rm CAA, Oil 01 cuvcring Code I (any auto), with limits no i s thn $1,000,000 uombffiu . single limits, in the event Con.5ultatit does not maintain comm=ial automobile Liability insurance, City will accept evidence of p onal au mc)bilc insurance, Kind regards, 2 Tu Tran Nguyen I Risk Management Technician City of Santa Ana - Human Resources Department 20 Civic Center Plaza I Santa Ana, CA 92701 Office: 714-647-5141 Email: TNguyen20(a)santa-ana.org I santa-ana.org/human-resources I Linkedln Instagram City Hall hours are 8 a.m. to 5 p.m. Monday through Thursday, and 8:00 a.m. to 5:00 p.m. every other Friday. Click here for a list of observed holidays and Friday closure dates. The mySantaAna 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. It is available to download from the Apple App Store and on Goode Play. Click here to report an issue directly from the City website. From: Najera, Luisa <Inaiera@santa-ana.org> Sent:Wednesday, February 18, 2026 12:58 PM To: Nguyen,Tu Tran <tnguyen20@santa-ana.org> Subject:COI - L. Martinez Hi Tu, I hope you are having a good day. Please let me know which document (s) Luis Martinez, Counseling Services for SAPID inmates, is missing. I believe it's the waiver of subrogation for CGL. Kindest regards, Lu4w Ncyercv Senior Risk Management Analyst City of Santa Ana I Human Resources Department 20 Civic Center Plaza I Santa Ana, CA 92701 V. I-A Office: 714-647-6959 Email: InaieraAsanta-ana.org City Hall hours are 8 a.m.to 5 p.m. Monday through Thursday,and 8:00 a.m.to 5:00 p.m. every other Friday. Click her for a list of observed holidays and Friday closure dates. The mySantaAna 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. It is available to download from the Apple App Store and on Google Play. Click here to report an issue directly from the City website. 3