HomeMy WebLinkAboutDROSMAN, THOMAS 1-2010J4 ' Ji: APIRES
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PROFESSIONAL SERVICES AGREEMENT
N-2010-088
THIS AGREEMENT, made and entered into this / `eday of August, 2010, by and between
Thomas Drosman, an individual (hereinafter "Consultant"), and THE CITY OF SANTA ANA, a
charter city and municipal corporation duly organized and existing under the constitution and laws
of the state of California (the "City").
RECITALS
A. The City desires to retain a skilled professional hearing officer to conduct administrative
hearings under various provisions of the Santa Ana Municipal Code.
B. Consultant represents that Consultant 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:
SCOPE OF SERVICES
Consultant shall provide services to conduct administrative hearings on behalf of the
City. The scope of services (including rates for fees and costs) is attached hereto as Exhibit A
and is incorporated by this reference to this Agreement.
2. DELIVERY OF WORK PRODUCT
Consultant shall deliver to City any work product such as an administrative record and
findings and conclusions of law, as may required in any particular matter referred to Consultant.
Such work product shall be in a format as directed by the City.
3. COMPENSATION
City agrees to pay, and Consultant agrees to accept as total payment for its services, the
cumulative rates and charges identified in Exhibit A. Payment by City shall be made within
thirty (30) days following receipt of proper invoice evidencing work performed, subject to City
accounting procedures. Payment need not be made for work which fails to meet the standards of
performance set forth in the Recitals which may reasonably be expected by City. Total
compensation including fees and costs payable under this Agreement shall not exceed $25,000
during the Term, as set forth below.
4. TERM
This Agreement shall commence on the date first written above and terminate on June 30,
2011, unless terminated earlier in accordance with provisions, below. The term of this
Agreement may be extended upon a writing executed by the City Manager and the City
Attorney.
5. 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.
6. INSURANCE
Prior to undertaking performance of work under this Agreement, Consultant shall
maintain and shall require its subcontractors, if any, to obtain and maintain insurance as
described below:
a. Commercial General Liability Insurance. Consultant shall maintain commercial
general liability insurance naming the City, its officers, employees, agents, volunteers and
representatives as additional insureds) and shall include, but not be limited to protection against
claims arising from bodily and personal injury, including death resulting therefrom and damage
to property, resulting from any act or occurrence arising out 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
bodily 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 of this Agreement and shall be approved in form by the City Attorney.
b. Business automobile liability insurance, or equivalent form, with a combined single
limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for
owned, hired and non-owned automobiles.
c. 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.
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d. Professional liability (errors and omissions) insurance, with a combined single limit of
not less than $1,000,000 per claim.
e. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section:
(1) 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 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 ten (10)
days prior written notice to the City.
f. If Consultant fails or refuses to produce or maintain the insurance required by this
section or fails or refuses to furnish the City with required proof that insurance has been procured
and is in force 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 to 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.
7. INDEMNIFICATION
Consultant agrees to and shall indemnify and hold harmless the City, its officers, agents,
employees, consultants, special counsel, and representatives from liability: (1) for personal
injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims
for personal injury, including health, and claims for property damage, which may arise due to
negligent acts, omissions or willful misconduct in the performance, 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 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 negligent acts,
omissions or willful misconduct in the performance 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
asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief
due to personal or property rights arises by reason of effects arising from this Agreement. City
may make all reasonable decisions with respect to its representation in any legal proceeding.
8. 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,
3
and further agrees to exercise the same degree of care it uses to protect its own information of
like importance, but in no event less than reasonable care. "Confidential Information" shall
include all nonpublic information. Confidential information includes not only written
information, but also information transferred orally, visually, electronically, or by other means.
Confidential information disclosed to either party by any subsidiary and/or agent of the other
party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure
shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is,
through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful
possession of the Consultant without an obligation of confidentiality; (d) is required to be
disclosed by operation of law; or (e) is independently developed by the Consultant without
reference to information disclosed by the City.
9. 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.
10. 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 Council
20 Civic Center Plaza
P.O. Box 1988
Santa Ana, CA 92702-1988
telefacsimile (714) 647-6956
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:
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
4
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.
11. 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 proposal or other instrument 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 otherwise, have been made by any party, or anyone acting on behalf of
any party, which are not embodied herein.
12. 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.
13. 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 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.
14. NON-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.
15. 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.
16. 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.
17. 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 hereto have executed this Agreement the date and year
first above written.
ATTEST:
MARIA D. HUIZAR
Clerk of the Council
CITY O ANTA NA
DAVID N. REAM
City Manager
6
APPROVED AS TO FORM:
CONSULTANT
Thomas Drosman
Tax ID# '),3 'y7SY1yy
EHIBIT A
SCOPE OF SERVICES
Scope of Duties
The Hearing Officer shall preside over the City's administrative hearings. The Hearing Officer
will be required to independently evaluate the facts of each case and make a determination as to
the merits of that case based upon the information presented at the hearing and the Santa Ana
Municipal Code. The Hearing Officer will be expected to be experienced and knowledgeable in
administrative hearing procedures. The Hearing Officer shall be responsive and maintain
excellent working relationships with property owners, residents, business representatives, and
City staff. . Hearing Officer service will include preparation of findings of facts, hearing
dispositions, billing statements, and other documents as necessary.
Fees
The Hearing Officer shall be compensated at the rate of $195 per hour. Maximum compensation
under this agreement shall not exceed $25,000 in any one fiscal year.
EXHIBIT B
ADDITIONAL INSURED ENDORSEMENT
FOR COMMERCIAL GENERAL LIABILITY 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 Center Plaza, Santa Ana, California 92701; its
officers, employees, agents, volunteers and representatives are named as additional insureds
("additional insureds") with regard to liability and defense of suits arising from the operations
and uses performed by or on behalf of the named insured.
2. With 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 by or for the benefit of the
additional insureds.
3. This insurance applies separately to each insured against whom claim is made or
suit is brought except with respect to 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
9
MDX
1 0
A? ° CERTIFICATE OF LIABILITY INSURANCE U022 DATE (MM/DD/YYYYI
08-23-2010
THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT NAME:
BB&T INS SVCS OF CA INC / PHS / ORANGE
PHONE
FAX
866
467
8730
(877
905
045
180672 P
(866
467
8730 F
877
905
0457 )
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PO BOX 33015 ADDRESS:
SAN ANTONIO TX 7 8 2 6 5
PRODUC
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INSURERIS) AFFORDING COVERAGE NAIC p
INSURED INSURER A: Hartford Casualty Ins CO
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W-2010-088
DROSMAN & PERCIVAL LLP INSURER B
38 TECHNOLOGY DR STE 250A INSURER C
IRVINE CA 92618 INSURER D
INSURER E ;
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE Of INSURANCE BO R INVD POLICY NUMBER (MM/DD/YYYYI (MM/DD/YYVYI LIMITS
GEN ERAL LIABILITY EACH OCCURRENCE S 1,0 0 0 0 0 0
COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrencel 8 300,000
CLAIMS-MADE D OCCUR MED EXP (Any one person) 5 10,000
A X General Liab 72 SBA ND2251 03/08/2010 03/08/2011 PERSONAL & ADV INJURY 8 1,000,000
GENERAL AGGREGATE 5 2,000,000
'L AGGRE GATE LIMIT S- PER: p
APPR
vl!? SO F'- PRODUCTS - COMP/OP AGG 8 2,000,000
POLICY PRO
-
ECT X LOC
I- 8
AUT OMOBILE LIABILITY _ COMBINED SINGLE LIMIT
(Ee accident) 5 1
000
000
ANY AUTO ,A, ^
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,
vn
Q FL
CH BODILY INJURY (P
) 8
O er person
ALL
WNED AUTOS CITY A h1
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er acc
ent
A SCHEDULED AUTOS
7 2 ND2
1 PROPERTY DAMAGE
$
X HIRED AUTOS 03/08/20
0 03/08/2011 (Per accidentl
X NON-OWNED AUTOS $
9
X UMBRELLA UAB X OCCUR EACH OCCURRENCE 8
EXCESS UAB
CLAIMS-MADE
AGGREGATE _
8
A DEDUCTIBLE 72 SBA ND2251 03/08/2010 03/08/2011
8
X RETENTION $10,000 8
WORKERS COMPENSATION WG STATU- OTH-
AND EMPLOYERS' LIABILITY TORY OMITS ER
YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE?
OFFICER/MEMBEREXCLUDED7 NIA E.L. EACH ACCIDENT 8
(Mandatory In NHI E.L. DISEASE - EA EMPLOYE 8
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION Of OPERATIONS I LOCATIONS/ VEHICLES (Attach ACORD 707, Add/Uonel Rematka Schedule, K mom apace le tepuhed)
Those usual to the Insured's Operations. THIS ENDORSEMENT MODIFIES SUCH
INSURANCE SUCH IS AFFORDED BY POLICY NUMBER RELATING TO THE FOLLOWING: THE
CITY OF SANTA ANA 20 CIVIC CENTER PLAZA SANTA ANA CA 92701• ITS OFFICER
EMPLOYEES AGENTS VOLUNTEERS AND REPRESENTATIVES ARE NAMEb AS ADDITIONAL
I IUN
CITY OF SANTA ANA
20 CIVIC CENTER PLZ
SANTA ANA, CA 92701
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORUED REPRESENTATIVE
W 7 atsts-ZUU.9 ACUHD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
BB&T INS SVCS OF CA INC/PHS/ORANGE
PO BOX 33015
SAN ANTONIO TX, 78265
CITY OF SANTA ANA
20 CIVIC CENTER PLZ
SANTA ANA, CA 92701
Additional Certholder Text
ARISING FROM OPERATIONS AND USES PERFORMED BY OR ON BEHALF OF THE NAMED INSURED.
RESPECT TO CLAIMS ARISING OUT OF THE OPERATIONS AND USAGE PERFORMED BY OR ON
BEHALF OF THE NAMED INSURED, SUCH INSURANCE AS IS AFFORDED BY THIS POLICY IS
PRIMARY AND NON ADDITIONAL TO OR CONTRIBUTING WITH ANY OTHER INSURANCE CARRIED BY
OR FOR THE BENEFIT OF THE ADDITIONAL INSURED. THIS INSURANCE APPLIES SEPARATELY TO
EACH INSURED AGAINST WHOM CLAIM IS MADE OR SUIT IS BROUGHT EXCEPT WITH RESPECT TO
THE COMPANIES LIMITS OF LIABILITIES. THE INCLUSION OF ANY PERSON OR ORGANIZATION
AS AS INSURED SHALL NOT AFFECT ANY RIGHT WHICH SUCH PERSON OR ORGANIZATION WOULD
HAVE AS A CLAIMANT IS NOT SO INCLUDED.
APPR
OSEP FLETCHER
Y ATTORNEY
ACORD 25 (2009/09)
COMMON POLICY CONDITIONS
All coverages of this policy are subject to the following conditions.
A. Cancellation
1. The first Named Insured shown in the
Declarations may cancel this policy by mailing
or delivering to us advance written notice of
cancellation.
2. We may cancel this policy by mailing or
delivering to the first Named Insured written
notice of cancellation at least:
a. 5 days before the effective date of
cancellation if any one of the following
conditions exists at any building that is
Covered Property in this policy:
(1) The building has been vacant or
unoccupied 60 or more consecutive
days. This does not apply to:
(a) Seasonal unoccupancy; or
(b) Buildings in the course of
construction, renovation or
addition.
Buildings with 65% or more of the rental
units or floor area vacant or unoccupied
are considered unoccupied under this
provision.
(2) After damage by a Covered Cause of
Loss, permanent repairs to the
building:
(a) Have not started; and
(b) Have not been contracted for,
within 30 days of initial payment of
loss.
(3) The building has:
(a) An outstanding order to vacate;
(b) An outstanding demolition order;
or
(c) Been declared unsafe by
governmental authority.
(4) Fixed and salvageable items have
been or are being removed from the
building and are not being replaced.
This does not apply to such removal
that is necessary or incidental to any
renovation or remodeling.
(5) Failure to:
(a) Furnish necessary heat, water,
sewer service or electricity for 30
consecutive days or more, except
during a period of seasonal
unoccupancy;or
(b) Pay property taxes that are owing
and have been outstanding for
more than one year following the
date due, except that this
provision will not apply where you
are in a bona fide dispute with the
taxing authority regarding
payment of such taxes.
b. 10 days before the effective date of
cancellation if we cancel for nonpayment
of premium.
c. 30 days before the effective date of
cancellation if we cancel for any other
reason.
3. We will mail or deliver our notice to the first
Named Insured's last mailing address known
to us.
4. Notice of cancellation will state the effective
date of cancellation. The policy period will
end on that date.
5. If this policy is canceled, we will send the first
Named Insured any premium refund due.
Such refund will be pro rata. The cancellation
will be effective even if we have not made or
offered a refund.
6. If notice is mailed, proof of mailing will be
sufficient proof of notice.
7. If the first Named Insured cancels this policy,
we will retain no less than $100 of the
premium.
B. Changes
This policy contains all the agreements between you
and us concerning the insurance afforded. The first
Named Insured shown in the Declarations is
authorized to make changes in the terms of this
policy with our consent. This policy's terms can be
amended or waived only by endorsement issued
by us and made a part of this policy.
Form SS 00 05 04 05 Page 1 of 3
0 2005, The Hartford
BUSINESS AUTOMOBILE INSURANCE
p.2
nwn rover
CERTIFICATE OF INSURANCE
SUCH INSURANCE AS RESPECTS THE INTEREST OF THE CERTIFICATE HOLDER NAMED BELOW WILL NOT BE
CANCELED OR OTHERWISE TERMINATED WITHOUT GIVING 10 DAYS PRIOR WRITTEN NOTICE TO THE
CERTIFICATE HOLDER, BUT IN NO EVENT SHALL THIS CERTIFICATE BE VALID MORE THAN 30 DAYS FROM
THE DATE WRITTEN. THIS CERTIFICATE OF INSURANCE DOES NOT CHANGE THE COVERAGE PROVIDED BY
ANY POLICY DESCRIBED BELOW.
This certifies that STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY of Bloomington, Illinois
? STATE FARM FIRE AND CASUALTY COMPANY of Bloomington, Illinois
? STATE FARM COUNTY MUTUAL INSURANCE COMPANY OF TEXAS of Dallas, Texas
? STATE FARM INDEMNITY COMPANY of Bloomington, Illinois, or
? STATE FARM GUARANTY INSURANCE COMPANY of Bloomington, Illinois
haa. nnvpraoe In force for the followina Named Insured as shown below:
NAMED INSURED: DROSMArr, TOM
ADDRESS OF NAMED INSURED: 17552 COTTONWOOD, IRVINE, CA 92612-2808
POLICY NUMBER 252 5786-A25-75 75-F3-5096-9
EFFECTIVE DATE
OF POLICY 07/25/10- 01/25/10 06/19/10-06/19/11
DESCRIPTION OF 1991 MAZDA MX5
VIN # PERSONAL
LIABILITY
VEHICLE (Inducting VIN) JV11NA351=1223250 UMBRELLA POLICY
LIABILITY COVERAGE ® YES ? NO ® YES ? NO ? YES ? NO ? YES ? NO
LIMITS OF LIABILITY
a. Bodily Injury
Each Person 5250,000 APPROVED FORM
Each Accident $500,000
b. Property Damage 1,10 ET HER
Each Accident $100,000
r- Bodily Injury &
Property Damage
Single Limit
Each Accident $1,000,000
PHYSICAL DAMAGE
COVERAGES
® YES
? NO
? YES ? NO
? YES
? NO
? YES
? NO
a. Comprehensive $ 250 Deductible $ Deductible $ Deductible $ Deductible
® YES ? NO ? YES ? NO ? YES ? NO ? YES ? NO
b. Collision $ 250 Deductible $ Deductible $ DeductlNe $ Deductible
EMPLOYERS NON-OWNED
CAR LIABILITY COVERAGE
? YES
? NO
? YES ? NO
? YES
? NO
? YES
? NO
LIABILIIY
G
HIRED ? YES ? NO ? YES ? NO ? YES ? NO ? YES ? NO
VE
E
FLEET - COVERAGE FOR
ND
N D ? YES ? NO ? YES ? NO ? YES ? NO ? YES ? NO
MOTOR E
S
THE CITY OF SANTA ANA
20 CIVIC CENTER PLAZA
SANTA ANA, CA 92701
AGENT 8644 08/31/2010
Tithe
Rick Reed
1125 E 16°-" Street, Suite 7
Upland, CA 91784
Holder
INTERNAL STATE FARM USE ONLY: p Request permanent Certificate of insurance for liability coverage.
122429.3 Rev. 07,26-2005 ? Request Certificate Holder to be added as an Additional Insured.
WORKERS' COMPENSATION INSURANCE
POLICYHOLDER COPY
SG
P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 08-23-2010
CITY OF SANTA ANA SG
20 CIVIC CENTER PLZ
SANTA ANA CA 92701-4058
GROUP: 000388
POLICY NUMBER: 0002323-2010
CERTIFICATE ID: 1
CERTIFICATE EXPIRES: 04-01-2011
04-01-2010/04-01-2011
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer.
We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document
with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy.
tth,r,zed Representative Interim President and CEO
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2010-08-23 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED:
CITY OF SANTA ANA
ENDORSEMENT #1700 - DROSMAN, C. THOMAS - EXCLUDED.
ENDORSEMENT #1700 - PERCIVAL, JAMES R - EXCLUDED.
APPROVED fie!5;q_Q-FORM
In YEY
SIT TORNEY
EMPLOYER
DROSMAN, C. THOMAS (PARTNER) AND PERCIVAL,
JAMES R. (PARTNER) DBA: DROSMAN & PERCIVAL,
LLP
38 TECHNOLOGY DR STE 250
IRVINE CA 92818
[PAR,CS]
(REV.1-2010) PRINTED : 08-23-2010
PROFESSIONAL LIABILITY INSURANCE
A CORD
CERTIFICATE OF LIABILITY INSURANCE DATE (MWDDff"
08/24/2010
TM.
PRODUCER Phone: (831) 624-5588 Fax: 831-624-5108 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
CHRISTOPHER LEE INSURANCE SERVICES ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P.O. BOX 221818 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
CARMEL CA 93922 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC #
Aoencv Licit: OE36383
INSURED INSURER A: XL INSURANCE
DROSMAN, & PERCIVAL, LLP INSURER B:
38 TECHNOLOGY DRIVE, SUITE 260A INSURER C:
IRVINE CA 92618
INSURER D:
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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR ADD
INSR
TYPE OF INSURANCE
POLICY NUMBER POLICY EFFECTIVE
DATE MMID POLICY EXPIRATION
DATE MMID LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
PREMISES Ea --n4/ $
CLAIMS MADE 7 OCCUR MED. EXP (Any one person) S
PERSONAL & ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG. $
POLICY PRO LOC
JECT
AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT
$
ANY AUTO (Es eoeident)
ALL OWNED AUTOS BODILY INJURY
(Per
erson)
$
SCHEDULED AUTOS p
HIRED AUTOS Rlv? BODILY INJURY
$
NON-OWNED AUTOS OU A
APPR (Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY t-L
30 H L AUTO ONLY - EA ACCIDENT $
ANY AUTO TT
CITY A Y OTHER THAN EA ACC
AUTO ONLY: AGG $
EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR ? CLAIMS MADE AGGREGATE $
S
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND 1/JC STATU- OTHER
TORY LIMITS
EMPLOYERS' LIABILITY
ER
EXECUTIVE
E.L. EACH ACCIDENT
$
ANY PROPRIETORIPARTN
I
OFFICERIMEMBER EXCLUDED? E.L. DISEASE-EA EMPLOYEE $
N yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE-POLICY LIMIT
S
A OTHER: LAWYERS PROFESSIONAL
LIABILITY INSURANCE XLP9605601 10/15109 10115/10 $1,000,000 PER CLAIM, $1,000,000 PER
AGGREGATE, $10K DEDUCTIBLE
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS
CERTIFICATF HCII nFR CANCFI 1 ATICIN
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
CITY OF SANTA ANA EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS
,
20 CIVIC CENTER PLAZA, WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE
TO DO SO SHALL I SE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,
SANTA ANA, CALIFORNIA 92701." ITS AGENTS OR P NTATIVES.
AUTHORIZ ESENTATIVE
Attention: MaryChancellor
A%'Unu LO (LUUT/UO) uenincate 1F Zytf ( 0 ACORD CORPORATION 1988