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Home My WebLink AboutSASSOON, DR. MAUREEN 1B - 2011INSURANCE ON FILE WORK MAY PROCEED N-2010-013-001 UNTIL INSURANCE EXPIRES /- // CLERK OF COUNCIL Q ??? ?2rSOV? v-?e? ` FIRST AMENDMENT TO AGREEMENT MAR 1 4 2011 ?r?'=Q THIS FIRST AMENDMENT TO AGREEMENT is entered into this day of lp?M MprA,eS 2011, by and between Dr. Maureen Bassoon, an individual (hereinafter "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 (hereinafter "City"). RECITALS: A. The parties entered into Agreement N-2010-013, dated February 2, 201 O, (hereinafter "said Agreement") by which Consultant agreed to provide professional Occupational and Environmental Health and Safety Consulting Services for the Personnel Services Agency. B. In accordance with the terms and conditions of said Agreement, the parties wish to extend the term of said Agreement through June 30, 2012. NOW, THEREFORE, in consideration of the mutual and respective promises, and subject to all the terms and conditions of said Agreement, except as herein modified, the parties agree as follows: Section 3, TERM, shall be extended to June 30, 2012. 2. Except as hereinabove modified, all terms and conditions of said Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to Agreement on the day and year first above written. C? Y OF SANTA ANA Kathie S. Gonzalez Executive Director of the Personnel Services Agency APPROVED AS TO FORM: JOSEPH STRAKA Acting C?ty, ttorne ?? By: Meli s Crosthwaite Deputy City Attorney ??? to ? ? ?R. MAUREEN BASSOON ATTEST: MARIA D. HUIZAR CLERK OF THE COUNCIL -°?????® CERTIFICs4TE CF Lf?4E1LITY I1?I$U R/41?CE OP ID z® DnTE (MMmD/YWYI ?-f DR>',III,U-1 04/26 10 PaapucFA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Hra]ck.a Sohafaitz West ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE T.4 cEUZSg #0428915 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXPEND OR Bd0 Apo11o 3traat, Suite 150 ALTER THE COVERAGE AFFORDED 6Y THE POLICIES 6ELOW. F.1 Segundo CA 90245 Phone: 310-524-1340 INSURERS AFFORDING COVERAGE NAIC it IN6VRED INSURER A: flm GChwatas 9ucpiua iinaa xna INSURER B- Dr. MallrOPSl $a9600I1 INSURER C: P O Htp]C 2028 INSURER D Pa1oa Verdes Peninsula CA 9D274 : INSURER E COV ERAI THE POLICIES OF IN6VRANCE LISTED BELOW HAVE SEEN IS6UE0 TO THE LN6URE0 NM1ED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANV REQUIREMENT, TERM Ofl CONDITIpN OF ANY CONTRACT OR OTHER OOCUl.1ENT WITH RESPECT TO WHICH TH19 CERTIFICATE h7AY BE ISSUED OR MAY PERTAIN. THE INfiURANCE AFFORDED BY THE POUCIE6 DE6CRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EJ(CLU610N5 AND CONDITIONS OF SUCH POLICIE6_ AGGREGATE LIMITS BHDWNfAAY HAVE BEEN REDUCED HY PAID CLAIh19. LTA tISR TYPE OFIN6UAMICB POLCY NV MBER DATE MM OD ATE M LIMIT S GENERAL LIABILITY EACH OCCURRENCE S 1 OOO OOO A X X COMMERCIAL GENERAL LIABILIT`f G24061H14002 05/01/1D 05/01/11 PREMIBE9 Eaomrranca S 50,000 CLAfM9 MADE O OCCUR NIED E%P (Any one ponanl S 5 O0 D PEA6DNAL6AOV INJURY S 1 OOO OOO X n $2 r 500 DE:d/OCt?LTr GENERAL AGGREGATE S 2 000 OOD GEN'L AGGREGATE LIMIT APPLIES PER PAODUCT9-COMP/OP AGG 52, DOO OOD X PDLICY JECT LOG AUT OMOBILE LIABILITY COMBINED SINGLE LIMB ANY ALrTD (Ea atxldaMl 6 ALL OWNED ADIOS GODLY INJURY 6CHEDULED AUTOS IPet Pet?N S HIRED ADT06 ?a?? APrRO ?e ?v? ?S pODLY INJURY (Pare¢Idenl) 5 NON-OWNED AUTOS !•V PROPERTY DAMAGE S [PSrn¢itlalll CAAAOE LIABpJTY - AUTO ONLY- EA ACCIOEM 5 ANY AUTO EA AcD 9 . ° 1° SSA M. ROSTHW n u o oN?v AGO S FJtCEHS / UMBRFJIA LIABILfrY EACH OCCURRENCE 6 OCCUR ? CLAIMS MADE AGGREQATE 5 5 DEODCTIBLE 6 RETENTION 5 S WOR KERS CDMPENSATION AND ElIPLDYER9' DAB1LrtY 1. / N O Y LIMITS ER ANY PROPRIETOR/PARTNER/EXECIJ"TIV? OFFIGER/MEMHER EJ(CLUDED7 EL FACH ACCIDENT S (Nendstaryln NHl EL DI6EASE-EA EMPLOYEE 5 If>>es, desclllp under 6PEC VaL PROVI610N6 halnw EL DI6EABE-POLICY LIMIT 5 OTHER A Pro£aasional Liab. G24D61B140D2 05/01/1D 05/01/11 Prof 2.iaU $1mm$2mmAgg =nc1s. Pollution 6 A9Beexp9 ewo/a teals cape D®duct. $5 000/Clm DESCRIPTION OF OPERATIONS / LOCATONS / V EH]CLES / EIlCLU610NS ADOEO BY ENDORSE]KEM! SPECIAL PROVISIONS '+10 Days =F cancelled £or nonpayment o£ premiTDm. The Certificate Holder is recognized aB Asa+tioaal =nausad par andorsam0at (ENV-31D0) attaohed. CERTIFICATE HOLDER GANCELLlT10N 6HOVLD ANY OF THE ABOV E DESCRIBED POLICIES BE CANCELLID BEFORE THE E%PIRATION CBANTAA DATE THEREOF,THEISSUWBIN6UREA WILL ENDEAVOR TO MAIL 3D+ DAYS WRfrTEN C1 ty Of 53Ata Alfa NODGETO THE cERT1FlCATH HOLDER NAMED TD THE LEFT. BUT FAILURETO DO 90 SHALL ELiak: I'dan8gemasst D1YJ_H iOn IMPOSE NO DBL.IDATON OR WIHILRY OF ANY HIND UPON TNEINSDREA, [TS AGENTS OR Attn: Carolyn Ric,hard P O HOX 1988 ?,??A??. . _ Santa Ana CA 92702 AU DijIZEO REPRESENTATIVE ACLfIi0 z5 lauun/uTy wTrsDn-zpD9 nL.ORV CVHI?OwanON. All rlenrs resDrved. The ACORD name and IDBD are raBlslared marks DF ACORD IMPORTANT If tY?e certificate holder Is an ADDITIONAL INSURED, the policy(ies} must be endorsed. A statement on this certificate does noY confer rights to the certificate holder in Ileu of such endorsement(s). DISCLAIMER If SUBROGATION IS 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). This Certificate of Insurance does not constitute a contract between the Issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. Named 1r?suR37 Endamvmvnl Numhar Dr. Maureen Sassoon Pollry Syrnbvl Polity Number PoVOr Pannd Elfedlva Daly of Endoraemvnl EPW G2406tB'14 UD2 1 70 Issued Hy (Name at Insumnm Company) Westchester Surplus Unes Insurance Company Insert the pv?ry number. Tha remainder of the Infonnaeon rs 1v be enmplelvd only when IIJs vndbrsement Is Ivsued subsequent {o the propvmllnn of Iha polity. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT OWNERS, LESSEES OR CONTRAGTORS-SCHEDULED PERSON OR DRGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE CONTRACTOR'S POLLUTION LIABILITY COVERAGE SCHEDULE• 1•lama of Person or Omanlzatlom Any parson or arganlzatlon that is an owner of real property or personal property on which you are performing operations, ar a contractor on whose behalf you era performing operations, and only at the specific written request of such person or organization to you, wherein such request Is made prior to commencement of operations. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations es applicable to this endorserent.) A. SECTION 11 -WHO 1S AN INSURED is amended to include as an insured the parson or organlzatlon shown to the Schedule, but only tv[th respect to liability edsing out of your ongoing operatJons performed for that insured. B. Willi respect to the insurance afforded to these addltlonal Insureds, the following exclusion Is added: Exclusions This Insurance does not apply to bodily injury or property damage occurdng afler_ (7) All work, including materials, parts or equipment furnished In conneclfon wtitr ouch work, on the project (other then service, maintenance ar repairs) to be performed by or on behalf of the addltlonal Insureds) at the site of the covered operations has been competed; or (2) That portion of your work out of which the Injury or damage arises has been put to Its Intended use by any person or organlzallon other than eneiher contractor or subcanlractor engaged In performing operations for a principal as a part of the same project. ENV-35OD (D6-D4) Includes copyrighted mate riot of Insurance Services OHSca, Inc. v?ilh ILS penntsslon Page t of'1 GrIIrFIX RD CERTIFICATE OF LIABILITY INSURANCE gTENNre " wren THIS CERTIFICATE E ISSUED AS A NUTTIER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NE4ATWELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES BELOW, THIS CERTLSICATE OF INSURANCE WEB NOT CONSTITUTE A CONTRACT BETWEEN THE ISBUINO INSUPERIak AUTHORIZED REPRESENTATNE OR PRODUCER, AND THE CER MPUTE HOLDER. IMPORTANT: if to EMBREGe HDIONIs It AWRIONAL INSURED, IRS polkyUee) mot Do ludwmd IISUSRWAMN IS WANED, suN)mNto pEBClG HBINBI In IIrN OI BuEH eEdBrtSA! u McNeraPochaldson PPAwCm 710.6941740 u BraNhe9cHafnW- O v 7,0•5 74.134 3 "ucRI 796941741 Llcense10410916 9 Y ? /? tau ,?BhaNaoR aw•Ire?onm FJS¢purtdB, CA 90245 ?. (?l I I MpWm AitORwoMPACL NNEI NWA® DY.M¢IIBBASaBNOEA SUPER A:WBMhNestoY$O IuaWealn P0$EA9098 HauAesa: PalosVsldas PBNIMe4M, CA 90274 wEnaE: MRmei O; MWREAE: to GIIAASod COAdMOBBBIIMBpONY,EIADN pdNNBmas regBleIn BAddreBmlNL ABIAWreMISo IYBmNdCeG AO09 Nm WAMINrds LOMB CDVEPAOE9 CEATIFlCATENUMBER: AEN610NNUMBER:1 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELDW HAVE BEEN ISSUED To THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NDGATER NUMITHATANWNGANY REQUIREMENT, TERM OR CoNOIT10N OF ANY CONTRACT OR OTHER DOMMENL KIN RESPECT TO WHICH THE CEATFEATE JAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORCE D BY THE POSTED DESCRIBES HEREIN E FJWECT70 ALL THE TEAMS, EXCLUAX)NS AND COXN70NS OF SUCH POLICIES LIMBS SHOWN SAY HAVE BEE N REDUCE 0 BY PAN CLAIMS. NPFOFPoEPAm POLLYWNB[A PMLCte D1 ? oNSrAUUNUrr Eeu¢uLwuNU F 1NOD,DO A x coNNrwxuuHEwuwwm X 1498181490 WMIfl BE01112 putisamom F Sp,CO CIMYSMRDE 510CGR YfO4P ml ,wN a d,BO PwsENNBBwauAr E 1,GOB,O x EAMODBGnEEIN BPKRMIECPXE,TE F X,ooo,B mnNNaNMATEwrtAwuESVm ?BUmBB?PCeooN , X,?u,oo x ram PaE Fec t NA WmFWBWN P.cuMNEBSHCUUUn 1 6adaN ?+? aaBAYlwumP.oN? F NIFNAFOWreB I 90CAYIWUAY PAVSNM i mNE[ULLOWN! m0.°FmYCANILE B N?Mta APPROV IP„?`",NI IroNmnAOWBOt ; T! AS T(1 Ft? E treNUAlxa acme ^-- NcNamulae?cF B damwe cxuMxce lau A4iDl S ` ?I1E F L tdp oEDESG¢ Assiste N^ oil t y A I,oI'na y PRIPIL90reiEF54AVl WCBIAM NroMnmsASlusun Y unreor?TamBAnlm.?uum eLUEHW.cmfm s ? N?tl?INawrecwrcm Nls ELaCEREPAFMPImE ! 1rndwlhub, [6 PIpNBi fG Badw EINMASEPaGYlW7 t A IoGuImWLME dmd,M+RId Dalonn aslmns PwuG st?szmnuo sPllEdond SBESNSCOVGICWMSNUID tldud i40BaCl OeAONmCNWORMNUXl ILWIIWIIfV1%1FI IILNLmm101,ldWaulRWWfiOkYyllreXywNnpgoV 840 Apollo 6Veek$ul1e 160 ?a N V ou ARMAU-0 MISHEAR ,DDiYB f CBnElGd IOYAOApBYmBNIBIOoreRHWB. THIDBIN&lBBHONBE9 i IBEBpEMBd EBAddiMEOa dIBNId pIPBAd01dlmBRl)ENVd1B0)IdatHed, CERRFICATEHOLDER CANCELLATDN C$ANTAA 9NOLIDM'YOFiNPAEOVEOfIEAIFEDPoLEIEB BECANCE6P09Ef0AE THE FXPPATION G11P HEREOF, NONCE WILL Be OEMVFAftl N CrydSMMaAIre pccCAlANCawnHTHEVaLCrPAwISIDUS RlskManagemeW,M1a AMm BNsa MBIaGs AmmRBFOREPN?msme ZOCMECarHeEPI¢s ? ,I $aMSAm, CA 9YN1 F??n?. ®1B8&ZBWpCCROCOAPDPATNIN, pD dShG memd, ACORD98 )7DOBIOD) TheAWRO nvroendlopoeleredleGredmlXeBIACtlRO _ - _ _. _7 ?m?ureresDr. Maureen $assoon FndrsameN Nuaam PoNcyaym6ol PdcyNUmNtr Potlry PAhG EflectNADareA[EMasemA EPW G21061B1400R To more y arts AauaACe mpeoy WeSIChCiler$a@haa Llnes nsorence De THI6ENDOR6EMENr CHANCES'ME POLICY, PL?ASEREWNCAREFULLY. OWNERS, LESSEES ORCONTRACTORS- SCHEDULED PERSON OftORG4NVAiWN_ Thls andorsemenE mctlMas IhaNreRce provYktl underhisllowlrD, COMMERCIPL GENERN. LMBIIBY COVERAGE CDNiRACTIXC$ POLLUTION LIABILNY COVERAGE scNE°utE; NAreA d PAR1A R CIOAAQBL'D7: Any pareoN or orgahlsalloD that loan owner of real preaw a pa@orlel prcpertyon whgh you ar¢ perfomling opemtlores, or a coolraclaron whore ha epryu aze peNOlminq opero?s, and only alNe spedBcwtM¢n request oisuch pe@on ototganlratlon to yw, whemin such request Is made pNar to csmmencemeot d operations, ADDITIONAL INSURED ENDORSEMENT (N no snlry appears a6ma, InlormeUoli ?aquUad fh complete Nls eodsrsamerl<wll de shmm m ?e Derdaiatlons as applicable m Ibh ectlomemact A, 6ECilON II •WND I$ AN IN$UREO M emended to hdutle as an insured Iha person or wgardsetloh shmm N the fichetlute, but only vdfh reaped Io;IMhplty arfsirl0 out of yom angoyg Nperellsns performed for that Insured. B. Wth aped to the Inauarme eRordatl to 0ese adtlltlona Insde?, the fcllwrlnq exclusion Is atldetll Z. &duslAns This ineurenea does mt apply to 6adlly Fury or propehy damage oaurtlDq aflEC ?1) Allwodc,intlutlMgmaleNals,pa?MorequlpmmtM1anishedMwnnedlonwifhsuch wok, on Me proud ?oUtarfhan samMa, melnleceaca or repelm) M he pedamletl by or an behalf Di the adtltlanel hlsurad?a) el tl?e sIM of the covered opmetlons hea hwsncompk?tl;a? ?2) That paltloo o<yourwdk out of which the Iryury or damage ansas has bean put tD Ntend? usre by any pe?wo at s?ganhetla? other IheO arulher ca?haCf« or suhmntmclorengep¢tl M pedolmllg opamllsnsfo? a prindpal as a pad Of the same project. EN4a1ro1CSa41 InduEesapytlahlaP?relreIAAllmuremA SArvIAre pIN&ImvAh Xepvnlsalm Pepeid1 47