HomeMy WebLinkAboutSASSOON, DR. MAUREEN 1C - 2012INSURANCE ON FILE
WORK MAY PROCEED
UNTIL INSURANCE EXPIRES
T- / -/-'?
CLERK OF COUNCIL
DATE:
N-2010-013-002
P ?0???`?2 SECOND AMENDMENT TO AGREEMENT
?tza MoYZa?eB THIS SECOND AMENDMENT TO AGREEMENT is entered into on 15` day of July,
2012, by and between Dr. Maureen Sassoon, an, individual ("Consulta?rt") 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. The pasties entered into that certain Agreement # N-2l 10-013, dated February 1 O, 2010, and
a First Amendment to Agreement #N-2010-013-001 dated February 8, 2011, (hereinaRer
"said Agreement") by which Consultant has provided Occupational and Environmental
Health and Safety Consulting services.
B. In accordance with the terms and conditions of said Agreement, the parties wish to extend the
term of said Agreement to June 30°i, 2013.
WHEREFORE, in consideration of the covenants contained in said Agreement, and subject to all
the terms and conditions of said Agreement, except those amended in this Second Amendment to
Agreement, the parties agree as follows:
1 . Section 3, Term, shall be amended to provide for a termination date of June 30, 2013.
2. Except as hereinabove amended, 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 date and year first written above.
ATTEST:
?n Rte.-?z. , ,?
MARIA D. iiiJIZAR
Clerk of the Council
CITY OT SANTA ANA
PAUL M. WALTERS
City Manager
APPROVED AS TO FORM:
SONIA R. CARVALHO
City Att?•ney /?
„' i? /
By: -
Jo Str ca
C of Assistant City Attorney
? \? ? v`?
Dr. Maureen Sassoon
DRMAU-1 OP ID• T6
?? awTE (MM/DO/wrYl
?'?°? ° CERTIFICATE OF LIABILITY INSURANCE 04/13/12
THIS CERTIFICATE IS 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 POLICIE8
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(8), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: 1( the certlltcate holder Is an ADDITIONAL INSURED, the polley(les) must be endorsed. if SUBROGATION IS WAIVED, sub)ect to
the terms and eonditlons of the policy, eertaln polletes may require an endonsemenL A statement on this aertitleate does not confer rlghts to the
eartiticata holder In Ilau of such endorsement a .
PRODUCER co AcT Carole 3. Mitchell
80084-3806 NAME:
Hrekke Sehafnitz Waat - D vl(oNE .310-624-1367 FAw?x No :310-624-1368
License X10428916 E- wIL
100 Wilshire Blvd. ? 960 oDRESS: CarOle.mltCh011 slg.us
Santa Monica, CA 8040'1 NAIC •
Darla Gra ,-. =R8-URER(S AFFOROINO COVEMOE
Y __ _ __ _? e.. ?..,..e 1 1„ue l..a
INSURED
P O Box 2028
Palos Verdes Peninsula, CA 80274
rnvl?Iaac3Es
...?. t?,c o ,Inv ocarnn
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISIEU Ht LUw nnvc occly
ON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
INDICATED. NOTWITHSTANDING ANV REQUIREMENT, TERM OR CONDITI
NCE AFFO RD EO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL T HE TERMS,
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURA
AIMS
.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CL
INBR T'PE OF INSURANCE POLICY NUMBER MM Y E M 1 D P
LT LIMITS
00
000
1
GENERAL LIABILITY -
X 624270427001 06107!12 06lO V13 EACH OCCURRENCE S
pRE MISE • orartenra S ,
,
SO,OO
A X COMIAERCIAL GENERAL LUBILITY S
CLAIMS-MADE O OCCUR MEO EXP (My onp parson
PERSONAL 8 AOV INJURY S 1,000.00
GENERAL AGGREGATE S 2,000,00
X Prot g POIIUt-CLM OOD
OO
2
PRODUCTS-COMPAPAGG S ,
,
GEN'L AGG REOATE LIMIT APPLIES PER:
Emp Ben. s
N/
PODGY PRO LOG OMB O LE IT
AV TOMOBILE LUBILITY Ea a - ent
BODILY INJURY (Paf parson) S
ANY AUTO
ALL OWNED SCHEDVLED
BODILY INJURY (Par ac<itlanp S
AVT09 AUTOS PROP AMAGE y
NON-OWNED pare enl
H IREO AVTOS AVTOS S
EACH OCCURRENCE S
VMBRELLA LU\B OCCUR
AGGREGATE S
EXCESS LUIB CWMS-MADE
S
OED RETENTION WC STAT V- TH-
SATION
WORI(ERS COMPEN
AND EMPLOYERS' LIABILIT' Y / N
E_L. EACH ACCIDENT S
ANY PROPRIETOR/PARTNER/EY.ECUTVE
NIA
O
OFFICER/MEM BER EXCLVDE O7 E.L. DISEASE - EA EMPLOYE S
(M?ndalory In NNI
1/ as, deac?+urWer
DESCRIPTION OF OPERATIONS Eebw
E.L. DISEASE-POLICY LIMIT S
ON OF OPERATION6 /LOCATIONS /VEHICLES (Aaach ACORD 101, AtldHloml Ramarka Sohadulo, H mono apace b npulod)
IP
OE BCR
T
a IF cancallad for nonpayment oP premium. Tha CartiPicata Holder ie
+10 Da
yy
nlzad ae Additional Inaurad par endorsement (ENV-3100) attaohad.
o
g
rac
City of 8enta Ana
Risk Management, M28
Attn: Briza Morales
20 C1vlc Center Plaza
Santa Ana, CA 92701
ACORD 26 (2010106)
CSANTAA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTCE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISION8.
AUTHORIZED REPRESENTATVE
.????
® 1988-2010 ACORD CORPORATION. Afl rlghts reserved.
The ACORD name and IoOo era registered marks of ACORD
`. r2.n c: 4',-.., --••?•'•?.
I?+ fY1Fl??fC'8ri 509Sn1%(\ e. .z rr e. r.•u++ .v.J gar
G a.."T?+\ .la.. + /Ir. j?ta+J1 U.y !'; a(. a r' .I:CJ c `r•.'iw•C•.i u..l c •Y n'r y'.1
6c?1° ? rJ427?427 -ciQt I U[!U i+10':2 to 115;'01:20 S 3 (i5/01i2CY 1 Z
4Yaslrchrclt?r Suipl?y Ur'aa insurarlr$ C.a,rnft?rly
h+w•t llN/eaey?nir•G8r n•d rnln.KP34'eir T+Il'?"n-..,rl ?} =r• -*'V-vdalv •:T..t?N..?n:fG.:n?a..•m.-.!!.Ip=0.ti3s,r,:ra '.. ru.. yrnF, u(..-T-'?.n 3.>+:r
TI115 ENDORSEMENT CI?fAAJGES '1-Hf PgI.ICY. PLEASE RE-AO IT CAREFULLY.
ADDITfONAL IIJSURF_O FNDORSCMENT
OWt?JERS, LF_SSEES OR CON7RAC101iS -SCHEDULED PERSON 0[i ORGANIZATION
-fTii< can[fursetr•?r-,ct rt;odi`ies i.?sut?l?Crz fsrt>v it3Ptl erncer It ?c, 1r?hiswb??l
C:Ohr1h4ERG'lAl GEIJEfiAL I-tABILIT'Y c;C%Vf2.F2AC;L-
C)t?iJiRl?CTpFZ't? POl_I_uTsc\t,I 1.'ARSI::T!' CGVLR+SCik_
i5?l1?ULE;
ti:i..•O G[ r^:-irg Oal hr r;l'r:'1!r/Or!1 ¢_
Anj• t->F•??an .x Orgni\•.Ztllia6 u\al is ar.i ulvtlrr ca rs:J protcrrty tr R1=°?,nal ieUU1:11y 11:1 whir.h yon pry 17a•ft.rntiny
ra t;1+.Igli(Irs, nr ?l ?Antr?rtor on WilnS'C li?'h:\II y ;u .-. `1- tier!-.rmu\g .:iJ',O riOui, IS:, ..nrl [airy aI li7lr SUCCifiC vlrillCn rCril;c ?l of
sucn f:erS•_ul ar vrgnt\+zF31?im 0? you. whnrrrin utJ\ ?6C;ul.;:r ri n-re?UC prior Io r,?Jnunoncnnt?nl rl e, tier:Illcns
l Y P -_ - ? --- in Ch[s Uecar.ralions .u
if no u1Cr xr{r mnr[[ abovE.. tnforrn'iticr r. wuurl.lJ lu ee r.nq r-.l r. tl\is e.nr.ara qrn r?nl sviil l+r- a+.l?+u n^-•
appiic:avlc: fu ll\Ls endory Errrte r\I.}
A. SECTION N - Wf-IU IS AN INSURED is arn¢rnclc-ct M inrludr3 as an ir.su.-?a'i t%i[? parson ar orpArii?talian sl7ov:n in
tflla set?etclu:?, bul only wihr rr?tiprBCt lu IraUiriiy sr`•isin{l caul or /our orl?oiny ouerntiorrs pEriorrneci trH that i1\sured.
R. \•Virti rr.?F;rant to Ihr_? insurnnsH 3ftgrd F-ci lu ll u?sc- .arlrii[inr?l insa.rr+5h, it. r-: In:It>v+ir ?aJ nxCluSipn iS <Sda Cd:.
J_ EXGIISIOnG
`nie; i<ttt.Iranta: clops not apply In bodily Injury or profFOriy darnago ocntr,lt7c; after:
(1) A°1 :v of k, incaUCrir?r{) rn:eterixda, rlertC? u1 etyult?nlteril I?In:i?lt4'al irl ccxr:eeaiun ivilir ?u<:I+ work, un Ili[: Ixoielr(
(o?i•terr Il+ar? ktsrvicu, n1„Inlr?rarly_ 4» r?laaitsl to br.: r?ifonr:Ird fly or un Ur_h;-Ili ui II\n addilibnal iT75ur[zll(:?1
?t I7rr3 slUj of flir_ c:t?4erF-[f [yrleratior:s I;as bGhr. c•at?sl?lcrlerl; pr
(:7) l'i«rl porJicn qr your work oul cit whirr lh? Injury or darnarjl3 3ri?C=s. rlas bc-t.n puI to iIS 1n1en.913t1 use by
any pE, ?e?n eat ? or>_{ani'tation olhr.r U\.:.r. ?Jr1G11?[?r txlr,lt%?t--I[lr o! sukx:nea:<ictor [:ngagesd in periurrn8•.3
oflr:rallon? for a f7tlnGlp:r1 +s .-, p:.ul of tt-to Ea.Tr? prc?;ur-t.
c1?V-? rOtl (Uks-0?il If1?4J+JC6 40Pyrip7 rlt@= M9ly nUl Cf IrIGUr3t?C'V Strrvi•?as !Jff;cn, I?i_..vnh irz porn li?Y?n rev<ie + :•r t