HomeMy WebLinkAboutWELDY, SCOTT DR., DBA SERRANO ANIMAL & BIRD HOSPITAL 8City of Santa Qna
Clerk of the Cou:._il
AGREEMENT TERMINATION FORM
Please complete this form in its entirety when the attached agreement and all
amendments (if any) are no longer in effect.
Note: If your agreement is grant related, please ensure that all grant retention requirements
have been satisfied prior to signing the termination form.
Is the agreement(s) a permanent record? Yes _ No
Return form to the Clerk of the Council Office (M-30).
Call 647-1520 if you have any questions.
i
The agreement with
COTC Office Use Only
City of Santa Ana
t;1e 02 2021
Clerk of the Council
No. A—ao iLl—tO`Z—C.c; was completed on op/L721 12M� and final payment has been made.
(List all amendments. Use space below if needed.)
A—DD I L{--LD 9
A----ac I Y t0 �-'- 01
pt--a01W-- I &-0 :�L
Revised: 10-18-16
Department: M--BA
Phone/Ext.:
Signature:fldw
Date: ISO
iNSUNANU� ON FILE
WORK MAY PROCEED
NTIL INSURANCE EXPIRES
DCLER
ATE
CONSULTANT AGREEMENT
A-20UA08
THIS AGREEMENT, made and entered into this 1" day of July, 2014 by and between
Dr. Scott Weldy DVM, dba Serrano Animal & Bird Hospital (hereinafter "Consultant"), and the
City of Santa Ana, a charter city and municipal corporation organized and existing under the
Constitution and taws of the State of California (hereinafter `City").
RECITAI.,S
A. The City desires to retain a consultant having special skill and 1,mowledge in the field of
veterinary services.
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 in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the
terms and conditions hereinafter set forth, the parties agree as follows:
1. SCOPE OF SERVICES
Consultant shall provide veterinary services to the Santa Ana Zoo at Prentice Park, as set
forth in Exhibit A to this Agreement.
2. COMPENSATION
a. City agrees to .pay, and Consultant agrees to accept as total payment for its services, an
amount which shall not exceed Eighty -Fora- Thousand Five Hundred Dollars ($84,500) amnually
during the Term of this Agreement. Payment shall include Sixty Five Thousand Dollars
($65,000) for base bid Scope of Work and Nineteen Thousand Five Hundred Dollars ($19,500)
identified in contingency for extra services subject to prior approval by the City.
b. 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.
3. TERM
This Agreement shall continence on the date first written above and terminate on June 30,
2015, unless terminated earlier in accordance with Section 12, below. There shall be two (2)
one-year options to renew, exercisable by the City Manager under the same terms and conditions
as this Agreement.
4. 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.
5. INSURANCE
Prior to undertaking performance of work rmder 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, agents, volunteers, and employees as
additional insured(s) 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 thwi 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.
d. The following requirements apply to the insurance to be provided by Consultant
pursuant to this section:
(i) Consultant shall maintain all insurance required above in frill 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
thirty (30) days prior written notice to the City.
e. 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 affect 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.
6. 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 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 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 teens of, or
effects arising from this Agreement. City may make all reasonable decisions with respect to its
representation in any legal proceeding.
7. CONFIDENTIALITY
If Consultant receives from the City information which due to the nature of such
information is reasonably understood to be confidential and/or proprietary, Consultant agrees
that it shall not use or disclose such information except in the performance of this Agreement,
and further agrees to exercise the same degree of care it uses to protect its own information of
like importance, but in no event less than reasonable care. "Confidential Information" shall
include all nonpublic information. Confidential information includes not only written
information, but also information transferred orally, visually, electronically, or by other means.
Confidential information disclosed to either party by any subsidiary and/or agent of the other
party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure
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.
8. 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.
9. 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 facsimile or other telegraphic
communication in the manner provided in this Section, to the following persons:
To City: Cleric of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
P.O. Box 1988
Santa Ana, CA 92702-1988
Facsimile (714) 647-6956
With courtesy copies to:
and
Executive Director of Parks, Recreation and Community Services Agency
City of Santa Ana
26 Civic Center Plaza (M-75)
Santa Ana, California 92702
Facsimile (714) 571-4221.
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, California 92702
Facsimile (714) 647-6515
To Consultant: Scott Weldy, DVM
Serrano Animal & Bird Hospital
21771 Lake Forest Dr. # I l
Lake Forest, California 92630
Facsimile (949) 855-9744
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 facsimile, commmumication 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.
10. EXCLUSIVITY AND AMENDMENT
This Agreement represents the complete and exclusive statement between the City and
Consultant, and supersedes any and all other agreements, oral or written, between the parties. In
the event of a conflict between the terms of this Agreement and any attachments hereto, the
terms of this Agreement shall prevail. This Agreement may not be modified except by written
instrument signed by the City and by an authorized representative of Consultant. The parties
agree that any terms or conditions of any purchase order or other instrument that are inconsistent
with, or in addition to, that terms and conditions hereof, shall not bind or obligate Consultant nor
the City. Each party to this Agreement aclmowledges 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.
11. 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.
12. 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.
13. 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.
14. JURISDICTION - VENUE
This Agreement and all questions relating to its validity, interpretation, performance, and
enforcement shall be government and construed in accordance with the laws of the State of
California. 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.
15. PROFESSIONAL LICENSES
Consultant shall, throughout the term of this Agreement, maintain all necessary licenses,
permits, approvals, waivers, and exemptions necessary for the provision of the services
hereunder and required by the laws and regulations of the United States, the State of California,
the City of Santa Ana and all other governmental agencies. Consultant shall notify the City
immediately and in writing of her inability to obtain or maintain such permits, licenses,
approvals, waivers, and exemptions. Said inability shall be cause for termination of this
Agreement.
16. 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
APPROVED AS TO FORM:
Sonia R. Carvalho
City Attorney
By:
Lisa Storck
Assistant City Attorney
CITY OF SANTA ANA
City Manager
SERRANO ANIMAL AND
BIRD HOSPITAL
r-2'��
SC TT WE , DVM
Owner �q
Tax ID # 31-071a�
EXHIBIT A
SCOPE OF SERVICES
I. CONSULTANT'S OBLIGATIONS
Consultant agrees to render veterinary services to City at the Santa Ana Zoo at Prentice
Park ("Zoo") and in the home practice/place of business on a continuing basis for the
duration of this Agreement, including, but not limited to the following:
SCOPE OF WORK (BASE BID REQUIREMENTS)
A. Serve as a medical officer for the Zoo's animal collection.
B. Serve as caretaker of drugs, narcotics, and pharmaceutical equipment. Consultant
also will administer or supervise, including verbal and written communications on
the administration of narcotics, pharmaceuticals, and pharmaceutical equipment to
the animals in the Zoo collection.
C. Provide a comprehensive program of preventative and curative medical care for
the animal collection; including amival and routine exams, annual review of the
nutritional needs of all species and recommendations for any dietary changes, and
a comprehensive parasite treatment plan for all species.
D. Consult with appropriate zoological and/or human experts and Zoo staff to make
recommendations regarding the nutritional and medical needs of the collection.
E. Visit the Zoo facilities and examine the animals' health and sanitation on average
12 hours per week. The Zoo Curator and the Consultant will decided on the hours
on an as -needed basis.
F. Assist the Zoo Curator in establishing and maintaining complete medical history
records for each animal in the collection.
G. Approve the detailed report of medical treatment administered and other services
performed at each visit as prepared by Zoo staff (or by the veterinarian) and sign
the zoo vet visit log (time sheets) for the Zoo files.
H. Exercise his/her best professional judgment and practice and make his/her best
efforts to maintain the animals. Advise Zoo staff on maintenance of same so as to
insure the best medical, husbandry, enrichment and living conditions possible for
the animal collection.
I. Provide telephone consultation, advice and prescription instructions on a
reasonably unlimited basis, either with staff or other consulting veterinarians
employed by City.
Provide a signature as City's consulting/attending veterinarian, for necessary and
required certificates, licenses, permits or other documents.
K. Advise on ordering medicine, supplies or instruments.
L. Obtain at his/her cost, medical malpractice insurance.
REIMBURSABLE EXPENSES (SUBJECT TO PRIOR CITY APPROVAL)
*specialty tools and supplies not available in the Zoo hospital (i.e. access to
ultrasound and digital radiography)
* specialist diagnostic services (i.e. radiograph, dental, and surgical consultations)
• after-hours emergency care (i.e. animals needing 24 hr. care)
*off -site clinic visits (i.e. animals taken to Serrano Animal Hospital for
emergency treatment)
II CITY OBLIGATIONS
In order to assist Consultant in execution of his responsibilities under this Agreement and
to enhance the care of the animals in the collection, the City agrees to do the following:
A. Maintain a phannaceutical safe for the storage of all controlled drugs and
narcotics.
B. Maintain a facility for the use in the surgery and/or treatment of the collection
with recovery and holding cages and related equipment as necessary at the Zoo.
C. Provide Consultant with staff support from. Zoo personnel.
D. Purchase equipment, biological, drugs, narcotics, pharmaceuticals and/or other
medical supplies upon reasonable request of Consultant, as needed.
E. Provide staff assistance for the capture and treatment of animals.
F. Provide staff treatment of specimens on telephone or written instructions from
Consultant.
G. Provide additional veterinarians, where advisable for emergencies and, as
necessary, as back-up for the services listed herein.
H. Maintain diagnostic or treatment notes filed in our records by backup
veterinarians we may employ, for the Consultant's review or use.
I. Pay for all outside laboratory expenses incurred as a result of Consultant's
supervision of animals in the collection.
Pay all other expenses necessary for the care of the collection when reasonably
recommended by Consultant and approved by the Executive Director of the Parks,
Recreation and Community Services Agency or his/her designated representative.
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 Cleric of the Council, 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
to
SERANA OP ID: LMO
CERTIFICATE OF LIABILITY INSURANCE DATE 812013V
Q7116rz613
THIS CERTIFICATE 13 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 poiicy(ies) must be endorsed. It SUBROGATION 13 WAIVED, subject to
the terns 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 Ilan of such endomement(s).
PRODUCER Phone:888-762-3143 C TACT
_..___
Veterinary Ins. ServiOas Co. MIME: . .__.. T FAR
CA I.Inomo SnFRAIRA Fax: 916-021.2266 PRO . (ArC
Kathy R. Noe, CPCU, ARM -VP
INsuREo arrano Animal —& Bird Hoap Inc
dba:Serrano Animal & Bird Hosp
Scott H. Weidy, DVM
21771 Lake Forest Drive #111
Lake Forest, CA 92630
INSURERS) ARORf11Ne COVERAGE
COVFRAr;FC r:FRTIPICATF NUMRFR• RFVISI0N NIIMIiFR,
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.
NSRr _.....�..._... PDCH, llaRl ......_. _, _ __ -P077 `PCL`ICYEXP_. .. _......_ .,.�.�.__
LTR TYPI etSURANCR , POLICYNUMOER MlOD LIMITS
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GENL AGGREGATE LIMIT APPiJES PER !PRODUCTS-ODMPICP AGO $
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DESCRIPTION (W OPERATIONS I LOCATIONS I VEHIC (Anach ACORD IM, Addl Wnu flemadm Sche"o, it mop qmY u R Wmdl
k
Cityy of Santa Ana, its officers, agents, employees and volunteers are
included as addtional insureds. The insurance provided is primary,
.--
°Tire insurance provided under this policg is primary 6 non contributory with
any other insurance available to the additional insured° 0 .W^"
30 Days NOC(10 Days NOC for non-payment
Qkl
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City of Santa Ana
Fin & Mgt Svcs Agency
Purchasing Div.
20 Civic Center Plaza M-16
Santa Ana, CA 92701
ACORD 25 (2010106)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
Kathy R. Noe, CPCU, ARM •VP
The ACORD name and logo am registered marks of ACORD
rinhtc racanrn.i
NOTEPAD SERAN-1 PAGE 2
iNsuRED1 NAME Serrano Animal & Bird Hosp Inc OP ID: L.MIO DATE 07/18113
"This insurance applies separately to each insured against whom claim is
made or suit is brought except with respect to the companies limit of
liability. The inclusin of any person or organisation as an insured shall
not affect any right which such person or organisation would have as a
claimant if not so included"
Additional Insured -- Owners, Lessees or Contractors — AB 90 67 12 93
Policy Amendment Section 11
Insured:
Serrano Animal & Bird Hospital
Pplicv Number
AZC80888736
Producer
Veterinary Ins; Services Co
I:f calve Nate
07/01/13
Schedule
Name of Person(s) or Organization(s)
City of Santa Ana, Its officers, agents and employees
26 Civic Center Plaza
Santa Ana, CA 92701
City of Santa Ana, its Officers, agents, employees and volunteers are included as additional insureds.
The insurance provided is primary, "The insurance provided under this policy is primary and non-
contributory with any other insurance available to 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 limit 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: "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 92702.
(If no entry appears above, information required to complete this Endorsement will be shown in the Declarations
as applicable to this Endorsement)
The following is Added to Part I — WHO IS AN IN- arising out ofyour work for that insured by or for
SURED in the Business Liability Section of this policy you.
5. The person or organization shown in the Schedule AI I other terms and conditions of the policy apply.
is also an insured, but only with respects to liability
This form must be attached to Change Endorsement when issued after the policy is written,
One ofthe Fireman's Fund Insurance Companies as named in the policy.
saaY..Xar�
Secretary
Authorized Agent
A89067 12-93
Contains copyrighted Maenad of Ia;ueanve Snttims Offices, Ine., 1984
Wic(iaer
President
Nate
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Y 1\5�51.�Ytt ^C,{t�� h(C[6Ypp.
07/02/2013 15:33 9498551070 SASH PAGE 02MI
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spbnaaraa by AV M A Veterinary P>fOfessiona yJLmahility �r f Vinsurance
Polic \�,
CsoctomGtteoflnsnrance ZURICH This pa16sY navidca acaerroaae covamke. piaaanrcviewthe patGay rnra(b11&
XT;RM 1: insured by 04 stock company below aed baremofter called the V.vsq •t7s A cw (0710,
Is L I T Company Zerlah America" Inaaraaco Company
F1'FM 2t Named CordtiMto Holder, member somber, IRC, and address
Scott Ne21ry Weldy, IDVM
a!o Sotxano A2limol & Bird Flosp
21771 Lake Forest, Suite I I I
Lake Forest, CA 92630-2782 pp
1Jil4iBJIlpi�/ltlJJIJJOIAIJtJJ1171JttJBAl11JJBIIIIIBIJAIIJIl
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WELDY SCOTT MNRY DR 24154
3Cl'RM 5: Penoth st and co"a awamary
Liability $ 222.00
Veterinary License Defense $ 69.00
TOTAL Dt%: $ 291..00
MauterFolicyNiambor; I Certificate Number:
TEOL 9241302.08 1 36548
FOR tTrIFOI2114ATION Olt TO FU X A CLAIM
kLTASX CALL (800) 229-7548
ATIN is PoticyPadod From; 1101/2010'Ta; 1/01/2014
12t01 aes soosavd time at the address of ibc Named eateifiaato l laldu as
ITEM 42 )Limits of liability
Class Each claim
IN 17 IV Apgfogale
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7; Sehedole of Plan Numbers
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SERANA OP ID: DT
A� CERTIFICATE OF LIABILITY INSURANCE D0612612014ATE )
OSlZ6/2014
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 POLICIES
BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: H the carNgcate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. 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 canter rights to the
certificate holder in lieu of such endorsements).
PRODUCER
Veterinary Ins. Services Co.
CA License 4OF64180
1400 River Park Drive, #180
Sacramento, CA 96816
CONTACT
NONE,
MAN�Ny0.
�P,-EnOc888-762-3143 {slrt, :o : 815-821,-2266
Ala..:
AI
_.._._............_.....__._........__..__�..._,_.,.
_..... INSURERIS Al FFOFRji COVERAee
_
Kathy R. Noe, CPCU. ARM -VP
INSURER A: Fireman's Fund Insurance Co.
INSURED Serrano Animal &Bird Hoop, In � _
Scott H, Weldy, DVM
21771 Lake Forest Drive #111
INSURERS:
— —
----- --
N8URER0_Y_�,
Lake Forest, CA 92630
INSURER Ea
INSURER F:
IFICATF NI
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY 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,
TYPE OF MSURIWCE
D
new -I-
.'._.-......
pODGy NUMBER
V EPF
MID
GV EYP
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_ .__.._...__.-.....
LIMITS
A
X
COMMERCIAL. GENER�AL LIABILITY
CLAIMS -MADE I. ^ 1 occua
X
C80897850
07I01/201d
07l01l2015
EA�ECCURRENCE
$ 1,00D,00
-
_
$ _ 100,00
MED EXP (Any ono person)
is 10,00
--.__..._�__...
PERSONAL&ADVINJURY
�$
GENLAGGREW,ISLIMIT APPLIES PER
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—
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A
AUTOMOBILE
X
LIABILITY
ANYAUTO _
ALL OWNED SCHEDULED
AUTOS AUTOS
NON-OV/NE0
NIREDALnOB °C ! AUTOS
AZC8tl697850
O7/0172014
07101➢2015
rIEO NEI) I l UMIT
s =1tl
$ 1,000,00
BODILY IN JURY (Pot ponan)
_.._
_�._.._.. _.. _..._.
$
I
BODILY INJURY. Per axldanl
( )�
.......
$
i�{Per AglJAent1
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UMBRELLA UAe
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_._
A
WORKERS COMPENSATION
ANDEMPLOYERS'LLAmLITY YIN
ANYPROPRIETORI-ARTNERIEXEOUTIVE
OFFICERIMEMSER EXCLUDED?
IMaadalory In NID
Hyyea&"950 under
OESCRIPTI'a DP PE TIONB helix
NIA
WZP81020444
07f0112014
0710112015
PE TFI-
-.{-.--._.—
B.L.EACH ACCIDENT
is 1,000.00
EA. DISEASE -EA EMPLOYEE'S
^1,000,00_
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks $enaduie, may ha mumma it mare space 1s ngaaa4l
City of Santa Ana, its officers, agents, employeas and volunteers are
included as additional insureds. The insurance provided is primary.
"The insurance provided under this polio is primary &non contributory with ,'L} aic�
any other insurance available to the additional insured" 1'j±'nnVE'A�
30 Days NOC/10 Days HOC for non-payment
�S R K
ttorney �
City of Santa Ana
Fin & Mgt Svcs Agency
Purchasing Div.
20 Civic Center Plaza M-16
ASS13Lar
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES Be CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NQTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
ARM
_1'
2,_
ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD
Additional Insured — Owners, Lessees or Contractors — Ali 90 67 12 93
Policy Amendment Section 11
Insured: "Serrano Animal & Bird Hospital Policy Nunther AZC80897850
roduaer Veterinary Ins Services Co ctivc Nate 0710IN
Schedule
Name of Person(s) or Organizatiou(s)
City of Santa Ana, Its officers, agents and employees
zd Civic Center Plaza
Santa Ana, CA 92701
City of Santa Ana, Its Officers, agents, employees and volunteers are Included as additional insureds,
The Insurance provided Is primary. "The Insurance provided under this policy is primary and non-
contributory with any other insurance available to 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 limit 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,"
(if no carry appears above, information required to complete this Endorsement will be sbown in the Declarations
as applicable to this Endorsement)
The following is Added to part I _„ WHO IS AN IN- arising out of your work for that insuroci by or for
SURED in the Business Liability Section of this policy you,
5. The person or organization shown in the Schedule All other terms and conditions of the policy apply,
is also an insured, but only with respects to liability
11ris *arm must be attached to Change Endorsement when issued after the policy is written.
One of the Fireman"s Fund Insurance Companies m named in the pollcy,
Sa�ldv S8 .7fary�
Secretary
Aut rorized Age t
An a8712,93
Conlslns o0nyrigttsd Mnlorinl of bauf000n Smgus Offim, Inc„ 7984
Miefra rg Gagocco
President
VROVV,D AS TO )C OA1`n.
LISA 5, sTORCK
Assistant City Attorney
SERAN-1 OP ID., ITT
CERTIFICATE OF LIABILITY INSURANCE rwre lummar"")
0710712016
THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RICH a S R H S I
C T 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 INSURERIS), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT* If the certificate holder Is an ADDITIONAL INSURED, the POIlCylles) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain Politics may require an endorsement A statement on this certificate does not confer rights to the
certificate, holder in lieu of such andrimAmantial
PRODUCIR NTAC
Veterinary Ins, Services Co, a 1Rt_k9_k1._q?CU, ARM -V!P
CA License 00F64100 43 62-31
1400 River Park Drive, 4100 L -"- _... . .....
Sacramento, CA 9$816 c knrasY vdsc-Ines ,Ytrom
Kathy R, Non, CPCU, ARM VP . .........
...... 040901 A Allianz Globaffireman's Fund
YNSLIRVD Serrano Animal & Bird Hospital
Scott H, Weldy, DV M A V" INSUReR 81i_
21771 Lake Forest Drive #111 .2 I osx' "
Lake Forest, CA 92630 INSLIRER 0;
0418 IS TO CERTIFY THAT THE POLICIES: OF INSURANCE LISTED BELOW HHAVEE BEE I SUED TO THE INSURED NAMED ABOVE FOR THE iZLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICHTHIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CON0171ONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS,
4
Y ryps Of INURANCI ADD
X 'CONIMNRCIALQWNERAL LIABILITY POLICY NUa91R AAfcd)rfyyv a RMY111 UMIS
1,EACHOCCURRINCE [5 1.00000
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CLAIMSMADE OCCUR x
MED EXP fAftv 0" DeMn) J N 10.0
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PER
PRO,
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toe
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$
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aoulty INJURY (P- owson)
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BODILY INJURY (P& awdom)
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IOREDAUY013NfiN-CrMNF
PROP
U#*R*ItUA "An OCCUR
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woftAlo; ct"PaNuo"
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ANY PAOP0IEI(QHffW�PAfln1N A YIN
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,11 of Santa Ana, its officers agents, employees and representatives are Cl by,
ric waded as additional insu;iQs, JS
City Of Santa An*
Fin & Mgt Svcs Agency
Pumhasing Div,
20 Civic cen"r Plata M -is
?
17e'r
SA40,0
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Ser-Off
714E EXPIRATION DATE THEREOF. NOTICE WLL BE DIELNM;MD 01
ACCORDANCE WITH THE POLICY PROVISIONS.
0 `1984M4 $10091 01RIPORATION. Al:l r—ights reserved.
ACORD 25 (2014101) The ACORD name and logo am registered maft of ACORO
Additional Insured — Owners, Lessees or Contractors — AB " 67 12 93
Policy Amendment Section]]
inaitmt Serrano Animal & Bird Hospital 139-1-i-cy—N-prnber AZC80911904
P-MOLIP-c—er Veterinary Ins Services Ca Q c 07101116
-. AL
Schedule
Name of P'erson(s) or Organization(s)
Of)) of Santa A na, Its offirers, agents and ensployees
26 Civic Center Plaza
Santa Apia, CA 92 701
City of Santa Ana, & officers, agentv, employees representatives are included as additional
insureds.
"The insurance provided under this policy is primary and non-contributory with any other
Insurance available to the additional insured. This insurance applies separately to each
insured against whom claim is made or suit is brought except wjjhrespect to the companies
limit of liability. The inclusion of any person or organization as an insured shaft not affect
any right which such person or organization ivould have as a claimant if not so included. "
30 Days Notice of Cancella,lion/10 Days Notice of Cancellation for Nonpayment of Premium
(if no entry appears above, information required to complete this Endorsement will be shown in the Declarations
as applicable to this Endorsement)
The following is Added to Pan I - WHO IS AN IN. arising out of your work for that insured by or for
SURER in the Business Liability Section of this policy You.
5, The person or organization shown in the Schedule All other terms and conditions of the policy apply,
is also an insured, but only with respects to liability
This fiorm musi be attached it) (1agi: EndorsLownt when issued aftct the policy is written,
One of the Fireman's Fund Insurance Companies as named in the policy,
President
Dote
A09067 11.93
Cuftwtm capy6ghled MgtOLIMI Of,ustattrKV I'mmtTl clakN's, M81
Reviewe�d by:
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