HomeMy WebLinkAboutHIMELSTEIN, MANDAL E.-2014INSURANCE NOT ON FILE
WORK MAY NOT PROCEED
CLERK OF COUNCIL
N- 2014 -124
DATE' SEP 1 5 2014 CONSULTANT AGREEMENT
O1• PBAW
0r "THIS AGREEMENT made and entered into this ay of i e , 2014 by and
between Mandel E. Himelstein (hereinafter "Contractor "), and the CIT 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 City desires to retain a Contractor having special skill and knowledge in the field of
arbitration and mediation to provide professional administrative hearing services.
B. Contractor represents that Contractor is able and willing to provide such services to the
City.
C. hi undertaking the performance of this Agreement, Contractor represents that it is
knowledgeable in its field and that any services performed by Contractor under this
Agreement will be performed in compliance with such standards as may reasonably be
expected from a professional consulting firm in the field.
NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the
terms and conditions hereinafter set forth, the parties agree as follows:
I. SCOPE OF SERVICES
Contractor will provide professional Administrative Hearing services for the City of
Santa Ana Community Preservation Department and Public Works Department, as set forth in
Exhibit A, attached hereto and incorporated herein by this reference. Such hearings may include
Vehicle Abatement, Administrative Citation Appeals, and Alternative Public Nuisance
Abatement. Administrative Hearing officer services may be utilized by other agencies with the
City of Santa Ana.
2. COMPENSATION
a. City agrees to pay, and Contractor agrees to accept as total payment for its services,
the rates and charges identified in Exhibit A. The total Burn to be expended for Administrative
Hearing Services provided by alt contracted Hearing Officers shall not exceed $25,000 during
the term of this Agreement. However, this Agreement does not guarantee that any set amount of
the authorized $25,000 will be expended on any particular Contractor.
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 commence on the date first written above and terminate three (3)
years from said commencement date or upon the depletion of the maximum contract amount as
stated in Section 2 above, unless terminated earlier in accordance with provisions, below. The
term of this Agreement may be extended for my be extended up to two additional one -year
periods, upon a writing executed by both parties, including the City Manager and the City
Attorney for the City.
4. INDEPENDENT CONTRACTOR
Contractor 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, ajoint venture relationship, or
to allow the City to exercise discretion or control over the professional manner in which
Contractor performs the services which are the subject matter of this Agreement; however, the
services to be provided by Contractor shall be provided in a manner consistent with all
applicable standards and regulations governing such services. Contractor 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 under this Agreement, Contractor shall
maintain and shall require its subcontractors, if any, to obtain and maintain insurance as
described below:
a. Worker's Compensation Insurance. In accordance with the provisions of Section 3300
of the Labor Code, Contractor, if Contractor 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 render this Agreement, Contractor agrees to obtain and maintain any
employer's liability insurance with limits not less than $1,000,000 per accident.
b. Professional liability (errors and omissions) insurance, with a combined single limit of
not less than $1,000,000 per claim, subject to $1,000,000.00 aggregate.
c. The following requirements apply to the insurance to be provided by Contractor
pursuant to this section:
(i) Contractor 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
thirty (30) days prior written notice to the City.
d. If Contractor 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 Contractor's right to be paid for its
time and materials expended prior to notification of termination. Contractor 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
Contractor agrees to and shall indemnify and hold harmless the City, its officers, agents,
employees, consultants, special counsel, and representatives from liability 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 negligent 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. This indemnity and hold harmless agreement applies to all claims
for damages, just compensation, restitution, judicial or equitable relief suffered by reason of the
events referred to in this Section or by reason of the tenns of, or effects, arising from this
Agreement. The Contractor further agrees to indemnify, hold harmless the City, regarding any
action by a third party challenging the validity of this Agreement, or asserting that personal
injury, damages, just compensation, restitution, judicial or equitable relief due to personal or
property rights arises by reason of the terms of, or effects arising from this Agreement. City may
make all reasonable decisions with respect to its representation in any legal proceeding.
CONFIDENTIALITY
If Contractor receives from the City information which due to the nature of such
information is reasonably understood to be confidential and /or proprietary, Contractor 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 Contractor without reference to information
disclosed by the City.
8. CONFLICT OF INTEREST CLAUSE
Contractor 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 telefacsimile 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
telefacsimile (714) 647 -6956
With courtesy copies to:
and
Executive Director of Planning and Building Agency
City of Santa Ana
20 Civic Center Plaza (M -20)
P.O. Box 1988
Santa Ana, California 92702
telefacsimile (714) 647 -5897
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 Contractor: Mandel E. Himelstein
PO Box 180519
Coronado, California 92178 -0519
telefacsimile (619) 435 -8980
A party may change its address by giving notice in writing to the other party. If sent by
mail, communication shall be effective or deemed to have been given three (3) clays 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
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
Contractor, 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 Contractor. The parties
agree that any terms or conditions of any purchase order or other instrument that are inconsistent
with, or in addition to, the terms and conditions hereof, shall not bind or obligate either
Contractor or the City. Each party to this Agreement acknowledges that no representations,
inducements, promises or agreements, orally or otherwise, have been made by any party, or
anyone acting on behalf of any party, which are not embodied herein.
11. ASSIGNMENT
hlasmuch as this Agreement is intended to secure the specialized services of Contractor,
Contractor 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, Contractor shall be entitled to receive and the City shall pay Contractor
compensation for all services performed by Contractor prior to receipt of such notice of termination,
subject to the following conditions:
a. Asa condition of such payment, the Executive Director may require Contractor 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 Contractor 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
Contractor 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. Contractor 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 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
Contractor 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. Contractor 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.
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
Cleric of the Council
APPROVED AS TO FORM:
SONIA R. CARVALHO
City At rye I
BY: ` t
Ryan O.
RECOMMENDED FOR APPROVAL:
V' �.�
KAREN HALUZA
Interim Executive Director
Planning & Building Agency
CITY OF (SANTA ANA
,J
DAVID CAVAZOS
City Manager
4PWE. HIMELSTEIN
ID# 3/6 - 3o - 0 r ?p
EXHIBIT A
SCOPE OF SERVICES
(Attached)
EXHIBIT A
SCOPE OF SERVICES
BACKGROUND
In order to provide effective and expeditious hearings to individuals cited for
violations of the Santa Ana Municipal Code (SAMC), the City would like to develop a
list of Hearing Officers to conduct Administrative Hearings. The selected Hearing
Officers will be assigned cases on a rotating, as- needed basis.
The Hearing Officer will conduct Administrative Hearings for the City of Santa Ana.
Primarily, the Hearing Officer will hear administrative citation appeals, alternative
nuisance abatement proceedings and vehicle abatement proceedings associated
with action of the City's Planning and Building agency. The Hearing Officer may
also be asked to provide administrative hearings for other City Agencies (i.e. Public
Works Agency).
The Hearing Officer will be charged with making a just determination as to whether a
municipal code was violated, whether the property owner is still in violation, and will
also make determinations as to whether the process for the abatement of a
nuisance, including inoperative vehicles, will move forward. Hearings will be held in
accordance with the City of Santa Ana Municipal Code (Chapter 2 Sections 1 -21
through 1 -21.8, Chapter 16 Section 119, Chapter 17 Sections 17 -108 and 135).
GENERAL INFORMATION
It is the intent of the City to establish a list of qualified Hearing Officers. The actual
number of hearing officers utilized will depend on the total number of qualified
candidates established by the proposal process, and the number of hearings
required.
A. When appropriate, the City will provide forms and information in its possession
relevant to the conduct of a fair hearing, including, but not limited to, Notices of
Violation, Administrative Citations, and Vehicle Abatement Notices.
B. The Hearing Officer shall be responsible for the review of documents provided
by the City prior to the hearing.
C. All documents and other products used or developed during preparation for a
hearing will become the property of the City.
D. 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 must 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. The Hearing Officer's service will include
preparation of finding of facts, hearing dispositions, billing statements, and other
documents as necessary.
JOB REQUIREMENTS FOR ADMINISTRATIVE HEARING OFFICERS
The selected consultant shall meet the following expectations and /or provide the
following services:
A. The Hearing Officer must be independent and impartial. In this regard, a
hearing officer may not:
1. Be an employee of the City of Santa Ana or any public agency that is
involved in testifying at a hearing;
2. Be a member of any board or commission of the City of Santa Ana;
3. Have a personal or professional interest that would conflict with his /her
objectivity in the hearing.
B. All hearings will be conducted at Santa Ana City Hall, at dates and times to be
determined by the City.
C. A hearing officer must possess the necessary support and equipment to perform
his /her duties as a hearing officer including telephone, computer, internet and e-
mail access.
D. A hearing officer must possess standards of neutrality and confidentiality.
E. A hearing officer must organize and maintain individual case files along with
detailed records of activity on each case, such as research, drafting of orders,
decisions and correspondence.
F. A hearing officer must comply with all legal and contractual timelines, including,
but not limited to:
1. Rendering a final written decision, including findings of fact disposing of
all issues raised by the parties in a hearing not later than 10 -days after
the date of the hearing;
2. Mailing the final written decision to the appellant, with a copy to the City,
on the date the decision is rendered;
3. Returning individual case files to the City within 30 -days of rendering a
final decision. The files, which must be organized and maintained by
the hearing officer are the property of the City and must be maintained
in accordance with the Agency's record retention schedule. It is
therefore imperative that the files are returned to the Agency within 30-
days of the date of the final decision.
4. Upon notification that the agency has received a request for a
document pursuant to the Public Information Act, the relevant document
must be provided to the City immediately.
G. The hearing officer shall prepare and submit to the Planning and Building
Agency a standard invoice detailing the activities and expenses by case.
Payment for services and reimbursement of expenses by the City to the hearing
officer are further conditioned upon:
1. The reasonableness of the amount of time spent by the hearing officer
on the case(s) for which the hearing officer is seeking
payment/reimbursement.
2. The hearing officer's timely submission of reasonable and acceptable
documentation supporting all expenses being claimed by the hearing
officer: and
3. The hearing officer's prompt return to the City of all file materials
relating to closed cases;
H. Providing hearing officer services to other clients is not barred so long as the
hearing officer does not decline the request for hearing services more than two
consecutive times; specifically, the hearing offer must:
1. Maintain the ability to respond to requests for hearings and prehearing
motions within 24- hours;
2. Meet all applicable time lines; and
3. Demonstrate that such outside practice does not conflict with
contractual work with the City of Santa Ana.
4. Comply with the decision format requirements set by the City pursuant
to the rules governing a hearing officer's decision as per the SAMC
(Chapter 2 Sections 1 -21 through 1 -21.8, Chapter 16 Section 119,
Chapter 17 Sections 17 -108 and 135). The decisions of the hearing
officer must include formal findings of fact, and meet in all respects the
minimum requirements applicable to the decisions of executive
agencies conducting contested cases.
5. There is no guarantee as to the number of cases that will be assigned
to a hearing officer. The City anticipates that it will establish a list of
qualified hearing officers and assign hearings based on a rotation of
names on the list.
COMPENSATION
The City agrees to pay and the applicant agrees to accept as total compensation
for all services and costs, a rate of $100 per hour, to the nearest quarter hour, for
all hearing officer services provided to the City. Said services include review of
the materials provided by the City, holding of the hearing and providing findings
and determination. The City will not pay costs associated with providing hearings
including City validating parking receipts for the time that hearing officer is
performing services for the City and travel time to and from the hearing site.
_
CERTIFICATE OF LIABILITY
INSURANCE
DATE(M,
8/12/
MID YYY)
0 14
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ��iiLTER
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACTf
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must die
the terms and conditions of the policy, certain policies may require an endorse t: A stlatement
NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
THE COVERAGE AFFORDED BY THE POLICIES
BETWEEN THE ISSUING INSURER(S), AUTHORIZED
endorsed. If SUBROGATION IS WAIVED, subject to
on this certificate does not confer rights to the
certificate holder In lieu of such endorsement(s). t�9 Tq
PRODUCER _ ,, hi — I AME',
COMPLETE EQUITY MARKETS INC PHONE
NC No
Ext (847) 541 -0900 VC.NO:(947)
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41 -0444
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1190 Flex Court / '' Y /yt MAIL
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Lake Zurich, IL 60047 ( f�i (I, {
CLERK (II
' INSURER
INSURERISI AFFORDING COVERAGE
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A: Underwriters Er Lloyd's London
INSURED Mandel E. Himelstein
INSURER
B'.
INSURER
C:
1730 Avenida del Mundo #907
INSURER
D:
Coronado, CA 92118 p f 99 J�
INSURER
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INSURER
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COVERAGES
THIS
INDICATED.
CERTIFICATE
EXCLUSIONS
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CERTIFICATE
IS TO CERTIFY THAT THE POLICIES
NOTWITHSTANDING ANY REQUIREMENT,
MAY BE ISSUED OR MAY PERTAIN,
AND CONDITIONS OF SUCH POLICIES.
TYPE OF INSURANCE
COMMERCIAL GENERAL LIABILITY
OF INSURANCE
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POLICY NUMBER
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CONTRACT OR
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BY PAID
1 POLI Y FF
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DESCRIBED HEREIN
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DESCRIPTION OF OPERATIONS) LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may
be attached if more space is required)
This is a four page certificate.
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CERTIFICATE HOLDER CANCELLATION
s
City of Santa Ana
SHOULD
THE
ACCORDANCE
ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
DATE THEREOF, NOTICE WILL BE DELIVERED
WITH THE POLICY PROVISIONS,
BEFORE
IN
AUTHORIZED
REPRESENTATIVE
(51988 2014 ACORD CORPORATION. All rights
I 111,V1d.
ACORD25(2014/01) The ACORD name and logo are registered
marks of ACORD
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Certificate of L
MANDEL
Policy Number: 626687
Subject to all policy terms, conditions, exclusions and endorsementis of the policy.
The City of Santa Ana is listed as an additional insured but only per the terms & conditions of the
endorsement generated and subject to all policy terms, conditions, exclusions, and endorsements.
SURPLUS LINES NOTICE TO POLICYHOLDER - PLEASE SEE
3
By
T.P. Molloy
1. THE INSURANCE POLICY THAI? YOU HAVE PURCHASED
BEING ISSUED BY AN INSURER THAT IS NOT LICENSED
THE STATE OF CALIFORNIA. THESE COMPANIES A
CALLED "NONADMITTED" OR "SURPLUS LINE" INSURERS.
2. THE INSURER IS NOT SUB.
SOLVENCY REGULATION AND I
TO CALIFORNIA LICENSED INSI
3. THE INSURER DOES NOT PAI
INSURANCE GUARANTEE FUNI
LAW. THEREFORE, THESE Ft
CLAIMS OR PROTECT YOUR
BECOMES INSOLVENT AND
PAYMENTS AS PROMISED.
4. THE INSURER SHOULD BE LICI
INSURER IN ANOTHER STATE I.
A NON - UNITED STATES (ALIE
ASK QUESTIONS OF YOUR INSI
"SURPLUS LINE" BROKER OR
DEPARTMENT OF INSURAN
TOLL -FREE TELEPHONE NU.
WHETHER OR NOT THE IN
FOREIGN OR NON - UNITED ST
FOR ADDITIONAL INFORMA'I
YOU MAY ALSO CONTACT THI
AT WWW.NAIC.ORG.
TO THE FIN.
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FIBER: 1- 800 -927 -4357. ASK
>URER IS LICENSED AS A
RTES (ALIEN) INSURER AND
[ON ABOUT THE INSURER.
NAIC'S INTERNET WEB SITE
5. FOREIGN INSURERS SHOULD BE LICENSED BY A STATE N
THE UNITED STATES AND YOU MAY CONTACT TFIAT
STATE'S DEPARTMENT OF INSURANCE TO OBTAIN MORE
INFORMATION ABOUT THAT INSURER.
6. FOR NON - UNITED STATES (ALI
SHOULD BE LICENSED BY A
UNITED STATES AND SHO
INTERNATIONAL INSURERS DI
APPROVED NONADMITTED NC
ASK YOUR AGENT, BROKER 0b
OBTAIN MORE INFORMATION,
:N) INSURERS, THE INSU R
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1- UNITED STATES INSURES.
"SURPLUS LINE " BROKER TO
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7. CALIFORNIA MAINTAINS A L
LINE INSURERS. ASK YOUR
INSURER IS ON THAT LIST,
INTERNET WEB SITE OF THE
INSURANCE: WWWANSURANC
8. IF YOU, AS THE APPL1CAt
INSURANCE POLICY YOU HA
IMMEDIATELY, EITHER BEC.
WAS GOING TO LAPSE WITH]
BECAUSE YOU WERE REQU:
WITHIN TWO BUSINESS DAYS,
THIS DISCLOSURE FORM AIN
SIGNATURE UNTIL AFTER COQ
YOU HAVE THE RIGHT TO C�
FIVE DAYS OF RECEIVING
CANCEL COVERAGE, THE PRI
AND ANY BROKER'S FEE CHA
WILL BE RETURNED TO YOU.
D-2 (Effective July 21, 2011)
' OF APPROVED SURPL
TENT OR BROKER IF T]
VIEW THAT LIST AT T
.T PnRNIA DEPARTMENT
T, REQUIRED THAT T:
TE PURCHASED BE BOU]
USE EXISTING COVERA
1 TWO BUSINESS DAYS
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kND YOU DID NOT RECEI
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1.RAGE BECAME EFFECTP
, THIS POLICY W:
DISCLOSURE. IF
Vl WILL BE PROF
) FOR THIS INSUF
NOTICE:
1. THE INSURANCE POLICY THAT YOU HAVE PURCHASED IS
BEING ISSUED BY AN INSURER THAT IS NOT LICENSED BY
THE STATE OF CALIFORNIA. THESE COMPANIES ARE
CALLED "NONADMITTED" OR "SURPLUS LINE" INSURERS.
2. THE INSURER IS NOT SUBJECT TO THE FINANCIAL
SOLVENCY REGULATION AND ENFORCEMENT THAT APPLY
TO CALIFORNIA LICENSED INSURERS.
3. THE INSURER DOES NOT PARTICIPATE IN ANY OF THE
INSURANCE GUARANTEE FUNDS CREATED BY CALIFORNIA
LAW. THEREFORE, THESE FUNDS WILL NOT PAY YOUR
CLAIMS OR PROTECT YOUR ASSETS IF THE INSURER
BECOMES INSOLVENT AND IS UNABLE TO MAKE
PAYMENTS AS PROMISED.
4. THE INSURER SHOULD BE LICENSED EITHER AS A FOREIGN
INSURER IN ANOTHER STATE IN THE UNITED STATES OR AS
A NON - UNITED STATES (ALIEN) INSURER. YOU SHOULD
ASK QUESTIONS OF YOUR INSURANCE AGENT, BROKER, OR
"SURPLUS LINE" BROKER OR CONTACT THE CALIFORNIA
DEPARTMENT OF INSURANCE AT THE FOLLOWING
TOLL -FREE TELEPHONE NUMBER: 1- 800 -927 -4357. ASK
WHETHER OR NOT THE INSURER IS LICENSED AS A
FOREIGN OR NON - UNITED STATES (ALIEN) INSURER AND
FOR ADDITIONAL INFORMATION ABOUT THE INSURER.
YOU MAY ALSO CONTACT THE NAIC'S INTERNET WEB SITE
AT WWWNAIC.ORG.
5. FOREIGN INSURERS SHOULD BE LICENSED BY A STATE IN
THE UNITED STATES AND YOU MAY CONTACT THAT
STATE'S DEPARTMENT OF INSURANCE TO OBTAIN MORE
INFORMATION ABOUT THAT INSURER.
6. FOR NON - UNITED STATES (ALIEN) INSURERS, THE INSURER
SHOULD BE LICENSED BY A COUNTRY OUTSIDE OF THE
UNITED STATES AND SHOULD BE ON TLIE NAIL'S
INTERNATIONAL INSURERS DEPARTMENT (IID) LISTING OF
APPROVED NONADMITTED NON- UNITED STATES INSURERS.
ASK YOUR AGENT, BROKER OR "SURPLUS LINE" BROKER TO
OBTAIN MORE INFORMATION ABOUT THAT INSURER.
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7. CALIFORNIA MAINTAINS A LIST OF APPROVED SURPLUS
LINE INSURERS. ASK YOUR AGENT OR BROKER IF THE
INSURER IS ON THAT LIST, OR VIEW THAT LIST AT THE
INTERNET WEB SITE OF THE CALIFORNIA DEPARTMENT OF
INSURANCE: WWW.INSURANCE.CA.GOV.
8. IF YOU, AS THE APPLICANT, REQUIRED THAT THE
INSURANCE POLICY YOU HAVE PURCHASED BE BOUND
IMMEDIATELY, EITHER BECAUSE EXISTING COVERAGE
WAS GOING TO LAPSE WITHIN TWO BUSINESS DAYS OR
BECAUSE YOU WERE REQUIRED TO HAVE COVERAGE
WITHIN TWO BUSINESS DAYS, AND YOU DID NOT RECEIVE
THIS DISCLOSURE FORM AND A REQUEST FOR YOUR
SIGNATURE UNTIL AFTER COVERAGE BECAME EFFECTIVE,
YOU HAVE THE RIGHT TO CANCEL THIS POLICY WITHIN
FIVE DAYS OF RECEIVING THIS DISCLOSURE. IF YOU
CANCEL COVERAGE, THE PREMIUM WILL BE PRORATED
AND ANY BROKER'S FEE CHARGED FOR THIS INSURANCE
WILL BE RETURNED TO YOU.
D-2 (Effective July 21, 2011)
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