HomeMy WebLinkAboutURBAN FUTURES, INC.-2017INSURANCE ON FILE N-2017-206
WORK MAY PROCEED
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'DAT' 9-29 1fi AGREEMENT FOR PROVISION OF
a F Ms Cc�) BOND CONTINUING DISCLOSURE SERVICES
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THIS AGREEMENT is made and entered into this 22id day of August, 2017 by and between
Urban Futures, Inc., ("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
("City").
RECITALS
A. The City desires to retain a consultant having special skill and knowledge in the field of
municipal financial services relating to bond continuing disclosure requirements.
B. Consultant represents that it 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:
1. SCOPE OF SERVICES
Consultant shall perform municipal financial services relating to bond continuing
disclosure requirements as set forth in the Scope of Work, attached hereto as Exhibit A, and
incorporated by reference.
2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services,
the rates and charges identified in Exhibit B. The annual sum to be expended under
this Agreement shall not exceed 52,375 per year. The total sum to be expended shall
not exceed $4,750 during the term of this Agreement,
b. Payment by City shall be made within 45 days (forty-five) 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 September 17, 2017 and continue for a two (2) year
term through September 16, 2019, unless terminated earlier in accordance with Section 14, below.
The term of this Agreement may be extended upon a writing executed by the City Manager and
the City Attorney
Page 1 of 10
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. OWNERSHIP OF MATERIALS
This Agreement creates a non-exclusive and perpetual license for City to copy, use,
modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property
embodied in plans, specifications, studies, drawings, estimates, and other documents or works of
authorship fixed in any tangible medium of expression, including but not limited to, physical
drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or
caused to be prepared by Consultant under this Agreement ("Documents & Data"). Consultant
shall require all subcontractors to agree in writing that City is granted a non-exclusive and
perpetual license for any Documents & Data the subcontractor prepares under this Agreement.
Consultant represents and warrants that Consultant has the legal right to license any and all
Documents & Data. Consultant makes no such representation and warranty in regard to
Documents & Data which were provided to Consultant by the City. City shall not be limited in
any way in its use of the Documents and Data at any time, provided that any such use not within
the purposes intended by this Agreement shall be at City's sole risk.
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 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 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, with $2,000,000 in the
aggregate. Such insurance shall (a) name the City, its officers, employees, agents,
and representatives as additional insured(s); (b) be primary and not contributory
with respect to insurance or self-insurance programs maintained by the City; and
(c) contain standard separation of insureds provisions.
Page 2 of 10
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
3700 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. If Consultant is or employs a licensed professional such as an architect or engineer:
Professional liability (errors and omissions) insurance, with a combined single limit
of not less than $1,000,000 per claim with $2,000,000 in the aggregate.
e. 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 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 by the City.
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.
iv. Consultant shall supply City with a fully executed additional insured
endorsement.
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 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.
7. INDEMNIFICATION
Consultant agrees to defend, and shall indemnify and hold harmless the City, its officers,
agents, employees, contractors, special coimsel, and representatives from liability: (1) for personal
injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for
personal injury, including death, and claims for property damage, which may arise from the
negligent operations of the Consultant, its subcontractors, agents, employees, or other persons
acting on its 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
Page 3 of 10
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 terms of, or effects arising from this Agreement. City may make all reasonable
decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing,
to the extent Consultant's services are subject to Civil Code Section 2782.8, the above indemnity
shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of,
pertain to, or relate to the negligence, recklessness, or willful misconduct of the Consultant.
8. RECORDS
Consultant shall keep records and invoices in connection with the work to be performed
under this Agreement. Consultant shall maintain complete and accurate records with respect to
the costs incurred under this Agreement and any services, expenditures, and disbursements
charged to the City for a minimum period of three (3) years, or for any longer period required by
law, from the date of final payment to Consultant under this Agreement. All such records and
invoices shall be clearly identifiable. Consultant shall allow a representative of the City to
examine, audit, and make transcripts or copies of such records and any other documents created
pursuant to this Agreement during regular business hours, Consultant shall allow inspection of all
work, data, documents, proceedings, and activities related to this Agreement for a period of three
(3) years from the date of final payment to Consultant under this Agreement.
9. 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; (e) 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.
10. 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.
Page 4 of 10
11. 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.
12. 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, the terms and conditions hereof, shall not bind or obligate Consultant 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 is not embodied herein.
13. 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.
14. 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(s) 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.
Page 5 of 10
15. WAIVER
No waiver of breach, failure of any condition, or any right or remedy contained in or granted by
the provisions of this Agreement shall be effective unless it is in writing and signed by the party
waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy
shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor
shall any waiver constitute a continuing waiver unless the writing so specifies.
16. 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.
17. 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.
18. ARSCELLANEOUS PROVISIONS
a. Each undersigned represents and warrants that its signature herein below 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.
19. 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 fax or other telegraphic communication in
the manner provided in this Section, to the following persons:
To City:
Clerk of the City Council
City of Santa Ana
20 Civic Center Plaza (M-30)
Page 6 of 10
P.Q. Box 1988
Santa Ana, CA 92702-1988
Fax: 714- 647-6956
With courtesy copies to:
Executive Director of Finance and Management Services
City of Santa Ana
20 Civic Center Plaza (M-17)
P.O. Box 1988
Santa Ana, CA 92702
Fax: 714-647-5414
Sonia R. Carvalho
City Attorney
City of Santa Ana
20 Civic Center Plaza (M-29)
P.O. Box 1988
Santa Ana, California 92702
Fax: 714-647-6515
To Consultant:
Michael P. Busch, CEO
3111 North Tustin
Suite 230
Orange, CA 92865
Fax: 714-283-5464
A parry 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 fax, 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.
--signature page to follow --
Page 7 of 10
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first
above written.
ATTEST:
APPROVED AS TO FORINT:
SONIA R. CARVALHO
City Attorney
By:
Lisa Storck
Assistant City Attorney
RECOMMENDED FOR APPROVAL:
FRANCISICO GUTIERRI REZ��
Executive Director
Finance and Management Services Agency
CITY OF SANTA ANA
iJ. K c
City anager
URBAN FUTURES,
9 tier (,,.
ichael P. Busch
Chief Executive Office
Page 8 of 10
EXHIBIT A
SCOPE OF SERVICES
EXHIBIT "A"
SCOPE OF WORK
The CONSULTANT will be expected to provide full annual continuing disclosure reporting
for the CITY'S outstanding bond transactions as required by the Securities Exchange
Commission's Rule 15c2-12 and in accordance with the specific disclosure reporting
requirements detailed in each respective bond transcript. Specifically, CONSULTANT
will:
1. Collect the necessary financial and statistical information necessary from CITY
staff, auditors or any other source as required.
2. Transmit the annual report for each bond transaction listed below to the Municipal
Securities Rulemaking Board's (MSRB) nationally recognized data repository
known as EMMA.
The CONSULTANT will provide Services as described in this agreement for the following
bond transactions:
este eons m�sues
$68,010,000
CITYOFSANTAANA
Gas T ReRevenue Certi sates_ otPortieloodon Series 2007
$15,690,000
SANTA ANA FINANCING AUTHORITY
Water Revenue Refunding Sonds, Series 2014
$1,585,000
CITYOFSANTAANA
Assessment District No. 2015-01
Limited Obligation (mnrovement Bonds
Services for future bond transactions may be added to this project with the mutual
agreement of the CITY and the CONSULTANT.
EXHIBIT "B" COMPENSATION RATES
AND CHARGES
Dissemination of Reports ............................ .....Included in annual fee
Online Publication of Reports .................................................Included in annual fee
Significant Event Monitoring and Notice Preparation ...................Included in annual fee
Preparation of Annual Disclosure Report as stated below (annual fee per issue to satisfy
all requirements):
City Bond Issues Annual Fee
$68,010,000
CITYOFSANTAANA
Gas Tax Revenue Certl/icotes of Particfoation Series 2007 b0
$15,630,000
SANTA ANA FINANCINGAUTNORITY
Water Revenue Refundlnn Bonds Series 2014 5750
$1,585,000
CITY OF SANTA ANA
Assessment District No. 2015.01
Limited Obldavtio I /mvrovement Bonds Si 025
Total Annual Fee
9
$2,375
Reports
Reports
InformatiortUbfss are to be supplied by UPI: $126 par hour, not an smead amount can be pmJided when
InfamatloMeblas aro to be supplied by UFI: $125 per hour, not to exbaed amount Cann be pmNdod when
annual fee. Nullification to the City of all ratings changes Is guaranteed to be made prior to the MRB'a'10
Business Day rule. UFI will draft end past to ENM4 on the CIhys behalf any two matedal avert notoes per
of Material Events bond Issue free of charge each year. A charge of $126 per matedal event for dralft and passing Is Incurred
thereafter. Ifanametedal event affects more than one bond Issue, dlafea will only be $925 total, regardless
of number of nottce$ draflellpoated. In the case of a draw on Debt Samoa Reserves, UFI will conwat the
Trustee on the Citys behalf In order to draft and post the necessary material avant hetica.
*Hourly fees proposed as below.
CEO/President
$246
Managing Principal
$226
P&Cipal
$195
Associate
$176
Analyst
$126
Assistant/Clerical
$50
Policy Number: Date Entered:
C;LKIIt- IUA1tzOF LIAbILIIY INSUKANk," 3/2/2017
THIS CERTIFICATE is ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
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if SUBROGATION 15 WAIVED, subject to the terns and conditions of
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PRODUCER Michael Geffre Insurance Agency
496 N COAST HWY STE A
LAGUEA BEACH, CA 92851
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20 CIVIC CENTER DR.
SANTA ANA, CA 92701 AUTHORIZED REPRESENTATIVE
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CERTIFICATE OF LIABILITY INSURANCE
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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(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed, If SUBROGATION IS WAIVED, subject to
the farms 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(st.
PRODUCER
Brown & Brown of Now York Inc.
900 Westchester Avenue, N•311
Rye Break, NY 10973
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17821 E. 17th Street
INSURER e:
Tustin, CA 92780
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COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD
INDICATED. NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
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DESCRIPTION OE OPERATIONS I LOCATIONS I VEHICLES (ACORD Uni Additional Remarks Schedule, may he attached if mere apace Is required)
City of Santa Ana Is listed as an Additional Insured under the Errors & Omissions Liability policy. Waiver of Subrogatlon is included.
CERTIFICATE HOLDER CANCELLATION
Y
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Santa Ana
Attn: Teresa Ramirez
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
THE POLICY PROVISION
ACCORDANCE WITH S.
20 Civic Center Plaza
AUTHORIZED REPRESENTATIVE
i Santa Ana, CA 92701
101990.2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
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Policy N um bars
Date Entered'.
DATE
�7PL7 GLK I II-JUA 1 k Uf- LIABIL1 I Y INSUKANUL 3/2/2017
THIS CERTIFICATE I$ ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,
THIS
CERTIFIBELOWTTE DOES NOT HIS NIS CERTI I ATE�OF INSURANCE DOES NOT IRMATIVELY OR L CONSTITUTE Y AMEND, XAEALTERND OR AFFORDED CONTRACT BETWEEN THE ISSUING IINSUER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an Auul ZONAL INSURED, the pollcyges) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and canditlons of the policy, certain policies may require an endorsement, A statement on
PRODUCER Michael GBffre Insura m Agency
996 N COAST HWY SSE A
LAGtM BEACH, CA 92651
INSURED
and DRA ISOM ADVISORS
17621 E. 17TH ST. STE 295/255
TUSTIN, CA 92780
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ERTIFY THAT THE POLICIES OF 1NSIJRANOE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY FLKWU
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MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
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Or OPERATIONS I LOCATIONS I VEHICLE 5 OCORD 401, AMIMOMNR MPks SCNoduu, mNy ua5"ACNOd "MOM "IM0is raWMHU
THE CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBER POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ATTN: RISK MANAGER ACCORDANCEWITH THE POLICY PROVISIONS,
20 CIVIC CENTER DR. �_.........
SANTA ANA, CA 92701 AUTHORIMI)REPRESENTATIVE
HICHASL GISFERZ
61335.2016 ACORD CORPORATION. All rights rAUnU`V d.
ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD / J
Produced using Forms BOSS Pius SORwam. www.FormS6oss.COm, impressive Publishing 500-206-1977
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URBAPUT-01 AGREEN
AC>R"e
�..r-.---, CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDIYYYY)
12/29/2016
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(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(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 certiflcste does not confer rights to the
certificate holder in lieu of such ondorsement s .
PRODUCER
Brown & Brown of New York Inc.
BOO Westchester Avenue, N411
Rya Brook, NY 10573
CONTACT
PHONE 914 337-1639c No; 914) 337-1596
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ADDRESS: certificates When .com
)NSURER B AFFORWNe COVERAGE
MAIC q
iNsuReRALlborty Surplus Insurance Corp10725
INSURED
INSURER a
$
INSURER 0: ..,.......,
PREMISEa(Ea occurrence
Urban Futures, Inc.
.............._,........._..�............_....__.._
INSURER 0:
MED EXt+ Arryare wr)
17821 E. 17th Street
Tustin, CA 82780
INSURER E:
INSURER P ;
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 HATH 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.
ILTR
TYPE OP INSURANCED
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POLICYNUMSER
MM ODY P
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LIMITS
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CLAIMS MADE ❑ OCCUR.._.,..........�,..
EACH OCCURRENCE
$
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$
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PERSONAL &ADV INJURY
$
LIMN r APPLIES PER:
POLICY L-�_7 jER& 0 LOC
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OTHER:
AUTOMOBILE
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IS
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BODILY INJURY (par xtoideM)
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FR D E
Per accident
UM13RELLA LIAa OCCUR
EACH OCCURRENCE
$
EXCESS LIAB CLAIMS -MADE
AGGREGATE
$
DED RETENTION
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WORKERS COMPENSATION
AND EMPLOYERS! LIABILITY YIN
ANY PROPRIETORIPARTNERlEXECUTIVE
OPFICERIMEMSER EXCLUDED? Cl
(Mandatory In NH)
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DESCRIPTION OF OPERATIONS below
NIA
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E.L. DISEASE - EA EMPLOYEE
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E.L. DISEASE -POLICY LIMIT
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X EOSNASET3N00i 1212312016 1212312011 Each 2050,00
A E&O1Cyber Liability EOSNABET3NO01 1212312D16 12!2$12017 Retention Each Claim
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addinenal Remarks Schedule, nifty be attached if more space is required)
City of Santa Ana is listed as an Additional Insured under the Errors & Omissions Liability policy. Waiver of Subrogatlon Is Included.
CERTIFICATE HOLDER CANCELLATION
(01988.201& ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Santa Ana
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Attn: Teresa Ramirez
ACCORDANCE WITH THE POLICY PROVISIONS,
20 Civic Center Plana
AUTHORIZED REPRESENTATIVE
Santa Ana, CA 92701
(01988.201& ACORD CORPORATION. All rights reserved.
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
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