04-0824_DAVIS COMPANY, THE_Professional Services Agreementri
E
Professional Services Agreement
For A Examination of Staffing and Skill Levels
of the Planning Department, City of San Juan Capistrano
The City of San Juan Capistrano (City, hereinafter) hereby agrees to retain The Davis Company
(Consultant, hereinafter) to provide an Examination of Staffing and Skill Levels of Planning
Department as described in Section 1: Project Objective.
Section 1. Project Objective: Consultant shall evaluate and render opinions and
recommendations on current and near-term future staffing and skill level requirements for the
Planning Department. The evaluation to be undertaken by Consultant will consider available
quantitative (i.e., activity volume) that the department can provide and rely heavily on qualitative
factors that focus on plans, processes, priorities and service levels that are present or needed in
the department. The department evaluation is to be completed within an eight-week period and
in accordance with the attached Project Work Plan & Schedule (Attachment A).
Section 2. Compensation: As compensation for providing the services described in Section 1
above, City agrees to pay Consultant a professional fee of $190.00 per hour for Partner level
services for an estimated 50 hours of work, not to exceed $10,000, including expenses. Expenses
shall include reimbursement for directly incurred expenses for such items as travel,
printing/copies/facsimiles, long distance telephone conferences and postage/delivery charges, in
accordance with the following schedule:
Expense Category
a. Travel, postage and
long-distance telephone charges
b. Copies/Printing
a Faxes received
d. Faxes sent
Rate
Direct Charges (no mark-up)
$0.15 per page
$0.15 per page
$0.25 per page + long distance charges
Fees and expenses shall be invoiced monthly for services provided the previous 30 days, and are
due upon presentation to the City. Additional or optional services shall be provided by
Consultant only upon written notice from City.
Section 3. Term: The agreement is effective upon the date that it is executed by City and shall
continue in force until all work is completed. City may terminate the agreement for any reason
upon providing five days written notice of such termination to The Davis Company, c/o Michael
Davis at 555 University Avenue, Suite 116, Sacramento, CA 95825. In the event City terminates
Consultant's services for reasons unrelated to Consultant's performance, City shall pay
Consultant for his services, including fees and actual expenses, through the phase of work in
which the Consultant is engaged as of the date of termination. The balance of the fee is then
waived.
Section 4. Insurance: Consultant warrants to City that The Davis Company currently has and
shall keep in force without interruption at his own expense during the term of this agreement, the
following insurance: (1) workers' compensation and employer's liability insurance, in
accordance with the laws of the State of California; (2) broad form comprehensive public
liability and property damage insurance with a limit of not less than $1,000,000.00, and (3)
PROFESSIONAL SERVICESAGREEMENTR£: PLANNINGDEPT. EVALUATION PACE I
SD
0 0
automobile public liability and property damage insurance, including owned, hired, and non -
owned automobiles.
Consultant shall furnish the City with appropriate certificates naming the City as an additional
insured.
Section 5: Consultant agrees to indemnify and hold harmless City and its officers, officials,
employees and volunteers from and against all claims, damages, losses and expenses resulting
from Consultant's negligent performance of the work described herein, caused in whole or in
part by any negligent act or omission of consultant, any subcontractors, anyone directly or
indirectly employed by any of them or anyone for whose acts any of them may be liable, except
whereby the active negligence, sole negligence, or willful misconduct of the City.
Section 6. Non -Assignment: Consultant agrees not to assign, transfer or convey any interests,
rights or responsibilities applicable to this contract to other parties without the City's written
consent.
Signature of Consultant:
Michael Davis
Date: 0 4/O /
Signature of City Representative:
Dave Adams, City Manager
Date: �0 o1`t (0 4
PROFESSIONAL SERVICES AGREEMENT RE.' PLANNING DEPT EVALUATION
PAGE 2
MICHAEL DAVIS
JAMES D. WILLIAMS
PA
The Davis Company
PROJECT WORK PLAN & SCHEDULE
PROJECT: Staffing and Skill Levels Evaluation
CLIENT/AGENCY: San Juan Capistrano; Planning Department
DATE SUBMITTED: August 13, 2004
OR 1FCTIVF: Evaluate staffing requirements for comprehensive planning and related activities
in the Planning Department (e.g. current and long range planning, housing, historic
preservation, regional activity monitoring, public service counter and related activities).
WORK PLAN ELEMENTS
Task
Description
Schedule
1
Projenr initiation: Review and finalize study objectives, issues,
Week 1
methodologies and schedule with Planning Dir., HR Mgr., ACM and City
Manager.
8/18
2
TntrnrinrePro jeCt to Planning Deput*nent Frnn—__tiny Pe_a: Conduct briefing(s)
Week 2
for department employees. Suggest convening two briefing sessions to
avoid closing department to the public. Briefings require approximately
8/25
30-40 minutes each.
3
FM Inyees Complete Work Activity k Inh Responsibility
Weeks 3-4
Qnestionn ,�: Project consultant provides and reviews the questionnaire
with employees during the Task 2 briefivs. Employees complete and
9/10
return the questionnaires by September 10 .
4
Crnr; ,t;rn) Tlntn Collection; City staff provides available statistical data re:
Week 3
work load for major service activities such as: pre -application services,
current application processing, long range planning, EIR processing,
9/10
counter /public service inquiries, commission support, administration and
supervision, regional planning, public education, and special
projects/activities, etc. (See note 2 on next page)
555 University Avenue, Suite 116, Sacramento, CA 95825 916.567.9510 TEL 916.567.9540 FAX
11150 Santa Monica Blvd., Suite 230, Los Angeles, CA 90025 310.473.1457 TEL 310.575.9739 FAX
ATTACHMENT A: PROFESSIONAL SERVICES AGREEMENT RE: PLANNING DEPT. EVALUATION PAGE 3
PROJECT WORK PLAN & SPED ULE •
SAN JUAN CAPISTRANO, PLANNING DEPT.
PAGE 2 OF 2 PACES.
Task
Description
Schedule
5
Review Questionnaires & Other Data: Review questionnaires in
Week 5
preparation for conducting interviews with employees; review budget
and organization chart(s); review statistical data (see task 4 above);
9/17
and review major plans and documents (e.g. general plan/elements;
written operating procedures, manuals, guidelines, etc.).
6
Interview Employees: Interview Department employees, individually
Week 6
or in small groups, to clarify workflow, work load, job tasks and
9/24
public service functions.
7
Review Staffing Support for Primary Functions: Information and
Week 7
data obtained from Tasks 3-5 will be applied to evaluate staffing
levels, skill requirements and workload distribution. The evaluation
will also take into account supervisor's views on strengths,
10/1
weaknesses and new initiatives that are anticipated. (See notes 1-2
below)
8
Present Findings/Conclusions. Prepare and issue a Management
Week 8
Letter outlining the consultant's findings, conclusions and
recommendations. The Management Letter will specify
10/8
recommended solutions to existing and near-term service
requirements. (See note 3 below)
Note # I
The main focus of the evaluation is on services and work activities that are currently assigned to the Planning Department. To
the extent realignment of service activities involving other City departments may be needed to improve services and or
productivity, these observations will be provided for further consideration and analysis by the City.
Note #2:
Through a review of employee -prepared questionnaires and interviews with employees and supervisors, an assessment of
strengths and weaknesses of department staffing practices will be made with focus on:
I. Permit Processing/CEQA: application intake and evaluation, initial studies and comprehensive environmental analysis,
report writing, community meetings and public hearings, design review and mitigation monitoring.
2. Public Information & Assistance: counter services, public notices, dissemination of public information and pre -application
assistance to prospective applicants.
3. Supervision: providing direction, supervision and training for employees and evaluating/overseeing work in progress.
4. Administrative Support: record keeping, scheduling, permit tracking and support for research and coordination of
commission and community meetings.
S. Special Projects: activities such as long range planning, regional/project mitigation monitoring, redevelopment/housing,
historic preservation, updating of plans, policies, procedures, guidelines, and reporting to regional/State agencies, etc.
Note #3:
Deliverables will include recommendations to address staffing and skill level requirements, plus recommendations for
organizational or reporting relationship changes that are appropriate.
A TTACHMENTA. PROFESSIONAL SERV/CESAGREEMENTRE: PLANNING DEPT. EVALUATION PAGE
• Professional Services Agreement
For Executive Recruitment Services
The City of San Jan Capistrano (City, hereinafter) hereby agrees to retain The Davis Company
(Consultant, hereinafter) to provide executive recruitment services for the position of
Engineering & Building Director as described in Section 1: Scope of Services.
Section 1. Scope of Services: Consultant agrees to provide the services that are described in the
attached letter and proposal to the City of San Jan Capistrano dated May 4, 2004, which is
included as Attachment A and is a part of this agreement. This agreement includes all of the
services for which Consultant is being retained.
Section 2. Compensation: As compensation for providing the services described in Section 1
above, City agrees to pay Consultant a lump sum professional fee of $ 12,500.00 as follows:
Professional Fee Installments *
Amount
Installment 1: 15 % of the fee is due upon being
retained (i.e. retention fee)
$1,875.00
Installment 2: 35% of the fee upon completion of
• outreach tasks which as listed in Step 2 on the
$ 4,375.00
Recruitment Schedule
Installment 3: 35 % upon completion of Step 4 on
the Recruitment Schedule — presentation of finalists
$4,350.00
to the City.
Installment 4: 15 % upon completion of Step 6 on
the Recruitment Schedule — City's completion of
$1,875.00
finalists interviews and evaluations.
* See Attachment A for detailed list of Recruitment Steps
In addition to the professional fee, City shall reimburse Consultant's actual cost for expenses
that are directly related to the recruitment engagement in accordance with the following
schedule:
Expense Category Rate
a. Outside printing, travel, postage and
Long-distance telephone charges Direct Charges (no mark-up)
• b. Copies/Printing $0.15 per page
c. Report covers & bindings $1.50 per volume
Professional Services Agreement — City of San Jan Capistrano page I
SD
0
n
u
• Expense Category Rate
d. Faxes received $0.15 per page
e. Faxes sent $0.25 per page + long distance charges
f Use of Personal Auto $0.42 per mile
Fees and expenses shall be invoiced monthly and are due upon presentation to the City. The final
15% of the total fee, or $1,875.00, is invoiced upon completion of finalist interviews that City
shall conduct within not more than three weeks following Consultant's presentation of finalists
to City. Consultant shall be compensated at the rate of $170.00 per hour plus reimbursement for
expenses in accordance with the schedule listed above for any optional or additional services that
are required by the City and not included in Section I of this agreement. Additional or optional
services shall be provided by Consultant only upon written notice from City.
Section 3. Term: The agreement is effective upon the date that it is executed by City and shall
continue in force until all work is completed. City may terminate the agreement for any reason
upon providing five days written notice of such termination to The Davis Company, c/o Michael
Davis at 555 University Avenue, Suite 116, Sacramento, CA 95825. In the event City terminates
consultant's services for reasons unrelated to consultant's performance, City shall pay Consultant
for his services, including fees and actual expenses, through the phase of work in which the
consultant is engaged as of the date of termination. The balance of the fee is then waived.
Section 4. Insurance: Consultant warrants to City that he currently has and shall keep in force
without interruption at his own expense during the term of this agreement, the following
insurance: (1) workers' compensation and employers' liability insurance, in accordance with the
laws of the State of California; (2) broad form comprehensive public liability and property
damage insurance with a limit of not less than $1,000,000.00, and (3) automobile public liability
and property damage insurance, including owned, hired, and non -owned automobiles.
Upon City's request Consultant shall immediately furnish City with appropriate certificates
naming the City as and additional insured.
Section 5. Indemnity: Consultant agrees to indemnify and hold harmless City and its officers,
officials, employees and volunteers from and against all claims, damages, losses and expenses
resulting from Consultant's negligent performance of the work described herein, caused in whole
or in part by any negligent act or omission of consultant, any subcontractors, anyone directly or
indirectly employed by any of them or anyone for whose acts any of them may be liable, except
whereby the active negligence, sole negligence, or willful misconduct of the City.
Professional Services Agreement — City of San Jan Capistrano
page 2
• Section 6. Non — Assignment: Consultant agrees not to assign, transfer or convey any interests,
rights or responsibilities applicable to this contract to other parties without the City's written
consent.
Signature of Consultant: Signature of City Representative:
fT
Michael Davis
Date: `'-/,� Z,`7 Date:
Professional Services Agreement — City of San Jan Capistrano
page 3
All
ACORD.a CERTIFICA OF LIABILITY INSURANCE
oiio9/2 0 )
PRODUCER (916)286-5960 FAX (916)646-3996
Pan American Underwriters Inc
Li c #0132491
PO Box 13792
Sacramento, CA 95853
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC #
INSURED The Davis Company
DBA: Michael Davis
5SS University Ave Ste 116
Sacramento, CA 95825
INSURERA: Hartford Casualty Ins Company 29424
INSURERS: PHILADELPHIA INDEMNITY INS CO
INSURERC
IN R6:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
kDD'L
hm
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE IMMIDDIVY1
POLICY EXPIRATIONLTR
LIMITS
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
32400 Paseo
GENERAL LIABILITY
57SBAG36006
07/29/2003
07/29/2004
EACH OCCURRENCE $ 1,000,00
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED $ 300,000
CLAIMS MADE M OCCUR
MED EXP (Any one person) $ 10,000
A
PERSONAL 8 ADV INJURY $ 1,000,000
GENERALAGGREGATE $ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGO $ 2,000,00
POLICY PRO LOC
JECT
AUTOMOBILE
LIABILITY
57SBAGJ6006
07/29/2003
07/29/2004
COMBINED SINGLE LIMIT
ANY AUTO
(Ea accident) $ 1,000,00
BODILY INJURY $
ALL OWNED AUTOS
SCHEDULED AUTOS
(Per person)
A
BODILY INJURY $
X
HIRED AUTOS
X
NON -OWNED AUTOS
(Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
ANY AUTO
AUTO ONLY: AGO $
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE $
OCCUR rj CLAIMS MADE
AGGREGATE $
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
WC ,IT OTH-
EMPLOYERS' LIABILITY
E L. FACH ACCIDENT $
ANY PROPRIETORIPARTNEWEXECUTWE
E. L. DISEASE - EA EMPLOYE $
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
EL.DISEASE - POLICY LIMIT I $
roYessional
PHSDO58786
06/11/2004
06/11/2005
$1000000 Per Claim Limit
Liability
B
$1000000 Per Aggregate Limit
$5,000 Retention
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
ertificate holder is named as Additional Insured per form SS00080401 with respects to general
liability arising out of the operations performed by the named insured
30 day notice of cancellation for non-payment of premium
CFRTIFICATF Mrd nFR CAVI I. LATION
ACORD 26 (2001108) OACORD CORPORATION 1988
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
City of San
Juan Capistrano
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
Attn: Cindy
Russell
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
32400 Paseo
Adel anto
OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVE&
AUTHORIZED REPRESENTATIVE
San Juan Capistrano, CA 92675
ACORD 26 (2001108) OACORD CORPORATION 1988
W,
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2007/08)
E
Maria Guevara
0
From: Maria Guevara
Sent: Friday, December 10, 2004 10:13 AM fl JI
To: Julia Silva n
Subject: The Davis Company
Hi Julia,
I just want to inform you that I haven't received the workers comp insurance for T e Davis Company.
I will be adding them to the non -pay list next Friday.
Thanks,
Maria Guevara, Administrative Secretary
City of San Juan Capistrano
City Clerk Division
(949) 443-6309
NOV-5-2004 02:54P FROM:THE DACOMPANY 19165679540 019494683874P112 P:1,2
MICHAEL DAVIS
JAMES D. WILLIAMS
D s
The Davis Company
FAX MESSAGE
TO: Julia Silva
FROM: Mike Davis
FAX °^O ""�'�
SUBJECT:
DATE: 11-5-04
PAGES (including cover sheet): 2
MESSAGE:
Mike said he will work on g etting on for your City. Hope this will do for now.
Sheila
555 University Avenue, Suite 116, Sacramento, CA 95825 916.567.9510 ILL 916.567.9540 FAX
11 150 Santa Monica Blvd., Suitc 230, Los Angeles, CA 90025 310.473.1457 T EL 310.575.9739 FAX
NOV-5-2004 . 02:54P FROM:THE DA COMPANY 19165679540 019494883874P112 P:2/2
CER -h•^, ! DER COPY
STAMS P.O. BOX 420307, SAN FRANCISCO, CA 94142-0807
COMPENSAT.ON
. s RA NGE
Fu N iDl CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATRe 10-28-2004 GROUP:
POLICY HUMBER: 1759670-2004
CERTIFICATE ID: 4
CERTIFICATE EXPIRES 10-01-2005
4-.-OI-_701:'0-01-2005
01r8ICE OF Tim CITY CLERK
16600 CIVIC CENTER DR.
SILLFLOwIR CA 907095494
This is to renrFj that we have issued a valid Worker's compensation insurance policy in a form approved by the California
Insurance Ccrnmissionar to the employer named below for the policy period indicated.
This policy Ia not subject to, cancellation by the Fund except upon 10 days advan�e written notice to the employer -
We will also qh•e you 10 days advance notice should this policy be cancelied prlo> td its normal expirafon. _
Thosw:tm..� .' is sc:s^ce z not an insurance !icy a.^.d docs net a?nend. e? ta+ or agar the caverdfle afforded by the
polity listed Herein. Notwithstanding any requirement, term or condition of any cork react or other document with
respect to which tht certificate of irtsumnce may be issued or to which it may pertain, the insurance afforded by the policy
described herein is subjuu io aii the Terms, exciustons, arid Wnuitiu,tb, of bush poky.
JYIIIIV-�- :.r.GSG:.:.�up
Arte
wc90T!T,
STANDARD POLICY EXCLUSIONS! XNDIVIDUAL MMLOYBES, HUBBaND AND WIFE WELOYSRS,
WVLOYi:SH cc-im BD UNDER CPL INSURANCE AND EXPL40YERS =CLW D UNDER CALIFORNIA.
WORXERF COMPENSATION LAW.
gtipLOXb;R'S r>nrr.Imv- rTLZ
ET r.,rnlrC-DS,—RN$L COSTES $1, Ov D; 000 PIS O^.."Z.7'RtANCB-
Z6PL ,v
DAVIS, HICHAEL DHA: THE DAVIS COMPANY
555 VWXWERSITY AVB STI 116
SlA —A � .-za C;� 1x065
1
SC''lUsi2� i aoliM eMYlwwarYNwu �c aaim mnreeG•oFF1=sfiW FUND DOMM r•^'='
Maria Guevara
From: Maria Guevara
Sent: Friday, November 05, 2004 1:32 PM 1)� y/ \� w
To: Julia Silva ) V`
Subject: RE: Insurance
He doesn't if there are no other employees, in that case he needs to either fill out a form we have or
send us a letter stating that he doesn't have any employees.
-----Original Message -----
From: Julia Silva
Sent: Friday, November 05, 2004 12:38 PM
To: Maria Guevara
Subject: RE: Insurance
Maria,
Mike Davis has worked alone on our project -- does he still need worker's comp ins?
-----Original Message -----
From: Maria Guevara
Sent: Friday, November 05, 2004 9:16 AM
To: Julia Silva
Subject: Insurance
in
I never received workers comp for The Davis Company. I need to add them to the non -pay
list. Can you check with the before I do.
Thanks,
Maria Guevara, Administrative Secretary
City of San Juan Capistrano
City Clerk Division
(949) 443-6309
Aft
^ C
ALCOW, CERTIFICA IIABILITYINSUcATEIsI S
DATE (MM/DDIYYYY)
08/(30/2004
PR(5S9�OF7L
Pan American Underwriters Inc
License #0132491
P 0 Box 3947
Fresno, CA 93650
IS D AS O1
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC #
INSURED The Davis Company
DBA: Michael Davis
SSS University Ave Ste 116
Sacramento, CA 95825
INSURERA: Hartford Casualty Ins Company 29424
INSURER B: PHILADELPHIA INDEMNITY INS CO
INSURER C:
INSURER
INSURER E.
nnVFRAf.FS
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDIN
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTA
DD'TYpE
NqR9DATE
OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
imminn,vyi
POLICY EXPIRATION
LIMITS
GENERAL LIABILITY
57SBAG36006
07/29/2004
07/29/2005
EACH OCCURRENCE $ 1,000,00
X COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED $ 360,000
CLAIMS MADE FX OCCUR
MED EXP (Any one person) $ 10,000
A
PERSONAL BADV INJURY $ 1,000,00
GENERAL AGGREGATE $ 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER.
PRODUCTS - COMPIOP AGG $ 2,000,00
POLICY PRO-
JECT M LOC
AUTOMOBILE
LIABILITY
ANY AUTO
57SBAGJ6006
07/29/2004
07/29/2005
COMBINED SINGLE LIMIT
(Ea aooidenU $ 1,000,00
BODILY INJURY $
(Per person)
A
X
X
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY
(Per accident $
PROPERTY DAMAGE $
IPer eceidenl)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EA ACC $
ANY AUTO
AUTO ONLY: AGG $
EXCESSIUMBRELLA LIABILITY
EACH OCCURRENCE $
OCCUR EJ CLAIMS MADE
AGGREGATE $
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
WCSTATU- OTH-
EMPLOYERS' LIABILITY
ANY PROPRIETORIPARTNEWEXECUTIVE
OFFICERM/EMBER EXCLUDED?
E . EACH ACCIDENT 5
E. L. DISEASE - EA EMPLOYE $
If yes, describB under
SPECF�IAeL PROVISIONS below
E. L. DISEASE - POLICY LIMIT $
B
rOTesSlonal Liability
PHSD092285
06/11/2004
06/11/2005
$1,000,000 Per Claim Limit
$1,000,000 Per Aggregate Lmt
$5,000 Retention
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
ertificate holder is named as Additional Insured per form SS00080401 with respects to general
liability arising out of the operations performed by the named insured
10 day notice of cancellation for non-payment of premium
City of San Juan Capistrano
Attn: J. Silva
Human Resources Manager
32400 Paseo Adelanto
San Juan Capistrano, CA 92675
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
AUTHORIZED REPRESENTATIVE
ACORD 25 (2001/08) FAX: (949)493-IUS3 CACORD CORPORATION 1988
(b) That is Fire insurance for premises
rented to you or temporarily
occupied by you with permission of
the owner;
(c) That is insurance purchased by you
to cover your liability as a tenant for
'property damage' to premises
rented to you or temporarily
occupied by you with permission of
the owner; or
(d) If the loss arises out of the
maintenance or use of aircraft,
autos' or watercraft to the extent
not subject to Exclusion g. of
Section A. — Coverages.
(2) Any other primary insurance available to
you covering liability for damages
arising out of the premises or operations
for which you have been added as an
additional insured by attachment of an
endorsement.
When this insurance is excess over other
insurance, we will pay only our share of the
amount of the loss, if any, that exceeds the
sum of:
(1) The total amount that all such other
insurance would pay for the loss in the
absence of this insurance; and
(2) The total of all deductible and self-
insured amounts under all that other
insurance.
We will share the remaining loss, it any, with
any other insurance that is not described in
this excess of the Limits of Insurance shown
in the Declarations of this Coverage Part.
c. Method of Sharing
If all the other insurance permits contribution
by equal shares, we will follow this method
also. Under this approach, each insurer
contributes equal amounts until it has paid
its applicable limit of insurance or none of
the loss remains, whichever comes first.
If any of the other insurance does not permit
contribution by equal shares, we will
contribute by limits. Under this method,
each insurer's share is based on the ratio of
its applicable limit of insurance to the total
applicable limits of insurance of all insurers.
This provision provides such insurance as is
afforded under this coverage form, but only
with respect to your operations, 'your work'
or facilities owned or used by you.
E gESS LIABILITY COVERAGE FORM
F. OPTIONAL COVERAGES
If listed or shown as applicable in the Declarations,
one or more of the following Optional Coverages also
apply. These coverages are subject to the terms and
conditions applicable to Business Liability Coverage
in this policy, except as provided below:
1. Additional Insured - Designated Person or
Organization
WHO IS AN INSURED under Section C. is
amended to include as an insured'the person or
organization shown in the Declarations, but only
with respect to liability arising out of your
operations or premises owned by or rented to
you.
2. Additional Insured - Managers or Lessors of
Premises
a. WHO IS AN INSURED under Section C. is
amended to include as an insured the
person(s) or organization(s) shown in the
Declarations; but only with respect to liability
arising out of the ownership, maintenance or
use of that part of the premises leased to
you and shown in the Declarations and
subject to the following additional
exclusions:
b. Additional Exclusions
This insurance does not apply to:
(1) Any 'occurrence' which takes place
after you cease to be a tenant in that
premises; or
(2) Structural alterations, new construction
or demolition operations performed by or
for that person or organization.
3. Additional Insured - Grantor of Franchise
WHO IS AN INSURED under Section C. is
amended to include as an insured the person(s)
or organization(s) shown in the Declarations, but
only with respect to their liability as grantor of
franchise to you.
4. Additional Insured - Lessor of Leased
Equipment
a. WHO IS AN INSURED under Section C. is
amended to include as an insured the
person(s) or organization(s) shown in the
Declarations, but only with respect to their
liability arising out of the maintenance,
operation or use by you of equipment leased
to you by such person(s) or organization(s).
b. Additional Exclusions:
This insurance does not apply:
Form SS 00 08 04 01 Page 16 of 20
3USINESS LIABILITY COVERAC -ORM •
(1) To any 'occurrence' which takes place
(a) 'Bodily injury' or 'property damage'
after the equipment lease expires; or
for which the vendor is obligated to
(2) To 'bodily injury' or 'property damage'
pay damages by reason of the
arising out of the sole negligence of the
assumption of liability in a contract
lessor.
or agreement.
5. Additional Insured - Owners or Other
This exclusion does not apply to
Interests From Whom Land Has Been Leased
liability for damages that the vendor
WHO IS AN INSURED under Section C. is
would have in the absence of the
amended to include as an insured the person or
contract or agreement;
organization shown in the Declarations, but only
(b) Any express warranty unauthorized
with respect to liability arising out of the
by you;
ownership, maintenance or use of that part of the
(c) Any physical or chemical change in
land leased to you and shown in the
the product made intentionally by
Declarations and subject to the following
the vendor;
additional exclusion:
(d) Repackaging, unless unpacked
This insurance does not apply to:
solely for the purpose of inspection,
a. Any 'occurrence' that takes place after you
demonstration, testing, or the
cease to lease that land; or
substitution of parts under
b. Structural alterations, new construction or
instructions from the manufacturer,
demolition operations performed by or for
and then repackaged in the original
the person or organization shown in the
container;
Declarations.
(e) Any failure to make such
6. Additional Insured - State or Political
inspections, adjustments, tests or
Subdivision - Permits
servicing as the vendor has agreed
a. WHO IS AN INSURED under Section C. is
to make or normally undertakes to
amended include s an insured the state
make in the usual course of
politicalal subdivision shown in the
business, in connection with the
D
Declarations, but only with respect to
distribution or sale of the products;
operations performed by you or on your
(f) Demonstration, installation,
behalf for which the state or political
servicing or repair operations,
subdivision has issued a permit.
except such operations performed
b. Additional Exclusions
at the vendors premises in
This insurance does not apply to:
connection with the sale of the
product;
(1) 'Bodily injury', 'property damage' or
'personal
Products
s which, (g) Productch, atter distribution or
and advertising injury' arising
sale e
youhave been labeled or
out of operations performed for the state
relabeled or used a container,
or political subdivision; or
part or ingredient of any other thing
(2)'Bodily injury' or 'property damage'
or substance by or for the vendor.
included in the 'product -completed
operations' hazard.
(2) This insurance does not apply to any
7. Additional Insured - Vendors
insured person or organization, from
whom you have acquired such products,
a. WHO IS AN INSURED under Section C. is
or any ingredient, part dr container,
amended to include as an insured the
entering into, accompanying or
person(s) or organization(s) (referred to
containing such products.
below'as vendor) shown in the Declarations,
(3) This Provision 7. does not apply to any
but only with respect to 'bodily injury' or
vendor included as an insured by an
property damage' arising out of 'your
endorsement issued by us and made a
products' which are distributed or sold in the
part of this Coverage Form.
regular course of the vendors business.
b. Additional Exclusions
(1) The insurance afforded the vendor does
not apply to:
Page 16 of 20 Form SS 00 08 04 01
Form SS 00 08 04 01 Page 17 of 20
` �•
E•.17ESS LIABILITY COVERAGE FORM
(4) This Provision 7. does not apply if 'bodily
However, 'advertisement' does not include:
injury' or 'property damage' included
a. The design, printed material, information or
within the 'products -completed operations
images contained in, on or upon the
hazard' is excluded either by the
packaging or labeling of any goods or
provisions of this Coverage Form or by
products; or
endorsement.
b. An interactive conversation between or
8. Additional Insured – Controlling Interest
among persons through a computer network.
WHO IS AN INSURED under Section C. is
2,
'Advertising idea' means any idea for an
amended to include as an insured the person(s)
advertisement'.
or organization(s) shown in the Declarations but
bnly with respect to their liability arising out of:
3.
'Auto' means a land motor vehicle, trailer or
semi -trailer designed for travel on public roads,
o
a. Their financial control of you; or
including any attached machinery or equipment.
N
b. Premises they own, maintain or control while
But 'auto' does not include 'mobile equipment'.
you lease or occupy these premises.
4.
'Bodily injury'means bodily injury, sickness or
This insurance does not apply to structural
disease sustained by a person, including mental
o
alterations, new construction and demolition
anguish or death resulting from any of these at
0
operations performed by or for that person or
any time.
organization.
5.
'Coverage territory' means:
9. Additional Insured – Owners, Lessees or
E
Contractors – Scheduled Person or
a. The United States of America (including its
Organization.
territories and possessions), Puerto Rico
N
and Canada;
WHO IS AN INSURED under Section C. is
b. International waters or airspace, but onlyif
amended to include as insured the person or
the injury or damage occurs in the course of
*
organization shown in the Declarations, but only
travel transportation between any places
—_
with respect to liability arising out of your
included in a. above;
=_
ongoing operations performed for that insured.
10. Additional Insured – Co -Owner of Insured
C. All other parts of the world if the injury or
=
Promises
damage arises out of:
=
WHO IS AN INSURED under Section C. is
(1) Goods or products made or sold by you
=_
amended to include as an insured the parson(s)
in the territory described in a. above;
or Organization(s) shown in the Declarations, but
(2) The activities of a person whose home
only with respect to their liability as co-owner of
is in the territory described in a. above,
the premises shown in the Declarations.
but is away for a short time on your
G. LIABILITY AND MEDICAL EXPENSES
business; or
DEFINITIONS
(3) 'Personal and advertising injury'
offenses that take place through the
—
1. 'Advertisement' means the widespread public
Internet or similar electronic means of
=_
dissemination of information or images that has
communication
the purpose of inducing the sale of goods,
provided the Insureds responsibility to pay
—
products or services through:
damages is determined in the United States of
a. (1) Radio;
America (including its territories and possessions),
(2) Television;
Puerto Rico or Canada, in a suit on the merits
(3) Billboard;
according to the substantive law in such territory, or
in a settlement we agree to.
(4) Magazine;
6.
'Employee' ' includes a 'leased worker'.
—
(5) Newspaper;
'Employee' does not include a 'temporary
c
b. The Internet, but only that part of a web site
worker'.
that is about goods, products or services for
7,
'Executive officer means a person holding any
the purposes of inducing the sale of goods,
of the officer positions created by your charter,
products or services; or
constitution, by-laws or any other similar
c. Any other publication that is given
governing document.
widespread public distribution.
Form SS 00 08 04 01 Page 17 of 20
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may
require an endorsement. A statement on this certificate does not confer rights to the certificate
holder in lieu of such endorsement(s).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it
affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.
ACORD 25 (2001108)