HomeMy WebLinkAboutJDK CONSULTING - 2004-08-08• (, F- a-� � � a �r�r• �eV��CONTRACTS SUBMITTAL'-° '�
CITY CLERK'S OFFICE AUG [AN 9: 47
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To: JOAN FLYNN, City Clerk
Name of Contractor: JDK CONSULTING
Purpose of Contract: For Example: Audit Services or Water Quality Testing Huntington Lake -Huntington Central Park
Housing Rehabilitation Loan Program
Amount of Contract: Not to exceed $60,000.00.
Copy of contract distributed to: The or insurance certificate/waiver distributed
❑
Initiating Dept. ❑ to Risk Management
City Treasurer ❑ ORIGINAL bonds sent to Treasurer ❑
Nam %Extensior/
City Attorney's Office
f
Date: C
�1 7
AMENDMENT NO. 2 TO PROFESSIONAL SERVICES CONTRACT
BETWEEN THE CITY OF HUNTINGTON BEACH AND
JDK CONSULTING FOR CONSULTING SERVICES IN CONNECTION
WITH THE HOUSING REHABILITATION LOAN PROGRAM
THIS AMENDMENT NO. 2 is made and entered into by and between the City of
Huntington Beach, a municipal corporation of the State of California, hereinafter referred to as
"CITY, and JDK CONSULTING, a sole proprietorship, hereinafter referred to as
"CONSULTANT."
WHEREAS, CITY and CONSULTANT are parties to that certain agreement, dated
August 8, 2004, entitled "Professional Services Contract Between the City of Huntington Beach
and JDK Consulting for Consulting Services in Connection with the Housing Rehabilitation
Loan Program" which agreement shall hereinafter be referred to as the "Original Agreement,"
and
Since its execution, CITY and CONSULTANT wish to amend the Original Agreement to
reflect additional compensation to be paid to CONSULTANT,
NOW, THEREFORE, it is agreed by CITY and CONSULTANT as follows:
1. ADDITIONAL COMPENSATION
Section 4 of the Original Agreement, entitled "Compensation," is hereby amended
to read as follows:
4. COMPENSATION
In consideration of the performance of the services described herein,
CITY agrees to pay CONSULTANT on a time and materials basis at the rates specified
in Exhibit "B," which is attached hereto and incorporated by reference into this
Agreement, an additional fee not to exceed $10,000, including all costs and expenses.
This additional sum shall be added to the original sum of $40,000, previously amended to
$50,000, for a new total contract amount of Sixty Thousand Dollars ($60,000.00).
06-334/2828
2. REAFFIRMATION
Except as specifically modified herein, all other terms and conditions of the
Original Agreement shall remain in frill force and effect.
Executed this � � — day of v v � _ 2006 by
and through the authorized officers of the paties hereto
CONSULTANT,
JDK CONSULTIN , a sole proprietorship
By:
Jo ce deKreek, proprietor
CITY OF HUNTINGTON BEACH,
a municipal corporation of the State of California
f?4-
Director o Economic Dev ent
(Pursuant To HBMC , 3. 03.100)
APPROVED AS TO FORM:
City Attorney 11L1
A(UP
I � t
REVIEWED AND APPROVED:
City Admimstrat r
(only for contracts $50, 000.00 and over)
06-334/2828 2
oE,oNTING;,,-
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1. Date
2. Department
3. Requested by
CITY OF HUNTINGTON BEACH
Professional Service Contracts
Purchasing Certification
July 17, 2006
Economic Development
Terri King
4. Name of consultant: JDK Consulting
5. Attach the written statement of the specification, conditions and other requirements for
the requested services that was provided to solicited consultants in your answer to 11
of this form. , IZIIg
6. Amount of the contract: $60,000.00
7. Are sufficient funds available to fund this contract?' ® Yes, ❑ No
8. Company number and object code where funds are budgeted: 86880301.69365
9. Is this contract generally described on the list of professional service contracts
approved by the City Council'? ® Yes, ❑ No
10. Is this contract within $25,000 or 25% (whichever is less) of the amount stated on the
list of professional service contracts approved by the City Council?'
® Yes, ❑ No
11. Were (at least) informal written proposals requested of three consultants?
❑ Yes, ® No
Explanation: Contract needs to be amended to increase monetary limit.
12. Attach list of consultants from whom proposals were requested (including a contact
telephone number).j�g
13. Attach proposed scope of work. A j�
14. Attach proposed payment schedule. 'A-1/i9
Department Head Signature
Purchasin
I JCI V II.CJ
If the answer to any.these questions is "No," the contract will require approval from the City Council.
Professional Services Contract Purchasing Certification June 2006
Lr
To:
, City Clerk
Contracts Submittal to
City Clerk's Office
1. Name of Contractor: JDK Consulting
2. Purpose of Contract: For Example: Audit Services or Water Quality Testing Huntington Lake — Huntington Central Park
Consulting services with Housing Rehabilitation Loan Program
3. Amount of Contract: $50,000
Copy of contract distributed to: The ORIGINAL insurance certificate/waiver sent to Risk
Management
Initiating Dept._
Citv Treasurer ORIGINAL bonds sent to Treasurer
City Attorney's Office
Date:
g:/Attymisc/forms/city clerk contract transmittal.doc
CITY CLERK'S OFFICE USE ONLY:
C J �% 6=f
AMENDMENT NO. I TO PROFESSIONAL SERVICES CONTRACT
BETWEEN THE CITY OF HUNTINGTON BEACH AND
JDK CONSULTING FOR CONSULTING SERVICES IN CONNECTION
WITH THE HOUSING REHABILITATION LOAN PROGRAM
THIS AMENDMENT NO. 1 is made and entered into by and between the City of
Huntington Beach, a municipal corporation of the State of California, hereinafter referred to as
"CITY, and JDK CONSULTING, a sole proprietorship, hereinafter referred to as
"CONSULTANT."
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WHEREAS, CITY and CONSULTANT are parties to that certain agreement, dated
August 8, 2004, entitled "Professional Services Contract Between the City of Huntington Beach
and JDK Consulting for Consulting Services in Connection with the Housing Rehabilitation
Loan Program" which agreement shall hereinafter be referred to as the "Original Agreement,"
and
Since its execution, CITY and CONSULTANT wish to amend the Original Agreement to
reflect additional compensation to be paid to CONSULTANT,
NOW, THEREFORE, it is agreed by CITY and CONSULTANT as follows:
1. ADDITIONAL COMPENSATION
Section 4 of the Original Agreement, entitled "Compensation," is hereby amended
to read as follows:
4. COMPENSATION
In consideration of the performance of the services described herein,
CITY agrees to pay CONSULTANT on a time and materials basis at the rates specified
in Exhibit "B," which is attached hereto and incorporated by reference into this
Agreement, a fee, including all costs and expenses, not to exceed Fifty Thousand Dollars
($50,000.00).
05agree/jdkamend I
2. REAFFIRMATION
Except as specifically modified herein, all other terms and conditions of the
Original Agreement shall remain in full force and effect.
Executed by and through their authorized officers December 23, 2005.
CONSULTANT,
JDK CONSULTING a sole proprietorship CITY OF HUNTINGTON BEACH,
a municipal corporation of the State of California
By:
Jo e deKreek, proprietor
Directo f Economi velopment
(Pursuant To HBMC .03.100)
APMOVED AS TO FORM:.
i
City Attorn
il ),C;-55 1
REVIEWED AND APPROVED:
City Administra r
(only for contracts $50, 000.00 and over)
05agreeljdkamend 2
EXHIBIT "B"
Payment Schedule (Hourly Payment)
A. Hourly Rate
CONSULTANT'S fees for such services shall be based upon the following hourly rate and cost schedule: Sixty Dollars
($60.00) per hour, which rate includes payment for CONSULTANT's costs and expenses.
B. Travel
Charges for time during travel are normally not reimbursable and will only be paid if such time is actually
used in performing services for CITY or as otherwise arranged with CITY.
As CITY sometimes uses consultants that are outside of the nearest metropolitan area, CITY is very
conscious of travel costs. Subject to agreement otherwise, CONSULTANT will be held to charging no
fees on travel time to or from Huntington Beach.
Automobile expenses are limited to Twenty-seven Cents ($0.27) per mile. All other travel expenses must
be approved in advance by CITY in writin g. Requests for approval shall be submitted at least fourteen
(14) days in advance, to allow for reduced transportation fares. Meals are not billable to CITY, without
prior written consent of CITY.
C. Billing
l . All billing shall be done monthly in one -tenth -hour (0.10) increments and matched to an appropriate
breakdown of the time that was taken to perform that work and who performed it.
Minimum billing charges are unacceptable. CONSULTANT shall only charge for actual time spent. For
example, minimum of 0.2 hours for phone calls or 0.4 hours for letters is unreasonable unless that is an
accurate measure of time spent.
2. Each month's bill should include a total to date. That total should provide, at a glance, the total fees and
costs incurred to date for the case or matter.
3. Telephone, cellular phone and postage charges are billable at actual cost. A copy of all service bills/costs
should accompany the billing for each single item that exceeds Seventy -Five Dollars ($75.00). The fee
for the sending or receiving of facsimiles shall not exceed Twenty-five Cents ($0.25) per page. CITY
will not pay a fee or charge for telephone calls or facsimiles to CITY. Photocopier costs should be no
more than the actual cost of duplication, or Ten Cents ($0.10) per page, whichever is less.
4. CITY will not pay for secretarial time or secretarial overtime. CITY will not pay for secretarial tasks or
tasks that should be subsumed into CONSULTANT's overhead. For example, time spent for faxing,
mailing, arranging for messengers and calendaring are not acceptable charges.
5. CITY will not pay for word processing charges. This includes per page or hourly charges.
6. CITY will not pay for billing or discussion of bills. If CITY has questions about billing or needs
additional information on bills, that is not a chargeable event; CONSULTANT should respond without
charging CITY for the time required.
7. CITY appreciates when CONSULTANT has researched an issue previously and uses that research on the
present case. CITY has retained CONSULTANT because of its past experience. CONSULTANT shall
not charge CITY for work it has done and billed another client for in the past.
8. Delivery of work product: A copy of every memorandum, letter, report, calculation and other
documentation prepared by CONSULTANT shall be submitted to CITY to demonstrate progress toward
04agree/jdk consulting/7/21/4
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EXHIBIT "B" •
Payment Schedule (Hourly Payment)
completion of tasks. In the event CITY rejects or has comments on any such product, CITY shall identify
specific requirements for satisfactory completion.
CONSULTANT shall submit to CITY an invoice for each monthly payment due. Such invoice shall:
A) Reference this Agreement;
13) Describe the services performed;
C) Show the total amount of the payment due;
D) Include a certification by a principal member of CONSULTANT's firm that the work has been
performed in accordance with the provisions of this Agreement; and
E) For all payments include an estimate of the percentage of work completed.
Upon submission of any such invoice, if CITY is satisfied that CONSULTANT is making satisfactory
progress toward completion of tasks in accordance with this Agreement, CITY shall approve the invoice,
in which event payment shall be made within thirty (30) days of receipt of the invoice by CITY. Such
approval shall not be unreasonably withheld. If CITY does not approve an invoice, CITY shall notify
CONSULTANT in writing of the reasons for non -approval and the schedule of performance set forth in
Exhibit "A" may at the option of CITY be suspended until the parties agree that past performance by
CONSULTANT is in, or has been brought into compliance, or until this Agreement has expired or is
terminated as provided herein.
10. Any billings for extra work or additional services authorized in advance and in writing by CITY shall be
invoiced separately to CITY. Such invoice shall contain all of the information required above, and in
addition shall list the hours expended and hourly rate charged for such time. Such invoices shall be
approved by CITY if the work performed is in accordance with the extra work or additional services
requested, and if CITY is satisfied that the statement of hours worked and costs incurred is accurate.
Such approval shall not be unreasonably withheld. Any dispute between the parties concerning payment
of such an invoice shall be treated as separate and apart from the ongoing performance of the remainder
of this Agreement.
04agree/jdk consulting/7/21/-4
PROFESSIONAL SERVICE CONTRACT9
PURCHASING CERTIFICATION
1. Requested by: Terri King, Economic Development Department
2. Date: a zc; _a-00y
3. Name of consultant: JDK Consulting
4. Description of work to be performed.- Construction . Consulting Services in
connection with the City of HB Housing Rehabilitation Loan Program
5. Amount of the contract: $20,000 per year (2 Yr contract)
6. Are sufficient funds available to fund this contract?' ® Yes, ❑ No
7. Company number and object code where funds are budgeted: 866.80301
8. Is this contract generally described on the list of professional service contracts
approved by the City Council'? ® Yes, ❑ No
9. Is this contract within $25,000 or 25% (whichever is less) of the amount stated on
the list of professional service contracts approved by the City Council?'
® Yes, ❑ No
10. Were (at least) informal written proposals requested of three consultants?
® Yes, ❑ No
11. Attach list of consultants from whom proposals were requested (including a
contact telephone number).
12. Attach proposed scope of work.
13. Attach proposed payment schedule.
1
I ARD . AURIL, M nag r
Purchasing/Central Services
1 If the answer to any these questions is "No," the contract will require approval from the City Council.
su ity INSURANCE AND INDEMNIFICATION WAIVER
,m. &&-ha MODIFICATION REQUEST
1. Requested by: Stanley Smalewitz
2. Date: April 21, 2006
3. Name of contractor/permittee: JDK Consulting
4. Description of work to be performed: Rehabilitation/construction consulting
5. Value and length of contract: 2 yrs/amendment to increase contract from $40,000 to
50 000
6. Waiver/modification request: Waive E & O requirements (waived prior)
7. Reason for request and why it should be granted: cost too exorbitant for consultant and
due to unusual nature of work, not easily obtainable.
8. Identify the risks to the City in approving this waiver/modification: Risk is minimal.
D60artment Head Signature
/ Date:
APPROVALS
Approvals must be obtained in the order listed on this form. Two approvals are required
for a request to be granted. Approval from the City Administrator's Office is only required if
Risk Management and tob City Attorney's Office disagree.
1. Ri k Management '
Approved ❑ Denied Z z2z, n
Signature Date
2. ity Attorney's Office -
pproved El Denied e �h.
Signature V Date
3. City Administrator's Office
❑ Approved ❑ Denied
Signature Date
If approved, the completed waiver/modification request is to be submitted to the
City Attorney's Office along with the contract for approval. Once the contract has been approved,
this form is to be filed with the Risk Management Division of Administrative Services
Uf ►ty\
\Hum ig of Read
To: Connie Brockway, City Clerk
Contracts Submittal to
City Clerk's Office
1. Name of Contractor: JDK Consulting
2. Purpose of Contract: For Example: Audit Services or Water Qualim Testing Huntington Lake— Huntington Central Park
Consultingin connection with Housing Rehabilitation Loans
3. Amount of Contract: $40,000.00
Copy of contract distributed to: The ORIGINAL insurance certificate/waiver sent to Risk
Management
Initiating Dept._
City Treasurer ORIGINAL bonds sent to Treasurer
CITY CLERK'S OFFICE USE ONLY:
City Attorney's Office
Date: 8/12/04
g:/Attymisc/forms/city clerk contract transmittal.doc
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PROFESSIONAL SERVICES CONTRACT BETWEEN
THE CITY OF HUNTINGTON BEACH AND
JDK CONSULTING FOR CONSULTING SERVICES IN CONNECTION
WITH THE HOUSING REHABILITATION LOAN PROGRAM
THIS AGREEMENT ("Agreement") is made and entered into by and between the City of
Huntington Beach, a municipal corporation of the State of California, hereinafter referred to as
"CITY, and JDK CONSULTING, a sole proprietorship hereinafter referred to as
"CONSULTANT."
WHEREAS, CITY desires to engage the services of a consultant to provide construction
consulting services in connection with the CITY's Housing Rehabilitation Loan Program; and
Pursuant to documentation on file in the office of the City Clerk, the provisions of the
Huntington Beach Municipal Code, Chapter 3.03, relating to..procurement of professional service
contracts have been complied with; and
CONSULTANT has been selected to perform these services,
NOW, THEREFORE, it is agreed by CITY and CONSULTANT as follows:
1. SCOPE OF SERVICES
CONSULTANT shall provide all services as described in Exhibit "A," which is
attached hereto and incorporated into this Agreement by this reference. These services shall
sometimes hereinafter be referred to as the "PROJECT."
CONSULTANT hereby designates Joyce deKreek who shall represent it and be
its sole contact and agent in all consultations with CITY during the performance of this
Agreement.
04agree/jdk consulting/7/21/04 I
2. CITY STAFF ASSISTANCE
CITY shall assign a staff coordinator to work directly with CONSULTANT in the
performance of this Agreement.
3. TERM; TIME OF PERFORMANCE
Time is of the essence of this Agreement. The services of CONSULTANT are to
commence on U " g ' `{ , 2004 (the "Commencement Date"). This Agreement
shall automatically terminate two (2) years from the Commencement Date, unless extended or
sooner terminated as provided herein. All tasks specified in Exhibit "A" shall be completed no
later than two years from the Commencement Date. The time for performance of the tasks
identified in Exhibit "A" are generally to be shown in Exhibit "A." This schedule may be
amended to benefit the PROJECT if mutually agreed to in writing by CITY and
CONSULTANT.
4. COMPENSATION
In consideration of the performance of the services described herein, CITY agrees
to pay CONSULTANT on a time and materials basis at the rates specified in Exhibit "B,"
which is attached hereto and incorporated by reference into this Agreement, a fee, including all
costs and expenses, not to exceed Forty Thousand Dollars ($40,000.00).
5. EXTRA WORK
In the event CITY requires additional services not included in Exhibit "A" or
changes in the scope of services described in Exhibit "A," CONSULTANT will undertake such
work only after receiving written authorization from CITY. Additional compensation for such
extra work shall be allowed only if the prior written approval of CITY is obtained.
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6. METHOD OF PAYMENT
CONSULTANT shall be paid pursuant to the terms of Exhibit "B."
7. DISPOSITION OF PLANS, ESTIMATES AND OTHER DOCUMENTS
CONSULTANT agrees that title to all materials prepared hereunder, including,
without limitation, all original drawings, designs, reports, both field and office notices,
calculations, computer code, language, data or programs, maps, memoranda, letters and other
documents, shall belong to CITY, and CONSULTANT shall turn these materials over to CITY
upon expiration or termination of this Agreement or upon PROJECT completion, whichever
shall occur first. These materials may be used by CITY as it sees fit.
8. HOLD HARMLESS
CONSULTANT hereby agrees to protect, defend, indemnify and hold harmless
CITY, its officers, elected or appointed officials, employees, agents and volunteers from and
against any and all claims, damages, losses, expenses, judgments, demands and defense costs
(including, without limitation, costs and fees of litigation of every nature or liability of any kind
or nature) arising out of or in connection with CONSULTANT's (or CONSULTANT's
subcontractors, if any) negligent performance of this Agreement or its failure to comply with any
of its obligations contained in this Agreement by CONSULTANT, its officers, agents or
employees except such loss or damage which was caused by the sole negligence or willful
misconduct of CITY. CONSULTANT will conduct all defense at its sole cost and expense and
CITY shall approve selection of CONSULTANT's counsel. This indemnity shall apply to all
claims and liability regardless of whether any insurance policies are applicable. The policy
limits do not act as limitation upon the amount of indemnification to be provided by
CONSULTANT.
04agree/jdk c011sultine/7/21/04 3
9. PROFESSIONAL LIABILITY INSURANCE
CONSULTANT shall obtain and furnish to CITY a professional liability
insurance policy covering the work performed by it hereunder. This policy . shall provide
coverage for CONSULTANT's professional liability in an amount not less than One Million
Dollars ($1,000,000.00) per occurrence and in the aggregate. The above -mentioned insurance
shall not contain a self -insured retention, "deductible" or any other similar form of limitation on
the required coverage except with the express written consent of CITY. A claims -made policy
shall be acceptable if the policy further provides that:
A. The policy retroactive date coincides with or precedes the initiation of the
scope of work (including subsequent policies purchased as renewals or
replacements).
B. CONSULTANT shall notify CITY of circumstances or incidents that
might give rise to future claims.
CONSULTANT will make every effort to maintain similar insurance during the
required extended period of coverage following PROJECT completion. If insurance is
terminated for any reason, CONSULTANT agrees to purchase an extended reporting provision
of at least two (2) years to report claims arising from work performed in connection with this
Agreement.
10. WORKERS' COMPENSATION AND EMPLOYER'S LIABILITY
INSURANCE
Pursuant to California Labor Code Section 1861, CONSULTANT acknowledges
awareness of Section 3700 et seq. of this Code, which requires every employer to be insured
04aeree/jA consultine/7/21/04 4
against liability for workers' compensation; CONSULTANT covenants that it will comply with
such provisions prior to commencing performance of the work hereunder.
CONSULTANT shall obtain and furnish to City workers' compensation and
employer's liability insurance in an amount of not less than the State statutory limits.
CONSULTANT shall require all subcontractor to provide such workers'
compensation and employer's liability insurance for all of the subcontractors' employees.
CONSULTANT shall furnish to CITY a certificate of waiver of subrogation under the terms of
the workers' compensation and employer's liability insurance and CONSULTANT shall
similarly require all subcontractors' to waive subrogation.
11. GENERAL PUBLIC LIABILITY INSURANCE
In addition to the workers' compensation and employer's liability insurance and
CONSULTANT's covenant to defend, hold harmless and indemnify CITY, CONSULTANT
shall obtain and furnish to CITY, a policy of general public liability insurance, including motor
vehicle coverage covering the PROJECT. This policy shall indemnify CONSULTANT, its
officers, employees and agents while acting within the scope of their duties, against any and all
claims arising out or in connection with the PROJECT, and shall provide coverage in not less
than the following amount: combined single limit bodily injury and property damage, including
products/completed operations liability and blanket contractual liability, of One Million Dollars
($1,000,000) per occurrence. If coverage is provided under a form which includes a designated
general aggregate limit, the aggregate limit must be no less than One Million Dollars
($1,000,000) for this PROJECT. This policy shall name CITY, its officers, elected or appointed
officials, employees, agents, and volunteers as Additional Insureds, and shall specifically provide
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that any other insurance coverage which may be applicable to the PROJECT shall be deemed
excess coverage and that CONSULTANT's insurance shall be primary.
Under no circumstances shall said above -mentioned insurance contain a self -insured
retention, or a "deductible" or any other similar form of limitation on the required coverage.
12. CERTIFICATES OF INSURANCE: ADDITIONAL INSURED
ENDORSEMENTS
Prior to commencing performance of the work hereunder, CONSULTANT shall
furnish to CITY certificates of insurance subject to approval of the City Attorney evidencing the
foregoing insurance coverages as required by this Agreement; the certificates shall:
A. provide the name and policy number of each carrier and policy;
B. state that the policy is currently in force; and
C. promise that such policy shall not be suspended, voided or canceled by either
party, reduced in coverage or in limits except after thirty (30) days' prior written
notice; however, ten (10) days' prior written notice in the event of cancellation for
nonpayment of premium.
CONSULTANT shall maintain the foregoing insurance coverages in force until
the work under this Agreement is fully completed and accepted by CITY.
The requirement for carrying the foregoing insurance coverages shall not derogate
from the CONSULTANT's defense, hold harmless and indemnification obligations as set forth
under this Agreement. CITY or its representative shall at all times have the right to demand the
original or a copy of all the policies of insurance. CONSULTANT shall pay, in a prompt and
timely manner, the premiums on all insurance hereinabove required.
04agree/jdk conSLdting/7/21/04 6
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CONSULTANT shall provide a separate copy of the additional insured
endorsement to each of CONSULTANT's insurance policies, naming CITY, its officers, elected
and appointed officials, employees, agents and volunteers as Additional Insureds, to the City
Attorney for approval prior to any payment hereunder.
13 INDEPENDENT CONTRACTOR
CONSULTANT is, and shall be, acting at all times in the performance of this
Agreement as an independent contractor herein and not as an employee of CITY.
CONSULTANT shall secure at its own cost and expense, and be responsible for any and all
payment of all taxes, social security, state disability insurance compensation, unemployment
compensation and other payroll deductions for CONSULTANT and its officers, agents and
employees and all business licenses, if any, in connection with the PROJECT and/or the services
to be performed hereunder.
14. TERMINATION OF AGREEMENT
All work required hereunder shall be performed in a good and workmanlike
manner. CITY may terminate CONSULTANT's services hereunder at any time with or without
cause, and whether or not the PROJECT is fully complete. Any termination of this Agreement
by CITY shall be made in writing, notice of which shall be delivered to CONSULTANT as
provided herein. In the event of termination, all finished and unfinished documents, exhibits,
report, and evidence shall, at the option of CITY, become its property and shall be promptly
delivered to it by CONSULTANT.
15. ASSIGNMENT AND DELEGATION
This Agreement is a personal service contract and the work hereunder shall not be
assigned, delegated or subcontracted by CONSULTANT to any other person or entity without
04asree/jdk consulting/7/21/04 7
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s
the prior express written consent of CITY. If an assignment, delegation or subcontract is
approved, all approved assignees, delegates and subconsultants must satisfy the insurance
requirements as set forth in Sections 9 and 10 hereinabove.
16. COPYRIGHTS/PATENTS
CITY shall own all rights to any patent or copyright on any work, item or material
produced as a result of this Agreement.
17. CITY EMPLOYEES AND OFFICIALS
CONSULTANT shall employ no CITY official nor any regular CITY employee
in the work performed pursuant to this Agreement. No officer or employee of CITY shall have
any financial interest in this Agreement in violation of the applicable provisions of the California
Government Code.
18. NOTICES
Any notices, certificates, or other communications hereunder shall be given either
by personal delivery to CONSULTANT's agent (as designated in Section 1 hereinabove) or to
CITY as the situation shall warrant, or by enclosing the same in a sealed envelope, postage
prepaid, and depositing the same in the United States Postal Service, to the addresses specified
below. CITY and CONSULTANT may designate different addresses to which subsequent
notices, certificates or other communications will be sent by notifying the other party via
personal delivery, a reputable overnight carrier or U. S. certified mail -return receipt requested:
TO CITY:
TO CONSULTANT:
City of Huntington Beach Joyce deKreek
ATTN: Director of Economic Development JDK Consulting
2000 Main Street 19744 Beach Boulevard, Suite 347
Huntington Beach, CA 92648 Huntington Beach, CA 92648
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19. CONSENT
When CITY's consent/approval is required under this Agreement, its
consent/approval for one transaction or event shall not be deemed to be a consent/approval to
any subsequent occurrence of the same or any other transaction or event.
20. MODIFICATION
No waiver or modification of any language in this Agreement shall be valid
unless in writing and duly executed by both parties.
21. SECTION HEADINGS
The titles, captions, section, paragraph and subject headings, and descriptive
phrases at the beginning of the various sections in this Agreement are merely descriptive and are
included solely for convenience of reference only and are not representative of matters included
or excluded from such provisions, and do not interpret, define, limit or describe, or construe the
intent of the parties or affect the construction or interpretation of any provision of this
Agreement.
22. INTERPRETATION OF THIS AGREEMENT
The language of all parts of this Agreement shall in all cases be construed as a
whole, according to its fair meaning, and not strictly for or against any of the parties. If any
provision of this Agreement is held by an arbitrator or court of competent jurisdiction to be
unenforceable, void, illegal or invalid, such holding shall not invalidate or affect the remaining
covenants and provisions of this Agreement. No covenant or provision shall be deemed
dependent upon any other unless so expressly provided here. As used in this Agreement, the
masculine or neuter gender and singular or plural number shall be deemed to include the other
whenever the context so indicates or requires. Nothing contained herein shall be construed so as
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to require the commission of any act contrary to law, and wherever there is any conflict between
any provision contained herein and any present or future statute, law, ordinance or regulation
contrary to which the parties have no right to contract, then the latter shall prevail, and the
provision of this Agreement which is hereby affected shall be curtailed and limited only to the
extent necessary to bring it within the requirements of the law.
23. DUPLICATE ORIGINAL
The original of this Agreement and one or more copies hereto have been prepared
and signed in counterparts as duplicate originals, each of which so executed shall, irrespective of
the date of its execution and delivery, be deemed an original. Each duplicate original shall be
deemed an original instrument as against any party who has signed it.
24. IMMIGRATION
CONSULTANT shall be responsible for full compliance with the immigration
and naturalization laws of the United States and shall, in particular, comply with the provisions
of the United States Code regarding employment verification.
25. LEGAL SERVICES SUBCONTRACTING PROHIBITED
CONSULTANT and CITY agree that CITY is not liable for payment of any
subcontractor work involving legal services, and that such legal services are expressly outside
the scope of services contemplated hereunder. CONSULTANT understands that pursuant to
Huntington Beach City Charter Section 309, the City Attorney is the exclusive legal counsel for
CITY; and CITY shall not be liable for payment of any legal services expenses incurred by
CONSULTANT.
04agree/jdk consulting/7/21/04 10
26. ATTORNEY'S FEES
In the event suit is brought by either party to construe, interpret and/or enforce the
terms and/or provisions of this Agreement or to secure the performance hereof, each party shall
bear its own attorney's fees, such that the prevailing party shall not be entitled to recover its
attorney's fees from the nonprevailing party.
27. SURVIVAL
Terms and conditions of this Agreement, which by their sense and context survive
the expiration or termination of this Agreement, shall so survive.
28. GOVERNING LAW
This Agreement shall be governed and construed in accordance with the laws of
the State of California.
29. ENTIRETY
The parties acknowledge and agree that they are entering into this Agreement
freely and voluntarily following extensive arm's length negotiation, and that each has had the
opportunity to consult with legal counsel prior to executing this Agreement. The parties also
acknowledge and agree that no representations, inducements, promises, agreements or
warranties, oral or otherwise, have been made by that party or anyone acting on that party's
behalf, which are not embodied in this Agreement, and that that party has not executed this
Agreement in reliance on any representation, inducement, promise, agreement, warranty, fact or
circumstance not expressly set forth in this Agreement. This Agreement, and the attached
exhibits, contain the entire agreement between the parties respecting the subject matter of this
Agreement, and supersede all prior understandings and agreements whether oral or in writing
between the parties respecting the subject matter hereof.
04agree/jdk consulting/7/21/04 I I
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed
by and through their authorized officers on cif 8 , 20,0j(-
CONSULTANT,
JDK CONSULTIN . a sole proprietorship
By:
Joy e e reek proprietor
04agree/jdk consulting/7/21/04 12
CITY OF HUNTINGTON BEACH,
a municipal corporation of the State of California
Am
G 4K _
Director of Economic Development
(Pursuant To HBMC §3.03.100)
APPROVED AS TO FORM:
ity ttorn as
REVIEWED AND\APPR 'VED:
7
City PMn.imstrator
(only for contracts $30; P00.00 and over)
•
•
EXHIBIT "A"
A. STATEMENT OF WORK: (Narrative of work to be performed)
Provide services related to the management and administration of the City's
housing Rehabilitation Loan Program ("RLP").
B. CONSULTANT'S DUTIES AND RESPONSIBILITIES:
1. Perform initial inspection of single family residences, town homes, condos
and mobile homes within the City of Huntington Beach to determine
existing code violations and work that is RLP and Community
Development Block Grant ("CDBG") eligible, and prepare written work
specifications for each property inspected for proposed rehabilitation work,
to include highlighted code violations. Prepare additional copy of the same
work specifications with cost estimates of the proposed work, on a line item
basis, as well as a grand total amount.
2. Attend and facilitate meetings with construction and abatement contractors
and homeowners.
3. Perform final inspection and approval of completed rehabilitation work, as
per prepared written work specifications.
4. Provide construction and program -related consultation as needed.
C. CITY'S DUTIES AND RESPONSIBILITIES:
1. Provide information and documentation, when requested by
CONSULTANT and if necessary.
2. Attend various meetings with CONSULTANT, when requested by
CONSULTANT and if necessary.
D. WORK PROGRAM/PROJECT SCHEDULE:
CONSULTANT shall provide these services on an as needed basis as requested by
CITY.
1
jm17jn/01agiee/JDK Consulting/1/7/02
EXHIBIT "B"
Payment Scheduld (Hourly Payment)
A. Hourly Rate
CONSULTANT'S fees for such services shall be based upon the following hourly rate and cost schedule: Sixty Dollars
($60.00) per hour, which rate includes payment for CONSULTANT's costs and expenses.
B. Travel
Charges for time during travel are normally not reimbursable and will only be paid if such time is actually
used in performing services for CITY or as otherwise arranged with CITY.
As CITY sometimes uses consultants that are outside of the nearest metropolitan area, CITY is very
conscious of travel costs. Subject to agreement otherwise, CONSULTANT will be held to charging no
fees on travel time to or from Huntington Beach.
Automobile expenses are limited to Twenty-seven Cents ($0.27) per mile. All other travel expenses mast
be approved in advance by CITY in writin g. Requests for approval shall be submitted at least fourteen
(14) days in advance, to allow for reduced transportation fares. Meals are not billable to CITY, without
prior written consent of CITY.
C. BillinQ
1. All billing shall be done monthly in one -tenth -hour (0.10) increments and matched to an appropriate
breakdown of the time that was taken to perform that work and who performed it.
Minimum billing charges are unacceptable. CONSULTANT shall only charge for actual time spent. For
example, minimum of 0.2 hours for phone calls or 0.4 hours for letters is unreasonable unless that is an
accurate measure of time spent.
2. Each month's bill should include a total to date. That total should provide, at a glance, the total fees and
costs incurred to date for the case or matter.
3. Telephone, cellular phone and postage charges are billable at actual cost. A copy of all service bills/costs
should accompany the billing for each single item that exceeds Seventy -Five Dollars ($75.00). The fee
for the sending or receiving of facsimiles shall not exceed Twenty-five Cents ($0.25) per page. CITY
will not pay a fee or charge for telephone calls or facsimiles to CITY. Photocopier costs should be no
more than the actual cost of duplication, or Ten Cents ($0.10) per page, whichever is less.
4. CITY will not pay for secretarial time or secretarial overtime. CITY will not pay for secretarial tasks or
tasks that should be subsumed into CONSULTANT's overhead. For example, time spent for faxing,
mailing, arranging for messengers and calendaring are not acceptable charges.
5. CITY will not pay for word processing charges. This includes per page or hourly charges.
6. CITY will not pay for billing or discussion of bills. If CITY has questions about billing or needs
additional information on bills, that is not a chargeable event; CONSULTANT should respond without
charging CITY for the time required.
7. CITY appreciates when CONSULTANT has researched an issue previously and uses that research on the
present case. CITY has retained CONSULTANT because of its past experience. CONSULTANT shall
not charge CITY for work it has done and billed another client for in the past.
8. Delivery of work product: A copy of every memorandum, letter, report, calculation and other
documentation prepared by CONSULTANT shall be submitted to CITY to demonstrate progress toward
04agree/jdk consulting/7/21/4
• EXHIBIT "B" •
Paymeni Sehediile (Hourly Payment)
completion of tasks. In the event CITY rejects or has comments on any such product, CITY shall identify
specific requirements for satisfactory completion.
CONSULTANT shall submit to CITY an invoice for each monthly payment due. Such invoice shall:
A) Reference this Agreement;
B) Describe the services performed;
C) Show the total amount of the payment due;
D) Include a certification by a principal member of CONSULTANT's firm that the work has been
performed in accordance with the provisions of this Agreement; and
E) For all payments include an estimate of the percentage of work completed.
Upon submission of any such invoice, if CITY is satisfied that CONSULTANT is making satisfactory
progress toward completion of tasks in accordance with this Agreement, CITY shall approve the invoice,
in which event payment shall be made within thirty (30) days of receipt of the invoice by CITY. Such
approval shall not be unreasonably withheld. If CITY does not approve an invoice, CITY shall notify
CONSULTANT in writing of the reasons for non -approval and the schedule of performance set forth in
Exhibit "A" may at the option of CITY be suspended until the parties agree that past performance by
CONSULTANT is in, or has been brought into compliance, or until this Agreement has expired or is
terminated as provided herein.
t0. Any billings for extra work or additional services authorized in advance and in writing by CITY shall be
invoiced separately to CITY. Such invoice shall contain all of the information required above, and in
addition shall list the hours expended and hourly rate charged for such time. Such invoices shall be
approved by CITY if the work performed is in accordance with the extra work or additional services
requested, and if CITY is satisfied that the statement of hours worked and costs incurred is accurate.
Such approval shall not be unreasonably withheld. Any dispute between the parties concerning payment
of such an invoice shall be treated as separate and apart from the ongoing performance of the remainder
of this Agreement.
04agree/jdk consuldng/7/21/-4
Su ity PROFESSIONAL SERVICE CONTRACTS
no;m PURCHASING CERTIFICATION
HuBewh
1. Requested by: Terri King, Economic Development Department
2. Date: 1:� Z o 138�y
3. Name of consultant: JDK Consulting
4. Description of work to be performed: Construction Consulting Services in
connection with the City of HB Housing Rehabilitation Loan Program
5. Amount of the contract: $20,000 per year (2 Yr contract)
6. Are sufficient funds available to fund this contract?' ® Yes, ❑ No
7. Company number and object code where funds are budgeted: 866.80301
8. Is this contract generally described on the list of professional service contracts
approved by the City Council'? ®Yes, ❑ No
9. Is this contract within $25,000 or 25% (whichever is less) of the amount stated on
the list of professional service contracts approved by the City Council?'
® Yes, ❑ No
10. Were (at least) informal written proposals requested of three consultants?
® Yes, ❑ No
11. Attach list of consultants from whom proposals were requested (including a
contact telephone number).
12. Attach proposed scope of work.
13. Attach proposed payment schedule.
1 NRD . M A RIL, M nag r
Purchasing/Central Services
' If the answer to any these questions is 'No," the contract will require approval from the City Council.
•
C�
LIST OF CONTRACTORS SENT RFP FOR REHAB LOAN CONSTRUCTION
CONSULTING SERVICES
April 12, 2004
Joyce DeKreek
JDK Consulting
19744 Beach Blvd. #347
Huntington Beach, CA 92648
(714 969-8794
2birds a2surfside.net
Deborah A. Dirnu
Housing Programs
7441 Garden Grove Blvd., Ste. N
Garden Grove, CA 92841
(714) 799-7175
(714) 799 5506 FAX
DebbieDhousingprojzrams. com
Chris Bradley, Project Control Engnr.
Dugan & Associates
6350 Laurel Canyon Blvd., #406
North Hollywood, CA 91606
(818)752-7970
(818) 752-7976 FAX
dugancmkpacbell.net
Kathi Portland
444 S. Tustin H-1
Orange, CA 92866
(714) 738-6562
Rudy Munoz
9229 Utica Ave., Ste. 120
Rancho Cucamonga, CA 91730
(909) 476-9696
Date letters sent: April 12, 2004
Due date: April 30, 2004
g:?terri\ril) jdk\rfl) jdk2()04\rfp_consltbidlist041204.doe
s ,ity INSURANCE AND INDEMNIFICATION WAIVER
B MODIFICATION REQUEST
1. Requested by, David C. Biggs
2. Date: August 11, 2004
3. Name of contractor/permittee: JDK Consulting
4. Description of work to be performed: Residential rehabilitation construction consulting
and inspection
5. Value and length of contract: $20,000.00 per Year, 2 year contract
6. Waiver/modification request: language of cancellation clause
7. Reason for request and why it should be granted: Carrier unwilling to modify clause to
meet all of CitVs requirements
8. Identify the risks to the City in approving this waiver/modification: Risk is minimal:
consultant's tasks are primarily advisory in nature.
Department Head Signature
//d.
Date:
APPROVALS
Approvals must be obtained in the order listed on this form. Two approvals are required
for a request to be granted. Approval from the City Administrator's Office is only required if
Risk Management and the City Attorney's Office disagree.
1. Risk Management
Approved ❑ Denied
Signature Date
2. City Attorney's Office
proved ❑ Denie `js� 1
S gnatur Date
3. City Administrator's Office
❑ Approved ❑ Denied
Signature Date
If approved, the completed waiver/modification request is to be submitted to the
City Attorney's Office along with the contract for approval. Once the contract has been approved,
this form is to be filed with the Risk Management Division of Administrative Services
05/09/2017 03:05 FAX
IQ 002
iCERTIFICATE OF INSURANCE 10
-his certifies that ®
STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
❑
STATE FARM -GENERAL INSURANCE COMPANY, Bloomington, Illinois
❑
STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario
❑
STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida
❑
STATE FARM LLOYDS, Dallas, Texas
isures the following policyholder for the coverages indicated below:
Name of policyholder REES-DEKREEK, JOYCE
Address of policyholder 1608 RIVERVIEW CIRCLE RUNTINGTON BEACH CA 92648-2986
Location of operations SAME
Description of operations
-he policies listed below have been Issued to the policyholder for the policy periods shown. The insurance described in these policies i!+
ubiect to all the terms exclusions, and conditions of those policies.'ihe limits of liability shown may have been reduced by anv Daid claims.
POLICY NUMBER
TYPE OF INSURANCE
POLICY PERIOD
Effective Date ; Expiration Date
LIMITS OF LIABILITY
(at beginning of policy period)
Comprehensive
BODILY INJURY AND
'5-xL-9054-G
Business Liability 01/01/04 01/01/05
PROPERTY DAMAGE
his Insurance includes:
❑ Products - Completed Operations
❑ Contractual Liabillty
❑ Underground Hazard Coverage
Each Occurrence $ 1, 000, oco
❑ Personal Injury
❑ Advertising Injury
General Aggregate $ 2,000,000
❑ Explosion Hazard Coverage
❑ Collapse Hazard Coverage
Products — Completed $ 2, 000., 0 o o
❑
Operations Aggregate
POLICY PERIOD
BODILY INJURY AND PROPERTY DAMAGE
EXCESS LIABILITY
Effective Date Expiration Date
(Combined Single Limit)
❑ Umbrella
Each Occurrence $
❑ Other
Aggregate $
Part 1 STATUTORY
_
" E, =' ' J FORM
Part 2 BODILY INJURY
ORNEY i
Each Accident $
Disease Each Employee $
Disease - Policy Limit $
POLICY PERIOD
LIMITS OF LIABILITY
POLICY NUMBER
TYPE OF INSURANCE
Effective Date Expiration Date
(at beginning of policy period)
-HE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGAI IVELY
1MENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
If any of the described policies are canceled before
its expiration date, State Farm will try to mail a written
notice to the certificate holder 3o days before
Name and Address of Certificate Holder cancellation.
ADDL INSURED - SECTION II 1
'HE CITY OF FUNTINGTON BEACH AND THE HUNTINGTON BEACH
REDEVELOPMENT AGENCY AND THEIR OFFICERS EMPLOYEES,
REPRESENTATAIVES AND VOLUNTEERS Slgnat Authorized Representative
A MUNICIPAL CORPORATION
2000 MAIN ST Ttle
t-VNTINGTON BEACH CA 92648-2702 Agent's Code Stamp
AFO odsoe � 1
Jan Hobbs 75'rr0'
58-994 a.3 04-1999 Pnntea :n US A. F415
AUG-11-2004 13:12
S ity INSURANCE AND INDEMNIFICATION WAIVER
MODIFICATION REQUEST
1. Requested by: David C. Biggs
2. Date: July 28, 2004
3. Name of contractor/permittee: JDK Consulting
4. Description of work to be performed: Rehabilitation/construction consulting; Inspection in
residential dwellings; Preparation of work write-up reports; Construction related advising
5. Value and length of contract: $20,000 per year, 2 yr. contract
6. Waiver/modification request: Waive E & O requirements (waived prior)
7. Reason for request and why it should be granted: Cost too exorbitant for consultant and,
due to unusual nature of work, not easily defined or obtained
8. Identify the risks to the City in approving this waiver/modification: Risk is minimal since
licensed contractors actually perform and are liable for the work specified by consultant
eCX04
Department Head Signature
7/28/04
Date:
APPROVALS
Approvals must be obtained in the order listed on this form. Two approvals are required
for a request to be granted. Approval from the City Administrator's Office is only required if
Risk Management and the City Attomey's Office disagree.
1. Risk Management
XApproved ❑ Denied O
Signature Uake
2. ZAttorney's Office
proved ❑ Denied
Signature Date
3. City Administrator's Office
❑ Approved ❑ Denied
Signature Date
If approved, the completed waiver/modification request is to be submitted to the
City Attorney's Office along with the contract for approval. Once the contract has been approved,
this form is to be filed with the Risk Management Division of Administrative Services
•
•
"Policy Number DECLARATIONS PAGE
92-W5-5134-5
STATE FARM GENERAL "INSURANCE COMPANY i, � o
31303 AGOURA RD, WESTLAKE VILLAGE,CA 91363-0001
A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS
3001-F415 S
Named Insured and Mailing Address
DEKREEK-BEES, JOYCE
1608 RIVERVIEW CIR
HUNTINGTN BCH CA 92648-3707
Cov A - Inflation Coverage Index: N/A
BUSINESS POLICY - SPECIAL FORM 3 Cov B - Consumer Pricelndex: 188.0
AUTOMATIC RENEWAL - If the POLICY PERIOD is shown as 12 MONTHS, this policy will be renewed automatically
subject to the premiums, rules and forms in effect for each succeedin policy period If this policy is terminated, we will
give you and the Mortgagee/Lienholder written notice in compliance wi h the policy provisions or as required by law.
Policy Period: 1 Year The policy period begins and ends at 12:01 am standard time at the
Effective Date: MAY 1 2004 premises location.
Expiration Date: MAY 1 2005
Named Insured: I
Location of Covered Premises:
1608 RIVERVIEW CIR
HUNTINGTON BH CA 92648-3707
Coverages & Property
Section
A Buildings
B Business Personal Property
C Loss of Income - 12 Months
Section II
L Business Liability
M Medical Payments
Products -Completed Operations
(PCO) Aggregate
General Aggregate (Other
Than PCO)
Limits of Insurance
Excluded
$ 10,200
$ Actual Loss
$ 1,000,000
$ 2,000:000
$ 2,000,000
Forms, Options, and Endorsements
Special Form 3
FP-6143
Policy Endorsement
FE-6506.2
Terrorism Insurance Cov Notice
FE-6999
Amendatory Endorsement
FE-6205
Debris Removal Endorsement
FE-6451
Business Policy Endorsement
FE-6464
Amendatory Collapse
FE-6551
Deductibles - Section I
$ 1,000 Basic
In case of loss under this policy, the deductible will be
applied to each occurrence and will be deducted from the
amount of the loss. Other deductibles may apply - refer tc
Total Estimated
Premium $ 250.00
Minimum Premium
Audit Period: Annual
Discounts Applied:
Years in Business
Continued on Reverse Side of Page I
OTHER LIMITS AND EXCLUSIONS MAY APPL
Prepared
JUN 03 2004 Countersi i
FP-8030.2C LQKV By
06/1993 JASON HCIBB
Your policy consists of this page, any endorsements (7514) 848-32 6
and the policy form. PLEASE KEEP THESE TOGETHER. 1
TO YOUR POLICY
(01f21721
SCHEDULE OF OPERATIONS
Policy Number
92-W5-5134-5 STATE FARM GENERAL INSURANCE COMPANY
31303 AGOURA RD, WESTLAKE VILLAGE,CA 91363-0001
ASTOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS
Named Insured and Mailing Address EFFECTIVE DATE
3001-F415 S MAY,1 2004
DEKREEK-REES, JOYCE
1608 RIVERVIEW CIR
HUNTINGTN BCH CA 92648-3707
BUSINESS POLICY - SPECIAL FORM 3
PREMIUM SECTION 11
STAT BASES*/ ESTIMATED
DESCRIPTION OF OPERATIONS CLASS EXPOSURE RATE PREMIUM
-------------------------------------------- ----------------- ------ --------=-
CONSULTANTS (NOC) 982 P* 29000 4.93 $ 170.00
Prepared
JUN 03 2004
*PREMIUM BASES
S. PER 1000 GROSS SALES
P. PER 1000 PAYROLL
T. PER 000 ADMISSIONS
C. PER CAMPER DAY
H. PER 1000 GALLONS
(o 1 f2173b)
SH y
olic No. 92-W5-5134-5 2FFECTIVE MAY 01 2004 •
P
ADDITIONAL INSURED ENDORSEMENT
DESIGNATED PREMISES ONLY
Policy No.: 92-W5-5134-5
Named Insured: DEKREEK-BEES, JOYCE
Name of Additional Insured: THE CITY OF HUNTINGTON BEACH
A MUNICIPAL CORPORATION
Address of Additional Insured: 2000 MAIN ST
HUNTINGTON BH CA 92648-2702
Interest of Additional Insured: CONTRACTOR OF SERVICES
Location of Premises: PER CONTRACT
FE-6320
(7/88)
sun roue
IHrYr�NCr
The word "insured", wherever used in this policy, also includes the designated person or organization named above
as Additional Insured under the provisions of the policy Sections shown below as applicable by an 'W' to the extent
indicated.
❑ SECTION I. This applies only to COVERAGE A - BUILDINGS.
❑ SECTION I. This applies only to COVERAGE B - BUSINESS PERSONAL PROPERTY.
Description of Property:
El SECTION II. This applies only to COVERAGE L - BUSINESS LIABILITY and COVERAGE M -
MEDICAL PAYMENTS and then only with respect to the ownership, maintenance or use of
the premises designated above and operations necessary or incidental thereto. These
SECTION II coverages do not apply to:
1. structural alterations or new construction performed by or on behalf of the designated person or
organization;
2. personal injury caused by the designated person or organization;
3. liability the designated person or organization assumed under a contract; or
4. products -completed operations hazard arising out of goods or inventory which are not sold or
distributed by you or arising out of the manufacturing or packaging of such goods or inventory.
All other provisions of the policy apply.
FE-6320
(7/88) Printed in U.S.A.
`City of Huntington Beach
NUNMNGTON BEACH
2000 Main Street
California 92648
DFICLARATION of NON-E-MPLOYF-R STATUS
In order to comply with City Council Resolution No. 6277, you are required to Provide Proof of
Workers' Compensation insurance. If you have no employees, this form must be signed and returned
to:
City of Huntington beach
Risk Management Division
2000 Main Street
Huntington beach, CA 9264e
I certify that in the performance of the activity or work for which this permit is issued, I shall not
employ any Person in any manner so as to become subject to -California .Workers' Compensation
insurance requirements.
authorize the City of Huntington beach to immediately and retroactively revoke the license or
permit issued under this declaration if I hire any employees) or become sub'ect to the provisions of
the laws requiring Workers' Compensation Insurance.
Applicant,/Company Name:
Address: 19 %q
Applicant's Signature:
Title: -r1 9A
Location Signed:
J 7J k C-„
Telephone Number: �k(A�L/ V lvC
Al
Date: 42 -Z, z
N