Loading...
HomeMy WebLinkAboutMAYNE, RENEE - 2004-10-046f .0 (?, 1-1),IL-A—ri A) Council/Agency Meeting Held: D D Deferred/Continued to: Approved ❑ Conditionally Approved ❑ Denied low Ci CI rk'S ignatu r Council Meeting Date: October 4, 2004 Departmen ID umber: 04-040 CITY OF HUNTINGTON BEACH REQUEST FOR CITY COUNCIL ACTION d � SUBMITTED TO: HONORABLE MAYOR CITY COUNCIL MEMBERS _ CD SUBMITTED BY: PENELOPE CULBRETH-GRAFT, CITY ADMINISTRATOR- r . _. PREPARED BY: CLAY MARTIN, DIRECTOR OF ADMINISTRATIVE SERVICES z SUBJECT: APPROVE PROFESSIONAL SERVICES CONTRACT BE4EEA THE CITY OF HUNTINGTON BEACH AND RENEE MAYNE -i Statement of Issue, Funding Source, Recommended Action, Alternative Action(s), Analysis, Environmental Status, Attachment(s) Statement of Issue: Approve the professional services contract between the city and Renee Mayne for chief negotiator services for labor contract negotiations with the Fire Association (HBFA), Municipal Employees' Association (HBMEA), and the Police Officers' Association (HBPOA). Funding Source: Funding is available in the Human Resources Professional Services Account 10035303. Recommended Action: Motion to approve and authorize the execution by the Mayor and City Clerk of the Professional Services Contract between the City of Huntington Beach and Renee Mayne for chief negotiator services for labor contract negotiations. Alternative Action(s): Deny the execution of the Professional Services Contract and direct staff accordingly. Analysis: A contract with a professional consultant for chief negotiator services is necessary to assist staff in the performance of contract labor negotiations for three bargaining units, HBFA, HBMEA, and HBPOA. In addition to these three bargaining units, the city has five other bargaining units with labor contracts that are either currently expired or will have expired by calendar year end. This contract will provide valuable staff support. The requirements for contracting for professional services, as outlined in Chapter 3.03 of the City Municipal Code have been met. In August, a request for proposal was submitted to three management consultants in the labor relations field. Upon review, Renee Mayne was selected as the consultant who best meets the needs of the city for chief negotiator services. 9 REQUEST FOR ACTION MEETING DATE: October 4, 2004 DEPARTMENT ID NUMBER: 04-040 List of consultants are as follows: Avery and Associates 3'/2 N. Santa Cruz Ave. ste A Los Gatos, CA 95030 Liebert, Cassidy & Whitmore 6033 W. Century Blvd. ste 601 Los Angeles, CA 90045 Labor Management Success. P.O. Box 982 Monterey, CA 93942 Environmental Status: None Attachment(s): DADocuMents and Settings\reedk\Local Settings\Temporary Internet Files\OLKC\PS Contract R Mayne 100404.doc -2- ninn111nn• n.en wu J ATTACHMENT #1 U �i PROFESSIONAL SERVICES CONTRACT BETWEEN THE CITY OF HUNTINGTON BEACH AND RENEE MAYNE FOR CHIEF NEGOTIATOR SERVICES FOR LABOR CONTRACT NEGOTIATIONS Table of Contents 1 Scope of Services.....................................................................................................1 2 City Staff Assistance............................................................................................ 2 3 Term; Time of Performance.....................................................................................2 4 Compensation..........................................................................................................2 5 Extra Work...............................................................................................................2 6 Method of Payment..................................................................................................3 7 Disposition of Plans, Estimates and Other Documents...........................................3 8 Hold Harmless.........................................................................................................3 9 Professional Liability Insurance.............................................................................4 10 Certificate of Insurance............................................................................................5 11 Independent Contractor............................................................................................6 12 Termination of Agreement.......................................................................................6 13 Assignment and Delegation......................................................................................6 14 Copyrights/Patents...................................................................................................7 15 City Employees and Officials..................................................................................7 16 Notices.........................................................................................7 17 Consent....................................................................................................................8 18 Modification.............................................................................................................8 19 Section Headings.....................................................................................................8 20. Interpretation of this Agreement..............................................................................8 :.. 21 Duplicate Original....................................................................................................9 • 22 Immigration...............................................................................................................9 23 Legal Services Subcontracting Prohibited................................................................9 24 Attorney's Fees..........................................................................................................10 25 ................................................................................................................... Survival ..10 26 Governing Law.........................................................................................................10 27 Entirety......................................................................................................................10 0 . • PROFESSIONAL SERVICES CONTRACT BETWEEN THE CITY OF HUNTINGTON BEACH AND RENEF MAYNTF. FOR CHIEF NEGOTIATOR SERVICES FOR LABOR.CONTRACT NFGOTIATT.OMS THIS AGREEMENT ("Agreement") is made and entered into this day of G'7 .&k 20D�, by and between the City of Huntington Beach, a municipal corporation of the State of California, hereinafter referred to as "CITY, and Renee Mayne a sole pr0nri.et0rGhi.n hereinafter referred to as "CONSULTANT." WHEREAS, CITY desires to engage the services of a consultant to provide chief negotiator services for labor contract. negoristi_on.s 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 herself who shall represent it and be its sole contact and agent in all consultations with CITY during the performance of this Agreement. agree/forms/profsery 10/15101-A 1 • 0 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 as soon as practicable after the execution of this Agreement by CITY (the "Commencement Date"). This Agreement shall expire on September 30, 2005 , unless sooner terminated as provided herein. All tasks specified in Exhibit, "A" shall be completed no later than September 30, 2005 from the Commencement Date of this Agreement. These times may be extended with the written permission of CITY. 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 One Hundred Twenty -Five Thousand Dollars ($ 125,000.00 ). 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 agree/forms/profsery 10/15/01-A 2 compensation for such extra work shall be allowed only if the prior written approval of CITY is obtained. 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 agree/forms/profserv10/15/01-A 3 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. 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. agrcc/forms/profscrvl0/15/01-A 4 10. CERTIFICATE OF INSURANCE Prior to commencing performance of the work hereunder, CONSULTANT shall furnish to CITY a certificate of insurance subject to approval of the City Attorney evidencing the foregoing insurance coverage as required by this Agreement; the certificate shall: A. provide the name and policy number of each carrier and policy; B. shall state that the policy is currently in force; and C. shall 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 coverage in force until the work under this Agreement is fully completed and accepted by CITY. The requirement for carrying the foregoing insurance coverage shall not derogate from CONSULTANT's defense, hold harmless and indemnification obligations as set forth in this Agreement. CITY or its representative shall at all times have the right to demand the original or a copy of the policy of insurance. CONSULTANT shall pay, in a prompt and timely manner, the premiums on the insurance hereinabove required. 11. 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 agree/forms/profserv10/15/01-A 5 • 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. 12. 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. 13. 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 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. 14. 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. agree/forms/profserv10/15/01-A 6 15. 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. 16. 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 Renee Mayne ATTN: Director of Administrative Services P. 0. Box 982 2000 Main Street 7. Huntington Beach, CA 92648 Monterey, CA 93942 17. 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. agree/forms/profserv10/15/01-A 7 18. MODIFICATION .. No waiver or modification of any language in this Agreement shall be valid unless in writing and duly executed by both parties. 19. 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. 20. 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 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 agree/forms(profserv10/15/01-A 9 • which is hereby affected shall be curtailed and limited only to the extent necessary to bring it within the requirements of the law. 21. 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. 22. 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. 23. 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. 24. 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, agrcc/forms/profservl0/15101-A 9 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 non -prevailing party. 25. SURVIVAL Terms and conditions of this Agreement, which by their sense and context survive the expiration or termination of this Agreement, shall so survive. 26. GOVERNING LAW This Agreement shall be governed and construed in accordance with the laws of the State of California. 27. 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. agree/forms/profsery 10/ 15/01-A 10 • 0 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by and through their authorized offices the day, month and year first above written. CONSULTANT, Renee Mayne !n print name ITS: (circle one) Chairman/President/Vice President AND CITY OF HUNTINGTON BEACH, . a municipal corporation of the State of California 1 C"'.27 ( L"'t 0 - Director of (u cant To HBMC §3.03.100) APPROVED AS TO FORM: City Attorney 0Q y By. n print name ITS: (circle one) Secretary/Chief Financial Offider/Asst. Secretary — Treasurer agrce/forms/profsery 10/15/01 -A 11 City Admin (only for contracts $50, 09/24/2004 05:01 Sep 22 04 ostaep B314B42BB4 T, CITY•'OF HB �1 714 ; 86D -8804 PAGE F.13 IN WITNESS WHEREOF. the parties hcrcto have cattai:d this Agrucment to be uxecutod by and through llhcir authorized offices the day, moith and year tint above: written. CONSULTANT, Ranee Mayne CITY OF I IUNT1NGTON $EACI1, a munitr-ipal conxiation of the State of California dv. nlrCCtOrtiradtjlsiwrrg4f;ve $C=Vj.cNs — -- ((urYut,nr To HBMC §103. foo) print slaw 11'S: (cirrh•r+m) Clmirm mfPmwidunuVicc Yresldcnt APPROVED AS tO FORW AND City Attome T REVlLWED ANO APPROVED; taint nani<� ' ITS, (rirrir" rote) Sceroary/mur rinanciml UnkcrlAm. $��n try-Tr,neUrcr City Admini$tralor (only for cdnrrucrr S50.000.00 and mv.-r) ryitic�rarny�rprolhtW 1 W 15.01•A r EXHIBIT A SCOPE OF SERVICES 1. In accordance with the direction of the City Administrator or her designee, during the term of this agreement, the Consultant shall provide the City professional advice and execute the process and final disposition of labor negotiations for bargaining units assigned to the Consultant. 2. The Consultant shall serve as chief negotiator for labor negotiations between the CITY and its bargaining units assigned to the Consultant. The Consultant shall perform all necessary duties during the course of labor contract negotiations, which include: a. Gaining bargaining parameters and reporting status of negotiations to the City Administrator or her designee; b. Upon the request of the City Administrator or her designee, attending City Council closed session; c. Providing professional advice to the City Administrator or her designee regarding drafting of CITY contract proposals; d. Providing professional advice to the City Council regarding the potential options for reaching agreement with its bargaining units at the bargaining table; e. Scheduling and attending all labor contract negotiations; f. . Completing the administration and finalization of the signed Memoranda of Understanding. 4. The Consultant may provide, at the City's request, training services to City staff in the areas of contract administration, grievance handling and employee complaint resolution process. 7 EXHIBIT B BILL RATES AND PAYMENT FOR SERVICES 1. The City shall pay the Consultant the total sum of $100.00 (one hundred dollars) per hour for contracted services rendered during the term of this agreement, including travel time. 2. The City shall reimburse the Consultant for all mileage (IRS rate), lodging, printing, mail delivery expenses and any other expenses pre -approved in writing by the CITY and incurred during the course of rendering contracted services. 3. The Consultant shall provide the City an itemized invoice for payment. 4. The City shall pay the Consultant invoice within thirty (30) days of receipt. U'J/2//:1UU4 11:UIJ 41544t411:11 lKtNL HLKMN iNbU,tAN VAUL U1 A-C-PM. CERTIFICANOF LIABILITY INSURANCLO DATS rm*wffrm -OU27/04 "tomim THIS CERTIFICATE N INUEDAS A MATTER OF INFORMATICIF Irene C. Korman Ins. Services ONLY AND CONFERS No RIGWM UPON THE CERTIFICATE Irene FAZMA-110619789 HOLDER. THIS CERTIFICATE DOES NOT AMEND. EXTEND OR 422 Pcesidio-Avenue ALTER THE COVERAGE AFFORDED By THE POLICIES BELOW i 9 San ]Francisco CA 94115 Phone: 415-447-4212 Fax: 415-441-4161 INSURERS AFFORDING COVERAGE NAIC INSURER A: First Financial Ins. Co *MRW M43LIRER& Lloyds of London Management Success PODLabor 982 Monterey CA 93942 MURER a. INSURERS: THE POUCIES OF 0MRANIM LWW BROW WILE BEEN IISSUEID TO THE WNPAED NAWD MWO MO THE MJCV PERIOD WWATED WMTHSTANOM ANY RECUOUNWT TERM OR COM17TWN OF ANY CONTRAUr OR OTHM DOCUMENT WITH RESPECT TO VA404 THIS CERTWIrATI! MAY BE ISSUED OR MAY PMTAIK IM 694&a AFFORDED BY THE POUCUM 00SCRBEID MREN IS SU&MCT TO ALL THE Time. EXCLUXOM AND 00WW*NS OF SUCH PCUCES- AGGRE"M UMITS SHOWN MAY "M4! KCH REDUCED 8Y FMD CLASS. 'LTR OP INSIpeANOF POLICY NLIINBFiR pALOST& FeeNEM UAWTV EACHOCCURRENCIF 51000000 -[VMMEIVKL-N1%1; A X COMMIFICIAL GEMMAL UAM11Y FD149QS23464 01/16/06 01/14l05 $S0000 CLAM MADE 0 OCCUR MER IjXP(AT—p—ft) 11000 PERSOINIAL & ADV SLIURY $1000000 S 1000000 AGGREGATE -GSM. --A G-CR'E'G"J-%-TE-L-I *MIT —APPL*-9PER-: _GENERAL _ PROOUM-CO!t!!jAGG 6 1000000 i- I POLICY 17 M F1 Loc AUTONOMLS LABILITY COMSIMM av"aLrz LIMIT ANY AUTO ALL OWNED AVTOG 11013LY KIURY SCHEDULEIDAUT016 -- ------- WIRED AUTOS I BODILY INJURY NOW-OWNEI) AUTOS (RN PROPERTY DAMAGE I(Per S 8 GARAGE LIABILITY TO FORb I '. !�A ACCIDENT S EA ACC j0A;Q:T1-L'-1: ANY AVM S A_j -T! XC"—MWRGLLA LABILITY Aft ---& j RNEY EIOCCUR El CtAIMSMADE] DEMICTIRLE 1 RETENTOV a S WORKERS COMPENGATtON AND ,— EMPLOYERS' LA MUTY E.L. EACH ACCIDE!"T S E tW ,,aR,PRiETORFP UAW, G=jWCUTIVF 0159!?E - EA IEMFN- - 5 a�cs1E.L.01SEASE- 5 _LL POLICY LET OTN 1�dlz of London AHJN041035 01/14/04 01/14/05 RAO 1000000 DESCRIPTION OF OPERATIONS I LOCA104 I V941CIM I EXCLUSIONSova"—AWO ENT I SPECIAL PROWSKIINS Certificate holder as additional insured V— IF 5%##% a w- City of ftntirtqt*n Beach its agents, officers a employees 2000 Main St Huntington CA 92648 gvxDmc I SHOULD ANY OF THr ABOVE OESCRUIED POLWMS W CANCELLED BEFORE THE EXPIRATK DATE THEREOF. THE 03VING INSURER WILL P I "wL 10 DAYOWAMM" NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. •INSURANCE AND INDEMNIFICATION WAIVER MODIFICATION REQUEST 1. Requested by: Karen Foster, Risk Management 2. Date: September 27, 2004 3. Name of contractor/permittee: Labor Management Success 4. Description of work to be performed: Labor relations consultant work 5. Value and length of contract: 6. Waiver/modification request: 30-day cancellation clause wording 7. Reason for request and why it should be granted: Unable to . comply with the city's cancellation clause wording requirement 8. Identify the risks to the City in approving this waiver/modification: None. �z7a� Depa ent a nature 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. R',k Management Approved ❑ Deni 7/% o/ Signature Date 2. City Attorney's Office ® Approved ❑ 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 Attomey'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 09/24/2004 04:53 8314842884 rHut nZ CITY OF HUNTINGTON BEACH 2000 Main Street, Huntington Beach, CA 92649 Declaration of Non -Employer Status In order to comply with the 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 92648 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. 1 authorize the City of Huntington Beach to immediately and retroactively revoke the license or permit issued under this declaration if I hire any employee(s) or become subject to the provision of the laws requiring Workers' Compensation Insurance. Applicant/Corn any Name: f. ;c Address: G q n '-, , Applicant's Signature: Title: () -e 0f Location Signed: _ Telephone Number: ,e 1 4 21 �'__ 9. RCA ROUTING SHEET INITIATING DEPARTMENT: Administrative Services SUBJECT: Approve contract with Renee Mayne COUNCIL MEETING DATE: October 4, 2004 RCA ATTACHMENTS STATUS . Ordinance (w/exhibits & legislative draft if applicable) Attached ❑ Not Applicable ❑ Resolution (w/exhibits & legislative draft if applicable) Attached ❑ Not Applicable ❑ Tract Map, Location Map and/or other Exhibits Attached ❑ Not Appiicable ❑ Contract/Agreement (w/exhibits if applicable) AttachedNot Applicable ❑ (Signed in full by the City Attomey) Subleases, Third Party Agreements, etc. Attached Not Applicable ❑ ❑ Approved as to form by City Attome Certificates of Insurance (Approved b the City Attome ( pp y y y) Attached Not Applicable ❑ Fiscal Impact Statement (Unbudget, over $5,000) AttachedNot Applicable ❑ ❑ Bonds (If applicable) Attached Not Applicable ❑ ❑ Staff Report (If applicable) AttachedNot Applicable ❑ ❑ Commission, Board or Committee Report If applicable) ( pp ) Attached Not Applicable Elp ❑ Find in s/Conditions for Approval and/or Denial g pp Attached Not Applicable ❑ ❑ EXPLANATION FOR MISSING ATTACHMENTS REVIEWED RETURNED:.. ... tFORWARDED. Administrative Staff Assistant City Administrator Initial City Administrator Initial City Clerk EXPLANATION FOR RETURN OF. ITEM: KL A Author: Irma Youssefieh CONSEQUENCES How shall delay of this RCA adversely impact the City?): The delay in approving this contract would disrupt the meet and confer process and curtail the cit 's ability to reach agreement with POA, MEA and HBFA on new Memoranda of Understanding. �-Nqn —®R be the w Request for RCA Late Submittal 07/14/94