HomeMy WebLinkAboutSusan Saxe Clifford, PhD, APC - 2016-04-25 t
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.PROFESSIONAL SERVICES CONTRACT BETWEEN
THE CITY OF HUNTINGTON BEACH AND
SUSAN SAXE CLIFFORD, PHD APC
FOR
PSYCHOLOLGICAL SERVICES
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 Susan Saxe Clifford, PHD APC, a corporation hereinafter referred to. as
"CONSULTANT."
WHEREAS, CITY desires to engage the services of a consultant to provide
psychological pre-employment examinations and other psychological services as requested; 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 Dr. Susan Saxe Clifford who shall represent it
and be its sole contact and agent in all consultations with CITY during the performance of this
Agreement.
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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 Aig/L , 20 16 (the "Commencement Date"). This Agreement
shall automatically terminate three (3) 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 three (3) 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.
In the event the Commencement Date precedes the Effective Date,
CONSULTANT shall be bound by all terms and conditions as provided herein.
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 thirteen thousand Dollars ($13,000.00).
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
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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.
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 (or alleged 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
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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 without the express written consent of CITY; however
an insurance policy "deductible" of Ten Thousand Dollars ($10,000.00) or less is permitted. 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.
If CONSULTANT fails or refuses to produce or maintain the insurance required
by this section or fails or refuses to furnish the CITY with required proof that insurance has been
procured and is in force and paid for, the CITY shall have the right, at the CITY's election, to
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forthwith terminate this Agreement. Such termination shall not affect Consultant's right to be
paid for its time and materials expended prior to notification of termination. CONSULTANT
waives the right to receive compensation and agrees to indemnify the CITY for any work
performed prior to approval of insurance by the CITY.
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. 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.
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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 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.
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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.
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 Susan Saxe Clifford, PHD
ATTN: Captain Russell Reinhart
2000 Main Street 16530 Ventura Blvd. #203
Huntington Beach, CA 92648 Encino, CA 91436
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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.
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
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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.
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.
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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, 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.
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. SIGNATORIES
Each undersigned represents and warrants that its signature hereinbelow has the
power, authority and right to bind their respective parties to each of the terms of this Agreement,
and shall indemnify CITY fully for any injuries or damages to CITY in the event that such
authority or power is not, in fact, held by the signatory or is withdrawn.
28. 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
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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.
29. EFFECTIVE DATE
This Agreement shall be effective on the date of its approval by the City Attorney.
This Agreement shall expire when terminated as provided herein.
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed
by and through their authorized officers.
CONSULTANT, CITY OF HUNTINGTON BEACH,
a municipal corporation of the State of
Susan Saxe Clifford PHD APC California
COMPANY NAME
By: (Pursuant To HBMC§3.03.100)
APPROVED AS TO FORM:
print name
ITS: (circle one)Chairman/President/Vice President
AND
City Attorney MV .-y_)q_00
Date
print name RECEIVE AND FILE:
ITS: (circle one) Secretary/Chief Financial Officer/Asst.
Secretary—Treasurer
City Clely
Date
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EXUl113T "A"
A. Statement of work
In an effort for the Huntington Beach Police Department.to.hire quality personnel that
will serve the public, it is essential to properly screen candidates during the hiring
process. The Police Department requires ucare[ul and complete screening ofall
candidates forcnuploymnul` which inc}m]cS o psychological evaluation for snx`no police
officers and certain classes of civilian employees. Tlho CITY of Beach has
proposed to enter into x uunbuci with o liu:nuuJ professional to administer and rva}uohc
pre-employment psychological tests.
The CITY requires that the psychological evaluations bemjcnioiytcrod and evaluated inu
fair and impartial manner.
B.
CONsui-TANT's duties and responsib.ilitie.s
|. Thc CONSULTANT nho| meet the professional experience requirements detailed in
California Commission on Peace Officer Standards and Training(P(lST)
Commission Regulation 1955` including �x conbnuing professional education.
Z. CONS UL]ANT will administer psychological evaluations for sworn and certain
classes of civilian candidates for employment.with the Police Department in
adherence with the requirements of POST CononissionRegulation 1955.
1 The CONSULTANT will schedule with the candidate to conduct the evaluation. The
evaluation will inkc place ck the C{)NSL}LT/\INT's office orm mutually agreed upon
location
4. The CONSULTANT will provide the Police Dcpo,tnun\ with u written report o[each
evaluation.
5. The CONSULTANT will make themselves uvuiluh|efb, consultation with Police
Department staff when requested.
h. The CONSULTANT will conduct prc'omp\uymcn[psychological examinations for
an,orn and sc|oc(cd civilian candidates of the Police Department throughout the
duration of'the contract.
7. CONSULTANT will provide D\ncsu Dorduiy evaluations on Police Department
employees and other psychological -services unanos needed basis.
8. The CONS 1-i LTANT \vill provide worker's compensation insurance of not less than
what is set forth by CITY contract provisions.
'
C. C117-Y's dLIlIeS and responsibilities
1. Refer candidates for employment to the CONSULTANT for psychological
evaluation.
2. Pay CONSULTANT after an invoice is received from CONSULTANT.
3. Review all reports submitted by CONS UL'rAN"I'.
1). Work T.)roII,,ram/i)roieCt SChedLIIe
.1. Services will be assigned to the CONSULTAN'F on an as-needed basis.
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:
1. CON SU i.,rANT will be paid by the CITY a flat rate of$450.00 per pre-employment
psychological evaluation.
. . C;
2. CONSULTANT will be paid by the CITY $375.00 per hour for a fitness for duty
evaluation or other psychological services agreed to by the CITY and the
CONSULTANT.
3. CONSUL"I'ANT will be paid by the CITY $375.00 per hour for any Court appearance
on behalf o f the CITY.
4. CONSULTANT will be paid $200.00 for any cancellation within 24 hours of the
scheduled date and time of a scheduled pre-employment evaluation or other
psychological services.
B. Travel. Charges for time during travel are not reimbursable
C. Billing
1. All billing shall be done monthly in fifteen (15) minute increments and matched to
an appropriate breakdown of the time that was taken to perform that work and who
performed it.
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 project.
3. A copy of memoranda, letters, reports, calculations and other documentation
prepared by CONSUUFAN'r may be required to be, submitted to CITY to
demonstrate progress toward completion of tasks. In the event CITY rejects or has
comments on any such product, CITY shall identify specific requirements for
satisfactory completion.
4. 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 nncnnbcr 0fC(}N3OLT/\Nl_n firm
that the work has been performed in accordance with the provisionsofdhis
Agreement; and
El For all payments include ail estimate o[the percentage o[work completed.
Upon Submission oF any such invoice, if CITY ixsatisfied that CONSULTANT is
making soiiot'actory progress toward completion of tasks in accordance with this
/\grccrnmnt, C[[Y shall approve the invoicc, in which ovco1 payment abo} be made
within thirty (]0) days of rcp:ip|oFdhc invoice by CITY. Such mpp,nvo> shall not
be unreasonably vvithhc|d. l[CITY does not approve on invoice, CITY shall notify
CONS in v/bdng of the reasons for non-approval and the sobcdu|o of
perfbonuncc set forth in Exhibit ''A" may at the option of CITY be suspended until
the parties agree that past per[hnnaocc by CONSULTANT is in, or has been
brought into connp\iuncc, or ond| this &grccnncnt has expired or is terminated as
provided herein.
i Any billings for extra work or additional services authorized in advance and in
writing hv CITY shall be invoiced separately in CITY. Such invoice shall contain
all ofdhc information required above, and in addition shall list the hours expended
and hourly rate charged for such hnnc. Such invoices ahnU hc approved bvCITY if
the work pcd6oncd is in accordance ni,h the extra v/nd/ or additional services
requested, and ill' 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 paynncoi of such an.invoice shall be koou:d
as xcpurx|c and apart from the ongoing porR)rnnoncc of the pcnnaiodcr of this
/\&rccnocnt,
A,tcount :Number;:: CA. SuSA 165:0 Date: 4/DS/16 Initials: LUCILLEK
CERTI' F I C `OF INSURANCE
DARWIN NATTONAL ASSURANCE COMPANY
C/o American Profes.sional .Agency, Inc
95 Broadway, Ami'tyvillef 'NY I17:D1
500-421-�6:94.
This is tt cestlfp ith8t the insmvnre po4c5es OF441ed,below have been :.jssued by the company indicated
above to title insu3eG named hereim:aad that; s6ject to.ttieir;propie3one and.condltlonS sugh;pol cles:atfprQ
L1I9coveraQes':Indicated:insofar.as snob coverages applq.:'.to:the:occnpahiag,:.:gr..busYaiess:aF'tt�e:Gamed Yn3aretl,('S)
ab st'ated:: .
THIS CERTIFICATE CF INSURANCE NEITHER AFFIRMATIVELY NOR.NEGATI..VELY :AMENDS., EXTENDS OR
ALTERS THE COVERAGES) :AFFOWED BY TmE POLICY(I.ES} LISTED ON THIS CERTIFICATE.
Name :and Address of Insured.: Additional .Named 'Insureds
:SUSAN .SAKE-CLTFRORIJ., PH...:D.:. 'SUSAN :SAXE=CLIFFORD;. PHD
A PRCFES5IDN33I, CfPP. LATHY GOODM 7, :PIID
16-53:0 VENTURA BLVD
STE 203
ENgINo CA 93436
APPROVED
AS TO FORM
Type of Work Covered- PROFES 1-oNAL PSYCH-OLOGMST
Locat or ;of Opera:tlons: N/A
j Lf difLererm .than raddress'1"i d above) By:
Michael
Gates,City Attorney
C1&.1m..History,
Retro,active. .date. is 03 da-:2a0
?ol.i:cy Effect v. 6 d Exp raatimm liTmit.s of.
_..
Cgves;ages- Number Dane Date Lz b lit
PROFESSIONAL/ 2, 0,0'0., 000
LIABILIT 5D21-:01:3 3 Q1�;16. 3 ':0`3./17 4,..00:0 D0'0
NOTICE OF CANCELLATIC?N FT.T.LL :ONLY "BE GIVEN TO '.THE FIRST .NAPZD :INWRED,, WHO SHALL
ACT ON BF,Hl1'I;F OF ALL IIVSUREI3 . `[1rIT$ RESFE{:T :TQ GIBING OR RECE'IVfNG. NQTICE OF
CANCELT3AT:ION
Comments, THE POtiLQWSNG IS AN ADDITIONAL :INSURED ON .THI'$ :POLICY.:
CITY OF HUNTINGTAN BEACH'
This Certificate Issued ta.-
:Name:.1 SUSAN SAXE-CLIF'FORD; PH.:D._
A PROFESSIONAL CORP, �VN '
Address 5530 VENTURA -BLVD
STE 2a3. Au orized Rep11; tatiive
ENCINO CA 914.3:5
APA O'.0:1113 0:0 r 0:6/2D14:)
CITY OF HUNTINGTON BEACH
Professional Service Approval Form
PART I RECEIVED
MAR 11 2016
Date 2/18/2016 Project Manager Name Chuck Thomas
Requested by Name if different from Project Manager Finance Department
Department Police
PARTS I OF THE PROFESSIONAL SERVICES CONTRACTS APPROVAL FORM MUST BE COMPLETED
BY THE REQUESTING DEPARTMENT AND SIGNED BY THE CITY MANAGER, FOR APPROVAL,
BEFORE PROCEEDING WITH THE SOLICITATION OR CONTRACT PROCESS. PART I MUST BE FILED
WITH ALL APPROVED CONTRACTS.
1) Briefly provide the purpose for the agreement
Services from a licensed psychologist for Police Officer, Communications Operator and Dention Officer
pre-employment pyschological examinations and other psychological services as needed for the Police
Department The California Commission on Peace Officers Standards and Training (POST) requires all
Police Officer applicants to submit to a psychological examination The support/consulting services
include therapy, fitness for duty examinations, consulitng, critical incident debriefing and emergency crisis
intervention
2) Estimated cost of the services being sought $ 13,000
3) Are sufficient funds available to fund this contract? ® Yes ❑ No
If no, please explain
4) Check below how the services will be obtained
❑ A Bid solicitation process in accordance to the MC 3 03 060 procedures will be conducted
❑ MC 3 03 08(b)—Other Interagency Agreement procedure will be utilized
® MC 3 03 08—Contract Limits of$30,000 or less exempt procedure will be utilized
5) Is this contract generally described on the list of professional service contracts approved by the City
Council? If the answer to this question is "No," the contract will require approval from the City Council )
® Yes ❑ No
Fiscal Services page Signature (Purchasing Approval) Date
6) Amount, Business Unit(8 digits) and Object Code (5 digits)where funds are budgeted
(Please note that a budget check will occur at the object code level)-
Account number Contractual Dollar Amount
Business unit object# Fiscal Year Fiscal Year Fiscal Year
15/16 16/17 17/18
10070109-69360 $3 00 $5 00 $ 000
$ $ $
$ $ $
f<< l�u
Budget Ap oval Date
1.46
epartme ad Signature(s) Date
3 /74
ire for o Fin ce's Signature Date
ssistant Ci y anager's Signature Date
APPROVE�kll
DENIED ❑
professional service approval form-part i—saxeclifford
REV February 2015
CITY OF HUNTINGTON BEACH
Professional Service Approval Form
PART I
C1#lVanagers Signature Date
professional service approval form-part i_saxeclifford
REV February 2015
CITY OF HUNTINGTON BEACH
e FYM1,
Professional Service Approval Form
"~ PART II ��cE�v��
MAR 11 2016
Date 2/18/2016 Project Manager Chuck Thomas Penance Department
Requested by Name if different from Project Manager
Department Police
PARTS I & II OF THE PROFESSIONAL SERVICES CONTRACTS APPROVAL FORM MUST BE
COMPLETED BY THE REQUESTING DEPARTMENT AND SIGNED FOR APPROVAL. PART I& 11 MUST
BE FILED WITH ALL APPROVED CONTRACTS
1) Name of consultant Susan Saxe Clifford, PHD APC
2) Contract Number POL LOlt-O L
(Contract numbers are obtained through Finance Administration x 5630)
3) Amount of this contract $13,000
Account number Contractual Dollar Amount
Business unit object# Fiscal Year Fiscal Year Fiscal Year
15/16 16/17 17/18
10070109-69360 $3,000 $5,000 $5,000
$ $ $
4) Is this contract less than$50,000? ® Yes ❑ No
5) Does this contract fall within $50,000 and $100,000? ❑ Yes ® No
6) Is this contract over$100,000? ❑ Yes ® No
(Note Contracts requiring City Council Approval need to be signed by the Mayor and City Clerk Make
sure the appropriate signature page is attached to the contract)
7) Were formal written proposals requested from at least three available qualified consultants?
❑ Yes ® No
8) Attach a list of consultants from whom proposals were requested (including a contact telephone
number)
9) Attach Exhibit A, which describes the proposed scope of work
10) Attach Exhibit B, whic describes the payment terms of the contract
Fiscal ger(Purchasing) Date
9, a Ace
Budget Z;:--
proval Signature D to
X'-- (� / -2 1 le
Director of Finance (or designee) Signature Date
professional service approval form-part u_saxeclifford
REV February 2015