HomeMy WebLinkAboutAddiction Medicine Consultants, Inc. - 2005-12-01Contracts Submittal to
City Clerk's Office R, 7 C 7- I V F D
Hunt &-ach* 2005 DEC 16 AM I I: I I
To: City Clerk c;-Y IF
I'll U ial T 1 � 4') T C,� J 1'3E A CH
1. Name of Contractor: Addiction Medicine i �Y . ..... `�
2. Purpose of Contract: For Example: Audit Services or Water Quality Testing Huntington Lake - Huntington Central Park
07- Drug and Alcohol Testing Program
3. Amount of Contract: $5,200
Copy of contract distributed to: The ORIGINAL insurance certificate/waiver sent to Risk
Management
Initiating Dept._
City Treasurer _ ORIGINAL bonds sent to Treasurer
Natn6/Ex-rensio3/
City Attomey's Office
Date: 12/15/05
g:/Attymisc/forrns/city clerk contract transmittal.doc
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PROFESSIONAL SERVICES CONTRACT BETWEEN
THE CITY OF HUNTINGTON BEACH AND
ADDICTION MEDICINE CONSULTANTS, INC.
FOR
D.O.T. DRUG AND ALCOHOL TESTING PROGRAM
Table of Contents
Scopeof Services.................................................................................................... 1
CityStaff Assistance............................................................................................... 2
Term; Time of Performance.................................................................................... 2
Compensation.......................................................................................................... 2
ExtraWork.............................................................................................................. 2
Methodof Payment................................................................................................. 3
Disposition of Plans, Estimates and Other Documents ........................................... 3
HoldHarmless......................................................................................................... 3
Professional Liability Insurance.............................................................................4
Certificate of Insurance........................................................................................... 5
Independent Contractor........................................................................................... 6
Terminationof Agreement...................................................................................... 6
Assignmentand Delegation..................................................................................... 6
Copyrights/Patents.................................................................................................. 7
City Employees and Officials................................................................................. 7
Notices.........................................................................................7
Consent.................................................................................................................. 8
Modification............................................................................................................ 8
SectionHeadings..................................................................................................... 8
Interpretation of this Agreement............................................................................. 8
DuplicateOriginal................................................................................................... 9
Immigration.............................................................................................................. 9
Legal Services Subcontracting Prohibited............................................................... 9
Attorney's Fees......................................................................................................... 10
Survival.................................................................................................................... 10
GoverningLaw......................................................................................................... 10
Entirety..................................................................................................................... 10
PROFESSIONAL SERVICES CONTRACT BETWEEN
THE CITY OF HUNTINGTON BEACH AND
ADDICTION MEDICINE CONSULTANTS, INC.
FOR
D.O.T. DRUG AND ALCOHOL TESTING 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 Addiction Medicine Consultants, hereinafter referred to as
"CONSULTANT."
WHEREAS, CITY desires to engage the services of a consultant to provide
professional consulting services for a complete Department of Transportation (D.O.T.)
drug and alcohol testing program as more particularly set forth in Exhibit A attached
hereto; 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 David Herold who shall represent it and
be its sole contact and agent in all consultations with CITY during the performance of this
Agreement.
agree/citywide/revisions/profservl0/15/01-A 1
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 December 1, 2005 (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 September 30, 2008 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 Five Thousand Two Hundred Dollars
($5,200.00).
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/citywide/revisions/profservl0/15/01-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/citywide/revisions/profservl0/15/01-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 fixture 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.
agree/citywide/revisions/profservl0/15/01-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. 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 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
all payment of all taxes, social security, state disability insurance compensation,
agree/citywide/revisions/profservl0/15/01-A 5
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.
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
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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:
City of Huntington Beach
ATTN: Irma Youssefieh, Human
Resources Manager
2000 Main Street
Huntington Beach, CA 92648
17. CONSENT
TO CONSULTANT:
David Herold, President
Addiction Medicine Consultants, Inc.
Post Office Box 8878
Redlands, CA 92375
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.
agree/citywide/revisions/profservl0/15101-A 7
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
which is hereby affected shall be curtailed and limited only to the extent necessary to bring
it within the requirements of the law.
agree/citywide/revisions/profservl0/15101-A 8
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,
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.
agree/citywide/revisions/profservl0/15/01-A 9
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.
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be
-'>executed by and through their authorized officers on 1(� , 20�.
agree/citywide/revisions/profsery 10/15/01 -A 10
CONSULTANT,
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print name
ITS: (circle one) Chairma resider ice President APPROVED AS TO FORM:
(2
r4tsIbS City A o ey
CITY OF HUNTINGTON BEACH,
a municipal corporation of the State of California
r,mrvvier-yf �F Pu'ry C �"ii A �K ►� S1-a. wraiL
(PursuantTo HBMC §3.03.100)
AND
By:
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Secretary ITS: (circle on hief Financial Officer/Asst.
Secretary — Treasu
1 t/IS/a �—
agree/citywide/revisions/profservl0/15/01-A II
REVIEWED AND PRC
City do
(only for contr cts $5
00 and over)
EXHIBIT A
CITY OF HUNTINGTON BEACH
and
ADDICTION MEDICINE CONSULTANTS, INC. (AMC)
Effective October I, 2005 until September 30, 2008
CONTRACTOR SCOPE OF WORK
Administrated Program Services and Fee Schedule
Program Services Include:
Urine Drug Test (Emit Screen with GC/MC Confirmation)
SAMHSA Certified Laboratory for all Urine Drug Tests
Chair of Custody Forms and Collectton Supplies
Random Selection Generation for Covered Employees
Supervisor Training & Educational Materials
Storage of Positive Specimen as Required by D.O.T.
Federal Reporting as Required
Collection Site Selection
MRO Services for all Urine Drug Tests
Transportation to SAMSA Lab
Employee's Policy and Procedure Design
Employee Record Administration
Test Reporting
Alcohol Breath Testing as D.O.T. Requires
Consultant will provide a complete D.O.T. drug and alcohol testing program with a 50% random
selection method for a flat fee of $50.00 per covered employee for each contract year. For 90
covered drivers the annual fee is $4,500.00. This fee will be based upon the actual number of
employees in the random pool. Services beyond the random drug and alcohol would be charged
by the fee schedule listed below.
EXHIBIT B
PAYMENT SCHEDULE - TIME AND MATERIALS
(For services beyond random testing for the specified covered drivers)
Program Cost Per Urine Requisition Proceessed
Breath Alcohol Per Test Mobile, On Site, or at SBCL Site
Supervisor's Training Program per hour
Employee's Training Program per hour
Substance Abuse Professional per hour
D/L Isomer Confirmation Test
Split Specimen GC/MS Confirmation Test
$49.50
$40.00
$100.00
$100.00
$150.00
$65.00
$150.00
Rates for services are based upon current market contracts, adjustments in rates can occur with
the agreement of both parties.
s11 PROFESSIONAL SERVICE CONTRACTS
Htiom, � PURCHASING CERTIFICATION
1. Requested by: Irma Youssefieh, Human Resources Manager
2. Date: November 3, 2005
3. Name of consultant: Addiction Medicine Consultants, Inc.
4. Attach the written statement of the specification, conditions and other
requirements for the requested services that was provided to solicted
consultatnts in your answer to 11 of this form. See Exhibit A of contract
5. Amount of the contract: $ 5 , 200.00
6. Are sufficient funds available to fund this contract?' ® Yes, ❑ No
7. Company number and object code where funds are budgeted: 10030403.69365
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?'
In Yes, ❑_N�_--.__..
-
10. Were (at least) informal written proposals requested of three consultants?
❑ Yes, Q No Interagency transaction with City of Oxnard per
Agreement No. 3519-05-HR
11.
contact telephone number). N/A
12. Attach proposed scope of work
proposals were requested (including a
See Exhibit A of contract
13. Attach proposed payment schedule. See Exhibit B of contract
R HAR AMADRIL, Mana er
Purchasing/Central Services
' If the answer to any these questions is "No," the contract will require approval from the City Council.
Documentl 11/3/2005 10:47 AM
Y
AY INSURANCE AND INDEMNIFICATION WAIVER
MODIFICATION REQUES
DEC C 6 2005
1. Requested by: Christi Mendoza, Risk Management city of whim . un 8e e,
2. Date: December 6, 2005
pity Attomey's Offic
3. Name of contractor/permittee: Addiction Medicine Consultants Inc (dba: AMC)
4. Description of work to be performed: Company participates in the city's random drug
testing program collecting urine sampling.
5. Value and length of contract: $5,200.00; Three (3) years
6. Waiver/modification request: Cancellation clause wording/professional liability insurance
7. Reason for request and why it should be granted: Unable to comply with the cifir's
cancellation clause wording insurance requirement
8. Identify the risks to the City in approving this waiver/modification: None.
De Varn6iit d Sign ture ate:
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 Manag!T!5±inb oe City Attorney's Office disagree.
1. Risk Management
Approved ❑ Denied'
Signature Date
2. City Attorney's Office
roved ❑ Denie (�YV / 1vit Z
inn., Date
3. City Administrator's Office
❑ Approved ❑ Denied
Signature Date
If approved, the completed waiverimodification 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
agennlr_eeFn
.
AC014 'CERTIFICATE OF LIABILITY INSURANCE
11/15/ 5D )
PRODUCER
BB&T Insurance
110 Dixie Street
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Carrollton, GA 30117
770 214-1991 j-4-
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
Addiction Medicine Consultants Inc. dba
AMC
P.O. Box 8878
Redlands, CA 923755
wsURERA: Markel lns(StringerWare) ;
38970
INSURER B:
INSURER C:
INSURER D:
INSURER E:
COVFRAGFS
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES_ AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
ADD'
NSR
TYPE OF INSURANCE
POLICY NUMBER
DATEYMM/D CTIVE
PDATE MM/DD CY EXPIRATION
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE
$
COMMERCIAL GENERAL LIABILITY
DAM
APREMAGEISES (RENTED
E occurrence)
$
CLAIMS MADE 1-1 OCCUR
MEEK EXP_(Avy one person)
$.
PERSONAL 8 ADV INJURY
$
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$
POLICY PRO-
JECT LOC
AUTOMOBILE LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident)
$
BODILY INJURY
(Per person)
$
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per accident) .... _...
$
». _.... _.
HIRED AUTOS
- NON -OWNED AUTOS -
- -
- ..
.... - ....
.NSA
��
PROPERTY DAMAGE
(Per accident)
$
GARAGE LIABILITY
�� A
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
$
ANY AUTO
$
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE
$
OCCUR F1 CLAIMS MADE
AGGREGATE
$
$
DEDUCTIBLE
$
RETENTION $
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE
T OR LIMIT OTH-
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
OFFICER/MEMBER EXCLUDED?
If yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE -POLICY LIMIT$
A
OTHER Professional
3CD33013042
09/08/05
09/08/06
$1,000,000 Occurrence
$3,000,000 Aggregate
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Professional Liability - Testing Services; Claims Made; Retro Date: 09/08/03
Deductible: $1,000; Training Endorsement;
CERTIFICATE HOLDER CANCELLATION
City of Huntington Beach, HR Div.
Attn: Irmayoussefieh
2000 Main Street
Huntington Beach, CA 92648
LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN
:E TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
jE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
ACORD 25 (2001108) 1 of 2 #1635462 PDW 0 ACORD CORPORATION 1988