HomeMy WebLinkAboutCounseling Team International - 2019-11-01 AMENDMENT NO. 1 TO PROFESSIONAL SERVICES CONTRACT
BETWEEN THE CITY OF HUNTINGTON BEACH AND
THE COUNSELING TEAM INTERNATIONAL
FOR
PSYCHOLOGICAL COUNSELING SERVICES
THIS AMENDMENT is made and entered into by and between the CITY OF
HUNTINGTON BEACH, a California municipal corporation, hereinafter referred to as
"CITY," and The Counseling Team International, a California Corporation hereinafter
referred to as "CONSULTANT."
WHEREAS, CITY and CONSULTANT are parties to that certain agreement,
dated November 1, 2019 entitled"Professional Services Contract Between the City of
Huntington Beach and The Counseling Team International for Psychological Counseling
Services." which agreement shall hereinafter be referred to as the "Original Agreement,"
and
CITY and CONSULTANT wish to amend the Original Agreement to reflect the
additional work to be performed by CONSULTANT and the additional compensation to
be paid in consideration thereof by CITY to CONSULTANT,
NOW, THEREFORE, it is agreed by CITY and CONSULTANT as follows:
1. ADDITIONAL COMPENSATION
In consideration of the additional services to be performed, CITY agrees
to pay CONSULTANT, and CONSULTANT agrees to accept from CITY as full
payment for services rendered, an additional sum not to exceed Fourteen Thousand Four
Hundred Dollars ($14,400) in addition to the original sum of Fifteen Thousand Six
Hundred Dollars ($15,600), for a new total not to exceed Sixty Three Thousand Dollars
($30,000).
20-8630/231068 1
2. REAFFIRMATION
Except as specifically modified herein, all other terms and conditions of
the Original Agreement shall remain in full force and effect.
IN WITNESS WHEREOF, the parties hereto have caused this agreement to be
executed by their authorized officers on 2020.
%"'
CONSULTANT, JCITY OF HUNTINGTON BEACH,
a municipal corporation of the State of
THE COUNSELING TEAM California
INTERNATIONAL
By: Director/Chief
(Pursuant To HBMC§3.03.100)
print name APPROVED AS TO FORM:
ITS: (circle one)Chairman/PresidenWice President
AND
u
By: �ity Att ey
Date
print name
ITS: (circle one)Secretary/Chief Financial Officer/Asst. RECEIVE AND FILE:
Secretary—Treasurer
City Clerk
Date
COUNTERPART
20-8630/231068 2
2. REAFFIRMATION
Except as specifically modified herein, all other terms and conditions of
the Original Agreement shall remain in full force and effect.
IN WITNESS WHEREOF,the parties hereto have caused this agreement to be
executed by their authorized officers on , 2020.
CONSULTANT, CITY OF HUNTINGTON BEACH,
a municipal corporation of the State of
THE COUNSELING TEAM California
INTERNATIONAL
By: 1 � ,I '� Director/Chief
(Pursuant To HBMC§3.03.100)
print name APPROVED AS TO FORM:
ITS: (circle are)Chairman/ residcn icc President
AND
y:(
B ���� �,� ) City Attorney 1
�IZ✓ C�stc: t. Date
print name
ITS: (circle one)secretary/ .1icPPinnnciai Officcl/ sSt. RECEIVE AND FILE:
Secretary—Treasurer
COUNTERPART City Clerk
Date
20-8630/231068 2
PROFESSIONAL SERVICES CONTRACT BETWEEN
THE CITY OF HUNTINGTON BEACH AND
THE COUNSELING TEAM INTERNATIONAL
FOR
PSYCHOLOGICAL COUNSELING 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 The Counseling Team International, a California Corporation hereinafter referred to
as "CONSULTANT."
WHEREAS, CITY desires to engage the services of a consultant to perform psychological
counseling services; 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 Julie Casto Koot who shall represent it and be
its sole contact and agent in all consultations with CITY during the performance of this Agreement.
2. CITY STAFF ASSISTANCE
CITY shall assign a staff coordinator to work directly with CONSULTANT in the
performance of this Agreement.
1 9-8 1 3 5/2 1 703 8
agree/surfnet/professional Svcs to$49
05/19-204132 1 of 12
3. TERM; TIME OF PERFORMANCE
Time is of the essence of this Agreement. The services of CONSULTANT are to
commence on /VOc/P.h 6 er- , 20 (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 one (1) year 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 Fifteen Thousand Six Hundred Dollars ($15,600).
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.
6. METHOD OF PAYMENT
CONSULTANT shall be paid pursuant to the terms of Exhibit "B."
19-8135/217038
agree/surfnet/profession at Svcs to$49
05/19-204132 2 of 12
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
A. 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 applicable. The policy limits
do not act as limitation upon the amount of indemnification to be provided by CONSULTANT.
B. To the extent that CONSULTANT performs"Design Professional Services"within
the meaning of Civil Code Section 2782.8,then the following Hold Harmless provision applies in
place of subsection A above:
19-8135/217038
agree/surfnet/profession alsvcsto$49
05/19-204132 3 of 12
"CONSULTANT hereby agrees to protect, defend, indemnify and hold harmless
CITY and its officers, elected or appointed officials, employees, agents and volunteers, from and
against any and all claims, damages, losses, expenses, demands and defense costs (including,
without limitation, costs and fees of litigation of every nature or liability of any kind or nature) to
the extent that the claims against CONSULTANT arise out of, pertain to, or relate to the
negligence, recklessness, or willful misconduct of CONSULTANT. In no event shall the cost to
defend charged to CONSULTANT exceed CONSULTANT's proportionate percentage of fault.
However, notwithstanding the previous sentence, in the event one or more other defendants to the
claims and/or litigation is unable to pay its share of defense costs due to bankruptcy or dissolution
of the business, CONSULTANT shall meet and confer with CITY and other defendants regarding
unpaid defense costs. The duty to indemnify, including the duty and the cost to defend, is limited
as provided in California Civil Code Section 2782.8.
C. Regardless of whether subparagraph A or B applies, CITY shall be reimbursed by
CONSULTANT for all costs and attorney's fees incurred by CITY in enforcing this obligation.
This indemnity shall apply to all claims and liability regardless of whether any insurance policies
are applicable. The policy limits do not act as a 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
1 9-8 1 3 5/2 1 703 8
agree/surfnet/professional svcs to$49
05/19-204132 4 of 12
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
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;
19-8135/217038
agree/surfnet/professional svcs to$49
05/19-204132 5 of 12
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.
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
19-8135/217038
agree/surfnet/professional svcs to$49
05/19-204132 6 of 12
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 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.
19-8135/217038
agree/surfnet/professionalsves to$49
05/19-204132 7 of 12
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 The Counseling Team International
ATTN: David Segura, Fire Chief ATTN: Julie Casto Koot
2000 Main Street 1881 Business Center Drive, Suite 11
Huntington Beach, CA 92648 San Bernardino, CA 92408
909-884-0133 Ext. 225
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
19-8135/217038
agree/surfnet/professional sves to$49
05/19-204132 8 of 12
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.
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
19-8135/217038
agree/surfnet/profession al sves to$49
05/19-204132 9 of 12
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.
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
19-8135/217038
agree/surfnet/professional svcs to$49
05/19-204132 10 of 12
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.
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.
1 9-8 1 3 5/2 1 703 8
agree/surfnet/professional svcs to$49
05/19-204132 11 of 12
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
Julie Casto Koot Calif a
The Counseling Team International
By: Director/Chief
(Pursuant To HBMC§3.03.100)
print name APPROVED AS TO FORM:
ITS: (circle one)Chairman/PresidentNice President
AND
By. 7ate
City Attorney AW
print name
ITS: (circle one) Secretary/Chief Financial Officer/Asst. RECEIVE AND FILE:
Secretary—Treasurer
COUNTFRPART AIM
City Clerk
Date — -
19-8135/217038
agree/surfnet/professionalsvcs to$49
05/19-204132 12 of 12
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
Julie Casto Koot California
Th Counseling Team International
By: �"' "` . Director/Chief
to (Pursuant To HBMC§3.03.100)
print namet `�.. ^�...., APPROVED AS TO FORM:
�^-��
ITS: (circle one)Ciwinna�ice:President
AND
B City Attorney Ajj j
tiJ �1rFty Date
print name
ITS: (circle one)Secretary/Chief Financial Officer/Asst. RECEIVE AND FILE:.
Secretary—Treasurer
City Clerk
COUNTERPART Date
1 9-8 1 3 5/2 1 703 8
agree/surfnet/professional sm to$49
05/19-204132 12 of 12
EXHIBIT "A"
EXHIBIT A
EXHIBIT A
EMPLOYEE SUPPORT SERVICES TO BE DELIVERED
A. TCTI shall provide short-term counseling services to employees and their
eligible family members living in the home. Short-term counseling is
determined by the Mental Health Professional on a case by case basis. If it is
determined that the issues require long-term treatment(i.e.: acute or chronic
emotional disorders) then the Mental Health Professional can refer accordingly.
B. TCTI shall provide training for the management team and supervisory team
related to the program. They will receive short training sessions on how the
program works, and how he or she can relate to the program and support it. It is
important to build the relationship between managers and supervisors so they can
work together as part of a cooperative team. Training them together supports
this teamwork.
C. TCTI provides initial orientation training to all employees related to the program.
We believe that this is a very important aspect which gives the employee an
opportunity to find out who we are and learn about our program;
D. TCTI shall maintain the confidentiality of all employees and their eligible family
members living in the home referred for counseling. The cornerstone of every
successful Employee Support Services Program is the pledge of confidentiality;
without it, there is no credibility. Employees will not reveal their personal
problems if there are not clear legal guidelines about confidentiality.
Confidentiality means that all personal information parted will be respected and
safeguarded. It may be used only in a responsible manner for the purpose of
helping in rehabilitating the person. Our records are kept secure in accordance
with our professional code of ethics, Federal Regulations and state laws. We
also have a top of the line alarm system installed, which protects our records.
TCTI will not reveal the names or identities of employees or family members
who come to the program voluntarily.
E. TCTI's staff will be available to provide counseling services in a convenient and timely
manner. To make an appointment, an employee or eligible family member may appear
in person or call the office between the hours of 7:30 A.M - 4:30 P.M. Monday through
Friday. The employee or the eligible family member will then come to the office at the
prescribed time, where a counseling session will take place. If an emergency takes place
after hours, TCTI provides a 24-hour answering service. The Answering Service will
contact one of our on-call Mental Health Professionals to handle the emergency.
F. TCTI designed a website with the user in mind! We currently offer over 75 Articles,
Handouts and Surveys or Tests to utilize on various topics as vW61`P as`l inks W helpful
Organizations and Associations.
EXHIBIT A
CRITICAL INCIDENTS
A Critical Incident can be a situation faced by employees. Two types of crises can occur during
a Critical Incident. An Exhaustion Crisis is when an individual has been coping with an
intense stressful situation(s) or event(s) for a long period of time and reaches the point of
exhaustion and cannot cope. A Shock Crisis is when a sudden change or event such as
shooting, fire, assault, etc.
Examples are:
- Serious injury, death, or suicide of a fellow co-worker
- Shootings (including both shooting or being shot at, whether anyone was hit or not)
- Any other serious threat to the life of you or your co-worker
- Serious injury or death of a civilian resulting from department's operations
- Any incident in which circumstances are unusual
- Any incident in which sights and sounds are distressing
- Any catastrophic event/major disasters
- Rescuing a victim, where pain and suffering is obvious
- Mass casualty event
- Knowing the victim
- Death, injury, or abuse of a child
- Contact with communicative diseases, e.g. AIDS/Hepatitis B
- Major traffic accident
- Death of a close family member
- Sudden Infant Death Syndrome
- Toxic chemical fire/explosion
- Extreme attempts where lives are lost
- Hostage or barricaded situation
- Physical or Sexual Assault
HIGH STRESS EVENTS
- Incidents that attract extremely unusual or possible derogatory news media coverage
- Current social/legal/media reactions to your department
- Accumulative critical events in a short time span
- Serious threat to child, spouse, relative or friend
- Injuries or illness that could threaten career
- Victim resembles loved one
EXHIBIT A
TR2AINING
TCTI is able to provide a wide variety of training classes. This educational approach can serve
as a proactive measure, as well as a follow-up tool, for the Huntington Beach Fire Department.
Classes can be tailored to fit your specific needs and can range from 2 to 8 hours. Training
programs can provide the Department information and skills that will maximize their ability to
function as a team and to continue to develop productive careers.
• Adrenal Burnout
• Alcohol and Drug Awareness in the Workplace (Substance Abuse)
• Anger Management
• Assisting Children in the Aftermath of a Tragedy
• Borderline Personality Disorder
• Bullying in the Workplace
• Burnout-Compassion Fatigue
• Burnout& Secondary Trauma Among Forensic Interviewers
• Conflict Resolution and Assertiveness
• Coping with Change
• When Cops Cross the Line
• Creating a Strong Marriage
• Crimes Against Children& Secondary Trauma to Public Safety Personnel
• Dealing with Depression and Suicide Situations
• Dealing with Difficult People
• Dealing with a Terminal Illness
• Discovering Your Intuition
• Diversity in Public Safety
• Divorce— What Price?
• Exposure to Child Pornography for Court Personnel and Jurors
• Families in Turmoil
• Firing and Layoffs
• Generational Differences in Public Safety Personnel
• Grief and Bereavement
• Handling Layoffs
• Handling Retirement Concerns
• Handling Sleep Difficulties
• Handling Your Anger
EXHIBIT A
• Holiday Stress
• Homicide Investigator Stress
• How to Help Staff in Crisis
• How Peer Support Can I.D. Aggressive Behavior in Peers
• Humor in the Workplace
• Hypertensive Sleep Issues
• Understanding Intuition
• Leadership Resiliency
• Listening Techniques and Communication Skills
• Living with a Third Person in my Marriage
• Managing Sleep Disorders, Shift Work and Hypervigilance
• Motivating Employees
• Overcoming Adversity
• Dealing with Post-Infidelity Issues
• Posttraumatic Growth
• Preventing Suicide for Public Safety Personnel
• Professional Conduct for Exceptional Teamwork
• Retirement Concerns for Public Safety Personnel
• Self-Image and Care
• S.O.S. —Significant Other Survival
• Stress Management
• Teaching the Benefits Mindfulness
• Terminal Illness & Grief
• The Dynamics of Fear
• The Effects of Social Media on Family and Relationships
• The Employee Problem Solver
• The Essentials of Customer Service
• The Power of Building Resiliency in Public Safety Personnel
• Understanding Eye Movement Desensitization and Reprocessing (EMDR)
• Understanding Posttraumatic Stress Disorder for Public Safety Personnel
• Understanding the Impact of Medications for Public Safety Personnel
• Understanding the LGBTQ co-worker
• Wellness in the Workplace and at Leisure
• Wellness Solutions --Ways to Combat Stress
• Workplace Violence
BASIC (PEER SUPPORT Tai NG
This three-day course brings participants together that have been selected as peer supporters by
their department on a volunteer basis from all ranks and positions within the workplace.
Throughout this class, participants will acquire supportive skills which are designed to help
them assist their co-workers who are experiencing a variety of life crisis situations,who feel
comfortable talking to someone that has "been there" and understands what it's like to work
"their jobs".
Peer support provides a way for employees and their family members to confidentially talk
about personal/professional problems with specially trained co-workers who understand and
want to help. Their primary function is to LISTEN, ASSESS and whenever necessary, REFER
to mental health professionals. They are taught to complement those services provided by
mental health professionals.
Class Topics
• Developing a Peer Support Program
• Self-Disclosure
• Active Listening/Paraphrasing
• Crisis Intervention Techniques
• Dealing with Depression and Suicide Situations
• Grief and Mourning
• Line-of-Duty-Deaths
• Critical Incident Stress Management
• Eye Movement Desensitization and Reprocessing (EMDR)
• Diversity in Public Safety (LGBTQIA)
• Substance Abuse
(ICISF Certified and Continuing Education Credit is available for Fire Personnel through
EMSAIICEMA)
BASIC CRITICAL INCI W'S&ESS MANAGEMENT
TRAINING
The Basic CISM training program is designed to present the core elements of a comprehensive,
systematic and multi-component crisis intervention curriculum. The 2-day course prepares
participants to understand a wide range of crisis intervention services including pre and post
incident crisis education, significant other support services, on-scene support services, crisis
intervention for individuals, demobilizations after large-scale traumatic incidents, small group
defusings and group interventions known as Critical Incident Stress Debriefing (CISD). The
Basic CISM course specifically prepares participants to provide several of these interventions,
specifically demobilizations, defusings and CISD. The need for appropriate follow-up services
and referrals when necessary is also described. Considerable evidence gathered to date strongly
supports the multi-component crisis intervention strategy, which is discussed in this course.
Basic CISM training is open to any person who wishes to know more about.crisis.intervention
techniques such as CISD. Emergency services and disaster workers, security;:safety, military,
industrial and school system personnel, EAPs, human resources personnel, psychologists, social
workers, counselors and others can all benefit from the Basic CISM training. The course is
certified through the International Critical Incident Stress Foundation(ICISF) and comes with
an ICISF workbook and certificate of completion.
Class Topics
Types of Critical Incidents
• Critical Incident Stress
• Stress Preventatives
• Demobilizations
Defusings
7 Phases of Debriefings
(ICISF Certified and Continuing Education Credit is available for Fire Personnel through
EMSAIICENI4)
EXHIBIT
ADVANCED PEER SUPPORT TRAINING
Advanced Peer Support training is designed to enhance skills learned in the basic Peer Support
course, strengthen current skills of Peer Supporters, introduce new topics and learn ways to help
keep the Peer Support team healthy and strong. An overview of the signs, symptoms and
treatment recommendations for Posttraumatic Stress Disorder(PTSD) will be covered, and a
treatment option known as Eye Movement Desensitization and Reprocessing(EMDR) will be
identified and explored. Participants will also learn about Suicide Prevention and Intervention
and will obtain a 4 hour Gatekeeping QPR certificate, as well as ways to be prepared on
handling difficult debriefing situations.
Class Topics
• Understanding PTSD
• Learn the differences between Posttraumatic Stress and PTSD
• Review Eye Movement Desensitization and Reprocessing (EMDR)
• Develop skills for dealing with suicidal peers
• Develop skills for handling difficult debriefings
• Reinforce basic Peer Support skills
• Discover ways to keep your Peer Support team healthy
(ICISF Certified and Continuing Education Credit is available for Fire Personnel through
EMSAIICEMA)
PSYCHOLOGICAL ESTING�AND SCREENING
The Purpose
Proposed are the standards for psychological screening of public safety personnel applicants.
Psychological screening can assess the emotional stability of the above said candidates while
focusing on two main categories:
1. Screening for evidence of clinical psychopathology, which when present, may be
assumed to substantially interfere with the safe and efficient functioning of an individual
in the public safety profession.
2. Screening for variants of non-clinical psychological functioning which, although
not definitive of psychopathology per se, can be empirically related to relatively poor
performance in training and/or subsequent job functions in the public safety profession.
The Process
Psychological screenings are conducted by one of TCTI's Clinical Psychologists, Dr. Kathleen
Wellbrock, Dr. Sara Hibbs, Dr. Nels Klyver or Dr. Angelika Robinson who are involved in the
objective test assessment of the screening procedure. They are well versed through training and
experience, in the construct and interpretation of psychological testing instruments.
After integrating the test data and clinical interview data, the doctor prepares a written summary
of findings and interpretations. The summary will state clearly the evidence, if any, of
psychopathology suggested by the test battery and corroborated by the clinical interview and
will mention the job-related impact of such findings.
The three best sources of information on the evaluation of public safety applicants usually are:
1) a psychological test battery; 2) background information and 3) in depth "clinical" interview
by one of our doctors who are experts in the public safety profession. Psychological screening
minimizes the admission of inappropriate candidates.
Research shows that excessive stress can lead to aggressive and unconventional behavior, as
well as mental and physical problems and breakdowns on the job. There is considerable
evidence suggesting that more public safety personnel are affected by job-related stress than the
normal work force.
The screening process can aid in detecting the stress prone individuals and can be beneficial in
the prevention and management of undue stress in those individuals and therefore aids the
department humanely and financially.
Statistically, 5% to 20% of public safety personnel are psychologically unsuitable. Not all
applicants perform at the same level and the unsuitable applicants do not always appear as
obviously inappropriate. Some individuals will look very good, while others will obviously
look unacceptable. A great majority will be somewhere in-between. This in-between or middle
range person who, upon evaluation by the doctor demonstrates risk of engaging in liability
resulting behavior should be screened out.
The following tests are used in the screening proccess. The Minnesota Mult phasic Personality
Inventory-2 (MMPI-2), the most widely used and accepted psychological test in the United
States today. The California Psychological Inventory (CPI) or The Sixteen Personality Factor
Test (16PF), a short form I.Q., which is the Wonderlic Personnel Test and a Sentence
Completion Test is used to give insight into the applicant's personality.
To schedule an appointment, the department will need to call the Psychological Testing
Coordinator at (909) 884-0133 x229. The Psychological Testing Coordinator will set up the
written testing date with the department. The written testing is conducted at 9:00 am Monday
thru Friday. The applicant will need to allow four to six hours for the written test. During the
written test, the Psychological Testing Coordinator will schedule the oral interview with the
applicant not to exceed 5-working days following the written testing. The oral interview will
last approximately 45 minutes with one of our Clinical Psychologists. {t' ie aplli'can't will need
to come dressed in business attire for this interview. In some cases, a department may
request that a same day oral appointment be made. This is usually necessary if the applicant
lives further than one hour away. In that case, the department will need to notify The
Counseling Team International as soon as possible in order to assure that the test can be set up
in a timely manner. Usually, the oral interview appointments fill up approximately two weeks
in advance. Our facility can accommodate up to 24 applicants at a time or, arrangements can be made
for the testing coordinator to conduct the written examination at a facility of your choice for those groups
larger than 24 applicants.
The Results
After the testing is scored, the applicant is interviewed using background'mater al"provided by
the applicant and his test results. History being the best predictor of future behavior, evaluee's
relationships: social, familial and vocational are explored. This interview and the
accompanying test results are summarized in a brief report, which supports a final score,
Psychologically Suitable— Score 3.0 or Psychologically Unsuitable—Score 2.0
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:
See attached Exhibit B
B. Travel Charges for time during travel are not reimbursable.
C. Billiniz
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 CONSULTANT 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;
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
1
Exhibit B
into compliance, or until this Agreement has expired or is terminated as provided
herein.
5. 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.
2
Exhibit B
EXHIBIT B
PROGRAM OPERATIONS COST
Upon signing this contract between Huntington Beach Fire Department and The Counseling
Team International (TCTI), TCTI shall provide the following services:
A. Professional Short-term Confidential Counseling - for approximately 140 Full Time Fire
Personnel and their eligible dependents living within the home. (this includes Marine Safety
Personnel)
B. Supervisor Referrals—provide consultations with supervisors regarding problem employees
and/or any aspect of the Employee Support Services (ESS).
C. Follow-up Sessions - for employees involved in Critical Incidents.
D. TCTI will conduct an initial orientation for all levels, including management concerning
services provided by the Employee Support Services (ESS) for no charge. TCTI will
provide all literature for management, employees and their eligible dependents, i.e.,
brochures, flyers, supervisor handbooks, business cards, etc...
E. TCTI will attend one health fair a year at no charge.
F. Consultation services. This service is included in the professional counseling portion of this
contract.
All services above will not exceed the annual amount of$15,600.00. This will be at the rate of
$1,300.00 per month.
Additional Services not included in the amount above:
Training—provide a wide variety of training classes at the reduced rate`of$150'.00`per hour.
There will be an additional $50.00 fee per hour for travel. All ICISF certified classes will be
billed at the set rate for the requested subject.
Critical Incident Intervention - provide 24-hour on-call Critical Incident Debriefing services
at the reduced rate of$200.00 per hour.
3-Day Basic Peer Support $299.00 per student
(ICISF Certified and Continuing Education Credit is available for Fire Personnel through
ICEMMIEMSA)
2-Day Basic Critical Incident Stress Management (CISM) $199.00 per student
(ICISF Certified and Continuing Education Credit is available for Fire Personnel through
ICEMM/EMSA))
2-Day Advanced Peer Support $199.00 per student
(ICISF Certified and Continuing Education Credit is available for Fire Personnel through
ICEMAIEMSA)
EXHIBIT B
Peer Support Consultation: $75.00,per hour
Peer Support Meetings (Quarterly): $110.00 per hour
Pre-Employment Psychological Evaluation: TCTI will provide the written test, oral interview and written report
to the department at the reduced rate of$300.00 per applicant.
BY. BYIN
c Bo 1 e ro' ;°PIi trectar
The Counseling Team International
Date: Date:
PROFESSIONAL SERVICES CONTRACT BETWEEN
THE CITY OF HUNTINGTON BEACH AND
THE COUNSELING TEAM INTERNATIONAL
FOR
PSYCHOLOGICAL COUNSELING SERVICES
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 Signatories............................................................................................................................ 10
28 Entirety................................................................................................................................. 10
29 Effective Date.................................................................................I 1
Ct® PHILADELPHIA
NSURANCH COMPANiIt%
pCH
A\Inrl�•••I lire n.l�.)laiu.11 •
Certificate of Liability Insurance
Date Issued:1 0/3 012 0 1 9
Underwritten by:Philadelphia Indemnity Insurance Company One Bala Plaza,Suite 100 Bala Cynwyd,PA 19004•NAIC#:18058
Adm inistered by:CPH&Associates•711 S.Dearborn St.Ste 205 Chicago,IL 60605 P 800.875,1911 F 312,987,0902 info@cphins.com
DISCLAIMER:This certificate is issued as a matter of information only and confers no rights upon the certificate holder.The Certificate of Insurance does not
constitute a contract between the issuing insurer(s)r authorized representative or producer,and the certificate holder,nor does it affirmatively or negatively amend,
extend,or alter the coverage afforded by the policies listed thereon.
Insured: Nancy K. Bohl Inc.dba The Counseling Policy Number: 025826
Team International
Nancy Bohl Policy Term: 08/31/2019 to 08/31/2020
1881 Business Center Drive#11
San Bernardino, CA 92408
Covered Locations
Professional Liability: Portable coverage, not location specific
Coverage Type Per Incident Aggregate
(Occurrence Form) (Per Individual claim) (Total amount per year)
Professional Liability $ 1,000,000 $ 5,000,000
Supplemental Liability $ 1,000,000 $5,000,000
Licensing Board Defense $35,000 $35;000
Commercial General N/A NIA
Liability NIA NIA
FirelWater Legal Liability
Business Personal Property NIA NIA
Vicarious Sexual $ 1,000,000 $ 1,000,000
Misconduct
Cyber Liability
(Claims Made Form)
Retroactive Date: $ 25,000 $ 25,000
08/31/2018
Comments/Special Descriptions:
Certificate Holder
City of Huntington Beach
Chief David Segura
2000 Main Street, 5th Floor
APPROVED AS TO FORrHuntington Beach,CA 92648
N C r ficatqs been added as an additional insured
tiy:
If the certificate holder is an ADDITIOMCNilliM D.I(RA cy(tes) endorsed,A statement on this certificate does not confer rights to the certificate holder in
lieu of such endorsemenl(s).Notice of ggjWIA[FW()RNply be provided to the first named insured in accordance with policy provisions,who shall act on behalf of all
additional insureds with respeglTvi,69 FRyFF141�d'ht9lWlhE!N('F
Authorized Representative
C.Philip Hodson
oATs(MMIDDfwvvl
a�oRU' CERTIFICATE OF LIABILITY INSURANCE 07116=19
THIS CERTIFICATE IS ISSUED AS A (NATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCED AND THE CERTIFICATE HOLDER_
IMPORTANT: III the certificate holder is an ADDITIONAL INSURED,the policy(.es)must have ADDITIONAL INSURED provisions or be endorsed.
IF SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement an
this certificate does not confer rights to the certificate holder in lieu of such endorseme s.
PRPOU�R CONTACT -
RdeFarm SKALA INSURANCE AGENCY INC WE _ . 909-883-8861 i FAX
a 4214 N SIERRA WAY ks AAtL GENE GENESKAIACOM I
ADDRESS'_ -. .------ -
SAN BERNARDINO.CA 92407 — — -- _-
INSURER- AFFORDING COVERAGE -_ NAIL s
---—---
GENE SKALA,AGENT LICAak0587032 INSURER A: State Farm Central Insurance Company 25151
INSUrrAo - -- --- ulsuRFu a: State Farm Mutual Automobile Insurance Company 25178
INSURER C
NANCY K BOHL INC
DBA THE COUNSELING TEAM INTERNATIONAL INSLIR9tD;--_AND DBA THE ORGANIZATIONAL NETWORK _--
_ I INSURER F:
COVERAGES _ CERTIFICATE NUMBER: REVISION NUMBER-
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLIGY PERIOD
INDICATED NOTVNTHSTANCING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 0714ER DOCUMENT VMTH RESPECT TO WHICH T141S
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCL USIONSAND CONDITIONS OF SUCH POLICIES_LIMITS SHOVNd MAY WIVE BEEN REDUCED BY PAID CLAIMS.
ILl14 - -TYPE OF INSURANCE --- ADOL49UBR Jyyn POUCYNUMBER PYOLICYFFF nPOwao-i EDIP 4Mmi
COMMERCIAL GENERAL Lkoml.TY EACH OCCURRENCE $ 1,000,000
Tw�i7rCl`78T Ei7T�- 300,000
CIArLLS-MADE �_ OCCUR PREMISFSf,Enmrtrpr�pl b
HIRED AUTO MF D t xP;Arn erx tureen 15,000
A ENOL 921_1314261&92YD04220 07/12/2019 07/12/2020 --
PERS(INAI 8 ADv IN.IURY I
GrNL AGCREGATE LIMIT APPLIES PCR rYNERAL AAGRECATC 12.000,000
POLX)Y L-1 JECT I_ LUC PROOLICTS-COMPIUP AGC_ _fP1
OTHER _ _ r
AUTOMOBILE LIABILITY 4414187F2475 06/24/2019 1212412019 FOMNndEDNS1NGLF uMrr I
ANY AUTO BODILY NJURY(Perpmeon) r 1,000.0D0 -� --
B 1 OWNED SCHEDULED -
AUI0SONIY Autos BOOK VBfJURY(Per ecciderd) 11,000,000
riIREO NON-OVAIED PROPER YDiAMAGE i 1 000,000
---.;AUTOS ONLY AUTOS ONLY
I I
UnaREtLA LIAB JCCcUR FACHOCCURRENCf I-
EXCESS LIAR CLAIMS MADE ACl;Rr.GATE _ I
RETENTION 9 r
PER OTH-
wORN6RSCOiRSLUA ILIT __ ;TAB
AND EMPLOY6R5'L]ABILTrY YIN ANY PROPMETORIPARrNER,EXECUrIVE EL EACH ACCIDENT I
OFFICERIMEMBERExMUM)? NIA -_... -.---._...._.-
rNendMoey lei NN) EA.aXSEASE—EAEMPLOYEE E
If�reo,Onun6t under -
UF:cCHIPIIONOFOPgkATIONSDNed E.L.DISEASE POLICY LIMIT
I
I
1
i
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACO M Ift,Addltlecal Renedls Schedule,maybe aWaeAed R meet SPAC4 Is faWred)
Business Office Policy Property Locations;
1881 Business Center Or,San Bernardino, CA 92408 39766 Murrieta Hot Springs Rd,Ste DI60,Murriete,CA 92563
1545 Anacapa Rd Ste 7C,VirAorville,CA 92392 135 S State College Blvd Ste 200,Brea,CA 92821
444.Camino Del Rlo Ste 201 S,San Diego,CA 92108 701 Palomar Airport Rd.*300.Carlsbad,CA 92011
74075 El Pasco Ste AS,Palm Desert,CA 92260 232 Harrison Ave Ste D.Claremont,CA 91711
270 E HWY 246 Ste 11,Suellton,CA 93427
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE OF-SCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIFA710H DATE THEREOF, NOTICE WLL BE DELIVERED IN
For Insurance Verification Purpose. CORDANCE WITH THE POLICY PROVISIONS.
NANCY K BOHL INC DBA THE COUNSELING TEAM
INTERNATIONAL AND DBA THE ORGANIZATIONAL 0 ED REPRESENrA
NETWORK
d 198 2015 RD CORPO O IICY 'g is ed.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
footsaG r329i9.T.^03-1�:ote
POLICYHOLDER COPY SIP
TE
• P.O. BOX 8192, PLEASANTON, CA 94588
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
ISSUE DATE: 08-12-2019 GROUP:
POLICY NUMBER: 0702761-2019
CERTIFICATE 10: 48
CERTIFICATE EXPIRES: 08-12-2020
08-12-2019/08-12-2020
SP
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 80 days advance written notice to the employer.
We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document
with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy.
Authorized Representative President and CEO
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE.
ENDORSEMENT N0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2017-08-12 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED:
COUNTY OF VENTURA
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-12-2011 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
NANCY K BOHL INC OBA: THE COUNSELING TEAM SIP
INTERNATIONAL
1881 BUS CTR DR STE 11
SAN BERNADINO CA 92408
M0410
(REv.7-2014) PRINTED : 07-17-2019