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HomeMy WebLinkAboutWorkterra - 2020-06-15 PROFESSIONAL SERVICES CONTRACT BETWEEN THE CITY OF HUNTINGTON BEACH AND WORKTERRA FOR AFFORDABLE CARE ACT (ACA) TRACKING AND REPORTING 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 WorkTerra, a Limited Liability Corporation hereinafter referred to as "CONSULTANT." WHEREAS, CITY desires to engage the services of a consultant to perform tracking and reporting services relating to the Affordable Care Act (ACA); 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 Dennis Plankar 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. 20-8618/229113 3. TERM; TIME OF PERFORMANCE Time is of the essence of this Agreement. The services of CONSULTANT are to commence on V �l 20�-D (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 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 Thirty Thousand Dollars ($30,000). 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." 20-8618/229113 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: 20-8618/229113 "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 20-8618/229113 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; 20-8618/229113 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 20-86 1 8/229 1 1 3 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. 20-8618/229113 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 WorkTerra ATTN: Dahle Bulosan Dennis Plankar 2000 Main Street 5675 Gibraltar Drive Huntington Beach, CA 92648 Pleasanton, CA 94588 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 20-86 1 8/229 1 1 3 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 20-8618/229113 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 20-8618/229113 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. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by and through their authorized officers. 20-8618/229113 CONSULTANT, CITY OF HUNTINGTON BEACH, a municipal corporation of the State of WORKTERRA California COMPANY NAME E-Signed: 05/13/2020 01:15 PM CST Q By; eitrus c�i'ankar Director/Chief Bennis. builder.com (Pursuant To HBMC§3.03./00) 1P: 73.110.183.125 DocID:20200513131328898 print name APPROVED AS TO FORM: ITS: (circle one)Chairman/PresidentNice President President AND BY: t CityAttorney Y Li Date print name ITS: (circle one)Secretary/Chief Financial Officer/Asst. RECEIVE AND FILE: Secretary—Treasurer City Clerk Date COUNTERPART 20-8618/2'2")1 1.� 12 Doc ID: 20200513131328898 CONSULTANT, CITY OF HUNTINGTON BEACH, a municipal corporation of the State of WORKTERRA California COMPANY NAME � � Q By: Director/Chief (Pursuant To HBMC§3.03.100) print name APPROVED AS TO FORM: ITS: (circle one)Chairman/President/Vice President AND By: City Attorney �U) Da print name ITS: (circle one) Secretary/Chief Financial Officer/Asst. RECEIVE AND FILE: Secretary—Treasurer City Clerk Date &A �-20 COUNTERPART 20-8618/229113 EXHIBIT A ORKTE RR A Human Capital Management i STATEMENT OF WORK—ACA calendar year 2020 This Agreement is between City of Huntington Beach ("Client") and WORKTERRA ("Vendor") dated May 1, 2020. All capitalized terms used herein,but not defined herein,will have the meanings set forth In the Agreement. Unless expressly modified herein,all terms in the Agreement shall remain unchanged and in full force and effect. 1. SOW TERM.Vendor will provide the Services described in this SOW beginning on the date of Statement of Work—ACA t calendar year 2020 and will be effective for only the ACA services described herein for the 2020 calendar year. 2. APPLICATIONS. The Applications included in the scope of this SOW are as follows:WORKTERRA ACA Module 3. SCOPE AND DESCRIPTION OF SERVICES. The Services included in the scope of this SOW are as follows: WORKTERRRA will work with the client to establish the tools that the client intends to use and provide set up documentation and training. WORKTERRA will upload electronic files provided by clients directly to WORKTERRA that will include Information on employees who are not currently housed in the WORKTERRA system but will be in the software for ACA tracking purposes and who may become eligible based on hours worked. For those using the measurement period calculator, clients will forward files in the WORKTERRA format for hours worked. WORKTERRA will upload those as received. A. Implementation services Client will confirm in writing to Vendor the specific services to be utilized. Any additional information required to complete the client filing for 2020 will be uploaded into WORKTERRA based on agreed upon timelines for delivery of this data. Note that WORKTERRA is not acting as a compliance consultant or advisor. These tools are for the use of our clients as they see fit. WORKTERRA will not provide legal advice or guarantee regulatory results. WORKTERRA will not be responsible for any fees or penalties incurred by clients for ACA compliance. The client Is responsible for following the legal requirements and ensuring that all information provided is correct. B. Reporting Services WORKTERRA will provide 1095C forms for the eligible employees that are housed in WORKTERRA as of the date that the forms are due to be delivered to the employees. The delivery of the 1095 forms will be based on dates that will be sent by the end of October for client sign-off. The 1094C form will be provided and include information and copies of all 1095C forms that were delivered for employee fulfillment. This form will be provided in an electronic format after client testing form has been received. Clients who can file 1094-C and 109S-C forms with the IRS in a hardcopy format can use the electronic format to print and mail. Please confirm with your legal counsel to confirm eligibility for hardcopy filing. Note that WORKTERRA is not acting as a compliance consultant or advisor. The tool is for the use of our clients as they see fit. WORKTERRA will provide legal advice or guarantee regulatory results. EBSJWORKTERRA will not be responsible for any fees or penalties incurred by clients for ACA compliance. EXHIBIT B The client is responsible for following the legal requirements and ensuring that all information provided is correct. Yes No ACA Tool/Measurement Period Calculator $0.35 PEPM ® ❑ -Determination/Stability Period Calculator -Reporting tool -Full time equivalents -W-2 report -Exchange notifications ICost of coverage calculator i -Manage eligibility for non-benefit eligible employees(PEPM charged on full population in WORKTERRA) Utilizing our ACA tool including Look Back,Stability&Administrative Periods -Hours trending tools -PCORI fee calculator -Loading hours to track FTE -FTE estimator Yes No 1095-C Form Generation $2.50 per form ® ❑ -Create draft 1095C forms based on the information in WORKTERRA -Deliver draft 1095C forms to Client in December 2020* -Deliver final 1095Cs to client in January 2021* OR Yes No 1095-C form Mailing $3.50 per form ❑ ❑ -Create draft 1095C forms based on the information in WORKTERRA -Deliver draft 1095C forms to Client in December 2020* -Deliver final 1095Cs to client in January 2021* -WORKTERRA will mail 1095-C forms to Employees via first class mail by the deadline provided by the IRS Yes No Returned mailers will not be returned and will be destroyed upon receipt Understood ❑ *Dates could change depending on the IRS guidelines for the 2020 tax year C. Filing Services This is an optional service for clients who have contracted with WORKTERRA to provide the 1095C forms. WORKTERRA will file the 1094C and 1095C forms with the IRS through the IRS electronic process on or before the 2019 filing deadline on behalf of the employer. Clients who are required to file in an electronic format and who have elected to file on their own behalf will receive an electronic file in the required IRS format at least two weeks prior to the deadline for 2019 filing dependent on WORKTERRA receiving the approval on the forms by the timeline provided. All delivery dates are subject to the employer forwarding required information by agreed upon dates. Yes No Providing a Test File to the Client for the Client to File with the IRS $1,500.00 ❑ Yes No Providing the File to the Client for the Client to File with the IRS $2,500.00 ❑ -Creation of the 1094C/1095C XML file in the IRS format -Submission to the Client at least one week before the IRS deadline =_ -Checking for processing updates from the IRS website once per week -Defining and distributing to the client any error codes that occur from the IRS filing Yes No Providing the Refile to the Client for the Client to Refile with the IRS $1,500.00 ❑ -Creating a refile of the IRS XML for the Client after corrections are made -Submission to the Client by the IRS deadline -Checking for processing updates from the IRS website once per week -Defining and distributing to the client any error codes that occur from the IRS filing -Per refile fee OR Yes No Creation and Submission of the 1094/1095 XML $5,000.00 ® ❑ -Creation of the 1094C/1095C XML file in the IRS format -Submission to the IRS on the Client's behalf by the IRS deadline -Checking for processing updates from the IRS website once per week -Defining and distributing to the client any error codes that occur from the IRS filing -Creating a refile of the IRS XML for the Client after corrections are made -Submission of the refile to the IRS on the Client's behalf by the IRS deadline -Defining and distributing to the client any final error codes that occur from the IRS filing Yes No Any additional refiles to the IRS(fee per.file) $1,500.00 ❑ ❑ Additional Fees Definition of Codes or Researching Codes $175.00 per hour -Providing definition or research on IRS codes input onto the 1095C forms from WORKTERRA Codes Change Requests by Client $175.00 per hour -Changing of codes without Client providing legal guidance as to why they should be changed Historical Data Loads $2,500.00 per file -Data load of employee data with election date, if applicable. Includes up to eight hours of data scrubbing. File must be in our format. Additional Data Loads $2,500.00 per file -Data load of employee data such as hours worked,class changes,benefit statuses,etc. Includes up to eight hours of data scrubbing. File must be in our format. Reactivating Clients $2,500.00 per file -Any client that needs to be reactivated for research of ACA will incur this charge along with a monthly charge of$250 per month that the site needs to remain open. The$175 per hour charge for research will also apply should WORKTERRA need to assist. 4. FEES In exchange for the Services listed in this SOW,Client shall pay vendor the fees outlined within this SOW. Fees for any service not specifically outlined herein will be quoted upon request. Please note—these fees are based on the services as directed by the IRS as of the signing of this SOW. If there are additional changes to the regulations that require additional coding/services,our fees may need to be re-quoted. A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/os/oTl2020 Y) ozo THIS CERTIFICATE IS ISSUED AS A MATTER 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 PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)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 on this w certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT d Aon Risk Services Northeast, Inc. NAME: New York NY office PHONE N.Ext): (866) 283-7122 FAX No.: (800) 363-0105 One Liberty Plaza E-MAIL C 165 Broadway, Suite 3201 ADDRESS: _ New York NY 10006 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Federal Insurance Company 20281 WORKTERRA INSURERB: Chubb National Ins Co 10052 PO Box 11657 Pleasanton CA 94588 USA INSURERC: Lloyd's syndicate No. 2623 AA1128623 INSURERD: Chubb Indemnity insurance Co. 12777 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570081703054 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD POLICYEXMM/DD P LIMITS A _X__COMMERCIAL GENERAL.LIABILITY 0713112019 __EACH OCCURRENCE __ $1.,000_000 CLAIMS-MADE X❑OCCUR DAMAGE TO RENTED $1,OOO,000 PREMISES Ea occurrence MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 Mo X POLICY ❑JECTPRO- ❑LOC PRODUCTS-COMP/OPAGG Included co OTHER: p n A 7359-90-29 07/31/2019 07/31/2020 COMBINED SINGLE LIMIT N AUTOMOBILE LV161LRY Ea accident $1,000,000 X ANYAUTO BODILY INJURY(Per person) Z OWNED SCHEDULED BODILY INJURY(Per accident) N AUTOS AUTOS HIRED AUOTOS NON-OWNED PROPERTY DAMAGE V ONLY AUTOS ONLY Per accident t" 07 A J�E.CE..UMBRELLALIAROCCUR 78182735 07/31/2019 07/31/2020 EACH OCCURRENCE $5,000,000 L) LIABCLAIMS-MADE AGGREGATE $5,000,000 ED RETENTION B WORKERS COMPENSATION AND 2071763502 07 31/ 0019 07/31/2020 X I PER STATUTE I JOTH- EMPLOYERS'LIABILITY Y/N AOS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 D OFFICER/MEMBEREXCLUDED? N/A 2071776878 07/31/2019 07/31/2020 (Mandatory in NH) MS SC E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 c I Cyber Liability W1F934190301 07/31/2019 07/31/2020 Aggregate Limit $10,000,000 Claims Made SIR applies per policy ter s & condi ions DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) The Cyber Liability policy includes coverage for Professional Liability.city of Huntington Beach,its officers and employees are IL_ included as Additional Insured in accordance with the policy provisions of the Gene r0l*0W17tIt1S?Q0trYpRM � By: CHAEL E.GATES 5 CITY ATTORNEY CERTIFICATE HOLDER CANCELLATION CITY OF HUNTING SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE - POLICY PROVISIONS. City of Huntington Beach AUTHORIZED REPRESENTATIVE 2000 Main Street Huntington Beach CA 92648 USA ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r-H U S ET Liability Insurance Endorsement Poficy Period JULY 31,2019 1'0 JULY 31,ZJ20 Effective Date JULY 31.2019 Pc.'xy"VuM'bGr 3604-46-22[YFO Insured CAR 1-:LR15U ILO M.LLC Na m a r,f Ccrr pany W-VERAL INSURANCUCONIVANY Date Issued AUGUST'6,201.9 This Cndarstment applies to the following forms: GI.MRAL LIAI3ILrl'Y Under Who Is An lusumA the fotlow[ng provision is added, Who Is An Insured A ddtiwal Insured- Persons xur2anizations shown in the School,:are insureds;but they are insureds only ifyuu am Scheduled Pefsor) obligated pursuant to a;-,,iutraztT agreerrxatto provide them with such insurance as is afforded by Of Organization this policy. However,the person or organization is an insured only; • if and then only to thcoxtzat the personororganization isdcscTib4.%Jin the S0,zJul.*. • to the extent suchcuutraa- ur ag.rtcrrv.rit requires the p,,nun or organization to be afforded status as an insured; • fcractivitics that jidnctoccur,inwtviteor input,beforcthcexecutionof thecontract or a gremcnt;and • with rzspcv to damages,fuss,s,cast or expense for injury a damage to which this insurance applies. No person a orgauizatiun is an insured under this provision; • that is more spezifizally i;Jentlf1c;JuTdLr any otherprovision of the Whu Is An Insuroi section(rq crone ssof anv limitation applicable thereto). • with respect to any assumptiun a f liability(of anotberpason a urganization)by them in a contracts a2rccir.-cut.i'h is limitation aloes not apply to the liability fur damages,loss,cost or Meuse for injury or jdmuu,to which this insurance applies,that thcpasin or organization would have in the absence of such contractor acrzzmcnt, Uabdoy Msurance AddilonmOnxred-svhPdu.adParxn Or Onqan4atao ecnVar"Id FCFM 60-02-2M 7(,q".5-07) Endcrmfmns P.7-96 I CHUBS° UabHlty Endorsement {continued) Undcr C mItiuns,the fullowing prnvi siun is added to the condiflorn titicdOthcr lusuran e, conditions Other tMurance— if vuu areobligated,pursuartt to a:,mtma or aerocment,to pruvidc ttre p rson a organization Primary,Noncoottibutory shuwv in the SzhcJv1zwith primary insutancc such as is aff`ordud by this pilicv,then in Such case insurance-Scheduled this insuranct;isprirmry and.rz will nut seek contribution from insurance available to su:h person Persron Or Orgaruzatior) ororganiza[iun, Schedule PER SONS ORORGANIZAi'lONS111A'I YOU ARC OBLIGA'1'ED, PURSUAN'V 1 O W'KI]'1'EIr CON'I'RACI'Ok AGKLll N1EN'1'BL:I'wL.(:N YOU AND SUCI1 PERSON Oft ORGANIZATION,1'0 PROVA)L-W'Ili1 SUCII tNSURANC L, AS IS A-FORDED BY'1111S POLICY:BUl IELiY ARE NSURL31S ONLY IF AND I'0 1'11C MINIMUN4 LX'1'LN 1171A1 SUCl1 C'ON'1'KACI'UK AGIRMmvq'1, KLQU1RLS'I'HEPEKSON OKORGANIZATION TO BE Al'1'ORDEL7 S'I:4'I-US AS AN INS U RED, 11OWLVLR,NO PERSON ORORGANIZA'FION IS AN INSURED UNDER'Alls PROVISION WHO IS MORESPECIL'ICALLY DESCRIBED UNDER ANY O'I'IIER PROVISION Of II&Wl10ISAN INSURED SECI'IUN OI'THIS POLIC'Y-(KLGAKDLLSS-Ol-ANY LID1I1:A`PION:AI'l'LIC'ABLL'1'11LKL:1'O) --- ----- —— -- -- — — All utt=terms and conditions remain unchaneod, A r,:h crrzad A6FN son LatYt/Msoranw Addder.a.0awrad-SchaduladPar=nOrckganizaScn fasic�ga FGrM 80-M-cEW(AaV.5.07I Endcrwrnani N.qa 2 CITY OF HUNTINGTON BEACH Professional Service Approval Form PART Date: 4/30/2020 Project Manager Name: Dahle Bulosan/Tiffany Bose Requested by Name if different from Project Manager: Paulina Flores Department: Finance 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/ MUST BE FILED WITH ALL APPROVED CONTRACTS. 1) Briefly provide the purpose for the agreement: Affordable Care Act (ACA) tracking and reporting 2) Estimated cost of the services being sought: $23,379 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 4199 Principal frinance Analyst Signature (Purchasing Approval) Da e 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 Fiscal Year FY 19/20 FY 20/21 FY 21/22 10035201.69365 $7,793 $7793 $7,793 $ $ $ $ $ cm�" /P/I?r Budget Approval Date Department Head Signature(s) Date Chief Financial 00 cer Signature / Date assistant City Manager's Signature Date APPR VED DENIED ❑ S D City Manager's Signature Date professional service approval form-part i-workterra REV: 10/2019 CITY OF HUNTINGTON BEACH J.ft.Ono k. Professional Service Approval Form PART II Date. 4/30/2020 Project Manager: Dahle Bulosan/Tiffany Bose Requested by Name if different from Project Manager: Paulina Flores Department: Finance PARTS I & II OF THE PROFESSIONAL SERVICES CONTRACTS APPROVAL FORM MUST BE COMPLETED BY THE REQUESTING DEPARTMENT AND SIGNED FOR APPROVAL. PART 1 & 11 MUST BE FILED WITH ALL APPROVED CONTRACTS. 1) Name of consultant: WorkTerra 2) Contract Number: FIN 19- 3) Amount of this contract: $23,379 Account number Contractual Dollar Amount Business unit. object# Fiscal Year Fiscal Year Fiscal Year Fiscal Year 19/20 20/21 21/23 10035205.69365 $7,793 $7,793 $7,793 $ 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, which describes the payment terms of the contract. ¢r I,V_ Department Hea Date Principal Finance Analyst(Purchasing) Date e Budget Manager Approval Signature Date :J::� u s lv Chief Fin an is Officer(or designee) Signature Date professional service approval form - part ii-workterra REV: 10/2019