Dr. Howard Michaels - 2014 Agreement for EMS ServicesAGREEMENT FOR SERVICES
(For contracts over $5,000)
This AGREEMENT made this 1st day of May, 2014, between:
CITY: City of Gilroy, having a principal place of business at
7351 Rosanna Street, Gilroy, California
and CONSULTANT:
Dr. Howard Michaels, having a principal place of business at 5875 Killarney Circle
San Jose, CA 95138.
ARTICLE 1. TERM OF AGREEMENT
This Agreement will become effective on July 1, 2014 and will continue in effect through June
30, 2016 unless terminated in accordance with the provisions of Article 7 of this Agreement.
ARTICLE 2. INDEPENDENT CONTRACTOR STATUS
It is the express intention of the parties that CONSULTANT is an independent contractor and not
an employee, agent, joint venturer or partner of CITY. Nothing in this Agreement shall be
interpreted or construed as creating or establishing the relationship of employer and employee
between CITY and CONSULTANT or any employee or agent of CONSULTANT. Both parties
acknowledge that CONSULTANT is not an employee for state or federal tax purposes.
CONSULTANT shall not be entitled to any of the rights or benefits afforded to CITY'S
employees, including, without limitation, disability or unemployment insurance, workers'
compensation, medical insurance, sick leave, retirement benefits or any other employment
benefits. CONSULTANT shall retain the right to perform services for others during the term of
this Agreement.
ARTICLE 3. SERVICES TO BE PERFORMED BY CONSULTANT
A. Specific Services
CONSULTANT agrees to: Perform the services as outlined in Exhibit "A" ( "Specific
Provisions ") and Exhibit `B" ( "Scope of Services "), within the time periods described in
Exhibit "C" ( "Milestone Schedule ").
B. Method of Performing Services
CONSULTANT shall determine the method, details and means of performing the above -
described services. CITY shall have no right to, and shall not, control the manner or determine
the method of accomplishing CONSULTANT'S services.
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C. Employment of Assistants
CONSULTANT may, at the CONSULTANT'S own expense, employ such assistants as
CONSULTANT deems necessary to perform the services required of CONSULTANT by this
Agreement, subject to the prohibition against assignment and subcontracting contained in
Article 5 below. CITY may not control, direct, or supervise CONSULTANT'S assistants in the
performance of those services. CONSULTANT assumes full and sole responsibility for the
payment of all compensation and expenses of these assistants and for all state and federal income
tax, unemployment insurance, Social Security, disability insurance and other applicable
withholding.
D. Place of Work
CONSULTANT shall perform the services required by this Agreement at any place or location
and at such times as CONSULTANT shall determine is necessary to properly and timely perform
CONSULTANT'S services.
ARTICLE 4. COMPENSATION
A. Consideration
In consideration for the services to be performed by CONSULTANT, CITY agrees to pay
CONSULTANT the amounts set forth in Exhibit "D" ( "Payment Schedule "). In no event
however shall the total compensation paid to CONSULTANT exceed the amount set forth in
Exhibit "D ".
B. Invoices
CONSULTANT shall submit invoices for all services rendered.
C. Payment
Payment shall be due according to the payment schedule set forth in Exhibit "D ". No payment
will be made unless CONSULTANT has first provided City with a written receipt of invoice
describing the work performed and any approved direct expenses (as provided for in
Exhibit "A ", Section IV) incurred during the preceding period. If CITY objects to all or any
portion of any invoice, CITY shall notify CONSULTANT of the objection within thirty (30)
days from receipt of the invoice, give reasons for the objection, and pay that portion of the
invoice not in dispute. It shall not constitute a default or breach of this Agreement for CITY not
to pay any invoiced amounts to which it has objected until the objection has been resolved by
mutual agreement of the parties.
D. Expenses
CONSULTANT shall be responsible for all costs and expenses incident to the performance of
services for CITY, including but not limited to, all costs of equipment used or provided by
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CONSULTANT, all fees, fines, licenses, bonds or taxes required of or imposed against
CONSULTANT and all other of CONSULTANT'S costs of doing business. CITY shall not be
responsible for any expenses incurred by CONSULTANT in performing services for CITY,
except for those expenses constituting "direct expenses" referenced on Exhibit "A."
ARTICLE 5. OBLIGATIONS OF CONSULTANT
A. Tools and Instrumentalities
CONSULTANT shall supply all tools and instrumentalities required to perform the services
under this Agreement at its sole cost and expense. CONSULTANT is not required to purchase
or rent any tools, equipment or services from CITY.
B. Workers' Compensation
CONSULTANT agrees to provide workers' compensation insurance for CONSULTANT'S
employees and agents and agrees to hold harmless, defend with counsel acceptable to CITY and
indemnify CITY, its officers, representatives, agents and employees from and against any and all
claims, suits, damages, costs, fees, demands, causes of action, losses, liabilities and expenses,
including without limitation reasonable attorneys' fees, arising out of any injury, disability, or
death of any of CONSULTANT'S employees.
C. Indemnification of Liability, Duty to Defend
1. As to professional liability, to the fullest extent permitted by law,
CONSULTANT shall defend, through counsel approved by CITY (which approval shall not be
unreasonably withheld), indemnify and hold harmless CITY, its officers, representatives, agents
and employees against any and all suits, damages, costs, fees, claims, demands, causes of action,
losses, liabilities and expenses, including without limitation attorneys' fees, to the extent arising
or resulting directly or indirectly from any willful or negligent acts, errors or omissions of
CONSULTANT or CONSULTANT'S assistants, employees or agents, including all claims
relating to the injury or death of any person or damage to any property.
2. As to other liability, to the fullest extent permitted by law, CONSULTANT shall
defend, through counsel approved by CITY (which approval shall not be unreasonably withheld),
indemnify and hold harmless CITY, its officers, representatives, agents and employees against
any and all suits, damages, costs, fees, claims, demands, causes of action, losses, liabilities and
expenses, including without limitation attorneys' fees, arising or resulting directly or indirectly
from any act or omission of CONSULTANT or CONSULTANT'S assistants, employees or
agents, including all claims relating to the injury or death of any person or damage to any
property.
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D. Insurance
In addition to any other obligations under this Agreement, CONSULTANT shall, at no cost to
CITY, obtain and maintain throughout the term of this Agreement: (a) Commercial Liability
Insurance on a per occurrence basis, including coverage for owned and non -owned automobiles,
with a minimum combined single limit coverage of $1,000,000 per occurrence for all damages
due to bodily injury, sickness or disease, or death to any person, and damage to property,
including the loss of use thereof, and (b) Professional Liability Insurance (Errors & Omissions)
with a minimum coverage of $1,000,000 per occurrence or claim, and $2,000,000 aggregate;
provided however, Professional Liability Insurance written on a claims made basis must comply
with the requirements set forth below. Professional Liability Insurance written on a claims made
basis (including without limitation the initial policy obtained and all subsequent policies
purchased as renewals or replacements) must show the retroactive date, and the retroactive date
must be before the earlier of the effective date of the contract or the beginning of the contract
work. Claims made Professional Liability Insurance must be maintained, and written evidence
of insurance must be provided, for at least five (5) years after the completion of the contract
work. If claims made coverage is canceled or non - renewed, and not replaced with another
claims -made policy form with a retroactive date prior to the earlier of the effective date of the
contract or the beginning of the contract work, CONSULTANT must purchase so called
"extended reporting" or "tail" coverage for a minimum of five (5) years after completion of
work, which must also show a retroactive date that is before the earlier of the effective date of
the contract or the beginning of the contract work. As a condition precedent to CITY'S
obligations under this Agreement, CONSULTANT shall furnish written evidence of such
coverage (naming CITY, its officers and employees as additional insureds on the Comprehensive
Liability insurance policy referred to in (a) immediately above via a specific endorsement) and
requiring thirty (30) days written notice of policy lapse or cancellation, or of a material change in
policy terms.
E. Assignment
Notwithstanding any other provision of this Agreement, neither this Agreement nor any duties or
obligations of CONSULTANT under this Agreement may be assigned or subcontracted by
CONSULTANT without the prior written consent of CITY, which CITY may withhold in its
sole and absolute discretion.
F. State and Federal Taxes
As CONSULTANT is not CITY'S employee, CONSULTANT shall be responsible for paying
all required state and federal taxes. Without limiting the foregoing, CONSULTANT
acknowledges and agrees that:
• CITY will not withhold FICA (Social Security) from CONSULTANT'S
payments;
• CITY will not make state or federal unemployment insurance contributions on
CONSULTANT'S behalf,
• CITY will not withhold state or federal income tax from payment to
CONSULTANT;
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• CITY will not make disability insurance contributions on behalf of
CONSULTANT;
• CITY will not obtain workers' compensation insurance on behalf of
CONSULTANT.
ARTICLE 6. OBLIGATIONS OF CITY
A. Cooperation of City
CITY agrees to respond to all reasonable requests of CONSULTANT and provide access, at
reasonable times following receipt by CITY of reasonable notice, to all documents reasonably
necessary to the performance of CONSULTANT'S duties under this Agreement.
B. Assignment
CITY may assign this Agreement or any duties or obligations thereunder to a successor
governmental entity without the consent of CONSULTANT. Such assignment shall not release
CONSULTANT from any of CONSULTANT'S duties or obligations under this Agreement.
ARTICLE 7. TERMINATION OF AGREEMENT
A. Sale of Consultant's Business/ Death of Consultant.
CONSULTANT shall notify CITY of the proposed sale of CONSULTANT's business no later
than thirty (30) days prior to any such sale. CITY shall have the option of terminating this
Agreement within thirty (30) days after receiving such notice of sale. Any such CITY
termination pursuant to this Article 7.A shall be in writing and sent to the address for notices to
CONSULTANT set forth in Exhibit A, Subsection V.H., no later than thirty (30) days after
CITY' receipt of such notice of sale.
If CONSULTANT is an individual, this Agreement shall be deemed automatically terminated
upon death of CONSULTANT.
B. Termination by City for Default of Consultant
Should CONSULTANT default in the performance of this Agreement or materially breach any
of its provisions, CITY, at CITY'S option, may terminate this Agreement by giving written
notification to CONSULTANT. For the purposes of this section, material breach of this
Agreement shall include, but not be limited to the following:
1. CONSULTANT'S failure to professionally and /or timely perform any of the
services contemplated by this Agreement.
2. CONSULTANT'S breach of any of its representations, warranties or covenants
contained in this Agreement.
CONSULTANT shall be entitled to payment only for work completed in accordance with the
terms of this Agreement through the date of the termination notice, as reasonably determined by
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CITY, provided that such payment shall not exceed the amounts set forth in this Agreement for
the tasks described on Exhibit C" which have been fully, competently and timely rendered by
CONSULTANT. Notwithstanding the foregoing, if CITY terminates this Agreement due to
CONSULTANT'S default in the performance of this Agreement or material breach by
CONSULTANT of any of its provisions, then in addition to any other rights and remedies CITY
may have, CONSULTANT shall reimburse CITY, within ten (10) days after demand, for any
and all costs and expenses incurred by CITY in order to complete the tasks constituting the scope
of work as described in this Agreement, to the extent such costs and expenses exceed the
amounts CITY would have been obligated to pay CONSULTANT for the performance of that
task pursuant to this Agreement.
C. Termination for Failure to Make Agreed -Upon Payments
Should CITY fail to pay CONSULTANT all or any part of the compensation set forth in Article
4 of this Agreement on the date due, then if and only if such nonpayment constitutes a default
under this Agreement, CONSULTANT, at the CONSULTANT'S option, may terminate this
Agreement if such default is not remedied by CITY within thirty (30) days after demand for such
payment is given by CONSULTANT to CITY.
D. Transition after Termination
Upon termination, CONSULTANT shall immediately stop work, unless cessation could
potentially cause any damage or harm to person or property, in which case CONSULTANT shall
cease such work as soon as it is safe to do so. CONSULTANT shall incur no further expenses in
connection with this Agreement. CONSULTANT shall promptly deliver to CITY all work done
toward completion of the services required hereunder, and shall act in such a manner as to
facilitate any the assumption of CONSULTANT's duties by any new consultant hired by the
CITY to complete such services.
ARTICLE 8. GENERAL PROVISIONS
A. Amendment & Modification
No amendments, modifications, alterations or changes to the terms of this Agreement shall be
effective unless and until made in a writing signed by both parties hereto.
B. Americans with Disabilities Act of 1990
Throughout the term of this Agreement, the CONSULTANT shall comply fully with all
applicable provisions of the Americans with Disabilities Act of 1990 ( "the Act ") in its current
form and as it may be amended from time to time. CONSULTANT shall also require such
compliance of all subcontractors performing work under this Agreement, subject to the
prohibition against assignment and subcontracting contained in Article 5 above. The
CONSULTANT shall defend with counsel acceptable to CITY, indemnify and hold harmless the
CITY OF GILROY, its officers, employees, agents and representatives from and against all suits,
claims, demands, damages, costs, causes of action, losses, liabilities, expenses and fees,
including without limitation reasonable attorneys' fees, that may arise out of any violations of
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the Act by the CONSULTANT, its subcontractors, or the officers, employees, agents or
representatives of either.
C. Attorneys' Fees
If any action at law or in equity, including an action for declaratory relief, is brought to enforce
or interpret the provisions of this Agreement, the prevailing party will be entitled to reasonable
attorneys' fees, which may be set by the court in the same action or in a separate action brought
for that purpose, in addition to any other relief to which that party may be entitled.
D. Captions
The captions and headings of the various sections, paragraphs and subparagraphs of the
Agreement are for convenience only and shall not be considered nor referred to for resolving
questions of interpretation.
E. Compliance with Laws
The CONSULTANT shall keep itself informed of all State and National laws and all municipal
ordinances and regulations of the CITY which in any manner affect those engaged or employed
in the work, or the materials used in the work, or which in any way affect the conduct of the
work, and of all such orders and decrees of bodies or tribunals having any jurisdiction or
authority over the same. Without limiting the foregoing, CONSULTANT agrees to observe the
provisions of the Municipal Code of the CITY OF GILROY, obligating every contractor or
subcontractor under a contract or subcontract to the CITY OF GILROY for public works or for
goods or services to refrain from discriminatory employment or subcontracting practices on the
basis of the race, color, sex, religious creed, national origin, ancestry of any employee, applicant
for employment, or any potential subcontractor.
F. Conflict of Interest
CONSULTANT certifies that to the best of its knowledge, no CITY employee or office of any
public agency interested in this Agreement has any pecuniary interest in the business of
CONSULTANT and that no person associated with CONSULTANT has any interest that would
constitute a conflict of interest in any manner or degree as to the execution or performance of
this Agreement.
G. Entire Agreement
This Agreement supersedes any and all prior agreements, whether oral or written, between the
parties hereto with respect to the rendering of services by CONSULTANT for CITY and
contains all the covenants and agreements between the parties with respect to the rendering of
such services in any manner whatsoever. Each party to this Agreement acknowledges that no
representations, inducements, promises or agreements, orally or otherwise, have been made by
any party, or anyone acting on behalf of any party, which are not embodied herein, and that no
other agreement, statement or promise not contained in this Agreement shall be valid or binding.
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No other agreements or conversation with any officer, agent or employee of CITY prior to
execution of this Agreement shall affect or modify any of the terms or obligations contained in
any documents comprising this Agreement. Such other agreements or conversations shall be
considered as unofficial information and in no way binding upon CITY.
H. Governing Law and Venue
This Agreement shall be governed by and construed in accordance with the laws of the State of
California without regard to the conflict of laws provisions of any jurisdiction. The exclusive
jurisdiction and venue with respect to any and all disputes arising hereunder shall be in state and
federal courts located in Santa Clara County, California.
I. Notices
Any notice to be given hereunder by either party to the other may be effected either by personal
delivery in writing or by mail, registered or certified, postage prepaid with return receipt
requested. Mailed notices shall be addressed to the parties at the addresses appearing in
Exhibit "A ", Section V.H. but each party may change the address by written notice in
accordance with this paragraph. Notices delivered personally will be deemed delivered as of
actual receipt; mailed notices will be deemed delivered as of three (3) days after mailing.
J. Partial Invalidity
If any provision in this Agreement is held by a court of competent jurisdiction to be invalid, void
or unenforceable, the remaining provisions will nevertheless continue in full force without being
impaired or invalidated in any way.
K. Time of the Essence
All dates and times referred to in this Agreement are of the essence.
L. Waiver
CONSULTANT agrees that waiver by CITY of any one or more of the conditions of
performance under this Agreement shall not be construed as waiver(s) of any other condition of
performance under this Agreement.
Executed at Gilroy, California, on the date and year first above written.
CONSULTANT: CITY:
Dr. Howard Michaels, M.D. OTY O GILROY
By:
Na e: Howard Michaels Name: m Haglund
Title: Medical Director/ Consultant Title: City Administrator
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Social Security or Taxpayer
Identification Number
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EXHIBIT "A"
SPECIFIC PROVISIONS
PROJECT MANAGER
CONSULTANT shall provide the services indicated on the attached Exhibit "B ", Scope of
Services ( "Services "). (All exhibits referenced are incorporated herein by reference.) To
accomplish that end, CONSULTANT agrees to assign Dr. Howard E. Michaels, who will act in
the capacity of Project Manager, and who will personally direct such Services.
Except as may be specified elsewhere in this Agreement, CONSULTANT shall furnish all
technical and professional services including labor, material, equipment, transportation,
supervision and expertise to perform all operations necessary and required to complete the
Services in accordance with the terms of this Agreement.
II. NOTICE TO PROCEED /COMPLETION OF SERVICE
A. NOTICE TO PROCEED
CONSULTANT shall commence the Services upon delivery to CONSULTANT of a written
"Notice to Proceed ", which Notice to Proceed shall be in the form of a written communication
from designated City contact person(s). Notice to Proceed may be in the form of e -mail, fax or
letter authorizing commencement of the Services. For purposes of this Agreement, Fire EMS
Division Chief shall be the designated City contact person(s). Notice to Proceed shall be deemed
to have been delivered upon actual receipt by CONSULTANT or if otherwise delivered as
provided in the Section V.H. ( "Notices ") of this Exhibit "A ".
B. COMPLETION OF SERVICES
When CITY determines that CONSULTANT has completed all of the Services in accordance
with the terms of this Agreement, CITY shall give CONSULTANT written Notice of Final
Acceptance, and CONSULTANT shall not incur any further costs hereunder. CONSULTANT
may request this determination of completion when, in its opinion, it has completed all of the
Services as required by the terms of this Agreement and, if so requested, CITY shall make this
determination within two (2) weeks of such request, or if CITY determines that CONSULTANT
has not completed all of such Services as required by this Agreement, CITY shall so inform
CONSULTANT within this two (2) week period.
III. PROGRESS SCHEDULE
The schedule for performance and completion of the Services will be as set forth in the attached
Exhibit "C ".
IV. PAYMENT OF FEES AND DIRECT EXPENSES
Payments shall be made to CONSULTANT as provided for in Article 4 of this Agreement.
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Direct expenses are charges and fees not included in Exhibit "B ". CITY shall be obligated to
pay only for those direct expenses which have been previously approved in writing by CITY.
CONSULTANT shall obtain written approval from CITY prior to incurring or billing of direct
expenses.
Copies of pertinent financial records, including invoices, will be included with the submission of
billing(s) for all direct expenses.
V. OTHER PROVISIONS
A. STANDARD OF WORKMANSHIP
CONSULTANT represents and warrants that it has the qualifications, skills and licenses
necessary to perform the Services, and its duties and obligations, expressed and implied,
contained herein, and CITY expressly relies upon CONSULTANT'S representations and
warranties regarding its skills, qualifications and licenses. CONSULTANT shall perform such
Services and duties in conformance to and consistent with the standards generally recognized as
being employed by professionals in the same discipline in the State of California.
Any plans, designs, specifications, estimates, calculations, reports and other documents furnished
under this Agreement shall be of a quality acceptable to CITY. The minimum criteria for
acceptance shall be a product of neat appearance, well- organized, technically and grammatically
correct, checked and having the maker and checker identified. The minimum standard of
appearance, organization and content of the drawings shall be that used by CITY for similar
purposes.
B. RESPONSIBILITY OF CONSULTANT
CONSULTANT shall be responsible for the professional quality, technical accuracy, and the
coordination of the Services furnished by it under this Agreement. CONSULTANT shall not be
responsible for the accuracy of any project or technical information provided by the CITY. The
CITY'S review, acceptance or payment for any of the Services shall not be construed to operate
as a waiver of any rights under this Agreement or of any cause of action arising out of the
performance of this Agreement, and CONSULTANT shall be and remain liable to CITY in
accordance with applicable law for all damages to CITY caused by CONSULTANT'S negligent
performance of any of the services furnished under this Agreement.
C. RIGHT OF CITY TO INSPECT RECORDS OF CONSULTANT
CITY, through its authorized employees, representatives or agents, shall have the right, at any
and all reasonable times, to audit the books and records (including, but not limited to, invoices,
vouchers, canceled checks, time cards, etc.) of CONSULTANT for the purpose of verifying any
and all charges made by CONSULTANT in connection with this Agreement. CONSULTANT
shall maintain for a minimum period of three (3) years (from the date of final payment to
CONSULTANT), or for any longer period required by law, sufficient books and records in
accordance with standard California accounting practices to establish the correctness of all
charges submitted to CITY by CONSULTANT, all of which shall be made available to CITY at
the CITY's offices within five (5) business days after CITY's request.
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D. CONFIDENTIALITY OF MATERIAL
All ideas, memoranda, specifications, plans, manufacturing procedures, data (including, but not
limited to, computer data and source code), drawings, descriptions, documents, discussions or
other information developed or received by or for CONSULTANT and all other written and oral
information developed or received by or for CONSULTANT and all other written and oral
information submitted to CONSULTANT in connection with the performance of this Agreement
shall be held confidential by CONSULTANT and shall not, without the prior written consent of
CITY, be used for any purposes other than the performance of the Services, nor be disclosed to
an entity not connected with the performance of the such Services. Nothing furnished to
CONSULTANT which is otherwise known to CONSULTANT or is or becomes generally
known to the related industry (other than that which becomes generally known as the result of
CONSULTANT'S disclosure thereof) shall be deemed confidential. CONSULTANT shall not
use CITY'S name or insignia, or distribute publicity pertaining to the services rendered under
this Agreement in any magazine, trade paper, newspaper or other medium without the express
written consent of CITY.
E. NO PLEDGING OF CITY'S CREDIT.
Under no circumstances shall CONSULTANT have the authority or power to pledge the credit
of CITY or incur any obligation in the name of CITY.
F. OWNERSHIP OF MATERIAL.
All material including, but not limited to, computer information, data and source code, sketches,
tracings, drawings, plans, diagrams, quantities, estimates, specifications, proposals, tests, maps,
calculations, photographs, reports and other material developed, collected, prepared (or caused to
be prepared) under this Agreement shall be the property of CITY, but CONSULTANT may
retain and use copies thereof subject to Section V.D of this Exhibit "A ".
CITY shall not be limited in any way in its use of said material at any time for any work,
whether or not associated with the City project for which the Services are performed. However,
CONSULTANT shall not be responsible for, and City shall indemnify CONSULTANT from,
damages resulting from the use of said material for work other than PROJECT, including, but
not limited to, the release of this material to third parties for work other than on PROJECT.
G. NO THIRD PARTY BENEFICIARY.
This Agreement shall not be construed or deemed to be an agreement for the benefit of any third
party or parties, and no third party or parties shall have any claim or right of action hereunder for
any cause whatsoever.
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H. NOTICES.
Notices are to be sent as follows:
CITY:
City of Gilroy Fire Department
7070 Chestnut St.
Gilroy, CA 95020
CONSULTANT: Howard Michaels
5875 Killarney Circle
San Jose, CA 95138
I. FEDERAL FUNDING REQUIREMENTS.
❑ If the box to the left of this sentence is checked, this Agreement involves federal
funding and the requirements of this Section V.I. apply.
® If the box to the left of this sentence is checked, this Agreement does not involve
federal funding and the requirements of this Section V.I. do not apply.
1. DBE Program
CONSULTANT shall comply with the requirements of Title 49, Part 26, Code of Federal
Regulations (49 CFR 26) and the City- adopted Disadvantaged Business Enterprise programs.
2. Cost Principles
Federal Acquisition Regulations in Title 48, CFR 31, shall be used to determine the allowable
cost for individual items.
3. Covenant against Contingent Fees
The CONSULTANT warrants that he /she has not employed or retained any company or person,
other than a bona fide employee working for the CONSULTANT, to solicit or secure this
Agreement, and that he /she has not paid or agreed to pay any company or person, other than a
bona fide employee, any fee, commission, percentage, brokerage fee, gift or any other
consideration, contingent upon or resulting from the award or formation of this Agreement. For
breach or violation of this warranty, the Local Agency shall have the right to annul this
Agreement without liability or, at its discretion, to deduct from the agreement price or
consideration, or otherwise recover, the full amount of such fee, commission, percentage,
brokerage fee, gift or contingent fee.
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EXHIBIT "B"
SCOPE OF SERVICES
CONSULTANT is responsible for reviewing and providing input into the development of all
operational policies and procedures that directly or indirectly impact patient care and shall
provide the following services:
1. Provide medical control and oversight for the CITY'S EMS program, including but not
limited to:
a) Assisting the Program Manager in maintaining an EMS program consistent with
state and national prevailing "standards of practice and care."
b) Ensuring that the Gilroy Fire Department is providing care that is consistent with
ALS and BLS scope of practice, including Enhanced Scope EMT Basics as
outlined in state and county ordinances.
C) Approving agency EMS policies, procedures and protocols.
d) Establishing and monitoring all aspects of clinical performance.
e) Evaluating operational policies and procedures to determine if they may have a
negative impact on patient care and recommending the suspension of any
operation or procedure that poses a risk to patients or personnel.
f) Evaluating and acting on cases involving the certification/accreditation of EMS
personnel including:
i. Identification of employees who require guidance or further training in
medically- related matters and submission of findings to the EMS Program
Manager; and
ii. Recommending appropriate action as to any employee function in a
medical capacity within the EMS program.
g) Participating in the development of hiring requirements and pre - employment
screening procedures for new personnel.
h) Performing ongoing evaluation of ALS and BLS program effectiveness by
collecting and evaluating data, the relationship of process measurements to
outcomes, resuscitation effectiveness, survival rates from cardiac arrest, and
complication rates from procedures.
i) Carrying out research and development in the field of pre - hospital care (e.g.,
medical procedures, medical techniques, medications, equipment, etc.) to help the
EMS program improve its emergency service responses.
j) Reporting on the clinical aspects of the quality of care being provided and
identifying areas where improvement is needed
k) Proposing bio- medical equipment enhancements and recommending equipment
changes to ensure that the Fire Department remains "state of the art" in pre -
hospital care and is compliant with County requirements.
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1) Responding to emergency incidents and /or assuming a medical command role in
the Emergency Operations Center (EOC), when requested by the Fire
Department. The CONSULTANT's obligations shall be limited to liaison or
technical specialist, providing medical advice to the Incident Commander.
2. Provide medical control and oversight for CITY's Public Access Defibrillation program,
including but not limited to:
a) Assuring that Public Access Defibrillation programs managed by the City meets
current American Heart Association Standards.
b) Ensuring CPR and Public Access Defibrillator curriculum and instructor training
program is consistent with American Heart Association Guidelines.
c) Over site for Public Access Defibrillator Program as it is provided through the CITY.
d) Developing methods for assuring that PAD providers report on a quality
assurance /quality improvement plan as outlined by the American Heart Association.
e) Collecting, storing, and analyzing, at a minimum, the following data related to the
management of cardiac arrest patients, including:
I. Patient data, including age, sex, whether arrest was witnessed or unwitnessed and
initial cardiac rhythm;
II. EMS system data, including estimated time from collapse to call for help,
estimated time from collapse to initiation of CPR and ambulance response times;
III. Defibrillation performance, including device operational effectiveness, time from
arrival to initial defibrillation, time between defibrillation attempts, and
IV. Patient outcome, including rhythm after each shock, return of pulse and /or
spontaneous respiration in the field.
3. Provide medical control and oversight for CITY's Emergency Medical Dispatch System
(EMDS), including but not limited to:
a) Serving as liaison to Emergency Medical Dispatch Agency and County EMS
b) Participate in the Development of a quality assurance /quality improvement plan.
C) Perform control room observation, providing guidance regarding the application
of protocols and participate in the tape review process.
d) Make recommendations regarding changes to tiered response levels and protocols.
e) Participate in the evaluation of EMDS program effectiveness.
f) Promoting continuing dispatch education.
4. Design, evaluate, and administer a continuous quality improvement program (CQI) and a
comprehensive quality assurance program (CQA). Specific to this task, CONSULTANT
is responsible for determining that:
a) Appropriate levels of medical training have been received in order to ensure
competence of newly hired personnel.
4843 - 8575- 3109v2 _2 _
MDOLINGER104706083
b) Existing and proposed County and agency -based concurrent field and
telecommunications evaluation processes are capable of identifying sub - optimal
performance.
C) Existing and proposed County and agency -based continuing medical education
(CME) programs address agency needs for medical and operational training for
both communications and field personnel.
d) Existing and proposed County and agency -based retrospective review processes
are capable of determining the delivery of appropriate pre - hospital medical care
that is consistent with County and agency -based protocols and procedures.
e) All complaints related to medical care or patient disposition receive medical
investigation, evaluation, and response.
f) The EMS Program Manager is advised in all matters related to the design and
development of EMS quality management programs at the regional and County
level.
5. Provide medical oversight of EMS curriculum development and education, including but
not limited to:
a) Providing recommendations regarding the adequacy of the EMS training program
and in -house CME activities and content.
b) Assisting with the design and implementation of the CME program in response to
education and training needs. CONSULTANT will be used as an expert resource
in the development of CME programs, and will ensure consistency with emerging
pre - hospital "standards of practice."
C) Initiating recommendations, assisting with the development of EMS Training
Programs, and conducting in- service CME sessions.
d) Making recommendations regarding specific training programs being considered
or implemented.
6. Assist in the administration and support of the EMS program, including but not limited
to:
a) Providing input into the development of capital and operating budgets and
participating in related public hearings, as directed.
b) Providing medical input regarding allocation and deployment of EMS resources.
C) Representing the Fire Department with the medical community to ensure that the
practices of CITY and its personnel are satisfactorily meeting treatment and
operational policies.
d) Conducting orientations for Fire Department personnel relative to the elements of
the EMS program.
e) Assisting in making presentations to the City Council, its committees, and other
government and private organizations.
4843 - 8575- 3109v2 _3 _
MDOLINGER104706083
7. Act as medical liaison between the Fire Department and Office of Emergency Services
for the Weapons of Mass Destruction (WMD) program, and the Metropolitan Medical
Task Force (MMTF) including:
a) Providing medical oversight of HAZMAT procedures and MMTF exercises.
b) Providing support for disaster planning and training.
C) Providing MMTF triage support as requested by the Fire Department or the Office
of Emergency Services.
d) Performing ongoing evaluations of MMTF procedures, protocols, medical
techniques and medications that facilitate emergency response to incidents
involving weapons of mass destruction.
8. Provides for the purchase of medications necessary to provide ALS and BLS care
through the Fire Department's EMS Program
a) Maintains a DEA license independent of private practice for the purchase of
Controlled Substances used in patient care.
b) Purchases vaccines and medications as necessary to maintain the CITY'S
occupational health program available on government contract.
C) Provide for the purchase of medications through vendors as necessary for the
EMS Program.
The CONSULTANT shall be available in accordance with a work schedule approved by the
EMS Program Manager, including but not limited to posted office hours. In addition, the
CONSULTANT must be able to be contacted via cellular telephone, pager and e -mail. The
CONSULTANT shall provide the EMS Program Manager a plan for the provision of his/her
responsibilities in the event that the CONSULTANT is unavailable or unable to perform.
The plan shall include a list of alternates to call in the event the CONSULTANT does not
respond within 45 minutes to an emergency request or 90 minutes to a non - emergency
request. For planned absences, the CONSULTANT shall arrange a specific contact from the
list of alternates to provide continuous medical direction
4843 - 8575- 3109v2 _4_
MDOLINGER104706083
EXHIBIT "C"
MILESTONE SCHEDULE
There are no milestones.
4843 - 8575- 3109v2 _1
MDOLINGEM04706083
EXHIBIT "D"
PAYMENT SCHEDULE
Project Manager shall submit an invoice for services at least monthly if services are provided within
a given month. The City shall review the invoice and process it for payment using the normal City
accounts payable schedule.
In consideration for the services performed by CONSULTANT, CITY agrees to pay
CONSULTANT: Sixteen Thousand Five Hundred Dollars ($16,500) per year of this contract.
4843 - 8575- 3109v2
MDOLINGER104706083
DECLARATIONS
POLICY NUMBER: r GCHSE2315 Attaching to and forming part of
ALLIED HEALTH PROFESSIONAL LIABILITY INSURANCE
This Insurance is effected with Certain UNDERWRITERS AT LLOYD'S OF LONDON (not incorporated).
THIS IS A CLAIM&WADE PROFESSIONAL LIABILITY INSURANCE POLICY.
PLEASE READ CAREFULLY.
CA Surplus lines Tax & Fee Breakdown
Item 1 Named Insured: HOWARD E. MICHAELS, M.D. Fee: Carrier $ 100.00
Mailing Address: 255 S. MONTGOMERY, SAN JOSE, CA 95138 3% State Tax: $ 16$.83
Item 2 Policy Period: .200% Stamping Fee: $ 11.26
Inception: 819/13 Termination: SA114
both days at 12.01 a.m, local standard time at the address shown in Item 1. above
Item 3 Retroactive Date: 819105
Coverage shell apply only to those Claims reported pursuant to the berms and conditions of the Policy arising out of Professional Services desonW herein and performed
subsequent to the data above, or an Accident happening after.
Item 4 Limit of Liability:
(a) PROFESSIONAL LIABILITY: $1,000,000 Each Claim $3,000,000 Aggregate - Includes Claims Expenses.
Item 5 Deductible: $ !MO. 0 Each Clairn - includes Claims Expenses.
Item 6 Premium: $ 5,531.00
The premiwn paid in respect of the entire Policy Period of b"urmrce phis taxes and fees as applicable, which shall be payable in full at inception of this Insurance as
designated in item 2 of the Decimations
Item 7 Notice Of Claim To:
Mendes & Mount; UP
750 Seventh Avenue
New York, NY 10019 -6829
Attn: James McGuire
Item 8 Professional Services: Medical Director
Item 9 Notice of Election:
Recipient ofNotiee oflnsured's Cancellation, and Recipient ofNotice of Irsured4 intention to purchase Extended Reporting Period Coverage and premium for Extended
Reporting Period Coverage:
SHGINS Insurance Solutions, LLC
2948 Noioqul Avenue, #2
P. O. Box 411
Los Olives, California, 93441 USA
Item 10 Service of Suit: Mendes & Mount (as above)
SHGINS Insurance Solutions, LLC
California Lic#OH05102
Issue date: October 29, 2013
h
AuthorlSed- "^�ti Signatory:
Declaration of SHGINS Insurance Solutions, LLC. Limited Binding Authority, Agreement No: B1179AO38413000
It is understood and agreed that any reference in the attached wording to "Policy" shall be deemed to read Certificate.
MICHA -2 OP ID: RB
CERTIFICATE OF LIABILITY INSURANCE
E(MMIO
706104/2014 TE {MMtDDIYYW)
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 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 certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
InsPro Agents & Brokers Ins.
License #OB18019
4020 Moorpark Avenue, #104
San Jose, CA 95117
Inspro Agents &Brokers Ins Sery
NAME: Rhonda Buck
PHONE AX
arc No Ext :408- 241 -0014 AIC, No : 408- 241 -0037
ADDRESS:
INSURER(S) AFFORDING COVERAGE
NAIC #
wsURERA:Sentinel Insurance Co Ltd
LIMBS
INSURED Howard Michaels, M.D.
5875 Killarney Cir
San Jose, CA 95138
INSURER B:
COMMERCIAL GENERAL LIABILITY
INSURER C:
INSURER D
INSURER E:
EACH OCCURRENCE
INSURER F :
COVFRAtrFS 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 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
ADOL
INSD
SUBR
POLICY NUMBER
POLICY EFF
MMIDDIWY
0 C XP
MMIDDIYYYY
LIMBS
A
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
CLAIMS -MADE a OCCUR
57SBANL5390
07/02/2014
07/02/2015
AMAGETO
PREM SES (Ea occurrence)
$ 300,000
MED EX.P (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$ 2,000,000
POLICY ❑ PRO JECT ❑ LOC
PRODUCTS- COMP /OP AGG
$ 2,000,000
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$
BODILY INJURY (Per person)
$
ANY AUTO
ALL OWNED SCHEDULED
AUTOS NON�OWNED
HIRED AUTOS AUTOS
BODILY INJURY (Per accident)
$
PROPERTY DAtAAGE
(Per." ident
$
$
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE
$
HCLAIMS-IAADE
AGGREGATE
$
EXCESS LIAB
DIED I I RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPPIETOR/PARTNERIF_XECUTIVE F]
OFFICER/MEMBER EXCLUDED?
NIA
-
FER OT
STA T UTET I ER H
E.L. EACH ACCIDENT
$
E.L. DISEASE- EA EMPLOYEE
$
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 701, Additional Remarks Schedule, may be attached if more space is required)
City of Gilroy, it's Officers, Officials, and Employees are additional
insured as required by written contract with respect to operations of the
named insured per form SS00080405 attached.
CERTIFICATE HOLDER CANCELLATION
CITY -15
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Gilroy
ACCORDANCE WITH THE POLICY PROVISIONS.
Gilroy Fire Department
7070 Chestnut Street
AUTHORIZED REPRESENTATIVE
Gilroy, CA 95020
O 1988 -2014 ACORD CORPORATION. All rights reserved.
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90 This Spectrum Policy consists of the Declarations, Coverage Forms, Common Policy Conditions and any
53 other Forms and Endorsements issued to be a part of the Policy. This insurance is provided by the stock
NL insurance company of The Hartford Insurance Group shown below.
SBA
INSURER: SENTINEL INSURANCE COMPANY, LIMITED
ONE HARTFORD PLAZA, HARTFORD, CT 06155
COMPANY CODE: A
THE
Policy Number: 57 SBA NL5390 SC HARTFORD
SPECTRUM POLICY DECLARATIONS ORIGINAL
Named Insured and Mailing Address: HOWARD MICHAELS, M.D.
(No., Street, Town, State, Zip Code)
5875 KILLARNEY CIRCLE
SAN JOSE CA 95138
Policy Period: From 07/02/14 To 07/02/15 1 YEAR
12:01 a.m., Standard time at your mailing address shown above. Exception: 12 noon in New Hampshire.
Name of Agent /Broker: INSPRO AGENTS & BROKERS INS SRVCS
Code: 152163
Previous Policy Number: 57 SBA NL5390
Named Insured is: CORPORATION
Audit Period: NON- AUDITABLE
Type of Property Coverage: SPECIAL
Insurance Provided: In return for the payment of the premium and subject to all of the terms of this policy, we
agree with you to provide insurance as stated in this policy.
TOTAL ANNUAL PREMIUM IS:
$500 MP
R
Countersigned by!
L__— Authozed Repr entative Date
Form SS 00 02 12 06 Page 001 (CONTINUED ON NEXT PAGE)
Process Date: 04/18/14 Policy Expiration Date: 07/02/15
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SPECTRUM POLICY DECLARATIONS (Continued)
POLICY NUMBER: 57 SBA NL53 9 0
Location(s), Building(s), Business of Named Insured and Schedule of Coverages for Premises as designated by
Number below.
Location: 001 Building: 001
PROPERTY OPTIONAL COVERAGES APPLICABLE LIMITS OF INSURANCE
TO THIS LOCATION
STRETCH COVERAGES
FORM: SS 04 08
THIS FORM INCLUDES MANY ADDITIONAL
COVERAGES AND EXTENSIONS OF
COVERAGES. A SUMMARY OF THE
COVERAGE LIMITS IS ATTACHED.
LIMITED FUNGI, BACTERIA OR VIRUS
COVERAGE:
FORM SS 40 93
THIS IS THE MAXIMUM AMOUNT OF
INSURANCE FOR THIS COVERAGE,
SUBJECT TO ALL PROPERTY LIMITS
FOUND ELSEWHERE ON THIS
DECLARATION.
INCLUDING BUSINESS INCOME AND EXTRA
EXPENSE COVERAGE FOR:
Form SS 00 02 12 06
Process Date: 04/18/14
$ 50,000
30.DAYS
Page 003 (CONTINUED ON NEXT PAGE)
Policy Expiration Date: 07/02/15
SPECTRUM POLICY DECLARATIONS (Continued)
POLICY NUMBER: 57 SBA NL5390
BUSINESS LIABILITY
LIABILITY AND MEDICAL EXPENSES
MEDICAL EXPENSES -ANY ONE PERSON
PERSONAL AND ADVERTISING INJURY
DAMAGES TO PREMISES RENTED TO YOU
ANY ONE PREMISES
AGGREGATE LIMITS
PRODUCTS - COMPLETED OPERATIONS
FORM SS 05 09
GENERAL AGGREGATE
BUSINESS LIABILITY OPTIONAL
COVERAGES
HIRED /NON -OWNED AUTO LIABILITY
Form SS 00 02 12 06
Process Date: 04/18/14
LIMITS OF INSURANCE
$1,000,000
$ 10,000
$1,000,000
$1,000,000
$2,000,000
$2,000,000
$1,000,000
Page 005 (CONTINUED ON NEXT PAGE)
Policv Fxniratinn nate. 07/1
G & 0 INS SERVICES
820 PARK ROW #618
SALINAS, CA 93901
646107 17709 1 AT 0.406 PPACS01C 069 017709
Named insured
HOWARD E MICHAELS
5875 KILLARNEY CIRCL
JAN JOSE, CA 95138
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Commercial Auto
Insurance Coverage Summary
This is your Declarations Page
Your coverage has changed
PR98RFff1UFq
Policy number: 04320437 -4
Underwritten by:
United Financial Casualty Company
August 15, 2014
Policy Period: Sep 1, 2013 - Sep 1, 2014
Page 1 of 3
progressiveagent.com
Online Service
Make payments, check billing activity, print
policy documents, or check the status of a
claim.
1- 831 - 998 -7856
G & 0 INS SERVICES
Contact your broker for personalized service.
1- 800 - 444 -4487
For customer service if your broker
is unavailable or to report a claim.
Your coverage began on September 1, 2013 at 12:01 a.m. This policy expires on September 1, 2014 at 12:01 a.m.
1 his coverage summary replaces your prior one. Your insurance policy and any policy endorsements contain a full explanation of your
coverage. The policy limits shown for an auto may not be combined with the limits for the same coverage on another auto, unless the
policy contract allows the stacking of limits. The policy contract is form 6912 (06/10). The contract is modified by forms 2852CA
(09/06), 4757 (03/05), 1198 (01/04), 8610 (05/09), Z311 (11/07), Z313 (05/07), 4852CA (10/04), 4881 CA (12/04) and Z228 (01111)
The named insured organization type is a sole proprietorship.
Policy changes effective August 14, 2014
............................................................................................................................................ ...............................
Premium change: $0.00
.............................................................................................................................................. ...............................
Changes: The mailing address information has changed.
The changes shown above will not be effective prior to the time the changes were requested.
Continued
Form 6489 CA. (06110)
Outline of coverage
Liability
Description
Limits
............................... ...............................................................
Liability To Others
............................... . .......
Bodily Injury and Property Damage Liability
....................................................................................................
$1,000,000 combined single limit
...............................
Uninsured /Underinsured Motorist
$1,000,000 combined single limit
............................. . ..........................................................
Uninsured Motorist Property Damage
......................................................................................................
............................... . .............
Rejected ...............................
Medical Payments
.................................................... ...............................
$5,000 each person
. ................... I.............................
Comprehensive
Premium .
See Auto Coverage Schedule
......................................................................................................
Limit of liability less deductible
...............................
Collision
$230
See Auto Coverage Schedule
............. ...........................................................
Limit of liability less deductible
. ........ I ........... I............
Rental Reimbursement
Roadside
Limit
See Auto Coverage Schedule
......................................................................................................
...............................
Roadside Assistance
. ...........
$43
See Auto Coverage Schedule
I.......
$20
Subtotal policy premium
Max $900
................................... ............................... .
California Vehicle Assessment Fee
........................ I .........................................
.. ..... . ...... . ..................... I ......................... , .......................................
Fees
...............................
......................................................................................................
Total 12 month policy premium and fees
...............................
Rated driver
1. HOWARD E MICHAELS
Auto coverage schedule
1. 2004 Lexus GX 470
VIN: JTJBT20X640033564
Policy number: 04320437 -5
HOWARD E MICHAELS
Page 2 of 3
20
$1,499.00
............
1.75
.........................100.00
... ...............................
$1,600.75
Actual Cash Value (plus $2,000.00 Permanently Attached Equip)
Garaging Zip Code: 95012 Radius: 200
Liability
Liability
LIMNIM BI
Med Pay
Premium
$884
..................
$168
.......I.......................
$33
Physical Damage
Comp
Deductible
Comp
Premium
Collision
Deductible
Collision
Premium
Premium .
..... ....... .........
$500
....................
$121
I .... I.........................
$500
$230
Other Coverages
Rental
Limit
Rental
Premium
Roadside
Limit
Roadside
Premium
Premium
...... .... ... . ..........
$30 per day
. ...........
$43
... .........................
Selected
I.......
$20
Max $900
Premium discounts
Policy
.................... ......................... . .................................... I............................
04320437 -5 Business Experience and Paid In Full
Additional Insured information
........................................................................................................ ...............................
1 Additional Insured CITY OF GILROY
7351 ROSANNA ST GILROY, CA 95020
....... ............................... . ........... ..... ........................................... ...
...... ............................
2, Additional Insured S SANTA CLARA FIRE
15670 MONTEREY MONGAN HILL, CA 95037
Form 6489 CA (06/10)
Auto Total
$1,499
Continued
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3.
Additional Insured
4.
.......................
Additional Insured
5.
.......................
Additional Insured
6.
.......................
Additional Insured
Company officers
President
Fonn 6489 CA (06/10)
Policy number: 04320437 -5
HOWARD E MICHAELS
Page 3 of 3
...........................
CITY OF MILPITAS
455 E CALAVERAS MILPITAS, CA 95035
................................................... ...............................
CITY OF SAN JOSE
1661 SENTER AVE SAN JOSE, CA 95112
................................................... ...............................
CTY OF SNTA CLRA FD
777 BENTON ST SANTA CLARA, CA 95050
..................................... ............................... .............
CITY OF MT VIEW FD
1000 VILLA ST MT VIEW, CA 94041
Secretary
u�
Robert Varich
1125 Saratoga Ave
San Jose CA 95129
✓ Verify the information listed in the
Policy Declarations.
✓ Please call if you have any questions.
✓ Now you can pay your premium
before your bill is issued - visit
allstate.com or call 1-800-Allstate 19.
I' III' �' I����Irl����ll�' I' III��II�IIII1� 'I�IIII "I�I'�"III�II�I�
Howard & Jane Michaels
5875 Killarney Cir
San Jose CA 95138 -2347
A new policy period is about to begin. Here are your renewal materials.
We're pleased to once again offer you the opportunity to continue your policy for another
year. Your Allstate Insurance Company Personal Umbrella policy is just one of an array of
products we offer to meet a wide variety of insurance needs, and we appreciate your
business.
Your policy documents are inside.
You'll find listed on the enclosed Policy Declarations your coverages, limits, deductibles,
premiums, and any discounts you may have. As you read these materials, it would be a
good idea to consider whether anything needs updating. We'd be happy to help you make
sure that your insurance stays current with any changes in your life.
(over)
iPROP nifiiiiiiiiiiiii � -.. ...-
Renewing your policy is easy.
Here's what will happen and what you'll need to do before the beginning of your next policy
period.
• Please carefully check your Policy Declarations to make sure it accurately reflects
your information and the choices you've made. Get in touch with your agent right
away if there's anything you'd like to change.
• Keep an eye out for your bill, which will include information on payment options.
• If you're paying your premium using the Allstate Easy Pay Plan, you will not
receive a bill. Instead, we'll send you a statement detailing your withdrawal
schedule for the policy period.
• Carefully read all enclosed materials and store these documents with your other
important papers. Keep in mind that the policy documents included may change
each time you receive a renewal offer — please read them to make sure you know
about any important information or changes related to your insurance.
We're here to help you.
Feel free to call your agent at (408) 257-1234. Or take advantage of the online services at
allstate.com, where you can view account information or check claim status by registering
at the Allstate Customer Care Center.
Remember, insurance is not only protection for today. It helps pave the way to a financially
secure future.
We're glad you're with us.
Thomas J. Wilson
President, Allstate Insurance Company
1401095304310 41082280
Allstate Insurance Company
See the Important Payment and Coverage Information section for details about installment fees.
✓ Premium includes a charge for 3 automobiles
Page I
iodiiiiiiiiiiiiiiiiamminiiiiniiiiimiisua � —.. ._.
RENEWAL
Personal Umbrella
Policy Declarations
Summary
NAMED INSURED(S)
YOUR ALLSTATE AGENT IS: CONTACT YOUR AGENT AT:
Howard & Jane Michaels
Robert Varich (408) 257 -1234
5875 Killarney Cir
1125 Saratoga Ave
San Jose CA 95138 -2347
San Jose CA 95129
POLICY NUMBER
POLICY PERIOD PREMIUM PERIOD
9 14 698196 02/24
Begins on Feb. 24, 2014 Feb. 24, 2014 to Feb. 24, 2015
Ends on Feb. 24, 2015 at 12:01 a.m. Pacific Time
Total Premium for the Premium Period (Your bill will be mailed separately)
Excess Liability
$794.00
Dwelling(s) Rented to Others
$23.00
TOTAL
$817.00
See the Important Payment and Coverage Information section for details about installment fees.
✓ Premium includes a charge for 3 automobiles
Page I
iodiiiiiiiiiiiiiiiiamminiiiiniiiiimiisua � —.. ._.
Allstate Insurance Company
Policy Number: 9 14 698196 02/24 Your Agent: Robert Varich (408) 257.1234
For Premium Period Beginning: Feb. 24, 2014
REQUIRED UNDERLYING INSURANCE LIMITS
COVERAGE
REQUIRED UNDERLYING LIMIT
Residence /Farm Premises
$300,000
Residence /Farm Employees
$300,000
(Bodily Injury or Property Damage Liability or Single Limit Liability)
$100,000
Additional Dwelling Rented to Others
$300,000
(Bodily Injury or Property Damage Liability or Single Limit Liability)
$300,000
Incidental Office, Private School or Studio
$300,000
Bodily Injury or Property Damage Liability or Single Limit Liability
(This coverage may be maintained as part of your Comprehensive
Personal Liability, Homeowners Liability Insurance or similar
package policy)
$300,000
Automobiles
Bodily Injury Liability
$250,000 each person
or similar package policy)
$500,000 each accident
Property Damage Liability
$100,000
Or
Single Limit Liability
$500,000
For each Automobile you own, maintain or use
Recreational Motor Vehicles
Bodily Injury Liability
$100,000 each person
$300,000 each accident
Property Damage Liability
$100,000
Or
Single Limit Liability
$300,000
Watercraft
Bodily Injury Liability
$100,000 each person
$300,000 each accident
Property Damage Liability
$100,000
Or
Single Limit Liability
$300,000
For each Watercraft 26 feet or more in length, or powered
by one or more outboard motor with more than 25 total horsepower,
or which has total motor power of more than 50 horsepower.
For Boats not described above:
Single Limit Liability
$300,000
(This coverage may be maintained as part of your
Comprehensive Personal Liability, Homeowners Liability Insurance
or similar package policy)
Information as of Page 2
January 9, 2014 CA088RB0
Allstate Insurance Company
Policy Number: 9 14 698196 02/24 Your Agent: Robert Varich (408) 257 -1234
For Premium Period Beginning: Feb. 24, 2014
POLICY COVERAGES AND LIMITS OF LIABILITY
COVERAGES
LIMITS OF LIABILITY
Excess Liability $5,000,000 each occurrence
(EXCESS INSURANCE FOR LIABILITY TO THIRD PARTIES ONLY)
Your Policy Documents
Your Personal Umbrella policy consists of this Policy Declarations and the documents listed below. Please keep these
together.
Personal Umbrella Policy form AP128 - California PUP Amendatory End. form AP1310
CA Pers Umbrella Policy Amend End form AP2306 -1
Important Payment and Coverage Information
Please note: This is not a request for payment. Your bill will be mailed separately.
If you decide to pay your premium in installments, there will be a $3.50 installment fee charge for each payment due. If you
make 6 installment payments during the policy period, and do not change your payment plan method, then the total amount
of installment fees during the policy period will be $21.00.
If you are on the Allstate ® Easy Pay Plan, there will be a $1.00 installment fee charge for each payment due. if you make
6 installment payments during the policy period, and remain on the Allstate ® Easy Pay Plan, then the total amount of
installment fees during the policy period will be $6.00.
If you change payment plan methods or make additional payments, your installment fee charge for each payment due and the
total amount of installment fees during the policy period may change or even increase.
Please note that the Allstate Easy Pay Plan allows you to have your insurance payments automatically deducted from your
checking or savings account.
IN WITNESS WHEREOF, Allstate has caused this policy to be signed by two of its officers at Northbrook,
Illinois, and if required by state law, this policy shall not be binding unless countersigned on the Policy
Declarations by an authorized agent of Allstate.
Thomas J. Wilson
President
MWM � 00.(Ak
Mary J. McGinn
Secretary
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Allstate Insurance Company
Policy Number: 914 698196 02/14 Your Agent: Robert Varich (408) 257 -1234
For Premium Period Beginning: Feb. 24, 2014
POLICY PROVISIONS: Rates, Policy Forms and Payment of Premiums:
Applicable only with respect to policies issued on a continuous basis.
1. The rates and policy forms in effect for the company upon the inception date of the insurance
evidenced hereby, and upon each successive anniversary date, shall apply.
2. The phrase "Policy Period" as used in the policy shall be deemed to mean that period of time while
the applicable coverage of the policy is in force.
3. The named insured shall pay the required premium in advance of each successive premium period,
and upon notice of interim amendments.
IMPORTANT NOTICE
CONCERNING THE INSURANCE YOU MUST MAINTAIN
(Not a part of the Policy)
Please read the following provisions of the policy carefully:
(1) Required Underlying Insurance
It establishes the types of insurance and the limits you must maintain.
If, during the policy period, additional liability exposures exist, check the list of Required Underlying
Insurance on the policy declarations and secure any needed underlying coverage and limits.
In the event that you fail to maintain the Required Underlying Insurance you may be required to
personally incur or expend substantial sums of money for your legal defense and for payment of
damages, and with respect to which Allstate has no obligation to pay or provide reimbursement to
you.
(2) Retained Limits
It identifies the amount of any damages an Insured must pay for any occurrence.
(3) In the event that additional exposures are acquired after the issuance of this policy, please notify
Allstate of the additional exposure as soon as practicable.
None of the terms and conditions of the policy are modified by this Important Notice.
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