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HomeMy WebLinkAbout2012 CON Grossman Psychological Associates - Amendment #2 - Officer Assistance ProgramSECOND AMENDMENT TO AGREEMENT BETWEEN THE CITY OF NATIONAL CITY AND GROSSMAN PSYCHOLOGICAL ASSOCIATES, APC This Second Amendment to Agreement is entered into this day of July, 2012, by and between the City of National City, a municipal corporation (the "CITY"), and GROSSMAN PSYCHOLOGICAL ASSOCIATES, a professional corporation (the "CONSULTANT),. RECITALS A. The CITY and the CONTRACTOR entered into an Agreement on July 1, 2010 ("the Agreement"), wherein the CONSULTANT agreed to provide Pre -Placement Suitability Evaluations, Pre - Employment Psychological Examinations, an Officer Assistance Program, Critical Incident Debriefing, and Fitness for Duty Examinations for the National City Police Department located at 1200 National City Boulevard from July 1, 2010 through June 30, 2011, for an amount not to exceed $49,500. The Agreement provided an option to extend the term of the Agreement for one-year, with up to three extensions. C. The parties previously extended the Agreement for a one-year term from July 1, 2011 to June 30, 2012, (First Amendment to the Agreement). D. The parties desire to exercise the option to extend the Agreement for the second of the three one-year extensions by extending the term of the Agreement for one additional year, beginning July 1, 2012 and expiring on June 30, 2013. NOW, THEREFORE, the parties hereto agree that the Agreement shall be amended as follows: 1. The term of the Agreement is extended for an additional one-year term from July 1, 2012 through June 30, 2013, for an amount not to exceed $49,500, for a total Agreement amount of $148,500, to provide Pre -Placement Suitability Evaluations, Pre -Employment Psychological Examinations, an Officer Assistance Program, Critical Incident Debriefing, and Fitness for Duty Examinations for the National City Police Department. The parties further agree that with the foregoing exceptions, each and every term and provision of the Agreement dated July 1, 2010, shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the Agreement on the date and year first above written. CITY OF NATIONAL CITY By: on Morrison, Mayor PPROVED , TO FORM: audia G. E! q. City Attorne GROSSMAN PSYCHOLOGICAL ASSOCIATES, APC By: lQfl"'"' . Ira Grossman, PIID President DARWIN NATIONAL ASSURANCE COMPANY 10/26/11 - A Psychologists' Professional Liability Policy THIS TS A CLAIMS MADE POLICY - PLEASE READ CAREFULLY *** RENEWAL*** NOTICE: A LOWER LIMIT OF LIABILITY APPI.IES TO JUDGMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS OF SEXUAL MISCONDUCT (SEE THE SPECIAL PROVISION "SEXUAL MISCONDUCT" IN THE POLICY). DECLARATIONS POLICY NO: 5010-5093 ACCOUNT NO: CA-GROS455-0 0222405C ITEM 1. (a) NAME AND ADDRESS OF INSURED: ITEM 1. (b) ADDITIONAL NAMED INSUREDS: IRA GROSSMAN, PH.D. GROSSMAN PSYCHOLOGICAL ASSOCIATES, APC 4550 KEARNY VILLA RD STE 214 SAN DIEGO, CA 92123 ITEM 2. ADDITIONAL INSUREDS: CITY OF CHULA VISTA PURCHASING DIVISION 276 FOURTH AVE MS F-106 CHULA VISTA, CA 91910 ITEM 3. POLICY PERIOD: ITEM 4. LIMITS OF LIABILITY: • TYPEOFORG: PROFESSIONAL CORPORATION FROM: 12/01/11 TO: 12/01/12 I2:OIA.M. STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED HEREIN: (a) $ 2,000,000 EACH WRONGFUL ACT OR SERIES OF CONTINUOUS, REPEATED OR INTERRELATED WRONGFUL ACTS OR OCCURRENCE (b) $ 25,000 COSTS RELATED TO ANY SINGLE PROCEEDING (c) $ 4,000, 0.00 AGGREGATE, FOR ALL CLAIMS AND ALL PROCEEDINGS ITEMS PREMIUM SCHEDULE: ITEM 6 CLASSIFICATION NUMBER RATE ANNUAL PREMIUM 1ST PSYCHOLOGIST DEFENSE LIMIT 1 1494.00 -''''"----'''''',:`-'—'"--'7----"-; 1,195.00 - 75.00 s..fi �-- . s- L. " 'Ai91711 TipiJ�aL^ 2135i7ft1,'D'S"_ < 3. V 0 RETROACTIVE DATE: 12 / 01 / 92 TOTAL PREMIUM: 1,201.00 CRED ITEM 7. EXTENDED REPORTING PERIOD ADDITIONAL PREMIUM (ifexercised):$ 2,102.00 SCHEDULED RATING CREDIT INCLUDED ITEM 8. POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY PRGE2000 (3/2006) PRG21069 (1/2006) PRGe1121 THIS IS NOT A BILL. PREMIUM HAS BEEN PAID. PRGE2005 (3/2006) AUT• RJZED COMPANY REPRESENTATIVE Ameri •rofessional Agency * 95 Broadway, Amityville, NY 11701 Jun 01 12 08:27a p.2 ACORD® CERTIFICATE OF LIABILITY INSURANCE Dasio;i2o z 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 INSURERIS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certdreate 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 doss not confer rights to the certificate holder in lieu of such endorsements). PRODUCER MARILYN BILLINGSLEY 1527 W LEWIS STREET CONTACT NAME: 17 (A/C N tmFAX rare tANot 619-296-1683 ,.fxt1.6t9-296-6505 E-MAIL ADDRESS: SAN DIEGO, CA92103 IN SORER(S)AFFORDING COVERAGE NAICW i INSURER A: Stain Farm General Insurance Company 25j 1 INSORED BUCCIGROSS, RICHARD L MD MEDICAL CORP & GROSSMAN PSYCHOLOGICAL ASSOC 4550 KEARNY VILLA RD STE 214 SAN DIEGO, CA92123 INSURER A: _ INSURER C: INSURER 0. INSURERS: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TRIS :S TO CERTI-Y THAT THE POLICIES OF INSURANCE LISTED RELGVi HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INCICATED. NO1WTHSTA.NDING 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 DF SUCH POLICIES. LIMITS SHO N MAY HAVE BEEN REDUCED SY PAID CLAIMS. ILTRAnaLTYPE q OF INSURANCE IIN RAN Erfs POL tY YYYI . IM,.I:D❑ POLICY NUN BER 41MIDD•EFP RO:JCYE LLHITS j DENERAI. X uAea1TY COMMERCIAL GENERAL LIABILITY Y _wVD Y 90.51-4271-4 01/09/2012 01/09/2013 EACH OCCURRENCE $ 1,000.000 �TED I -PREMISES {Ea occurrence) $ 3E0 000 MEC EXY {Any one person) $ EOM CLAIMS -MADE I X I OCCUR PERSONAL P. ADV IN_URY $ GENERAL AS OREGATE $ 2,000,000 PRODUCTS- COMP/DP AGE $ 2,000,000 GEM. AGGREGATE X POLICY LIMIT A=PLIES PER JECT I LOC $ Es acciderl) SINGLE LIMIT $ AUTOMODILE — LIAsILIYY' ANY AUTO ALLOVN ED AUTOS HIRED AUTOS -' SCItECULED AUTOS NON-CwNE0 AUTOS BODILY INJURY:Per perBcn) $ BODILY INJURY) Per arziAen:) PROPER IY OP.M } I ed ,' I $ UMBRELLA LIAR EXCESS LUA6 _ OCCUR • CLAIMS -MADE EACH OCCURRENCE AGGREGATE $ $ DED RETENTION b WORKERS COMPENSATION AND EMPLOYERS' UABILITY YIN ANY P70PPo STOW?.4RTNEPoEXECUTNE. I O'FICEMEMBER EXCLUDED? I (Mandatary In EH) II yes, desoibe under DESCRP'IONL'-F OPERATIONS nek,w N/Ai At STATU- DYH I TQRY, OMITS I ER iE�L-EACH ACCIDENT $ I E.i.. OISEAS E.-EAEMPLOYEE $ E. L. DISEASE-PrJ11CY'_YNR $ DESCRIPTION OF OPERATIONS, LOCATIONS J VEHICLES [Reach ACORD 141, AddIHdnal Remarks Soheduln. If more apace s raquiredt BUSINESS -OFFICE CERTIFICATE HOLDER CANCELLATION CITY OF NATIONAL CITY ITS OFFICERS, AGENTS & EMPLOYEES 1243 NATIONAL CITY BLVD NATIONAL CITY CA 919S4-4397 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS- AUT40R2ED REPRESEQ C-_,AI TA E. i T% ji f i V, L ACORD 25 (2010105) Ns''I yOO-4u-iu nr+v rtv w.vnrvev+�v,e, r�,, ..y...�.�+�..---- The ACORD name and logo are registered tnarks of ACORD ,4DO1486 112849.7 0S-01-2012 Jun 01 12 08 28a p.3 .IO6'1 Policy No : 90 5142714 SECTION If ADDITIONAL INSURED ENDORSEMENT Policy No.: SO 514271 4 Named Insured_ SUCCIGROSS, RICHARD L MD A MEDICAL CORP & GROSSMAN PSYCHOLOGICAL ASSOC- FF.Ssa9 Additional Insured (include address): CITY OF NATIONAL CITY ITS OFFICERS. AGENTS & EMPLOYEES 1243 NATIONAL CtfY BLVD NATIONAL CITY, GA 91950-43D1 WHO IS AN tNSLJRED, under SECTION II DESIGNATICN OF INSURED. is amended an insured the Additional Insured shown above, but toy to the extent that liabi'iIy is impo Additional Insured sorely because of your work performed far that Additional Insured sh Include as on that above. Any Insurance provided to the Additionar insured shall only apply with respect to a claim made or a suit brought for damages for which you are provided coverage. The Primary Insurance coverage below applies only when there Is an "X" in ttte box. ® Primary insurance. The insurance provided to the Additional Insured shown abavshall be primary insurance. Any insurance carried by the Additional Insured shalt be nonca ibutary with respect to coverage provided to you. Ail other policy provisions apply. Printed In u.SA Jun 01 12 O6:28a WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SCI-EDULE Policy Number: 90 514271 4 Named insured: BUCCIGROSS, RICFIARD L MD A MEDICAL CORD & GROSSMAN PSYCHOLOGICAL ASSOC Name end Address of Parson or Organization: CITY OF NATIONAL CITY ITS OFFICERS, AGENTS & EMPLOYEES 1243 NATIONAL CITY BLVD NATIONAL CITY, CA 9195O-4301 p,4 ES-6GJ7 Page 1art The following is added to Paragraph 10. b_ of SECTION 1 AND SECTION 11— COMMON CONDITIONS: We waive any right of recovery we may have against +ha person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations: or b. Your work done under contract with that person or organization and included in the products - completed operations Hazard. This waiver applies only to the person cr organization shown ln the Schedule. AN ether policy provisions apply. FE-8671 �&. Coiwrot, State Farm Mutual Automobile rromance Company, 2009 [cameos mpyrlgreed meta Cal or fisurerce Sertiocts Office, trre. win tta psrrntrnton. pAn}fd l 3.6r. RESOLUTION NO. 2012 — 157 RESOLUTION OF THE CITY COUNCIL OF THE CITY OF NATIONAL CITY AUTHORIZING THE MAYOR TO EXECUTE THE SECOND AMENDMENT TO THE AGREEMENT WITH GROSSMAN PSYCHOLOGICAL ASSOCIATES, APC, IN THE NOT -TO -EXCEED AMOUNT OF $49,500 FOR AN ADDITIONAL ONE YEAR TERM TO PROVIDE PRE -PLACEMENT EVALUATIONS, PRE -EMPLOYMENT EXAMS, AN OFFICER ASSISTANCE PROGRAM, CRITICAL INCIDENT DEBRIEFINGS, AND FITNESS FOR DUTY EVALUATIONS FOR THE NATIONAL CITY POLICE DEPARTMENT WHEREAS, on July 1, 2010, the City entered into a one-year Agreement with Grossman Psychological Associates, APC, in the amount of $49,500 to provide pre -placement evaluations, pre -employment exams, an officer assistance program, critical incident debriefings, and fitness for duty evaluations for the National City Police Department; and WHEREAS, said Agreement provided the option to extend the term of the Agreement for three additional one-year terms; and WHEREAS, on July 5, 2011, the City Council adopted Resolution No. 2011-146, approving the First Amendment to the Agreement to extend the term of the Agreement for one year for the not to exceed amount of $49,500; and WHEREAS, the parties desire to exercise the option to extend the Agreement for the second of the three one-year extensions by extending the term of the Agreement for one additional year, beginning July 1, 2012, and expiring on June 30, 2013, in the amount of $49,500, for a total agreement amount of $148,500. NOW, THEREFORE, BE IT RESOLVED that the City Council of the City of National City hereby authorizes the Mayor to execute a Second Amendment to the Agreement in the not -to -exceed amount of $49,500 with Grossman Psychological Associates, APC, to provide pre -placement evaluations, pre -employment exams, an officer assistance program, critical incident debriefings, and fitness for duty evaluations to the Police Department from July 1, 2012 through June 30, 2013. Said Second Amendment to Agreement is on file in the office of the City Clerk. PASSED and ADOPTED this 17th day of July, 2012. n Morrison, Mayor ATTEST: Michael R. Dalla it Clerk y AP •' ROVED AS ORM: I feu Gacitua City Attorney Passed and adopted by the Council of the City of National City, California, on July 17, 2012 by the following vote, to -wit: Ayes: Councilmembers Morrison, Natividad, Rios, Sotelo-Solis, Zarate. Nays: None. Absent: None. Abstain: None. AUTHENTICATED BY: RON MORRISON Mayor of the City of National City, California /I City Clerk of the City National City, California By: Deputy I HEREBY CERTIFY that the above and foregoing is a full, true and correct copy of RESOLUTION NO. 2012-157 the City of National City, California, passed and adopted by the Council of said City on July 17, 2012. City Clerk of the City of National City, California By: Deputy CITY OF NATIONAL CITY, CALIFORNIA COUNCIL AGENDA STATEMENT MEETING DATE: July 17, 2012 AGENDA ITEM NO. 14 TEM TITLE: Resolution of the City Council of the City of National City authorizing the Mayor to execute a Second Amendment to the Agreement with Grossman Psychological Associates, APC, in the not -to exceed amount of $49,500 to provide Pre -Placement evaluations, Pre -Employment exams, an Officer Assistance Program, Critical Incident Debriefing and Fitness for Duty Evaluations for the Police Department for the term of one year. PREPARED BY: Ronni Zengota, Operations Assistant 7/ DEPARTMENT: Police ,O APPROVED BY: / 5 ri.Sd ? PHONE: 4516 EXPLANATION: On July 1, 2010, the City entered into an Agreement with Grossman Psychological Associates, APC, to provide Pre -Placement evaluations, Pre -Employment Exams, Officer Assistance Program, Critical Incident Debriefing and Fitness for Duty Exams for the Police Department from July 1, 2010 through June 30, 2011, for the not to exceed amount of $49,500. The Agreement provides the option to extend the Agreement for three (3) one-year terms. On July 5, 2011, the City extended the Agreement for one year (First Amendment) through June 2012. This Second Amendment to the Agreement in the not to exceed amount of $49,500 exercises the option for the second one-year extension through June 30, 2013. Grossman Psychological Associates, APC is a licensed psychologist that has specialized in police sychology since 1982, and is qualified by experience and ability to perform the services required by the rolice Department. FINANCIAL STATEMENT: ACCOUNT NO. Budgeted through the General Fund APPROVED: APPROVED: Finance MIS 001-411-000-205-0000 — Pre -placement, Pre -employment, Critical Incident Debriefing, Fitness For Duty 001-411-000-299-0000 — Officer Assistance Program ENVIRONMENTAL REVIEW: N/A ORDINANCE: INTRODUCTION: FINAL ADOPTION: STAFF RECOMMENDATION: Adopt Resolution BOARD / COMMISSION RECOMMENDATION: N/A ATTACHMENTS: mendment to Agreement RESOLUTION NO. 2012 — RESOLUTION OF THE CITY COUNCIL OF THE CITY OF NATIONAL CITY AUTHORIZING THE MAYOR TO EXECUTE THE SECOND AMENDMENT TO THE AGREEMENT WITH GROSSMAN PSYCHOLOGICAL ASSOCIATES, APC, IN THE NOT -TO -EXCEED AMOUNT OF $49,500 FOR AN ADDITIONAL ONE YEAR TERM TO PROVIDE PRE -PLACEMENT EVALUATIONS, PRE -EMPLOYMENT EXAMS, AN OFFICER ASSISTANCE PROGRAM, CRITICAL INCIDENT DEBRIEFINGS, AND FITNESS FOR DUTY EVALUATIONS FOR THE NATIONAL CITY POLICE DEPARTMENT WHEREAS, on July 1, 2010, the City entered into a one-year Agreement with Grossman Psychological Associates, APC, in the amount of $49,500 to provide pre -placement evaluations, pre -employment exams, an officer assistance program, critical incident debriefings, and fitness for duty evaluations for the National City Police Department; and WHEREAS, said Agreement provided the option to extend the term of the Agreement for three additional one-year terms; and WHEREAS, on July 5, 2011, the City Council adopted Resolution No. 2011-146, approving the First Amendment to the Agreement to extend the term of the Agreement for one year for the not to exceed amount of $49,500; and WHEREAS, the parties desire to exercise the option to extend the Agreement for the second of the three one-year extensions by extending the term of the Agreement for one additional year, beginning July 1, 2012, and expiring on June 30, 2013, in the amount of $49,500, for a total agreement amount of $148,500. NOW, THEREFORE, BE IT RESOLVED that the City Council of the City of National City hereby authorizes the Mayor to execute a Second Amendment to the Agreement in the not -to -exceed amount of $49,500 with Grossman Psychological Associates, APC, to provide pre -placement evaluations, pre -employment exams, an officer assistance program, critical incident debriefings, and fitness for duty evaluations to the Police Department from July 1, 2012 through June 30, 2013. Said Second Amendment to Agreement is on file in the office of the City Clerk. PASSED and ADOPTED this 17th day of July, 2012. Ron Morrison, Mayor ATTEST: APPROVED AS TO FORM: Michael R. Dalla, City Clerk Claudia Gacitua Silva City Attorney SECOND AMENDMENT TO AGREEMENT BETWEEN THE CITY OF NATIONAL CITY AND GROSSMAN PSYCHOLOGICAL ASSOCIATES, APC This Second Amendment to Agreement is entered into this day of July, 2012, by and between the City of National City, a municipal corporation (the "CITY"), and GROSSMAN PSYCHOLOGICAL ASSOCIATES, a professional corporation (the "CONSULTANT),. RECITALS A. The CITY and the CONTRACTOR entered into an Agreement on July 1, 2010 ("the Agreement"), wherein the CONSULTANT agreed to provide Pre -Placement Suitability Evaluations, Pre - Employment Psychological Examinations, an Officer Assistance Program, Critical Incident Debriefing, and Fitness for Duty Examinations for the National City Police Department located at 1200 National City Boulevard from July 1, 2010 through June 30, 2011, for an amount not to exceed $49,500. B. The Agreement provided an option to extend the term of the Agreement for one-year, with up to three extensions. C. The parties previously extended the Agreement for a one-year term from July 1, 2011 to June 30, 2012, (First Amendment to the Agreement). D. The parties desire to exercise the option to extend the Agreement for the second of the three one-year extensions by extending the term of the Agreement for one additional year, beginning July 1, 2012 and expiring on June 30, 2013. NOW, THEREFORE, the parties hereto agree that the Agreement shall be amended as follows: 1. The term of the Agreement is extended for an additional one-year term from July 1, 2012 through June 30, 2013, for an amount not to exceed $49,500, for a total Agreement amount of $148,500, to provide Pre -Placement Suitability Evaluations, Pre -Employment Psychological Examinations, an Officer Assistance Program, Critical Incident Debriefing, and Fitness for Duty Examinations for the National City Police Department. 2. The parties further agree that with the foregoing exceptions, each and every term and provision of the Agreement dated July 1, 2010, shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the Agreement on the date and year first above written. CITY OF NATIONAL CITY GROSSMAN PSYCHOLOGICAL ASSOCIATES, APC By: By: QJ�Jw ‘4+ Ron Morrison, 1 a Grossman, PHD Mayor President APPROVED AS TO FORM: Claudia G. Silva, Esq. City Attorney Jun 0112 08:27a p,2 AcoREY CERTIFICATE OF LIABILITY INSURANCE DQeioii2o YYY) 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 INSURERIS), 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 terns 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 sndorsernent(s). PRODUCER MARILYN BILLINGSLEY 1527 W LEWIS STREET CONTACT _kAme NE g, xt) 6t9.295-6505 ' FAX LAIC NR No1:515-295-1563 E-MAIL 'WORM: . , SAN DIEGO, CA92103 MSU RER[S) AFFORDING COVERAGE NAIL# INSURER A: State Farm General Insurance Company 2515i INSURED BUCC(GROSS, RICHARD L MDA MEDICAL CORP & GROSSMAN PSYCHOLOGICAL ASSOC 4550 KEARNY VILLA RD STE 214 SAN DIEGO, CA92123 INSURERS: INsuaER c, INSURER D: INSURER E, INSURER F; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE 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 SUDJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED 8Y PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL IN RN yJVn POLICYtrr POLICY£XP POLICYNUNIDER IMINDDAITYYl:IMMICDlYYYYI LIMITS GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY Y Y 90.51-4271-4 01/D912012 , 01f0912013 EACH OCCURRENCE "$ 1,000,000 DAMAGEIO ?TENTLD PREMISES [Ea occurrence) $ 300,000 CLAIM -MADE I K OCCUR MED EXP (Any one person) $ 5,000 PERRONAL&ADV INJURY $ GENERAL AGGREGATE S 2000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 GEI'L AGGREGATE LIMIT A'PLIES PER: �� POLICY ) ,P T LOC $ AUTOMOBILE _.__ LIABILITY' ! _ SCI-ZD ULED AUTOS NON -OWNED AUTOS I COMBINED 9NGLE LIMIT (Ea adidon0 5 BODILY INJURY 1Per per son) $ BODILY INJURY per accident) c PROPERTY DAMAGE [Per accident $ UMBRELLA LIAR EXCESS LIAB _ OCCUR CLAIMS DE E EACH OCCURRENCE $ AGGREGATE $ 5 TE0 RETENTION$ WORMERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR,PARTNER/EXECU71VE i INI 0710E/MEMBER EXCLUDED {Mandatory In NH7 lI yes, desc ibe under RESORPTION OF OPERATIONS 'nee, N/A 1 L `Nl WC STADU- 07H- TORY' [(NITS _fj; EL. EACH ACCIDENT EL, DISEASE -EA EMPLOYEE $ EL. DISEASE POLICY LING t Dr DESCRIPTION OF OPERATIONS! LOCATIONS/ VEHICLES (Attach ACORD 101,Addldonal Remarks Schedule, I1 mere apace Is regulated) BUSINESS -OFFICE NCELLATION CITY OF NATIONAL CITY ITS OFFICERS, AGENTS & EMPLOYEES 1243 NATIONAL CITY BLVD NATIONAL CITY CA 919504397 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRfiS TA E If. ( �_ ACORD 25 (2010/D5) 01988-2010 ACOR2,ORPO(AA LION, All rights reserved. TheACORD name and logo are registered marks of ACORD 40.014E6 132849.7 03-01-2012 10/26/11 - A DARWIN NATIONAL ASSURANCE COMPANY P9YChTHISISACLAIMSMADEPOL CY PLEASEREADtCAREFIJLLYy *** RENEWAL *** NOTICE: A LOWER LIMIT OF LIABILITY APPLIES TO JUDGMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS OF SEXUAL MISCONDUCT (SEE THE SPECIAL PROVISION "SEXUAL MISCONDUCT' IN THE POLICY). DECLARATIONS POLICY NO: 5010-5098 ACCOUNT NO: CA-GROS455-0 0222406C ITEM 1. (a) NAME AND ADDRESS OF INSURED: ITEM 1. (b) ADDITIONAL NAMED INSUREDS: IRA GROSSMAN, PH.D. GROSSMAN PSYCHOLOGICAL ASSOCIATES, APC 4550 KEARNY VILLA RD STE 214 SAN DIEGO, CA 92123 • TYPE OFORG: PROFESSIONAL CORPORATION ITEM 2. ADDITIONAL INSUREDS: CITY OF CHULA VISTA PURCHASING DIVISION 276 FOURTH AVE MS F-106 CHULA VISTA, CA 91910 ITEM 3. POLICY PERIOD: ITEM 4. LIMITS OF LIABILITY: FROM: 12 01/11 TO: 12/01/12 12:0I A.M. STANDARD TIME AT THE ADDRESS OF THE INSURED AS STATED HEREIN: (a) $ (b)$ 2,000,000 25,000 EACH WRONGFUL ACT OR SERIES OF CONTINUOUS, REPEATED OR INTERRELATED WRONGFUL ACTS OR OCCURRENCE COSTS RELATED TO ANY SINGLE PROCEEDING 4, 000, 0 0 0 AGGREGATE, FOR ALL CLAIMS AND ALL PROCEEDINGS • CLASSIFICATION NUMBER RATE ANNUAL PREMIUM 1ST PSYCHOLOGIST DEFENSE LIMIT 1 1494.00 1,195.00 - 75.00 a ITEM 6. .. 'L' I 1 i-ONAI TNS- RE"DS--* a . 1" - y £ `-5''D"ra:'i/_0= RETROACTIVE DATE: 12 / 01 / 92 TOTAL PREMIUM: 1,201.00 CRED ITEM 7. EXTENDED REPORTING PERIOD ADDITIONAL PREMIUM (if exercised):$ 2 , 102 . 00 SCHEDULED RATING CREDIT INCLUDED ITEM 8. POLICY FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY PRGE2000 (3/2006) PRGe1069 (1/2006) PRGe1121 THIS IS NOT A BILL. PREMIUM HAS BEEN PAID. PRGE2005 (3/2006) AUTkfORIZED COMPANY REPRESENTATIVE Americ rotessional Agency + 95 Broadway, Amityville, NY 11701 Jun011208:28a WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SCHEDULE Policy Number: 90 514271 4 Named Insured: BUCCIGRCSS, RICHARD 1_ MD A MEDICAL CORP & GROSSMAN PSYCHOLOGICAL ASSOC Name and Address of Parson or Organization: CITY OF NATIONAL CITY ITS OFFICERS, AGENTS & EMPLOYEES 1243 NATIONAL CITY OLVD NATIONAL CITY, CA G1950 4301 p,4 FE-ES71 Pege1(41 The following is added to Paragraph 10.b. of SECTION 1 AND SECTION 11— COMMON CONDIirONS: We waive any riytrt of recovery we may have against the person or organization ;drown in the Schedule because of payments we make for injury or damage arising out of. a. Your ongoing operations; or b. Your work done under contract wilh that persort or organisation ar.d included in the products- campteted operations hazard, This waiver applies only to the person or organization Shown in the Schedule. AI cuter policy provisions apply. FE-3671 COpyrot, Etats Farts Mutrai Autnmobda Ir utanw Company, 20E8 intuOes mpyrigMed matarls; of hears ase SErv{ps Office. ism. wet rs p5rrnlsmon. pnroydh 13.6A Jun 01 12 08:28a .W M Policy No.. 90 5142714 SECTION 1I ADDITIONAL INSURED ENDORSEMENT Policy No.: 90 514271 4 Named Insured_ BUCCIGROSS, RICHARD L MD A MEDICAL CORP & GROSSMAN PSYCHOLOGICAL ASSOC p.3 FE-Geo9 Additional Insured (include address): CITY OF NATIONAL CITY ITS OFFICERS, AGENTS & EMPLOYEES 1243 NATIONAL CITY BLVD NATIONAL CITY, CA 919504301 WHO IS AN INSURED, under SECTION II DESIGNATION OF INSURED. is amended 1 an insured the Additional insured shown above, but only to the extent that liability is impo Additional Insured solely because of your work perfOlmed for that Additional Insured sh Include as on that above. Any Insurance provided to the Additional Insured shall only app[y with respect to a claim made or a suit brought far damages for which you are provided coverage_ The Primary insurance coverage below applies only when there is an "X" in the box. ® Primary Insurance. The insurance provided to the Additional Insured shown stew shall be primary insurance. Any insurance carried by the Additional Insured shall be nonco ibutory with respect to coverage provided to you. Ali other policy provisions apply. POntx1 In U.SA OFFICE OF THE CITY CLERK 1243 National City Blvd. National City, California 91950 Michael R. Dalla, CMC - City Clerk 619-336-4228 phone / 619-336-4229 fax July 19, 2012 Dr. Ira Grossman Grossman Psychological Associates Landmark Centre 4550 Kearney Villa Road, Suite 214 San Diego, CA 92123 Dear Dr. Grossman, On July 17th, 2012, Resolution No. 2012-157 was passed and adopted by the City Council of the City of National City, authorizing execution of Second Amendment to the Agreement with Grossman Psychological Associates. We are enclosing for your records a certified copy of the above Resolution and a fully executed original Amendment. Sincerely, Michael R. Dalla, CMC City Clerk Enclosures cc: Police Dept.