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
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OF INSURANCE
IIN RAN Erfs
POL tY YYYI . IM,.I:D❑
POLICY NUN BER 41MIDD•EFP RO:JCYE LLHITS
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COMMERCIAL GENERAL LIABILITY
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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
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HIRED AUTOS
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NON-CwNE0
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BODILY INJURY:Per perBcn) $
BODILY INJURY) Per arziAen:)
PROPER IY OP.M }
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$
UMBRELLA LIAR
EXCESS LUA6
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EACH OCCURRENCE
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AND EMPLOYERS' UABILITY YIN
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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.
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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
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LIABILITY
COMMERCIAL GENERAL LIABILITY
Y
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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
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SCI-ZD ULED
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(Ea adidon0 5
BODILY INJURY 1Per per son) $
BODILY INJURY per accident) c
PROPERTY DAMAGE
[Per accident $
UMBRELLA LIAR
EXCESS LIAB
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CLAIMS DE
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EACH OCCURRENCE $
AGGREGATE $
5
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WORMERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR,PARTNER/EXECU71VE i INI
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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.