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Home My WebLink About2013 CON Independent Forensic Services - Sexual Assault Examination Services - Amendment #1FIRST AMENDMENT TO AGREEMENT BY AND BETWEEN THE CITY OF NATIONAL CITY AND INDEPENDENT FORENSIC SERVICES, LLC This First Amendment to Agreement is entered into this 12th day of November 2013, by and between the City of National City, a municipal corporation (the "CITY"), and INDEPENDENT FORENSIC SERVICES, LLC, a limited liability corporation (the "CONSULTANT"). RECITALS A. The Parties entered into an Agreement on July 1, 2012 (the "Agreement"), wherein INDEPENDENT FORENSIC SERVICES, LLC, agreed to provide Forensic Exams of Victims of Sexual Assaults, follow-up forensic exams, and suspect examinations for the National City Police Department located at 1200 National City Boulevard, National City, from July 1, 2012 through June 30, 2013. The Agreement provided an option to extend the term of the Agreement for one- year, with up to three extensions. B. The parties now desire to amend the Agreement to extend the term of the Agreement for an additional year, through Fiscal Year 2013- 2014, effective July 1, 2013 and ending June 30, 2014, for the not to exceed amount of $23,000, for a total not -to -exceed amount of $46,000. C. The parties further agree that with the foregoing exceptions, each and every term and provision of the Agreement dated July 1, 2012, 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 INDEPENDENT FORENSIC SERVICES, LLC (Sole proprietorship -one signature) By: Leslie Deese City Manager OVED AS TO FORM: citua Silva Claire Nelli. RN INDEPENDENT FORENSIC SERVICES 4529 College Ave San Diego, CA 92115 9/17/13 Ronnie, The only change in fees will be: Suspect exams will remain $471.00 at IFS facility And increase to $525.00 at law enforcement agencies/other medical facilities. Thank you, Claire Nelli RN,SANE-A Owner, Independent Forensic Services ��X/46irA a- CALIFORNIA - NATI_4NAL CITY +17COHPOSATBD City of National City (To be submitted only when there are no employees subject to Workers' Compensation) DECLARATION AND ADDENDUM TO ALL CONTRACTS AWARDED TO: l ri%De pe-AJdp,eir j o26Nsi - .SE-4viLEs (gyps.) (Company Name) For the purpose of inducing the City of National City to go forward with any contracts awarded "`' to �nJ �+✓�.�' f-uh•�eA...eZ.. Se r (Company), I declare as follows: 1, GC 4-, it (name) , (title), am authorized to execute this document on behalf of 1 F5 (company) with respect to compliance with the California Workers' Compensation and Labor laws. All work required will be performed personally and solely by volunteers of / IC-5 (company), who are independent contractors. If, however, /FS 1 t - (company) shall ever be required to hire employees or Subcontractors to perform this contract, _ 1F-5 (company) shall obtain Workers' Compensation Insurance and/or provide proof of Workers' Compensation Insurance coverage to the City of National City. This document constitutes a declaration by / f"S (company) against its financial interest, relative to any claims which may be asserted under the California Workers' Compensation and/or Labor laws against the City of National City relating to any bid or contract awarded 11=5 (company). if 5 (company) will defend, indemnify, and hold harmless the City of National City, its officers and employees, from any and all claims and liability, including Workers' Compensation claims and liability that may be asserted or established by any party in the event it hires an employee in violation of this addendum or if a volunteer of the organization makes a claim against or alleges liability of the City of National City for Workers' Compensation, and it will further indemnify the City of National City, its officers and employees, for all damages the City thereby suffers. I agree that these declarations shall constitute an addendum to any bid or contract awarded to: Dated: (company). q I i "1 , 20 I ') . (company) By: e LVA24_ (Signature of Authorized Representative) CZfht'�� NELC , A) - �t"Al✓ (Name and Title) SEP-3-2013 10:36 FROM:FELDMAN INS AGENCY 8183377569 TO:16192652891 P.5/6 .4CORL'� CERTIFICATE OF LIABILITY INSURANCE DATE p INDOPf Yn 09/01/2013 THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 71/118 CERTIFICATE DOHS NOT APFIR)NATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TIN CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS). AUTHORl2'ED REPRESENTATNE OR PRODUCER, AND TM CERTIFICATE HOLDER, IMPORTANT: N the minicab holder le in ADDITIONAL INSURED, the policy(Ise) must be andonted. 11 SUBROGATION I8 WANED, subject to the tans and conditions of the policy, certain policies may require an endoraanant. A statement on this ciAlfloals does not confer rights to the cartIRcata holder In Ileu of such endorsement/a). PRIOW= Richard Peldmen(3026P1W) 21063 Devonshire St Ste 205 Chatsworth N18UROD CA 91311.8253 NELLI, CLAIRE 4278 54TH PL STE C-54 SAN DIEGO COVERAGES CA 92115 CERTIFICATE NUMBER: NOIU PEONS ovcomotio. 818417-3886 P.MI_ NImultej 91 AFFORDING cosmos 1W Nok INSURER As Truck Insurance Exchange *EUNEs s Farmers insurance Exchange IReuuR c : Mld Century Insurance Company INSURER D: NANO E 21708 21852 21687 MWI@R I: INSURER P; • TFIIB fB TO CERTIFY THAT THE PoLIGIES OF INSURANCE LISTED BELOW HAVE BEEN issue) TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT 0R 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, ErCLUBIONS AND CONDRION8 OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR TYPE OP INSURANCE WISCAilsll 'AAA enn POLICY NUMBER itlATScAS- IYM®0/YYTY7 ppO��r gIp Oa1MOlYYYY1 ' ANTS DETmEnTAL UAOILTTT BAC_H t . 2L000y000 I 100,000 X COMMERCIAL GENERAL UABILRY �OCCURqRENCE PBFtD@EI __ CIAIME•MADE LJ OCCe/4 VA DIVIIIPVIIJ KO ExP (my ons ps/son) t <5 000 B 091415794 09/01/2013 09/01/2014 PERSONALAAOVINJURY .1 2L000,000 OPNERAL AGGREGATE s 4 000 000 t ..� 2,000,000 OEN . AGORSOATE LIMB APPUES PER `—1 -i _ PSODUCTs . COMPIOP AGG Palcv (- [T Lon 1 .AuroMomuewwun lb NGLEUMn t 2,000,000 BALL — ANY AUTO OWNED AUTO — SCHEDULED SCHEDULED AUTOS 081415794 09/01/2013 08/01/2014 BODN.Y INJURY (Pr porno)1 _._—.�. ........� ....___ BODILY INJURY Mr..aa.nq .. ...,_,.�....,...........— I� -- MRIDAUTOS X AAUUTO0ED ToDP IDAMAeE 1 1 ,,.__ UNerastAUAA __. OCCUR EACH OCCURRENCE 1 MENU LIAO CLAB,M.WOB AGGREGATE 1 [ 1 E DED RETENTION NOREERe COMPONSA710N AND DAPLOYIRI' umurr - WC ETAT6J101H- TORY LIMITS 1 ER ANYPROPRIETORMARTNERXECIITIVE TIN IB OFFICERAAEMBER En*. Wry a N IA El- EACH ACCIDENT t (Nenderor In NNI Nyye deeeAbe under EL DE MAEe - EA EMPLOYEE 1 D65o.RIPTIDN OF QPEAATIONs 1"WNok. EL IMAM • POLICY LIMIT t • DESCRIPTION OP OPERATIONS 'LOCATIONS / vSRICLEI (ANKH ACOSO Nt, Adding's.' Remrt. Ilehodule. a Inns Hem Y npdnd) 4278 54TH PL STE C.54, SAN DIEOO, CA 92115 Coningate Holder N elm en additional Insured "The City of National Cry, ICe elected olRcialo, officers agents, and employees.' CANCELLATION Cly of National City C/O Ronnl Zengote 1200 Nation& City BIYd National Clty AGORD 25 (2E10/05) CA 91980 SHOULD ANY 0P THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 0tPIRAT10N DATE TH5REOF, NORCO WIU. BE DELIVERED IN ACCORDANCE WITH 111E POLICY PROVISIONS. AUTHOMOESFWPRISENTATIVB 4 1Y6/ 61b`tRD CORPORATION. All fights rsservad. The ACORD name and logo are raglaterrd matins o/ ACORD CNA Producer Branch Prefix 018098 970 HPG Named Insured and Address: Claire M Nelli 4136 Oregon St San Diego, CA 92104-1726 Medical Specialty: Registered Nurse Excludes Cosmetic Procedures HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP Certificate of Tht5urattce OCCURENCE POLICY FORM Policy Number 0004006777 Print Date: 9/17/2013 nso nurses service organization. Policy Period from 09/26/13to 09/26/14at 12:01 AM Standard Time Program Administered by: Nurses Service Organization 159 E. County Line Road Hatboro, PA 19040-1218 1-800-247-1500 www.nso.com Code: Insurance is provided by: 80964 American Casualty Company of Reading, Pennsylvania 333 S. Wabash Avenue, Chicago, IL 60604 Professional Liability $2,000,000 each claim Your professional liability limits shown above include the following: * Good Samaritan Liability * Malplacement Liability * Personal Injury Liability * Sexual Misconduct Included in the PL limit shown above subject to $ 25,000 aggregate sublimit Coverage Extensions License Protection $ 25,000 per proceeding $ 25,000 Defendant Expense Benefit $ 1,000 per day limit $ 25,000 Deposition Representation $ 10,000 per deposition $ 10,000 Assault $ 25,000 per incident $ 25,000 Includes Workplace Violence Counseling Medical Payments $ 25,000 per person $ 100,000 First Aid $ 10,000 per incident $ 10,000 Damage to Property of Others S 10,000 per incident $ 10,000 Information Privacy (HIPAA) Fines and Penalties $ 25,000 per incident $ 25,000 Workplace Liability Workplace Liability Fire & Water Legal Liability Personal Liability Total: $ 163.00 $ 6,000,000 aggregate aggregate aggregate aggregate aggregate aggregate aggregate aggregate aggregate Included in Professional Liability Limit shown above Included in the PL limit shown above subject to $150,000 aggregate sublimit $1,000,000 aggregate Base Premium $163.00 Premium reflects Self Employed , Full Time Policy Forms & Endorsements(Please see attached list for a general description of many common policy forms and endorsements.) G-121500-D GSL15564 GSL3908 G-121503-C G-121501-C1 G-145184-A GSL15565 GSL17101 GSL13424 GSL19904 titert4144 cre ,1444•4+a IAA\ Chairman of the Board '" Secretary G-141241-B(03/2010) Coverage Change Date: G-147292-A GSL15563 G-123846-D04 GSL3886 Keep this document in a safe place.lt and proof of payment are your proof of coverage. There is no coverage in force unless the premium is paid in full.ln order to activate your coverage, please remit premium in full by the effective date of this Certificate of Insurance. Master Policy # 188711433 Endorsement Change Date: POLICY FORMS & ENDORSEMENTS The list below contains general descriptions of the policy forms and endorsements that may or may not apply to your professional liability insurance policy. Please refer to your Certificate of Insurance for the policy forms & endorsements specific to your state and your policy period. Coverages, rates and limits may differ or may not be available in all states. All products and services are subject to change without notice. Think Green —expanded definitions and copies of these policy forms and endorsements are available online at www.nso.com/policyforms COMMON POLICY FORMS & ENDORSEMENTS FORM # G-121500-D G-121503-C G-121501-C1 G-145184-A G-147292-A GSL15563 GSL15564 GSL15565 GSL17101 GSL13424 G-123846-004 GSL3886 GSL3908 GSL19904 DESCRIPTION Common Policy Conditions Workplace Liability Form Occurrence Policy Form - California Policyholder Notice - OFAC Compliance Notice Policyholder Notice - Silica, Mold & Asbestos Disclosure Information Privacy Coverage Endorsement HIPAA Fines, Penalties & Notification Costs Sexual Misconduct Sublimits of Liability Professional Liability & Sexual Misconduct Exclusion Healthcare Providers Professional Liability Assault Coverage Exclusion of Specified Activities Reuse of Parenteral Devices and Supplies Services to Animals California Cancellation and Non -Renewal Coverage & Cap on Losses from Certified Acts Terrorism Notice - Offer of Terrorism Coverage & Disclosure of Premium Exclusion of Cosmetic Procedures PLEASE REFER TO YOUR CERTIFICATE OF INSURANCE FOR THE POLICY FORMS & ENDORSEMENTS SPECII TO YOUR STATE AND YOUR POLICY PERIOD. For NJ residents: For KY residents: For WV residents: For FL residents: The PLIGA surcharge shown on the Certificate of Insurance is the NJ Property & Liability Insurance Guaranty Association. The Surcharge shown on the Certificate of Insurance is the KY Firefighters and Law Enforcement Foundation Program Fund and the KY LGPT is the KY Local Government Premium Tax which includes charges at a municipality and/or county level. The surcharge shown on the Certificate of Insurance is the WV Premium Surcharge. The FIGA Assessment shown on the Certificate of Insurance is the FL Insurance Guaranty Associati - 2012 Regular Assessment. Form#: G-141241-B (03/2010) Named Insured: Claire M Nelli Master Policy#: 188711433 Policy#: 0004006777 CITY OF NATIONAL CITY Office of the City Clerk 1243 National City Blvd., National City, California 91950 619-336-4228 phone / 619-336-4229 fax Michael R. Dalla, CMC - City Clerk INDEPENDENT FORENSIC SERVICES Amendment #1 Sexual Assault Victims & Suspects Examination Services Ronni Zengota (Police) Forwarded Copy of Amendment to Independent Forensic Services