HomeMy WebLinkAboutCoherence Associates Inc; 2020-07-20;DocuSign Envelope ID: 4C4C515E-6306-492D-AEA6-624D39178539
20th
July 20
AGREEMENT FOR MENTAL HEALTH COUNSELING AND TRAINING SERVICES
COHERENCE ASSOCIATES, INC.
THIS AGREEMENT is made and entered into as of the ______ day of
________ , 20_, by and between the CITY OF CARLSBAD, a municipal
corporation, ("City"), and Coherence Associates, Inc., a mental health service provider,
("Contractor").
RECITALS
A. City requires the professional services of a mental health service provider that is
experienced in Critical Incident Stress Management and mental health counseling and training
services.
B. Contractor has the necessary experience in providing professional services and
advice related to Critical Incident Stress Management and mental health counseling and training
services.
C. Contractor has submitted a proposal to City and has affirmed its willingness and
ability to perform such work.
NOW, THEREFORE, in consideration of these recitals and the mutual covenants
contained herein, City and Contractor agree as follows:
1. SCOPE OF WORK
City retains Contractor to perform, and Contractor agrees to render, those services (the
"Services") that are defined in attached Exhibit "A", which is incorporated by this reference in
accordance with this Agreement's terms and conditions.
2. STANDARD OF PERFORMANCE
While performing the Services, Contractor will exercise the reasonable professional care and skill
customarily exercised by reputable members of Contractor's profession practicing in the
Metropolitan Southern California Area, and will use reasonable diligence and best judgment while
exercising its professional skill and expertise.
3. TERM
The term of this Agreement will be effective for a period of five years from the date first above
written.
4. TIME IS OF THE ESSENCE
Time is of the essence for each and every provision of this Agreement.
5. COMPENSATION
The total fee payable for the Services to be performed during the initial Agreement term will be in
an amount not to exceed thirty-five thousand dollars ($35,000) per Agreement year. No other
compensation for the Services will be allowed except for items covered by subsequent
amendments to this Agreement. The City reserves the right to withhold a ten percent (10%)
retention until City has accepted the work and/or Services specified in Exhibit "A".
Incremental payments, if applicable, should be made as outlined in attached Exhibit "A".
6. STATUS OF CONTRACTOR
Contractor will perform the Services in Contractor's own way as an independent contractor and
in pursuit of Contractor's independent calling, and not as an employee of City. Contractor will be
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under control of City only as to the result to be accomplished, but will consult with City as
necessary. The persons used by Contractor to provide services under this Agreement will not be
considered employees of City for any purposes.
The payment made to Contractor pursuant to the Agreement will be the full and complete
compensation to which Contractor is entitled. City will not make any federal or state tax
withholdings on behalf of Contractor or its agents, employees or subcontractors. City will not be
required to pay any workers' compensation insurance or unemployment contributions on behalf
of Contractor or its employees or subcontractors. Contractor agrees to indemnify City within thirty
(30) days for any tax, retirement contribution, social security, overtime payment, unemployment
payment or workers' compensation payment which City may be required to make on behalf of
Contractor or any agent, employee, or subcontractor of Contractor for work done under this
Agreement. At the City's election, City may deduct the indemnification amount from any balance
owing to Contractor.
7. SUBCONTRACTING
Contractor will not subcontract any portion of the Services without prior written approval of City.
If Contractor subcontracts any of the Services, Contractor will be fully responsible to City for the
acts and omissions of Contractor's subcontractor and of the persons either directly or indirectly
employed by the subcontractor, as Contractor is for the acts and omissions of persons directly
employed by Contractor. Nothing contained in this Agreement will create any contractual
relationship between any subcontractor of Contractor and City. Contractor will be responsible for
payment of subcontractors. Contractor will bind every subcontractor and every subcontractor of
a subcontractor by the terms of this Agreement applicable to Contractor's work unless specifically
noted to the contrary in the subcontract and approved in writing by City.
8. OTHER CONTRACTORS
The City reserves the right to employ other Contractors in connection with the Services.
9. INDEMNIFICATION
Contractor agrees to indemnify and hold harmless the City and its officers, officials, employees
and volunteers from and against all claims, damages, losses and expenses including attorneys
fees arising out of the performance of the work described herein caused by any negligence,
recklessness, or willful misconduct of the Contractor, any subcontractor, anyone directly or
indirectly employed by any of them or anyone for whose acts any of them may be liable.
The parties expressly agree that any payment, attorney's fee, costs or expense City incurs or
makes to or on behalf of an injured employee under the City's self-administered workers'
compensation is included as a loss, expense or cost for the purposes of this section, and that this
section will survive the expiration or early termination of this Agreement.
10. INSURANCE
Contractor will obtain and maintain for the duration of the Agreement and any and all
amendments, insurance against claims for injuries to persons or damage to property which may
arise out of or in connection with performance of the services by Contractor or Contractor's
agents, representatives, employees or subcontractors. The insurance will be obtained from an
insurance carrier admitted and authorized to do business in the State of California. The insurance
carrier is required to have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus
line insurer on the State of California's List of Approved Surplus Line Insurers (LASLI) with a rating
in the latest Best's Key Rating Guide of at least "A:X"; OR an alien non-admitted insurer listed by
the National Association of Insurance Commissioners (NAIC) latest quarterly listings report.
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10.1 Coverage and Limits.
Contractor will maintain the types of coverage and minimum limits indicated below, unless the
Risk Manager or City Manager approves a lower amount. These minimum amounts of coverage
will not constitute any limitations or cap on Contractor's indemnification obligations under this
Agreement. City, its officers, agents and employees make no representation that the limits of the
insurance specified to be carried by Contractor pursuant to this Agreement are adequate to
protect Contractor. If Contractor believes that any required insurance coverage is inadequate,
Contractor will obtain such additional insurance coverage, as Contractor deems adequate, at
Contractor's sole expense. The full limits available to the named insured shall also be available
and applicable to the City as an additional insure.d.
10.1.1 Commercial General Liability (CGL) Insurance. Insurance written on an
"occurrence" basis, including personal & advertising injury, with limits no less than $2,000,000 per
occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply
separately to this project/location or the general aggregate limit shall be twice the required
occurrence limit.
10.1.2 Automobile Liability. (if the use of an automobile is involved for Contractor's work
for City). $2,000,000 combined single-limit per accident for bodily injury and property damage.
10.1.3 Workers' Compensation and Employer's Liability. Workers' Compensation limits as
required by the California Labor Code. Workers' Compensation will not be required if Contractor
has no employees and provides, to City's satisfaction, a declaration stating this.
10.1.4 Professional Liability. Errors and omissions liability appropriate to Contractor's
profession with limits of not less than $1,000,000 per claim. Coverage must be maintained for a
period of five years following the date of completion of the work.
10.2 Additional Provisions. Contractor will ensure that the policies of insurance required under
this Agreement contain, or are endorsed to contain, the following provisions:
10.2.1 The City will be named as an additional insured on Commercial General Liability
which shall provide primary coverage to the City.
10.2.2 Contractor will obtain occurrence coverage, excluding Professional Liability, which
will be written as claims-made coverage.
10.2.3 This insurance will be in force during the life of the Agreement and any extensions
of it and will not be canceled without thirty (30) days prior written notice to City sent by certified
mail pursuant to the Notice provisions of this Agreement.
10.3 Providing Certificates of Insurance and Endorsements. Prior to City's execution of this
Agreement, Contractor will furnish certificates of insurance and endorsements to City.
10.4 Failure to Maintain Coverage. If Contractor fails to maintain. any of these insurance
coverages, then City will have the option to declare Contractor in breach, or may purchase
replacement insurance or pay the premiums that are due on existing policies in order to maintain
the required coverages. Contractor is responsible for any payments made by City to obtain or
maintain insurance and City may collect these payments from Contractor or deduct the amount
paid from any sums due Contractor under this Agreement.
10.5 Submission of Insurance Policies. City reserves the right to require, at any time, complete
and certified copies of any or all required insurance policies and endorsements. ·
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11. BUSINESS LICENSE
Contractor will obtain and maintain a City of Carlsbad Business License for the term of the
Agreement, as may be amended from time-to-time.
12. ACCOUNTING RECORDS
Contractor will maintain complete and accurate records with respect to costs incurred under this
Agreement. All records will be clearly identifiable. Contractor will allow a representative of City
during normal business hours to examine, audit, and make transcripts or copies of records and
any other documents created pursuant to this Agreement and in compliance with HIPAA law.
Contractor will allow inspection of all work, data, documents, proceedings, and activities related
to the Agreement for a period of three (3) years from the date of final payment under this
Agreement.
13. OWNERSHIP OF DOCUMENTS
All work product produced by Contractor or its agents, employees, and subcontractors pursuant
to this Agreement is the property of City. In the event this Agreement is terminated, all work
product produced by Contractor or its agents, employees and subcontractors pursuant to this
Agreement will be delivered at once to City. Contractor will have the right to make one (1) copy
of the work product for Contractor's records.
14. COPYRIGHTS
Contractor agrees that all copyrights that arise from the services will be vested in City and
Contractor relinquishes all claims to the copyrights in favor of City.
15. NOTICES
The name of the persons who are authorized to give written notice or to receive written notice on
behalf of City and on behalf of Contractor under this Agreement.
For City
Name Darrin Schwabe
Title HR Manager
Department Human Resources
City of Carlsbad
Address 1635 Faraday Ave
. Carlsbad CA 92008
Phone No. 760-271-5548
For Contractor
Name Sara Gilman
Title President/Owner
Address 6183 Paseo del Norte Ste 140
Carlsbad CA 92011
Phone No. 760-942-8663
Email sara@saragilman.com
Each party will notify the other immediately of any changes of address that would require any
notice or delivery to be directed to another address.
16. CONFLICT OF INTEREST
Contractor shall file a Conflict of Interest Statement with the City Clerk in accordance with the
requirements of the City of Carlsbad Conflict of Interest Code. The Contractor shall report
investments or interests in all categories.
YesD No ■
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17. GENERAL COMPLIANCE WITH LAWS
Contractor will keep fully informed of federal, state and local laws and ordinances and regulations
which in any manner affect those employed by Contractor, or in any way affect the performance
of the Services by Contractor. Contractor will at all times observe and comply with these laws ,
ordinances, and regulations and will be responsible for the compliance of Contractor's services
with all applicable laws, ordinances and regulations.
Contractor will be aware of the requirements of the Immigration Reform and Control Act of 1986
and will comply with those requirements, including, but not limited to, verifying the eligibility for
employment of all agents, employees, subcontractors and consultants whose services are
required by this Agreement.
17 .1 FEMA Required Provisions
The City and Contractor shall comply with all applicable requirements of the Federal Emergency
Management Agency (FEMA) which are outlined in Exhibit "B", which is attached and
incorporated by this reference.
18. DISCRIMINATION AND HARASSMENT PROHIBITED
Contractor will comply with all applicable local, state and federal laws and regulations prohibiting
discrimination and harassment.
19. DISPUTE RESOLUTION
If a dispute should arise regarding the performance of the Services the following procedure will
be used to resolve any questions of fact or interpretation not otherwise settled by agreement
between the parties. Representatives of Contractor or City will reduce such questions, and their
respective views, to writing. A copy of such documented dispute will be forwarded to both parties
involved along with recommended methods of resolution, which would be of benefit to both
parties. The representative receiving the letter will reply to the letter along with a recommended
method of resolution within ten (10) business days. If the resolution thus obtained is unsatisfactory
to the aggrieved party, a letter outlining the disputes will be forwarded to the City Manager. The
City Manager will consider the facts and solutions recommended by each party and may then opt
to direct a solution to the problem. In such cases, the action of the City Manager will be binding
upon the parties involved, although nothing in this procedure will prohibit the parties from seeking
remedies available to them at law.
20. TERMINATION
In the event of the Contractor's failure to prosecute, deliver, or perform the Services, City may
terminate this Agreement for nonperformance by notifying Contractor by certified mail of the
termination . If City decides to abandon or indefinitely postpone the work or services contemplated
by this Agreement, City may terminate this Agreement upon written notice to Contractor. Upon
notification of termination, Contractor has five (5) business days to deliver any documents owned
by City and all work in progress to City address contained in this Agreement. City will make a
.determination of fact based upon the work product delivered to City and of the percentage of work
that Contractor has performed which is usable and of worth to City in having the Agreement
completed. Based upon that finding City will determine the final payment of the Agreement.
Either party upon tendering thirty (30) days written notice to the other party may terminate this
Agreement. In this event and upon request of City, Contractor will assemble the work product and
put it in order for proper filing and closing and deliver it to City. Contractor will be paid for work
performed to the termination date; however, the total will not exceed the lump sum fee payable
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under this Agreement. City will make the final determination as to the portions of tasks completed
and the compensation to be made.
21. COVENANTS AGAINST CONTINGENT FEES
Contractor warrants that Contractor has not employed or retained any company or person, other
than a bona fide employee working for Contractor, to solicit or secure this Agreement, and that
Contractor 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 making of this Agreement. For breach or violation
of this warranty, City will have the right to annul this Agreement without liability, or, in its discretion,
to deduct from the Agreement price or consideration, or otherwise recover, the full amount of the
fee, commission, percentage, brokerage fees, gift, or contingent fee.
22. CLAIMS AND LAWSUITS
By signing this Agreement, Contractor agrees that any Agreement claim submitted to City must
be asserted as part of the Agreement process as set forth in this Agreement and not in anticipation
of litigation or in conjunction with litigation. Contractor acknowledges that if a false claim is
submitted to City, it may be considered fraud and Contractor may be subject to criminal
prosecution. Contractor acknowledges that California Government Code sections 12650 et seq.,
the False Claims Act applies to this Agreement and, provides for civil penalties where a person
knowingly submits a false claim to a public entity. These provisions include false claims made
with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of
information. If City seeks to recover penalties pursuant to the False Claims Act, it is entitled to
recover its litigation costs, including attorney's fees. Contractor acknowledges that the filing of a
false claim may subject Contractor to an administrative debarment proceeding as the result of
which Contractor may be prevented to act as a Contractor on any public work or improvement for
a period of up to five (5) years. Contractor acknowledges debarment by another jurisdiction is
grounds for City to terminate this Agreement.
23. JURISDICTION AND VENUE
Any action at law or in equity brought by elther of the parties for the purpose of enforcing a right
or rights provided for by this Agreement will be tried in a court of competent jurisdiction in the
County of San Diego, State of California, and the parties waive all provisions of law providing for
a change of venue in these proceedings to any other county.
24. SUCCESSORS AND ASSIGNS
It is mutually understood and agreed that this Agreement will be binding upon City and Contractor
and their respective successors. Neither this Agreement nor any part of it nor any monies due or
to become due under it may be assigned by Contractor without the prior consent of City, which
shall not be unreasonably withheld.
25. ENTIRE AGREEMENT
This Agreement, together with any other written document referred to or contemplated by it, along
with the purchase order for this Agreement and its provisions, embody the entire Agreement and
understanding between the parties relating to the subject matter of it. In case of conflict, the terms
of the Agreement supersede the purchase order. Neither this Agreement nor any of its provisions
may be amended, modified, waived or discharged except in a writing signed by both parties.
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26. AUTHORITY
The individuals executing this Agreement and the instruments referenced in it on behalf of
Contractor each represent and warrant that they have the legal power, right and actual authority
to_ bind Contractor to the terms and conditions of this Agreement.
CONTRACTOR
.Oh,~
· (sign here) '---
Ua /' & G . fz;/Mqo C£J
(print name/title} )
CITY OF CARLSBAD, a municipal
corporation of the State of California
By:
Human Resources Director
ATTEST:
BARBARA ENGLESON
City Clerk
If required by City, proper notarial acknowledgment of execution by contractor must be attached.
If a corporation, Agreement must be signed by one corporate officer from each of the following
two groups.
Group A
Chairman,
President, or
Vice-President
Group B
Secretary,
Assistant Secretary,
CFO or Assistant Treasurer
Otherwise, the corporation must attach a resolution certified by the secretary or assistant
secretary under corporate seal empowering the offlcer(s) signing to bind the corporation.
APPROVED AS TO FORM:
CELIA A. BREWER, City Attorney
BY: ~ 7nc,,~n, -------------Assistant City Attorney
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CALIFORNIA ALL-P'URPOSE
c :ERTlFlCATE ,oF ACKNOWLE1DGMENT
A notary public or other officer completing this certificate verifies only the identity
of the individual who signed the document to which this certificate is attached,
and not the truthfulness, accuracy, orvalidity ofthat document
State of California
County of __ Sa_n_D_ie ___ g_o ____ _
}
}
On Jv ly 7 . "J::>J-1? before me, Charles Phan, Notary Public _
7 cP . (fie~~ 1n~ert name.and title of the officer)
personally appeared Sare. C, ~ @z;/ 1¥'1an _
who proved to me on the"basisof satisfactory evidence to be the person(s) whose
name(s) is/are -subscribed to the within instrument and acknowledged to me that
he/she/they ,executed the same in his/her1their authorized capacity(ies), and that by
his/her/their signature(s) on the instrument the person(s}, or the entity upon behalf df
which the person(s) acted, executed the '.instrument.
I certify under PENALTY OF PERJURYunder the laws .ofthe State ofCalifornia that
the foregoing paragraph is true a'i:1d correct
WITNESS my hand and o'fficial seal.
£
NotarY Public Signature 7mnary-Public Seal)
ADDIT.,o• NAL ·o-PTIONAL IN·. FOR·MATION INSTRUCTIONS FOR COMPJ..:;ETIN(ltHIS FORM · · ·• · ' ' ' · · · ·. · · · · · .. · ' 711is}or111 complies wiih currenrCa{ifornia s1a111ies regarding notary wording and.
DESCRIPTION OF THE ATTACHED DOCUMENT if needed. should be completed and al/ached to the document. Acknowledgments
· from otheutates maybe completedfore'.locumellls being sen/ to ihat stale so long
.as the wording does not require the California.notary 10 ,·iolate Ca/ifoniia.nota,j,·
(Title or description of attached document)
(Title ocdescription:of attached.document cc;mtinued)
Number of Pages_._ Document Date ___ _
CAPACITY CLAIMED BY THE SIGNER ,.
□ Individual (s)
0 Corporate Officer
(Title)
□ Partner(s)
□ Attorney~in~Fact o Trustee(s) ·
□ Other __ __;_ ______ _
law,
• State -and County information must be the'.Staic _and County :where the document·
signer(s)_pcrsonally appeared before the notarypublic·.forariknowledgment.
• Date ofnoturizntion must be the.dateihat the signer(s) personally 'appeared which
:must.also.be.the same date the acknowledgment is completed.
• The notary p1iblic ·must. print his ,or her name asii appears within :his or her
.commission followed by a comma and then your title-(rioiary public),
. • ·Print the name(s) of.document. signer(s) ,who personally appear at the time of
·notarization. ·
• lndicateihe correct siriglilar or plural forms by .crossing off incorrect.forms (i.e:
l!e/she/tlley,is l!ll'e) or circling the correct forms.sfailure to ,cortectlyindicate'this
:infonnation-may lead to rejection of document recording. ·
• The ,notary seal impression must 'be clear and photcigraphicaily reproducible.
Impression must not cover ,text or lines. -If seal impression smudges, re-seal if a
sutlicient area perinits, otherwise. complete a.different-acknowledgment form ..
• Signature-oflhe .notary public must match the signature on file with the office of
the coumy clerk:. .
❖ Additional infonnaiion is not required ·but could .help· to ensure this
acknowledgment is not misused.or attached to.a different document.
❖ lndicaie title or type of attached .document, number of pages and date.
❖ Indicate-the capacity claimed by the .signer, Jr.the claimed capacity is a
corpor4te offi.cer,inciicate the title (i.e. CEO,,CFO, Secretary). ·
• Securely attach this documentio.the signed documenhvith a.staple.
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EXHIBIT "A"
SCOPE OF SERVICES
Counseling and Post Incident Crisis Response Services
1. At the City's direction, Contractor will receive referrals for counseling services for
employees of the City of Carlsbad at a flat rate of $200.00 per hour.
2. Appointments will be offered within three working days, or at the discretion of the
employee.
3. A maximum of six (6) sessions is authorized per issue, each calendar year.
4. The City of Carlsbad does not pay for missed or late cancelled appointments. For any
appointments that are missed by the employee without 24-hour notice of cancellation , the
employee may be invoiced for the cost of the session ($200.00).
Confidentiality and Exceptions to Confidentiality
Contractor is required by law to abide by standard HIPPA regulations in the State of California.
All records will be maintained at the Contractor's office, and all issues of client confidentiality will
be protected. Records will not be released without signed employee authorization or legal
proceedings that compel records such as a court ordered subpoena.
Training Services
Contractor will provide online or classroom style, interactive training programs customized for the
City. Contractor will provide training sessions as requested at a location and time determined by
the City. Contractor will provide all training materials and supplies.
$800 Half-day (up to 4 hours)
$1,600 Full-day (between 4 and 8 hours)
Other
. Contractor may increase fees in an amount not to exceed three percent each agreement year.
Contractor will not be reimbursed for any travel related expenses (e.g., meals, lodging, mileage
reimbursement).
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EXHIBIT "B"
1. The contractor acknowledges Federal Emergency Management Agency (FEMA)
financial assistance will be used to fund the contract only. The contractor will comply will
all applicable federal law, regulations, executive orders, FEMA policies, procedures, and
directives.
2. The contractor shall not use the Department of Homeland Security (OHS) seal(s), logos,
crests, or reproductions of flags or likenesses of OHS agency officials without specific
FEMA pre-approval.
3. The Federal Government is not a party to this contract and is not subject to any
obligations or liabilities to the City of Carlsbad, contractor, or any other party pertaining
to any matter resulting from the contract.
4. The contractor acknowledges that 31 U.S.C. Sections 3801-3812 (Administrative
Remedies for False Claims and Statements) applies to the contractor's actions
pertaining to this contract.
5. Access to Records. The following access to records requirements apply to this contract:
(A) The contractor agrees to provide the City of Carlsbad, the FEMA Administrator, the
Comptroller General of the United States, or any of their authorized representatives
access to any books, documents, papers, and records of the contractor which are
directly pertinent to this contract for the purposes of making audits, examinations,
excerpts, and transcriptions.
(8) The contractor agrees to permit any of the foregoing parties to reproduce by any
means whatsoever or to copy excerpts and transcriptions as reasonably needed.
(C) The contractor agrees to provide the FEMA Administrator or authorized
representatives access to construction or other work sites pertaining to the work being
completed under the contract.
(D) In compliance with the Disaster Recovery Act of 2018 (Pub. L. No. 115-254, §§
1201-1246 (2018)), the City of Carlsbad and the contractor acknowledge and agree that
no language in this contract is intended to prohibit audits or internal reviews by the
FEMA Administrator or the Comptroller General of the United States.
6. Suspension and Debarment
(A) This contract is a covered transaction for purposes of 2 C.F.R. pt. 180 and 2 C.F.R.
pt. 3000. As such the contractor is required to verify that neither the contractor nor its
principals (defined at 2 C.F.R. § 180.995) or its affiliates (defined at 2 C.F.R. § 180.905)
are excluded (defined at 2 C.F.R. § 180.940) or disqualified (defined at 2 C.F.R. §
180.935).
(8) The contractor must comply with 2 C.F.R. pt. 180, subpart C and 2 C.F.R. pt. 3000,
subpart C and must include a requirement to comply with these regulations in any lower
tier covered transaction it enters into.
(C) This certification is a material representation of fact relied upon by the City of
Carlsbad. If it is later determined that the contractor did not comply with 2 C.F.R. pt. 180,
subpart C and 2 C.F.R. pt. 3000, subpart C, in addition to remedies available to the
State of California or the City of Carlsbad, the Federal Government may pursue
available remedies, including but not limited to suspension and/or debarment.
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(D) The bidder or proposer agrees to comply with the requirements of 2 C.F.R. pt. 180,
subpart C and 2 C.F.R. pt. 3000, subpart C while this offer is valid and throughout the
period of any contract that may arise from this offer. The bidder or proposer further
agrees to include a provision requiring such compliance in its lower tier covered
transactions.
7. To the extent any 'Federally mandated provisions incorporated by Exhibit B conflict with
other terms and provisions of this Agreement, the Federally mandated provision(s) shall
prevail.
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Account Number: CA CORE 72 10 Date: 6/18/20 Initials: LROSS
CERTIFICATE OF INSURANCE
ALLIED WORLD INSURANCE COMPANY
C/O: American Professional Agency, Inc.
95 Broadway, Amityville, NY 11701
800-421-6694
This is to certify that the insurance policies specified below have been issued by the company
indicated above t o the insured named herein and that, subject to their provisions and conditions,
such policies afford the covera'ges indicated insofar as such coverages apply to the occupation
or business of the Named Insured(s) as stated.
THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS
THE COVERAGE(S) AFFORDED BY THE POLICY(IES) LISTED ON THIS CERTIFICATE.
Name and Address of Named Insured:
COHERENCE ASSOCIATES INC
6183 PASO DEL NORTE
STE 140
CARLSBAD CA 92011
Additional Named Insureds:
SARA GILMAN
REANNON KERWOOD
CONNIE GLENN
MARY C MILITELLO
WALT P. FERRIS
DARCIE BROWN
AUDRA C WALLACE
JACLYN CHUNG
Type of Work Covered: MARRIAGE & FAMILY CORPORATION
Location of Operations: N/A
(If different than address listed above)
Claim History:
Retroactive date is 01/01/2005
Policy Effective Expiration Limits of
Coverages Number Date Date Liability
PROFESSIONAL/ 1,000,000
LIABILITY 5000-5704 1/01/20 1/01/21 3,000,000
NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED 1 WHO SHALL
ACT ON BEHALF OF ALL INSUREDS WITH RESPECT TO GIVING OR RECEIVING NOTICE OF
CANCELLATION.
Comments: ADDITIONAL INSURED(S) / LANDLORD(S):
-OMNINET PROPERTY MGMT FOREMOST PROF PLZ
-NEXTMED OWNER III LLC C/O COLLIERS INTL
-CITY OF CARLSBAD
· 1635 FARADAY AVE CARLSBAD CA 92008
This Certificate Issued to:
Name: COHERENCE ASSOCIATES INC
6183 PASO DEL NORTE
Address: STE 140
CARLSBAD CA 92011
APA 00138 00 (06/2014) /
WAIVERREQUESTFORM .
FACTORS IN SUPPORT OF REQUEST TO MODIFY INSURANCE REQUIREMENT(S)
Generally, a modification to the coverage requirement will be accepting a lower limit of coverage or waiving the
requirement( s).
Requested by:_D_e_bb_ie_Po_rt_e_r _____________ ~-------
(Name and Department) (Date)
Proposed modification(s) to the GL/Auto/WorkComp
(Type of insurance)
requirement(s) for Coherence Associates Inc.
(Name of contract)
D Reduce coverage to the amount of: ~$ ______ _
Ii] Waive coverage
D Other: -----------------------------------
FACTOR(S) IN.SUPPORT OF MODIFICATION(S)
(check those that apply)
□Significance of Contractor: Contractor has previous experience with the City that is important to the
efficiency of completing the scope of work and the quality of the work-product. [explain] ______ _
□Significance of Contractor: Contractor has unique skills and there are few if any alternatives. [explain:
include number of candidates RFP sent to and number responded if applicable]
□Contract Amount/Term of Contract: $ _______ . Work will be completed over a period of __ _
□Professional Liability coverage is not available to this contractor or would increase the cost of the contract by
$ [explain]. ___________________________ _
li]Other (e.g. explain why exposures are minimal, how exposures are covered in another policy, exposure
control mechanisms, and any other information pertinent to your request): Counseling/training services
have minimal liability and counselors do not travel between city facilities.
Approved by Risk Manager for this contract only:
H:\ WORD\Insurance\Admin Order #68.doc
06/15/2006
~
(Signature)
27
(' /~.-2,.o
(Date)