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Nancy K. Bohl INC dba The Counseling Team International; 2024-10-23;
Page 1 City Attorney Approved Version 5/22/2024 AGREEMENT FOR BEHAVIORAL HEALTH AND WELLNESS SERVICES NANCY K. BOHL, INC. DBA THE COUNSELING TEAM INTERNATIONAL THIS AGREEMENT is made and entered into as of the ______________ day of _________________________, 20___, by and between the City of Carlsbad, California, a municipal corporation ("City") and Nancy K. Bohl, INC. dba The Counseling Team International, a California corporation ("Contractor"). RECITALS A. City requires the professional services of a consultant that is experienced in behavioral health and wellness services for public safety personnel and their families. B. Contractor has the necessary experience in providing professional services and advice related to behavioral health and wellness services for public safety personnel and their families. 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 one (1) year from the date first above written. The City Manager may amend the Agreement to extend it for two (2) additional two (2) years or parts thereof. Extensions will be based upon a satisfactory review of Contractor's performance, City needs, and appropriation of funds by the City Council. The parties will prepare a written amendment indicating the effective date and length of the extended Agreement. 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 shall not exceed forty-five thousand dollars ($45,000.00). No other compensation for the Services will be allowed except for items covered by subsequent amendments to this Agreement. If the City elects to extend the Agreement, the amount shall not exceed forty-five thousand dollars ($45,000.00) per Agreement year. 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." Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 October 23rd 24 Page 2 City Attorney Approved Version 5/22/2024 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 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 defend (with counsel approved by the City), indemnify, and hold harmless the City and its officers, elected and appointed 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. If Contractor’s obligation to defend, indemnify, and/or hold harmless arises out of Contractor’s performance as a “design professional” (as that term is defined under Civil Code section 2782.8), then, and only to the extent required by Civil Code Section 2782.8, which is fully incorporated herein, Contractor’s indemnification obligation shall be limited to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Contractor, and, upon Contractor obtaining a Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 Page 3 City Attorney Approved Version 5/22/2024 final adjudication by a court of competent jurisdiction. Contractor’s liability for such claim, including the cost to defend, shall not exceed the Contractor’s proportionate percentage of fault. 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. 10.1 Coverages and Limits. Contractor will maintain the types of coverages and minimum limits indicated below, unless 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 insured. 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: Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 Page 4 City Attorney Approved Version 5/22/2024 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 If Contractor maintains higher limits than the minimums shown above, the City requires and will be entitled to coverage for the higher limits maintained by Contractor. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage will be available to the City.” 10.2.4 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. 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. Contractor will allow inspection of all work, data, documents, proceedings, and activities related to the Agreement for a period of four (4) 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. Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 Page 5 City Attorney Approved Version 5/22/2024 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 are: For City: For Contractor: Name Darbie Ernst Name Julie Casto Koot Title Lieutenant Title CFO/Director of Operations Dept Police Address 1881 Business Center Drive, Suite 11 CITY OF CARLSBAD SAN BERNARDINO, CA 92408 Address 2560 Orion Way Phone 800-222-9691 ext. 225 Carlsbad, CA 92010 Email jkoot@thecounselingteam.com Phone 442-339-2139 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 as required in the City of Carlsbad Conflict of Interest Code. Yes ☐ No ☒ If yes, list the contact information below for all individuals required to file: Name Email Phone Number 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. Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 City Attorney Approved Version 5/22/2024 Page 6 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. 18. CALIFORNIA AIR RESOURCES BOARD (CARB) ADVANCED CLEAN FLEETS REGULATIONS Contractor’s vehicles with a gross vehicle weight rating greater than 8,500 lbs. and light-duty package delivery vehicles operated in California may be subject to the California Air Resources Board (CARB) Advanced Clean Fleets regulations. Such vehicles may therefore be subject to requirements to reduce emissions of air pollutants. For more information, please visit the CARB Advanced Clean Fleets webpage at https://ww2.arb.ca.gov/our-work/programs/advanced-clean-fleets. 19. DISCRIMINATION AND HARASSMENT PROHIBITED Contractor will comply with all applicable local, state and federal laws and regulations prohibiting discrimination and harassment. 20. 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. 21. 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. City may terminate this Agreement by tendering thirty (30) days written notice to Contractor. Contractor may terminate this Agreement by tendering thirty (30) days written notice to City. In the event of termination of this Agreement by either party 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 under this Agreement. City will make the final determination as to the portions of tasks completed and the compensation to be made. Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 City Attorney Approved Version 5/22/2024 Page 7 22. 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. 23. 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. 24. JURISDICTION AND VENUE This Agreement shall be interpreted in accordance with the laws of the State of California. Any action at law or in equity brought by either 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. 25. 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. 26. THIRD PARTY RIGHTS Nothing in this Agreement should be construed to give any rights or benefits to any party other than the City and Contractor. 27. 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. This Agreement may be executed in counterparts. Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 City Attorney Approved Version 5/22/2024 Page 8 28. 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. Executed by Contractor this___________ day of _______________________, 20____. CONTRACTOR CITY OF CARLSBAD, a municipal corporation of the State of California Nancy K. Bohl, INC. dba The Counseling Team International, a California corporation By: By: (sign here) Police Chief Stephen Odom, Ph.D., CEO (print name/title) ATTEST: By: SHERRY FREISINGER, City Clerk (sign here) By: Julie Casto Koot, CFO/Director of Operations Deputy City Clerk (print name/title) 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 Group B Chairman, Secretary, President, or Assistant Secretary, Vice-President CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CINDIE K. McMAHON, City Attorney BY: _____________________________ Assistant City Attorney Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 23 24October City Attorney Approved Version 5/22/2024 Page 9 EXHIBIT A SCOPE OF SERVICES AND FEE The Counseling Team International will provide behavioral health and wellness services for Carlsbad Police Department personnel and their families. Behavioral Health and Wellness Services • The Counseling Team International (TCTI) will provide professional short-term confidential counseling for sworn and non-sworn employees of the Carlsbad Police Department, their spouses, and their tax-eligible dependents living within the home at the rate of $150.00 per hour session. • Consultations with supervisors regarding problem employees and/or any aspect of the Employee Support Services (ESS) will be billed at the rate of $150.00 per hour. • Follow-up sessions for employees involved in Critical Incidents will be billed at the rate of $150.00 per hour. • TCTI will conduct one orientation with upper command staff, administration and/or peer support at no charge. • TCTI will provide training for the management and supervisory team related to the program. • Services will be delivered in a timely manner. Emergencies will be handled on an immediate basis. • If appropriate for the client, TCTI will provide Telehealth services. • A maximum of ten (10) session is authorized per issue, each calendar year. • If TCTI accesses that additional sessions, not to exceed three (3), are needed to successfully resolve the issue, they will call the Carlsbad Police Department for authorization while maintaining patient confidentiality. • All collateral referrals for support (such as family therapy, child therapy, or any other specialized care) will be made by TCTI to ensure a smooth transition. • Alternatively, TCTI will attempt to access the employee’s health insurance for reimbursement or negotiate a self-pay arrangement that will not exceed the departmental rate. Private insurance co-pay is the responsibility of the employee. • For any appointments that are missed by the employee without 24-hour notice of cancellation, the employee may be invoiced for the full cost of the session. Confidentiality • TCTI shall maintain the confidentiality of all employees and their tax-eligible dependents living in the home referred for counseling in accordance with the standard HIPAA regulations in the State of California. • The Carlsbad Police Department will not be advised of the names or identities of employees or dependents who utilize these services. • Every attempt will be made to prevent overlap of employee appointments. • All issues of suicide, homicide, child abuse, elder abuse, and dependent adult abuse will be reporting according to the standard procedure to protect the client if a danger to self or others is assessed. This includes reports to the appropriate agency as required, including Child Protective Services, Adult Protective Services, and 911. Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 City Attorney Approved Version 5/22/2024 Page 10 Critical Incidents • If the Carlsbad Police Department requests critical incident services, the rate will be $275.00 per hour port-to-port. Training • Carlsbad Police Department employees may request to attend trainings provided by TCTI. • Training classes will be invoiced at $300.00 per hour per trainer + $100.00 per hour for travel • Not all trainings courses are provided at an hourly rate. Carlsbad Police Departmental Updates • TCTI will provide a yearly report of services rendered. This will include the number of contract hours, financial total, critical incident services, and extensions, if any, with no identifying information of employees utilizing these services. Billing • If the monthly invoice approaches or exceeds $2,000.00, TCTI will call or email the Chief of Police to note the increased use of services as soon as it becomes apparent that there is an unusual demand for services. • Billing will occur monthly and submitted to the police department’s Management Analyst or Office Specialist via email. • Date of service will be provided, but the invoice will not indicate any client names or identifying information. Upon the initial and subsequent anniversary dates of the Contract, the fees shall increase by 5% for all services outlined in the contract. Conflict of Interest • It is possible that two or more employees may present for counseling and share a similar issue that may generate a conflict of interest for the employee, counselor, and the department. To hand this ethically and professionally, a prompt referral will be made once the situation is realized. • The employee will not be informed about any of the details of the conflict, to protect confidentiality, but they will be referred to other mental health resources. These alternatives will also be provided in a voicemail message for coverage during vacations, illness, or other times during office closure. Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 City Attorney Approved Version 5/22/2024 Page 11 Pricing for Services, Trainings & Retreats Wellness Visits • 60-minute individual appointments with a clinician. • Recommend at least one annually for all employees. • The goal is to normalize seeing a clinician after a stressful call and destigmatize mental wellness and support stress management. • This is not a therapy session; no diagnosis or notes are taken. • These sessions are different from short-term counseling. • All sessions are confidential and protected by HIPPA. $150.00 per hour in person* *Travel may be charged depending on location Critical Incident Intervention Stand-By-Status (SBS) 24/7/365 on-call Critical Incident Stress Management Services. $275.00 per hour port-to-port Training thecounselingteam.com/training to view the entire course catalog. Please note that not all courses are priced at an hourly rate. $300.00 per hour per trainer + $100 per hour for travel 3-Day Basic Peer Support $299.00 per person 2-Day Basic Critical Incident Stress Management (CISM) $199.00 per person 2-Day Advanced Peer Support $199.00 per person 5-Day Wellness Coordinator Course $750.00 per person 8-Hour Retire Well Course $250.00 per person Peer Support Training No charge Peer Support Consultation No charge Peer Support Meetings $200.00 per hour + $100 per hour for travel Peer Support Candidate Interviews $200.00 per hour + $100 per hour for travel Peer Support Team Retreat $2,000.00 per attendee (3 Days, 2 Nights) Trauma and Resilience Retreat $3,000.00 per attendee (4 Days, 3 Nights) Police Chief Resilience Retreat $2,500.00 per attendee (3 Days, 2 Nights) First Responder Spouses and Significant Others Retreat $3,500.00 per attendee (4 Days, 3 Nights) Wellness Team Building $2,000.00 per attendee (3 Days, 2 Nights) Command Staff Resilience Retreat $2,500.00 per attendee (3 Days, 2 Nights) Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 ANY PROPRIETOR/PARTNER/EXECUTIVEOFFICER/MEMBER EXCLUDED? INSR ADDL SUBRLTRINSD WVD PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGGJECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE CLAIMS-MADE AGGREGATE $ DED RETENTION $ PER OTH-STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMITDESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 9/19/2024 License # 0757776 (877) 825-2681 (951) 231-2572 24319 Nancy K. Bohl, Inc. D.B.A The Counseling Team International 1881 Business Center Drive, Suite 11 San Bernardino, CA 92408 44768 A 1,000,000 X 5088-1981-01 8/31/2024 8/31/2025 0 SEE REMARKS FOR PROF 5,000 1,000,000 3,000,000 3,000,000 1,000,000B 5091-0457-01 8/31/2024 8/31/2025 2,000,000A 5090-0559-01 8/31/2024 8/31/2025 2,000,000 10,000 A Professional Liab 5088-1981-01 8/31/2024 OCC 1M / AGGREGATE 3,000,000 A Abuse Liability 5088-1981-01 8/31/2024 8/31/2025 OCC 1M / AGGREGATE 3,000,000 City of Carlsbad is Additional Insured with regard to General Liability when required by written contract per the attached endorsement form NPSSGL0000400 04/18. City of Carlsbad 2560 Orion Way Carlsbad, CA 92010 TRUEREC-01 KCHINNAVEL HUB International Insurance Services Inc. 1525 Faraday Avenue Suite 150 Carlsbad, CA 92008 Shawn Prince Cal.CPU@Hubinternational.com Allied World Surplus Lines Insurance Company Vantapro Specialty Insurance 8/31/2025 X X X X X X X X Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 ACORD" I ~ I ~ □ □ ~ ~ ~ □ □ ~ ~ ~ ~ ~ ~ ~ ~ H I I I I I □ I Insured Name: True Behavioral Health, LP DBA: FR Health Policy Number: 5088-1981-01 Policy Term: 8/31/2024 to 8/31/2025 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NPSS GL 00004 00 (04/18)Includes material copyrighted by ISO Properties, Inc., with its permission Page 1 of 9 NON-PROFIT AND SOCIAL SERVICES GENERAL LIABILITY ENHANCEMENT ENDORSEMENT It is understood and agreed that the following extensions only apply in the event that no other specific coverage for the indicated loss exposures are provided under this policy. If such specific coverage applies, the terms, conditions, and limits of that coverage are the sole and exclusive coverage applicable under this policy. Throughout this endorsement the words “you” and “your” refer to the “Named Insured” shown in the Declarations. The words “we”, “us”, and “our” refer to the “Company” providing this insurance. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The following is a summary of the Limits of Insurance and Additional Coverage provided by this endorsement. For complete details on specific coverages, consult the policy contract wording. A) Medical Payment – Limit increased to $20,000B) Supplementary Payments – Bail bonds increased to $3,000 / Loss of Earnings increased to$1,000 each dayC) Legal Liability Extension – For fire, lightning, explosion, smoke, and leaks from sprinklers limitincreased to $1,000,000D) Broadened definition of Who is an InsuredE) Knowledge or Notice of OccurrenceF) Broadened definition of Advertising Injury includes televised or videotaped publicationG) Amended definition of Bodily Injury to include mental anguishH) Amended Unintentional Failure to Disclose HazardsI) Amended Liberalization ClauseJ) Property Damage – Removal of exclusion for “Property Damage” resulting from the use ofreasonable force to protect persons or propertyK) Premises Sold or Abandoned by YouL) Added Blanket Additional Insured - Funding sourcesM) Added Blanket Additional Insured - Managers or lessors of premisesN) Additional Insured – By Contract, Agreement or PermitO) General Aggregate Limit Per LocationP) Blanket Special Events CoverageQ) Non-Owned Watercraft Coverage - Length is increased to 65 feetR) Blanket Waiver of SubrogationS)Violation of Rights of Residents Coverage (Patient’s Rights)T) Liquor Liability Exception to Exclusion U) Employee Criminal Defense Costs Only Coverage - $25,000 limit of insurance – each “criminalproceeding” A) MEDICAL PAYMENTSIf Medical Payments Coverage (Coverage C) is not otherwise excluded from this coverage part: Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 NPSS GL 00004 00 (04/18)Includes material copyrighted by ISO Properties, Inc., with its permission Page 2 of 9 1) The Medical Expense Limit is increased, subject to all the terms of Limits of Insurance (Section III) to $20,000.2) The requirement in the Insuring Agreement of Coverage C, that expenses must be incurred and reported to us within “one year” of the accident date is changed to “three years.”3) Exclusion of Coverage, at your option, does not apply to your “volunteer workers” or any person or organization under your direct supervision and control. B) SUPPLEMENTARY PAYMENTS - COVERAGES A AND B:1) The limit for the cost of bail bonds is changed from $250 to $3,000.2) The limit for loss of earnings is changed from $250 per day to $1,000 per day. C) LEGAL LIABILITY EXTENSION – FIRE, LIGHTNING, EXPLOSION, SMOKE, AND LEAKS FROM SPRINKLERS 1.The last paragraph of Section I – Coverage A – 2. Exclusions, is deleted and replaced by the following: Exclusions c. through n. does not apply to: a. damage by fire, lightning, explosion, smoke or leaks from automatic fire protective systems; to premises rented to you or temporarily occupied by you with the permission of the owner. A separate limit of insurance applies to this coverage as described in Section III – Limits of Insurance. 2.Paragraph 6. of Section III – Limits of Insurance is deleted and replaced by the following: 6.Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under COVERAGE A for damages because of “property damage”: a. resulting from fire, lightning, explosion, smoke or leaks from automatic fire protective systems, or any combination thereof; and b.caused by a resident; to premises, rented to you or temporarily occupied by you with the permission of the owner. Damage To Premises Rented To You Limit is the greater of: a.$1,000,000 for damages due to fire, lightning, explosion, smoke or leaks from automatic fire protective systems, or any combination there of. D) WHO IS AN INSUREDParagraph 2. of Section II – Who Is An Insured is deleted and replaced by the following: 2.Each of the following is also an insured, but only while working within the scope of their duties related to the conduct of your business; a.“Employees”, but only for acts within the scope of their employment by you; b.“Volunteer Workers”; c.Independent Contractors However, no “employees”, “volunteer workers” or independent contractors are insureds for: (1)“Bodily injury” or “personal and advertising injury”: (a)To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are al limited liability company), to a co-“employee” while in the course of his or her employment or performing duties related to the conduct of your business, or to your other “volunteer workers” or independent contractors while performing duties related to the conduct of your business; (b)To the spouse, child, parent, brother or sister of that co-“employee”, “volunteer worker” or independent contractors as a consequence of Paragraph (1)(a) above; Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 NPSS GL 00004 00 (04/18)Includes material copyrighted by ISO Properties, Inc., with its permission Page 3 of 9 (c)For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1)(a) or (b) above; or (d)Arising out of his or her providing or failing to provide professional health care services. (2)“Property damage” to property: (a)Owned, occupied or used by, (b)Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by you, any of your “employees”, “volunteer workers”, independent contractors, any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). d. Medical directors and administrators, including professional persons; e. If you are an organization other than a partnership or joint venture, your managers and supervisors are also insureds, but only with respect to their duties as your managers and supervisors; f.If you are a limited liability company, your members are insureds, but only with respect to their duties related to the conduct of your business; g.Any organization and subsidiary thereof which you control and actively manage on the effective date of this endorsement; h. Any person or organization that has financial control of you or owns, maintains or controls premises occupied by you and requires you to name them as an additional insured but only with respect to their liability arising out of: (1)Their financial control of you; or (2)Premises they own maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. i.Any State or Political Subdivision subject to the following provision: This insurance applies only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with premises you own, rent, or control and to which this insurance applies: (1)The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away openings, sidewalk vaults, street banners, or decorations and similar exposures; or (2)The construction, erection, or removal of elevators; or (3)The ownership, maintenance, or use of any elevators covered by this insurance. However, the insurance afforded for any organization and subsidiary thereof not named in the Declarations as a Named Insured, does not apply to injury or damage with respect to which an insured under this endorsement is also an insured under another policy, or would be an insured under such policy but for its termination or the exhaustion of its limits of insurance. j.Students in training, but not for “bodily injury” or “property damage” arising out of his or her rendering or failure to render professional services to patients; k. Your members but only with respect to their liability for your activities or activities they perform on your behalf; l. Your trustees or members of the board of governors while acting within the scope of their duties as such on your behalf; m. Any entity you are required in a written contract (hereinafter called Additional Insured) to name as an insured is an insured but only with respect to liability arising out of your premises, Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 NPSS GL 00004 00 (04/18)Includes material copyrighted by ISO Properties, Inc., with its permission Page 4 of 9 “your work” for the Additional Insured, or acts or omissions of the Additional Insured in connection with the general supervision of “your work” to the extent set forth below: Insurance does not apply to “bodily injury,” “property damage” or “personal and advertising injury” arising out of the rendering or failure to render any professional services by or for you, including: (1)The preparing, approving, or failing to prepare or approve, maps, shop drawings,opinions, reports, surveys, field orders, change orders, or drawings and specifications;and (2)Supervisors, inspection, or engineering services. Any coverage provided under this provision shall be excess over any other valid and collectible insurance available to the Additional Insured(s) whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary or you request that it apply on a primary basis. Paragraph 3.a. of Section II – Who Is An Insured is deleted and replaced by the following: a.Coverage under this provision is, subject to (1) and (2) below: (1)Effective on the acquisition or formation date; and (2)Afforded only until the end of the policy period of this Coverage Part or the nextanniversary of its inception date, whichever is earlier. E) KNOWLEDGE OR NOTICE OF OCCURRENCE1) As respects any loss reporting requirements under this policy, it is understood and agreed thatknowledge of an accident or incident by an agent, servant or “employee” of yours or any otherperson shall not in itself constitute knowledge by you, unless a corporate officer of yours shallhave received notice from said agent, servant, “employee” or any other person. 2) Your failure to give first report of a claim to us shall not invalidate coverage under this policy if theloss was inadvertently reported to another insurer. However, you shall report any such“Occurrence” to us within a reasonable time once you become aware of such error. F) ADVERTISING INJURY – TELEVISED OR VIDEOTAPED PUBLICATION1) The definition of “Personal and Advertising Injury” items 14. d., e., f. and g. are changed to read:“Personal and Advertising Injury” means injury, including consequential “bodily injury”, arising outof one or more of the following offenses: d.Oral, written, televised, or videotaped publication of material that slanders or libels a personor organization or disparages a person’s or organization’s goods, products, or services; e.Oral, written, televised, or videotaped publication of material that violates a person’s right ofprivacy; f.Misappropriation of advertising ideas or style of doing business; or g.Infringement of copyright, title, or slogan. 2) Exclusions b. and c. of Coverage B., Personal and Advertising Injury Liability, are changed toread: b.“Personal and advertising injury” arising out of oral, written, televised, or videotapedpublication of material, if done by or at the direction of the insured with knowledge of itsfalsity; c.“Personal and advertising injury” arising out of oral, written, televised, or videotapedpublication of material whose first publication took place before the beginning of the policyperiod. G) BODILY INJURY – MENTAL ANGUISHThe definition of “bodily injury” is changed to read: Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 NPSS GL 00004 00 (04/18)Includes material copyrighted by ISO Properties, Inc., with its permission Page 5 of 9 “Bodily Injury” means: a.Bodily injury, sickness, or disease sustained by a person, and includes mental anguishresulting from any of these; and b.Except for mental anguish, includes death resulting from the foregoing (item above) atany time. H) UNINTENTIONAL FAILURE TO DISCLOSE HAZARDSIt is agreed that, based on our reliance on your representations as to existing hazards, if you shouldunintentionally fail to disclose all such hazards prior to the beginning of the policy period of thisCoverage Part, we shall not deny coverage under this Coverage Part because of such failure. I) LIBERALIZATIONIf we adopt a change in our forms or rules which would broaden your coverage without an additionalpremium charge, your policy will automatically provide the additional coverages as of the date therevision is effective in your state. J) EXTENDED “PROPERTY DAMAGE”SECTION I – Coverages, Coverage A, 2. Exclusions, a. is deleted and replaced by the following: a.Expected or Intended Injury“Bodily Injury” or “Property Damage” expected or intended from the standpoint of the insured.This exclusion does not apply to “bodily injury” or “property damage” resulting from the use ofreasonable force to protect persons or property. K) PREMISES SOLD OR ABANDONED BY YOUSECTION I – Coverages, Coverage A., 2. Exclusions, j. (2) is deleted and replaced by the following: (2)Premises you sell, give away, or abandon, if the “property damage” arises out of any part ofthose premises, and occurred from hazards that were known by you or should havereasonably been known by you, at the time the property was transferred or abandoned. L) ADDITIONAL INSURED – FUNDING SOURCEUnder SECTION II – Who is an Insured, the following is added: Any person or organization with respect to their liability arising out of: a.Their financial control of you; or b.Premises they own, maintain, or control while you lease or occupy these premises.This insurance does not apply to structural alterations, new construction, and demolition operationsperformed by or for that person or organization. M) ADDITIONAL INSURED – MANAGERS OR LESSORS OF PREMISESUnder SECTION II – Who is an Insured, the following is added: Any person or organization with respect to their liability arising out of the ownership, maintenance, oruse of that part of the premises leased to you in writing, subject to the following additional exclusions: This insurance does not apply to:a. Any “occurrence” which takes place after you cease to be a tenant in that premises.b. Structural alteration, new construction, or demolition operations performed by or on behalf of thatperson or organization. N) ADDITIONAL INSURED - BY CONTRACT, AGREEMENT OR PERMIT1) Any person or organization is an insured with whom you are required to add as an additionalinsured to this policy by a written contract or written agreement, or permit that is:a) currently in effect or becoming effective during the term of this policy; and Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 NPSS GL 00004 00 (04/18)Includes material copyrighted by ISO Properties, Inc., with its permission Page 6 of 9 b) executed prior to the “bodily injury,” “property damage,” “personal and advertising injury”. 2) This insurance provided to the additional insured by this endorsement applies as follows:a)That person or organization is only an additional insured with respect to liability caused by your negligent acts or omissions at or from: (1) Premises you own, rent, lease, or occupy, or (2) Your ongoing operations performed for the additional insured at the job indicated bywritten contract or written agreement. b) The limits of insurance applicable to the additional insured are those specified in the writtencontract or written agreement or in the Declarations of this policy, whichever is less. Theselimits of insurance are inclusive of and not in addition to the limits of insurance shown in theDeclarations. 3) With respect to the insurance afforded these additional insureds, the following additionalexclusions apply:a) This insurance does not apply to “bodily injury” or “property damage” occurring after:(1)all work, including materials, parts or equipment furnished in connection with such work,on the project (other than service, maintenance or repairs) to be performed by or onbehalf of the additional insured(s) at the site of the covered operations has beencompleted; or (2) that portion of “your work” out of which the injury or damage arises has been put to itsintended use by any person or organization other than another contractor orsubcontractor engaged in performing operations on or at the same project. b) This insurance does not apply to “bodily injury,” “property damage,” “personal and advertisinginjury” caused by the rendering of or failure to render any professional services. 4) Regardless of whether other insurance is available to an additional insured on a primary basis,this insurance will be primary and noncontributory if a written contract between you and theadditional insured specifically requires that this insurance be primary. O) GENERAL AGGREGATE LIMIT PER LOCATIONSECTION III – Limits of Insurance, paragraph 2. is deleted and replaced by the following: 2.The General Aggregate Limit is the most we will pay for the sum of: a.Medical expenses under Coverage C; b.Damages under Coverage A, except damages because of “bodily injury” or “propertydamage” included in the “products-completed operations hazard, and c.Damages under Coverage B. A separate Location General Aggregate Limit applies to each “location” and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. SECTION V – DEFINITIONS, is amended by adding the following:“Location” means premises involving the same or connecting lots, or premises whose connection is interrupted only by a street, roadway, waterway or right-of-way of a railroad. P) BLANKET SPECIAL EVENTSThis insurance applies to “Bodily Injury,” “Property Damage,” and “Personal and Advertising Injury”arising out of all your special events. However, this insurance does not apply to the followingEXCLUDED EVENTS:a) Paradesb) Aircraft Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 NPSS GL 00004 00 (04/18)Includes material copyrighted by ISO Properties, Inc., with its permission Page 7 of 9 c) Motorcycle runs and automobile ralliesd) Fireworkse) Firearmsf) Animalsg) Carnivals and fairs with mechanical ridesh) Concertsi) Events including contact sportsj)Rodeosk) Political ralliesl) Any event lasting more than three (3) days (including otherwise acceptable events)m) Any event with greater than 1,000 people in attendance (including otherwise acceptable events) Separate coverage may be available at the company’s discretion for the events excluded above. Possible additional charges may apply if coverage is provided. Q) NON-OWNED WATERCRAFTSECTION I – Coverages. 2. Exclusions, paragraph g.(2) is deleted and replaced by the following: (2)A watercraft you do not own that is: (a)Less than 65 feet long, and (b)Not being used to carry persons or property for a charge; This provision applies to any person, who with your consent, either uses or is responsible for the use of a watercraft. This insurance is excess over any other valid and collectible insurance available to the insured whether primary, excess, or contingent. R) WAIVER OF SUBROGATIONWe will waive our right of subrogation in the event of a loss. We must be advised, prior to the loss, ofyour intention to waive subrogation. We also must know whom subrogation will be waived against. Ifyour request meets the underwriting criteria it will be done at no additional charge. S) VIOLATION OF RIGHTS OF RESIDENTS (PATIENT’S RIGHTS)1) The following is added to Section 1 – Coverages – Coverage A, paragraph 1. InsuringAgreement:“Bodily Injury” damages arising out of the violation of “Rights of Residents,” shall be deemed an“occurrence.” 2) As respects the coverage provided in paragraph A.1. of this endorsement, the followingexclusions are added to Section I – Coverages – Coverage A-2. Exclusions: This insurance does not apply to:a) Liability arising out of the willful or intentional violation of “Rights of Residents.”b) Fines or penalties assessed by a court or regulatory authority.c)Liability arising out of any act or omission in the furnishing, or failure to furnish, professionalservices in the medical treatment of “residents.” 3) As respects the violation of “Rights of Residents” Coverage, the following definition is added toSection V – Definitions: “Rights of residents” means:a.Any right granted to a resident under any state law regulating your business as a health carefacility. Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 NPSS GL 00004 00 (04/18)Includes material copyrighted by ISO Properties, Inc., with its permission Page 8 of 9 b. The “Rights of Residents” as included in the United States Department of Health and Welfareregulations governing participation of Intermediate Care Facilities and Skilled NursingFacilities, regardless of whether your facility is subject to those regulations. T. LIQUOR LIABILITY EXCLUSION – EXCEPTION FOR FUNDRAISING EVENTS SECTION I – Coverages, Coverage A., 2. Exclusions, c. is amended by adding the followingsubparagraph: This exclusion does not apply to “bodily injury” or “property damage” arising out of the selling, serving or furnishing of alcoholic beverages at any fundraising events. U.EMPLOYEE CRIMINAL DEFENSE COSTS ONLY COVERAGE 1.The following provision is added to the Policy: Employee Criminal Defense Costs Only Coverage We will pay, on your behalf, for “defense costs” incurred by your “employee” in a “criminal proceeding”. We will have the right, but not the duty to defend your “employee” in such “criminal proceeding”. 2.The most we will pay for any one “criminal proceeding” is $25,000, regardless of the number of “employees” involved in such “criminal proceeding”. The payment of “defense costs” under this Employee Criminal Defense Costs Only Coverage is in addition to and does not reduce the Limits of Insurance shown on the Declarations. However, the payment of “defense costs” under this Employee Criminal Defense Costs Only Coverage is included within and shall reduce the $25,000 each “criminal proceeding” Limit shown in Item V) of the Schedule above and we will not pay for any further “defense costs” for a “criminal proceeding” after the $25,000 limit has been exhausted. 3.The following additional Exclusions apply to this Employee Criminal Defense Costs OnlyCoverage: This insurance does not apply to: a.Coverage Provided Under Coverages A or B Any “defense costs” for which coverage is provided under COVERAGE A BODILY INJURYAND PROPERTY DAMAGE LIABILITY AND COVERAGE B PERSONAL ANDADVERTISING INJURY LIABILITY of this policy. b.Damages, Fines or Penalties Any damages, fines or penalties. 4.The following additional Definitions apply to this Employee Criminal Defense Costs Only Coverage: a.“Criminal proceeding” means: The prosecution of any of your “employees” commenced by the filing, with a court, or other regulatory enforcement agency, of an information, a complaint, or an indictment, and any Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 NPSS GL 00004 00 (04/18)Includes material copyrighted by ISO Properties, Inc., with its permission Page 9 of 9 amendments thereto, alleging that your “employee” had, during the policy period, committed one or more crimes involving one or more incidents, acts, or events. Such incidents, acts or events must arise within the scope of your “employee’s” employment by you or occur while your “employee” is performing duties related to the conduct of your business. Any “criminal proceeding” shall be considered a single “criminal proceeding”, notwithstanding the fact that the prosecution or investigation may involve multiple incidents, multiple counts or charges, and/or multiple trial and/or appellate proceedings. A subsequent or different prosecution or investigation based on the same incidents, acts, or events that provided the basis for the original prosecution or investigation shall not constitute a separate “criminal proceeding”. b.“Defense costs” means (1)Reasonable attorney fees (including fees for the services of paralegals, law clerks and/or investigators working under the direction of said attorney); and (2)Reasonable and necessary costs, excluding loss of income. 5.Under no circumstances will “defense costs” payable under this Employee Criminal DefenseCosts Only Coverage be payable as Supplementary Payments under Coverages A or B. All other terms and conditions of the policy remain the same. AUTHORIZED REPRESENTATIVE Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 WAIVER REQUEST FORM 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: (Name and Department) (Date) Proposed modification(s) to the __________________ requirement(s) for (Type of insurance) (Name of contract) Reduce coverage to the amount of: $ . Waive coverage 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]. 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): Approved by Risk Manager for this contract only: (Signature) (Date) Amanda Simpson, Police 10/03/2024 Auto behavioral health and wellness services ■1,000,000.00 ■ Counselors do not travel between city facilities. Docusign Envelope ID: 1BE8AF7E-7F4D-44CA-A769-49D8765E6C31 10/21/2024 □ □ □ □ □