COMPLETED BOARD ORDER�"��28
Before the Board of Supervisors in and for the
County of Monterey, State of California
Agreement No: A 11786
Authorize the Purchasing Manager for Natividad Medical Center
NMC) to execute the Agreement with Hooper, Lundy &
Bookman for Independent Consulting and Legal Services at NMC
in an amount not to exceed $100,000 for the period April 1, 2010
to March 31, 2011.
Upon motion of Supervisor Potter, seconded by Supervisor Armenta, and carried by those
members present, the Board hereby:
Authorized the Purchasing Manager for Natividad Medical Center NMC) to execute the
Agreement with Hooper, Lundy & Bookman for Independent Consulting and Legal Services at
NMC in an amount not to exceed $100,000 for the period April 1, 2010 to March 31, 2011.
PASSED AND ADOPTED this 27th day of July, 2010, by the following vote, to wit:
AYES: Supervisors Armenta, Calcagno, Salinas, Parker, Potter
NOES: None
ABSENT: None
I, Gail T. Borkowski, Clerk of the Board of Supervisors of the County of Monterey, State of California, hereby
certify that the foregoing is a true copy of an original order of said Board of Supervisors duly made and entered in
the minutes thereof of Minute Book 75 for the meeting on July 27, 2010.
Dated: July 29, 2010 Gail T. Borkowski, Clerk of the Board of Supervisors
County of Monterey, State of California
By 21
1 Deputy
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SIGNED BOARD REPORTX��"��MONTEREY COUNTY BOARD OF SUPERVISORS
MEETING: July 27, 2010
AGENDA NO.: If
SUBJECT: Authorize the Purchasing Manager for Natividad Medical Center NMC)
to execute the Agreement with Hooper, Lundy & Bookman for
Independent Consulting and Legal Services at NMC in an amount not to
exceed $100,000 for the period April 1, 2010 to March 31, 2011.
DEPARTMENT: Natividad Medical Center
RECOMMENDATION:
It is recommended the Board of Supervisors authorize the Purchasing Manager for Natividad
Medical Center NMC) to execute the Agreement with Hooper, Lundy & Bookman for Independent
Consulting and Legal Services at NMC in an amount not to exceed $100,000 for the period April 1,
2010 to March 31, 2011.
SUMMARY/DISCUSSION:
Hooper, Lundy & Bookman is a California law firm dedicated solely to the legal representation of
health care providers in Medicare Medicaid payments, health care business transactions, licensing
and certification. In consultation with the Office of the County Counsel, Hooper Lundy shall render
advice on a variety of healthcare-related issues to NMC
OTHER AGENCY INVOLVEMENT:
The Agreement has been reviewed and approved by County Counsel, the Auditor/Controller's
office, and the Natividad Medical Center Board of Trustees.
FINANCING:
The cost of this Amendment is $100,000 and is included in the Fiscal Year 2010/11 Approved
Budget. This action will not require any additional General Fund subsidy.
Prepared by:
Stacy Saetta Harry Weis
Deputy County Counsel Chief Executive Officer
July 14, 2010
Attachments: Agreement, Board Order
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AGREEMENT NO. A-11786 - HOOPE��COUNTY OF MONTEREY AGREEMENT FOR PROFESSIONAL SERVICES
NOT TO EXCEED $100,000)
This Professional Services Agreement Agreement") is made by and between the County of Monterey, a
political subdivision of the State of California hereinafter County") and:
Hooper, Lundy & Bookman, Inc.
hereinafter CONTRACTOR").
In consideration of the mutual covenants and conditions set forth in this Agreement, the parties agree as
follows:
1. SERVICES TO BE PROVIDED. The County hereby engages CONTRACTOR to perform, and
CONTRACTOR hereby agrees to perform, the services described in Exhibit A in conformity with the terms of
this Agreement. The services are generally described as follows:
Provide Analysis and potential negotiation of physician agreements; other healthcare matters regarding
Natividad Medical Center Natividad"), a general acute care teaching hospital owned and operated by the
County and located in Salinas, California.
2. PAYMENTS BY COUNTY. County shall pay the CONTRACTOR in accordance with the payment
provisions set forth in Exhibit A, subject to the limitations set forth in this Agreement. The total amount
payable by County to CONTRACTOR under this-Agreement shall not exceed the sum of $ 100,000.00
3. TERM OF AGREEMENT. The term of this Agreement is from April 1, 2010 to
March 31, 2011 unless sooner terminated pursuant to the terms of this Agreement. This
Agreement is of no force or effect until signed by both CONTRACTOR and County and with County signing
last, and CONTRACTOR may not commence work before County signs this Agreement.
4. ADDITIONAL PROVISIONS/EXHIBITS, The following attached exhibits are incorporated herein by
reference and constitute a part of this Agreement:
Exhibit A Scope of Services/Payment Provisions
Exhibit B HIPAA Business Associate Agreement
5. PERFORMANCE STANDARDS.
5.01. CONTRACTOR warrants that CONTRACTOR and CONTRACTOR's agents, employees, and
subcontractors performing services under this Agreement are specially trained, experienced, competent, and
appropriately licensed to perform the work and deliver the services required under this Agreement and are not
employees of the County, or immediate family of an employee of the County.
5.02. CONTRACTOR, its agents, employees, and subcontractors shall perform all work in a safe and
skillful manner and in compliance with all applicable laws and regulations. All work performed under this.
Agreement that is required by law to be performed or supervised by licensed personnel shall be performed in
accordance with such licensing requirements.
5.03. CONTRACTOR shall furnish, at its own expense, all materials, equipment, and personnel necessary
to carry out the terms of this Agreement, except as otherwise specified in this Agreement. CONTRACTOR
PSA S 100, 000 or Less, Revised 10/09/08 1 Of 8 Project ID:
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AGREEMENT NO. A-11786 - HOOPE��shall not use County premises, property including equipment, instruments, or supplies) or personnel for any
purpose other than in the performance of its obligations under this Agreement.
6. PAYMENT CONDITIONS.
6.01. CONTRACTOR shall submit to the Contract Administrator an invoice on a form acceptable to
County. If not otherwise specified, the CONTRACTOR may submit such invoice periodically or at the
completion of services, but in any event, not later than 30 days after completion of services. The invoice shall
set forth the amounts claimed by CONTRACTOR for the previous period, together with an itemized basis for
the amounts claimed, and such other information pertinent to the invoice as the County may require. The
Contract Administrator or his or her designee shall certify the invoice, either in the requested amount or in such
other amount as the County approves in conformity with this Agreement, and shall promptly submit such
invoice to the County Auditor-Controller for payment. The County Auditor-Controller shall pay the amount
certified within 30 days of receiving the certified invoice.
6.02. CONTRACTOR shall not receive reimbursement for travel expenses unless set forth in this
Agreement.
7. TERMINATION.
7.01. During the term of this Agreement, the County may terminate the Agreement for any reason by
giving written notice of termination to the CONTRACTOR at least thirty 30) days prior to the effective date of
termination. Such notice shall set forth the effective date of termination. In the event of such termination, the
amount payable under this Agreement shall be reduced in proportion to the services provided prior to the date of
termination.
7.02. The County may cancel and terminate this Agreement for good cause effective immediately upon
written notice to CONTRACTOR. Good cause" includes the failure of CONTRACTOR to perform the
required services at the time and in the manner provided under this Agreement. If County terminates this
Agreement for good cause, the County may be relieved of the payment of any consideration to
CONTRACTOR, and the County may proceed with the work in any manner which County deems proper. The
cost to the County shall be deducted from any sum due the CONTRACTOR under this Agreement,
8. INDEMNIFICATION. Centfaetor.-sha14-4nd4mnifj;-defaiid,-and-hold-harmless-the-Eou ez ey
herejrrafl~r"C-euflty=); its a�fis�rs; agents-arrd emplo3~ees-fFOt-any-olai}i
arising_.out_of,-or-in_connection-with,-penforrnance t.his-Agseomont4y-Gentraetor-arid~er-its-agents;-a e3'ees
or--sub-contr-actors-exc~epting,eniy-loss; injury-or-damage-caused-ay-the-negl}rgerree-or-wi~lf isseRdr~st-e
personne!-empaDyed-by-the-noun y,-It-is-tfa�-ir~ten e the-parties-to--this--.44g~ern i-te-pxeuid he-hroa st
possib[e~covesage fox. the.Couut3c._theCc~ntractot~shall-reixnk~u re-~~ n
expenses an4 iabif ities-incurred'-with-respect te-arty-litigatierr4ti-w}rie
the-Eentra
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9. INSURANCE.
9.01. Evidence of Coverage:
Prior to commencement of this Agreement, the Contractor shall provide a Certificate of
Insurance" certifying that coverage as required herein has been obtained. Individual endorsements
executed by the insurance carrier shall accompany the certificate. In addition, the Contractor upon
request shall provide a certified copy of the policy or policies,
PSA S100,000 or Less, Revised 10/09/08 2 of 8 Project ID:
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AGREEMENT NO. A-11786 - HOOPE��This verification of coverage shall be sent to the County's Contracts/Purchasing Department,
unless otherwise directed. The Contractor shall not receive a Notice to Proceed" with the work
under this Agreement until it has obtained all insurance required and the County has approved
such insurance. This approval of insurance shall neither relieve nor decrease the liability of the
Contractor.
9.02 Qualifying Insurers:
All coverage's, except surety, shall be issued by companies which hold a current policy holder's
alphabetic and financial size category rating of not less than A- VII, according to the current
Best's Key Rating Guide or a company of equal financial stability that is approved by the
County's Purchasing Manager.
9.03 Insurance Coverage Requirements: Without limiting CONTRACTOR's duty to indemnify,
CONTRACTOR shall maintain in effect throughout the term of this Agreement a policy or
policies of insurance with the following minimum limits of liability:
Commercial general liability insurance, including but not limited to premises and operations,
including coverage for Bodily Injury and Property Damage, Personal Injury, Contractual Liability,
Broad form Property Damage, Independent Contractors, Products and Completed Operations, with
a combined single limit for Bodily Injury and Property Damage of not less than $1,000,000 per
occurrence.
Exemption/Modification Justification attached; subject to approval).
Business automobile liability insurance, covering all motor vehicles, including owned, leased,
non-owned, and hired vehicles, used in providing services under this Agreement, with a combined
single limit for Bodily Injury and Property Damage of not less than $500,000 per occurrence.
Exemption/Modification Justification attached; subject to approval).
Workers' Compensation Insurance, if CONTRACTOR employs others in the performance of this
Agreement, in accordance with California Labor Code section 3700 and with Employer's Liability
limits not less than $1,000,000 each person, $1,000,000 each accident and $1,000,000 each
disease.
Exemption/Modification Justification attached; subject to approval).
Professional liability insurance, if required for the professional services being provided, e.g.,
those persons authorized by a license to engage in a business or profession regulated by the
California Business and Professions Code), in the amount of not less than $1,000,000 per claim
and $2,000,000 in the aggregate, to cover liability for malpractice or errors or omissions made in
the course of rendering professional services. If professional liability insurance is written on a
claims-made" basis rather than an occurrence basis, the CONTRACTOR shall, upon the
expiration or earlier termination of this Agreement, obtain extended reporting coverage tail
coverage") with the same liability limits. Any such tail coverage shall continue for at least three
years following the expiration or earlier termination of this Agreement.
Exemption/lylodification Justification attached; subject to approval).
9.04. Other Insurance Requirements:
All insurance required by this Agreement shall be with a company acceptable to the County and issued and
executed by an admitted insurer authorized to transact Insurance business in the State of California. Unless
otherwise specified by this Agreement, all such insurance shall be written on an occurrence basis, or, if the
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AGREEMENT NO. A-11786 - HOOPE��policy is not written on an occurrence basis, such policy with the coverage required herein shall continue in
effect for a period of three years following the date CONTRACTOR completes its performance of services
under this Agreement.
Each liability policy shall provide that the County shall be given notice in writing at least thirty days in
advance of any endorsed reduction in coverage or limit, cancellation, or intended non-renewal thereof.
Each policy shall provide coverage for Contractor and additional insureds with respect to claims arising
from each subcontractor, if any, performing work under this Agreement, or be accompanied by a certificate
of insurance from each subcontractor showing each subcontractor has identical insurance coverage to the
above requirements.
Commercial general liability and automobile liability policies shall provide an endorsement naming the
County of Monterey its officers, agents, and employees as Additional Insureds with respect to liability
arising out of the CONTRACTOR'S work, including ongoing and completed operations, and shall further
provide that such insurance is primary insurance to any insurance or self-insurance maintained by the
County and that the insurance of the Additional Insureds shall not be called upon to contribute to a loss
covered by the CONTRACTOR'S insurance. The required endorsement form for Commercial General
Liability Additional Insured is ISO Form CG 20 10 11-85 or CG 20 10 10 01 in tandem with CG 20 3710
01 2000). The required endorsement form for Automobile Additional Insured endorsement is ISO Form
CA 20480299.
Prior to the execution of this Agreement by the County, CONTRACTOR shall file certificates of insurance
with the County's contract administrator and County's Contracts/Purchasing Division, showing that the
CONTRACTOR has in effect the insurance required by this Agreement. The CONTRACTOR shall file a
new or amended certificate of insurance within five calendar days after any change is made in any
insurance policy, which would alter the information on the certificate then on file. Acceptance or approval
of insurance shall in no way modify or change the indemnification clause in this Agreement, which shall
continue in full force and effect.
CONTRACTOR shall at all times during the term of this Agreement maintain in force the insurance
coverage required under this Agreement and shall send, without demand by County, annual certificates to
County's Contract Administrator and County's Contracts/Purchasing Division. If the certificate is not
received by the expiration date, County shall notify CONTRACTOR and CONTRACTOR shall have five
calendar days to send in the certificate, evidencing no lapse in coverage during the interim. Failure by
CONTRACTOR to maintain such insurance is a default of this Agreement, which entitles County, at its
sole discretion, to terminate this Agreement immediately.
10. RECORDS AND CONFIDENTIALITY.
10.01. Confidentiality. CONTRACTOR and its officers, employees, agents, and subcontractors shall
comply with any and all federal, state, and local laws, which provide for the confidentiality of records and
other information. CONTRACTOR shall not disclose any confidential records or other confidential
information received from the County or prepared in connection with the performance of this Agreement,
unless County specifically permits CONTRACTOR to disclose such records or information.
CONTRACTOR shall promptly transmit to County any and all requests for disclosure of any such
confidential records or information. CONTRACTOR shall not use any confidential information gained by
CONTRACTOR in the performance of this Agreement except for the sole purpose of carrying out
CONTRACTOR's obligations under this Agreement.
PSA 5/00,000o,' Less, Revised /0/09/08 4 of 8 Project ID:
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AGREEMENT NO. A-11786 - HOOPE��10.02. County Records. When this Agreement expires or terminates, CONTRACTOR shall return to
County any County records which CONTRACTOR used or received from County to perform services
under this Agreement.
10.03. Maintenance of Records. CONTRACTOR shall prepare, maintain, and preserve all reports and
records that may be required by federal, state, and County rules and regulations related to services
performed under this Agreement. CONTRACTOR shall maintain such records for a period of at least three
years after receipt of final payment under this Agreement. If any litigation, claim, negotiation, audit
exception, or other action relating to this Agreement is pending at the end of the three year period, then
CONTRACTOR shall retain said records until such action is resolved.
10.04. Access to and Audit of Records. The County shall have the right to examine, monitor and audit
all records, documents, conditions, and activities of the CONTRACTOR and its subcontractors related to
services provided under this Agreement. Pursuant to Government Code section 8546.7, if this Agreement
involves the expenditure of public funds in excess of $ 10,000, the parties to this Agreement may be subject,
at the request of the County or as part of any audit of the County, to the examination and audit of the State
Auditor pertaining to matters connected with the performance of this Agreement for a period of three years
after final payment under the Agreement.
10.05. Royalties and Inventions. County shall have a royalty-free, exclusive and irrevocable license to
reproduce, publish, and use, and authorize others to do so, all original computer programs, writings, sound
recordings, pictorial reproductions, drawings, and other works of similar nature produced in the course of
or under this Agreement. CONTRACTOR shall not publish any such material without the prior written
approval of County.
11. NON-DISCRIMINATION. During the performance of this Agreement, CONTRACTOR, and its
subcontractors, shall not unlawfully discriminate against any person because of race, religious creed, color,
sex, national origin, ancestry, physical disability, mental disability, medical condition, marital status, age
over 40), or sexual orientation, either in CONTRACTOR's employment practices or in the furnishing of
services to recipients. CONTRACTOR shall ensure that the evaluation and treatment of its employees and
applicants for employment and all persons receiving and requesting services are free of such discrimination.
CONTRACTOR and any subcontractor shall, in the performance of this Agreement, fully comply with all
federal, state, and local laws and regulations which prohibit discrimination. The provision of services
primarily or exclusively to such target population as may be designated in this Agreement shall not be
deemed to be prohibited discrimination,
12. COMPLIANCE WITH TERMS OF STATE OR FEDERAL-GRANT. If this Agreement has been or
will be funded with monies received by the County pursuant to a contract with the state or federal
government in which the County is the grantee, CONTRACTOR will comply with all the provisions of said
contract, to the extent applicable to CONTRACTOR as a subgrantee under said contract, and said
provisions shall be deemed a part of this Agreement, as though fully set forth herein. Upon request, County
will deliver a copy of said contract to CONTRACTOR, at no cost to CONTRACTOR.
13. INDEPENDENT CONTRACTOR. In the performance of work, duties, and obligations under this
Agreement, CONTRACTOR is at all times acting and performing as an independent contractor and not as
an employee of the County. No offer or obligation of permanent employment with the County or particular
County department or agency is intended in any manner, and CONTRACTOR shall not become entitled by
virtue of this Agreement to receive from County any form of employee benefits including but not limited to
sick leave, vacation, retirement benefits, workers' compensation coverage, insurance or disability benefits.
CONTRACTOR shall be solely liable for and obligated to pay directly all applicable taxes, including
federal and state income taxes and social security, arising out of CONTRACTOR's performance of this
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AGREEMENT NO. A-11786 - HOOPE��Agreement. In connection therewith, CONTRACTOR shall defend, indemnify, and hold County harmless
from any and all liability which County may incur because of CONTRACTOR's failure to pay such taxes.
14. NOTICES. Notices required under this Agreement shall be delivered personally or by first-class, postage
pre-paid mail to the County and CONTRACTOR'S contract administrators at the addresses listed below:
FOR COUNTY:
Charles J. McKee, County Counsel
Name and Title
County of Monterey
168 West Alisal Street, 3rd Floor
Salinas, CA 93901
FOR CONTRACTOR:
Glenn E. Solomon, Esq.
Name and Title
Hooper, Lundy, & Bookman, INc.
1875 Century Park East, Suite 1600
Los Angeles, CA 90067
Address
831) 755-5045
Address
310) 551-8179
Phone Phone
15, MISCELLANEOUS PROVISIONS.
15.01 Conflict of Interest. CONTRACTOR represents that it presently has no interest and agrees not to
acquire any interest during the term of this Agreement, which would directly, or indirectly conflict in
any manner or to any degree with the full and complete performance of the professional services
required to be rendered under this Agreement.
15.02 Amendment. This Agreement may be amended or modified only by an instrument in writing signed
by the County and the CONTRACTOR.
15.03 Waiver. Any waiver of any terms and conditions of this Agreement must be in writing and signed
by the County and the CONTRACTOR. A waiver of any of the terms and conditions of this
Agreement shall not be construed as a waiver of any other terms or conditions in this Agreement.
15.04 Contractor. The term CONTRACTOR" as used in this Agreement includes CONTRACTOR's
officers, agents, and employees acting on CONTRACTOR's behalf in the performance of this
Agreement.
15.05 Disputes. CONTRACTOR shall continue to perform under this Agreement during any dispute.
15.06 Assignment and Subcontracting. The CONTRACTOR shall not assign, sell, or otherwise transfer its
interest or obligations in this Agreement without the prior written consent of the County. None of the
services covered by this Agreement shall be subcontracted without the prior written approval of the
County. Notwithstanding any such subcontract, CONTRACTOR shall continue to be liable for the
performance of all requirements of this Agreement.
15.07 Successors and Assi ns. This Agreement and the rights, privileges, duties, and obligations of the
County and CONTRACTOR under this Agreement, to the extent assignable or delegable, shall be
binding upon and inure to the benefit of the parties and their respective successors, permitted
assigns, and heirs.
PSA 5100,000 or Less, Revised 10/09/08 6 of 8 Project ID:
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AGREEMENT NO. A-11786 - HOOPE��15.08 Compliance with Applicable Law. The parties shall comply with all applicable federal, state, and
local laws and regulations in performing this Agreement.
15.09 Headings. The headings are for convenience only and shall not be used to interpret the terms of this
Agreement,
15.10 Time is of the Essence. Time is of the essence in each and all of the provisions of this Agreement.
15.11 Governing Law. This Agreement shall be governed by and interpreted under the laws of the State of
California.
15.12 Non-exclusive Agreement. This Agreement is non-exclusive and both County and CONTRACTOR
expressly reserve the right to contract with other entities for the same or similar services.
15.13 Construction of Agreement. The County and CONTRACTOR agree that each party has fully
participated in the review and revision of this Agreement and that any rule of construction to the
effect that ambiguities are to be resolved against the drafting party shall not apply in the
interpretation of this Agreement or any amendment to this Agreement.
15.14 Counterparts. This Agreement may be executed in two or more counterparts, each of which shall be
deemed an original, but all of which together shall constitute one and the same Agreement.
15.15 Authority. Any individual executing this Agreement on behalf of the County or the
CONTRACTOR represents and warrants hereby that he or she has the requisite authority to enter
into this Agreement on behalf of such party and bind the party to the terms and conditions of this
Agreement.
15.16 Integration. This Agreement, including the exhibits, represent the entire Agreement between the
County and the CONTRACTOR with respect to the subject matter of this Agreement and shall
supersede all prior negotiations, representations, or agreements, either written or oral, between the
County and the CONTRACTOR as of the effective date of this Agreement, which is the date that the
County signs the Agreement.
15.17 Interpretation of Conflicting Provisions. In the event of any conflict or inconsistency between the
provisions of this Agreement and the Provisions of any exhibit or other attachment to this
Agreement, the provisions of this Agreement shall prevail and control.
PSA $100,000 or Less, Revised 10/09/08 7 of 8 Project ID:
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AGREEMENT NO. A-11786 - HOOPE��IN WITNESS WHEREOF, County and CONTRACTOR have executed this Agreement as of the day and
year written below.
Date:
By:
Date:
n'tracts/Purchasing
72 CA1114~
Department Head if applicable)
Approved as to Form'
By:
Date:
Approved as to FisRal,P4ovisions
By:
A i itor
Date:
RISK MANAGEMENT
COUNTY OF MONTEREY
Apprdly d'9Ad 9iztbil Ttv1 FMNITY/
INSURANCE IQcNGIJAGE
By:
ounty Counsel
ry,ria e e
CONTRACTOR
By:
Contractor's Bussne6s Name*
Signature of Chair, President, or
Vice-President)*
Date: 06/17/10
By:
Date:
Hooper, Lundy & Bookman, Inc.
Signature of Secretary, Asst. Secretary, CFO,
Treasurer or Asst. Treasurer)*
Name and Title
*INSTRUCTIONS: If CONTRACTOR is a corporation, including limited liability and non-profit corporations, the full legal name of
the corporation shall be set forth above together with the signatures of two specified officers. If CONTRACTOR is a partnership, the
name of the partnership shall be set forth above together with the signature of a partner who has authority to execute this Agreement
on behalf of the partnership. If CONTRACTOR is contracting in an individual capacity, the individual shall set forth the name of the
business, if any, and shall personally sign the Agreement.
Approval by County Counsel is required only if changes are made to the standard provisions of the PSA
2Approval by Auditor/Controller is required
3Approval by Risk Management is required only if changes are made in paragraph 8 or 9
RSA $100,000 or Less, Revised 10/09/08 80f8 Project ID:
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2011.-U012
AGREEMENT NO. A-11786 - HOOPE�� EXHIBIT A
Hooper, Lundy & Bookman, Inc.
April 1, 2010 through March 31, 2011
1. CONTACT INFORMATION
CONTRACTOR:
Glenn E. Solomon, Esq.
Hooper, Lundy, & Bookman, Inc.
1875 Century Park East, Suite 1600
Los Angeles, CA 90067
310) 551-8179
David P. Henninger, Esq.
Hooper, Lundy, & Bookman, Inc.
1875 Century Park East, Suite 1600
Los Angeles, CA 90067
310) 551-8177
COUNTY:
OFFICE OF THE COUNTY COUNSEL Charles J. McKee
County Counsel
County of Monterey
168 West Alisal Street, 3rd Floor
Salinas, CA 93901
831) 755-5045
Stacy L. Saetta
Deputy County Counsel
County of Monterey
168 West Alisal Street, 3rd Floor
Salinas, CA 93901
831) 755-5045
William M. Litt
Deputy County Counsel
County of Monterey
168 West Alisal Street, 3rd Floor
Salinas, CA 93901
831) 755-5045
NATIVIDAD MEDICAL CENTER Harry Weis, CEO
Natividad Medical Center
1441 Constitutional Boulevard
Salinas, CA 93906
831) 755-4111
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AGREEMENT NO. A-11786 - HOOPE��
EXHIBIT A
II. SCOPE OF WORK
CONTRACTOR shall:
A. Provide legal services with respect to physician agreements, and
B. Other legal healthcare matters and other healthcare matters regarding Natividad Medical
Center Natividad").
III. PAYMENT PROVISIONS
A. COUNTY shall pay CONTRACTOR according to Section 6, PAYMENT
CONDITIONS, of this agreement.
B. CONTRACTOR's fees are based upon the number of attorney hours devoted to a
client's matters, and the then-existing hourly rates for the personnel involved. At
present, CONTRACTOR's hourly rates range from $495 to $685 for principals in
the firm, from $295 to $480 for associates, and from $230 to $265 for paralegals.
CONTRACTOR's hourly rates may be adjusted periodically. Variations in
CONTRACTOR's current hourly rates may be made in some cases, either upward
or downward, to account for complexity of issues, uniqueness of services,
expertise of the involved attorney, etc. COUNTY shall be billed at preferred rates
for CONTRACTOR's attorneys who provide services for the County. At present,
Glenn E. Solomon's standard hourly rate is $595.00; COUNTY shall be billed at his
preferred hourly rate of $540. At present, David P. Henninger's hourly rate is $660;
COUNTY shall be billed at his preferred hourly rate of $600. In addition to our
fees, CONTRACTOR also charges for expenses incurred by CONTRACTOR on
COUNTY's behalf. These expenses include, but are not limited to, long distance
telephone calls, document processing, photocopying, facsimile, delivery costs and
travel expenses. Such expenses shall be paid in accordance with COUNTY's
Travel Policy.
C. CONTRACTOR shall submit an invoice to the COUNTY no later than the 10`h of
the month following the month of service. Invoices shall be submitted to:
Stacy L. Saetta
Deputy County Counsel
County Counsel's Office
County of Monterey
168 West Alisal Street, 3rd Floor
Salinas, CA 93901
D. The maximum amount to be paid by COUNTY to CONTRACTOR under this
agreement shall not exceed One Hundred Thousand Dollars $100,000.00).
E. CONTRACTOR shall provide COUNTY with a detailed statement on a monthly
basis, covering its current fees and expenses. It will describe services rendered,
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AGREEMENT NO. A-11786 - HOOPE��
EXHIBIT A
and will also show the amount of COUNTY's retainer remaining in its trust
account or the amount owing to CONTRACTOR.
F. It is understood that CONTRACTOR's fees and charges shall be paid out of
Natividad's budget and that CONTRACTOR's fees and charges shall not be paid
out of the budget of County Counsel's Office.
IV. ADDITIONAL PROVISIONS
A. Reports
CONTRACTOR shall provide to Monterey County such reports as may be
requested by the Board of Supervisors or County Counsel.
B. Agreement to Arbitrate and Mediate
In the event of any disputes between the parties to this Agreement over
professional services rendered, the parties agree to resolve all such disputes
through binding arbitration in Los Angeles County before a retired judge of the
Los Angeles County Superior Court pursuant to the provisions of California Code
of Civil Procedure 1280, et seq., and the Federal Arbitration Act. Such retired
judge shall be selected by mutual agreement of the parties within 15 days of a
demand for arbitration by any party. If the parties are unable to select an
arbitrator through mutual agreement, an arbitrator shall be designated by the Los
Angeles County Superior Court upon petition to that court by any party. The
parties agree that speed and cost effectiveness of such arbitration are important to
all parties to this agreement, and agree that any such arbitration shall be
concluded within 120 days of the date of selection of the arbitrator. The parties
also agree that prior to the arbitration, they shall engage in mediation pursuant to
a mutually acceptable mediator, to be selected within 15 days of the date of the
request for arbitration. If the parties are unable to agree upon a mediator within
15 days of the date of a demand for arbitration by any party, the mediator may be
designated by the Los Angeles County Superior Court upon petition by any party.
The mediation shall be completed within 60 days of the designation of a mediator.
The parties shall share the costs of the arbitrator and the mediator, and each party
shall bear its own attorneys' fees for both the mediation and the arbitration.
Notwithstanding the foregoing, in the event of an action by this firm to collect
fees, Business and Professions Code 6201 permits COUNTY to request non-
binding arbitration through the local Bar Association, and if either party is
unsatisfied with the outcome of the non-binding arbitration, they have the right to
request a trial de novo in the Court. With respect to any action or proceeding by
this firm to collect fees, COUNTY may elect within 30 days of notice of a
demand for arbitration by this firm whether to proceed in accordance with the
provisions for binding arbitration or whether to proceed in accordance with the
procedures set forth in Business and Professions Code 6201. If COUNTY does
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AGREEMENT NO. A-11786 - HOOPE��
EXHIBIT A
not, the resolution of any such dispute will proceed in accordance with the
mediation and arbitration language set forth in the preceding paragraph.
C. Indemnification. Paragraph 8 of the Agreement shall be replaced in its entirety
with the following:
8. Indemnification.
Indemnification for Professional Liability. For liability arising
from professional and technical services provided under this
Agreement, Hooper Lundy shall indemnify, defend and hold
harmless County, its governing board, officers, agents, and
employees from any loss, injury, damage, expense and liability to
the extent arising out of the negligence of Hooper Lundy, its
employees, or agents.
General Indemnification. For any liability, other than arising out of
professional and technical services, Hooper Lundy shall
indemnify, defend and hold harmless, County, its governing board,
officers, agents, and employees from any loss, injury, damage,
expense and liability resulting from injury to or death of any
person and loss of or damage to property, or claim of such injury,
death, loss or damage caused by an act or omission in the
performance under this Agreement by Hooper Lundy, its
employees, or agents, excepting only loss, injury or damage caused
by the sole negligence or willful misconduct of the County.
Notwithstanding the foregoing two paragraphs, Hooper Lundy's
contract indemnity obligation shall be limited to indemnity liability
for which Hooper Lundy is insured by the program of insurance
described in described in Paragraph 9 of the Agreement and
Section IV D. of this Exhibit A.
D. Professional Liability Insurance. The provision concerning Professional Liability
Insurance, located within Paragraph 9.03, Section 9 of the Agreement, shall be
replaced in its entirety with the following:
Based on scope of work, CONTRACTOR shall provide professional liability
insurance in the amount of not less than $3,000,000 per claim and $5,000,000 in
the aggregate to cover liability for malpractice or errors or omissions made in the
course of rendering professional services. If professional liability insurance is
written on a claims-made" basis rather than an occurrence basis, the
CONTRACTOR shall, upon the expiration or earlier termination of this
Agreement, obtain extended reporting coverage tail coverage") with the same
liability limits. Any such tail coverage shall continue for at least three years
following the expiration or earlier termination of this Agreement.
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AGREEMENT NO. A-11786 - HOOPE��
EXHIBIT B
BUSINESS ASSOCIATE AGREEMENT
This Agreement is made effective April 1, 2010, by and between MONTEREY
COUNTY, hereinafter referred to as Covered Entity", and Hooper, Lundy & Bookman,
Inc., hereinafter referred to as Business Associate", individually, a Party" and
collectively, the Parties").
WITNESSETH:
WHEREAS, Sections 261 through 264 of the federal Health Insurance Portability
and Accountability Act of 1996, Public Law 104-191, known as the Administrative
Simplification provisions," direct the Department of Health and Human Services to
develop standards to protect the security, confidentiality and integrity of health
information; and
WHEREAS, pursuant to the Administrative Simplification provisions, the
Secretary of Health and Human Services has issued regulations modifying 45 CFR Parts
160 and 164 the HIPAA Privacy Rule"); and
WHEREAS, the Parties wish to enter into or have entered into an arrangement
whereby Business Associate will provide certain services to Covered Entity, and,
pursuant to such arrangement, Business Associate may be considered a business
associate" of Covered Entity as defined in the HIPAA Privacy Rule the agreement
evidencing such arrangement is entitled County of Monterey Agreement for
Professional Services, with a term of April 1, 2010 through March 31, 2011, and is
hereby referred to as the Arrangement Agreement"); and
WHEREAS, Business Associate may have access to Protected Health
Information as defined below) in fulfilling its responsibilities under such arrangement;
THEREFORE, in consideration of the Parties' continuing obligations under the
Arrangement Agreement, compliance with the HIPAA Privacy Rule, and other good and
valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the
Parties agree to the provisions of this Agreement in order to address the requirements of
the HIPAA Privacy Rule and to protect the interests of both Parties.
1. DEFINITIONS
Except as otherwise defined herein, any and all capitalized terms in this Section shall
have the definitions set forth in the HIPAA Privacy Rule. In the event of an inconsistency
between the provisions of this Agreement and mandatory provisions of the HIPAA
Privacy Rule, as amended, the HIPAA Privacy Rule shall control. Where provisions of
this Agreement are different than those mandated in the HIPAA Privacy Rule, but are
nonetheless permitted by the HIPAA Privacy Rule, the provisions of this Agreement shall
control.
The term Protected Health Information" means individually identifiable health
information including, without limitation, all information, data, documentation, and
materials, including without limitation, demographic, medical and financial information,
Page 1 of 4
BIB]
40387-U01
AGREEMENT-U02
NO.-U02
A-11786-U02
U02
HOOPER,-U02
LUNDY-U02
&-U02
BOOKMAN-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO89518-U03
MG89556-U03
AS89582-U03
AS89583-U03
AI93653-U03
DO93883-U03
C5-U03
AGREEMENTS-U03
7/28/2010-U04
RIVASR-U04
15342-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AGREEMENT-U07
HOOPER,-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
7/19/2010-U011
LUNDY-U012
&-U012
BOOKMAN-U012
INDEPENDENT-U012
CONSULTING-U012
LEGAL-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$100,000-U012
PERIOD-U012
APRIL-U012
1,-U012
2010-U012
TO-U012
MARCH-U012
31,-U012
2011.-U012
AGREEMENT NO. A-11786 - HOOPE��EXHIBIT B
that relates to the past, present, or future physical or mental health or condition of an
individual; the provision of health care to an individual; or the past, present, or future
payment for the provision of health care to an individual; and that identifies the individual
or with respect to which there is a reasonable basis to believe the information can be
used to identify the individual.
Business Associate acknowledges and agrees that all Protected Health Information that
is created or received by Covered Entity and disclosed or made available in any form,
including paper record, oral communication, audio recording, and electronic display by
Covered Entity or its operating units to Business Associate or is created or received by
Business Associate on Covered Entity's behalf shall be subject to this Agreement.
II. CONFIDENTIALITY REQUIREMENTS
a)
Business Associate agrees:
i) to use or disclose any Protected Health Information solely:
1) for meeting its obligations as set forth in any agreements between the
Parties evidencing their business relationship or 2) as required by
applicable law, rule or regulation, or by accrediting or credentialing
organization to whom Covered Entity is required to disclose such
information or as otherwise permitted under this Agreement, the
Arrangement Agreement if consistent with this Agreement and the
HIPAA Privacy Rule), or the HIPAA Privacy Rule, and 3) as would be
permitted by the HIPAA Privacy Rule if such use or disclosure were made
by Covered Entity;
ii) at termination of this Agreement, the Arrangement
Agreement or any similar documentation of the business relationship of
the Parties), or upon request of Covered Entity, whichever occurs first, if
feasible, Business Associate will return or destroy all Protected Health
Information received from or created or received by Business Associate
on behalf of Covered Entity that Business Associate still maintains in any
form and retain no copies of such information, or if such return or
destruction is not feasible, Business Associate will extend the protections
of this Agreement to the information and limit further uses and disclosures
to those purposes that make the return or destruction of the information
not feasible; and
iii) to ensure that its agents, including a subcontractor, to
whom it provides Protected Health Information received from or created
by Business Associate on behalf of Covered Entity, agrees to the same
restrictions and conditions that apply to Business Associate with respect
to such information. In addition, Business Associate agrees to take
reasonable steps to ensure that its employees' actions or omissions do
not cause Business Associate to breach the terms of this Agreement.
b) Notwithstanding the prohibitions set forth in this Agreement, Business
Associate may use and disclose Protected Health Information as follows:
i) if necessary, for the proper management and
administration of Business Associate or to carry out the legal
responsibilities of Business Associate, provided that as to any such
disclosure, the following requirements are met:
A) the disclosure is required by law; or
Page 2 of 4
BIB]
40387-U01
AGREEMENT-U02
NO.-U02
A-11786-U02
U02
HOOPER,-U02
LUNDY-U02
&-U02
BOOKMAN-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO89518-U03
MG89556-U03
AS89582-U03
AS89583-U03
AI93653-U03
DO93883-U03
C5-U03
AGREEMENTS-U03
7/28/2010-U04
RIVASR-U04
15342-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AGREEMENT-U07
HOOPER,-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
7/19/2010-U011
LUNDY-U012
&-U012
BOOKMAN-U012
INDEPENDENT-U012
CONSULTING-U012
LEGAL-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$100,000-U012
PERIOD-U012
APRIL-U012
1,-U012
2010-U012
TO-U012
MARCH-U012
31,-U012
2011.-U012
AGREEMENT NO. A-11786 - HOOPE��EXHIBIT B
B) Business Associate obtains reasonable assurances
from the person to whom the information is disclosed that it will be
held confidentially and used or further disclosed only as required
by law or for the purpose for which it was disclosed to the person,
and the person notifies Business Associate of any instances of
which it is aware in which the confidentiality of the information has
been breached;
ii) for data aggregation services, if to be provided by
Business Associate for the health care operations of Covered Entity
pursuant to any agreements between the Parties evidencing their
business relationship. For purposes of this Agreement, data aggregation
services means the combining of Protected Health Information by
Business Associate with the protected health information received by
Business Associate in its capacity as a business associate of another
covered entity, to permit data analyses that relate to the health care
operations of the respective covered entities.
c) Business Associate will implement appropriate safeguards to prevent use
or disclosure of Protected Health Information other than as permitted in this Agreement.
The Secretary of Health and Human Services shall have the right to audit Business
Associate's records and practices related to use and disclosure of Protected Health
Information to ensure Covered Entity's compliance with the terms of the HIPAA Privacy
Rule. Business Associate shall report to Covered Entity any use or disclosure of
Protected Health Information which is not in compliance with the terms of this Agreement
of which it becomes aware. In addition, Business Associate agrees to mitigate, to the
extent practicable, any harmful effect that is known to Business Associate of a use or
disclosure of Protected Health Information by Business Associate in violation of the
requirements of this Agreement.
Ill. AVAILABILITY OF PHI
Business Associate agrees to make available Protected Health Information to the extent
and in the manner required by Section 164.524 of the HIPAA Privacy Rule. Business
Associate agrees to make Protected Health Information available for amendment and
incorporate any amendments to Protected Health Information in accordance with the
requirements of Section 164.526 of the HIPAA Privacy Rule. In addition, Business
Associate agrees to make Protected Health Information available for purposes of
accounting of disclosures, as required by Section 164.528 of the HIPAA Privacy Rule.
IV. TERMINATION
Notwithstanding anything in this Agreement to the contrary, Covered Entity shall have
the right to terminate this Agreement and the Arrangement Agreement immediately if
Covered Entity determines that Business Associate has violated any material term of this
Agreement. If Covered Entity reasonably believes that Business Associate will violate a
material term of this Agreement and, where practicable, Covered Entity gives written
notice to Business Associate of such belief within a reasonable time after forming such
belief, and Business Associate fails to provide adequate written assurances to Covered
Entity that it will not breach the cited term of this Agreement within a reasonable period
of time given the specific circumstances, but in any event, before the threatened breach
Page 3 of 4
BIB]
40387-U01
AGREEMENT-U02
NO.-U02
A-11786-U02
U02
HOOPER,-U02
LUNDY-U02
&-U02
BOOKMAN-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO89518-U03
MG89556-U03
AS89582-U03
AS89583-U03
AI93653-U03
DO93883-U03
C5-U03
AGREEMENTS-U03
7/28/2010-U04
RIVASR-U04
15342-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AGREEMENT-U07
HOOPER,-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
7/19/2010-U011
LUNDY-U012
&-U012
BOOKMAN-U012
INDEPENDENT-U012
CONSULTING-U012
LEGAL-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$100,000-U012
PERIOD-U012
APRIL-U012
1,-U012
2010-U012
TO-U012
MARCH-U012
31,-U012
2011.-U012
AGREEMENT NO. A-11786 - HOOPE��EXHIBIT B
is to occur, then Covered Entity shall have the right to terminate this Agreement and the
Arrangement Agreement immediately.
V. MISCELLANEOUS
Except as expressly stated herein or the HIPAA Privacy Rule, the parties to this
Agreement do not intend to create any rights in any third parties. The obligations of
Business Associate under this Section shall survive the expiration, termination, or
cancellation of this Agreement, the Arrangement Agreement and/or the business
relationship of the parties, and shall continue to bind Business Associate, its agents,
employees, contractors, successors, and assigns as set forth herein.
This Agreement may be amended or modified only in a writing signed by the Parties. No
Party may assign its respective rights and obligations under this Agreement without the
prior written consent of the other Party. None of the provisions of this Agreement are
intended to create, nor will they be deemed to create any relationship between the
Parties other than that of independent parties contracting with each other solely for the
purposes of effecting the provisions of this Agreement and any other agreements
between the Parties evidencing their business relationship. This Agreement will be
governed by the laws of the State of California. No change, waiver or discharge of any
liability or obligation hereunder on any one or more occasions shall be deemed a waiver
of performance of any continuing or other obligation, or shall prohibit enforcement of any
obligation, on any other occasion.
The parties agree that, in the event that any documentation of the arrangement pursuant
to which Business Associate provides services to Covered Entity contains provisions
relating to the use or disclosure of Protected Health Information which are more
restrictive than the provisions of this Agreement, the provisions of the more restrictive
documentation will control. The provisions of this Agreement are intended to establish
the minimum requirements regarding Business Associate's use and disclosure of
Protected Health Information.
In the event that any provision of this Agreement is held by a court of competent
jurisdiction to be invalid or unenforceable, the remainder of the provisions of this
Agreement will remain in full force and effect. In addition, in the event a party believes in
good faith that any provision of this Agreement fails to comply with the then-current
requirements of the HIPAA Privacy Rule, such party shall notify the other party in writing.
For a period of up to thirty days, the parties shall address in good faith such concern and
amend the terms of this Agreement, if necessary to bring it into compliance. If, after
such thirty-day period, the Agreement fails to comply with the HIPAA Privacy Rule, then
either party has the right to terminate upon written notice to the other party.
Page 4 of 4
BIB]
40387-U01
AGREEMENT-U02
NO.-U02
A-11786-U02
U02
HOOPER,-U02
LUNDY-U02
&-U02
BOOKMAN-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO89518-U03
MG89556-U03
AS89582-U03
AS89583-U03
AI93653-U03
DO93883-U03
C5-U03
AGREEMENTS-U03
7/28/2010-U04
RIVASR-U04
15342-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AGREEMENT-U07
HOOPER,-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
7/19/2010-U011
LUNDY-U012
&-U012
BOOKMAN-U012
INDEPENDENT-U012
CONSULTING-U012
LEGAL-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$100,000-U012
PERIOD-U012
APRIL-U012
1,-U012
2010-U012
TO-U012
MARCH-U012
31,-U012
2011.-U012
AGREEMENT NO. A-11786 - HOOPE��EXHIBIT B
IN WITNESS WHEREOF, the Parties have executed this Agreement as of the
day and year written above.
COVERED ENTITY: BUSINESS ASSOCIAT
By:
Title: Purchasing Me11 gerQ f Title:
Date: 7-vy Date:
Page 5 of 4
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40387-U01
AGREEMENT-U02
NO.-U02
A-11786-U02
U02
HOOPER,-U02
LUNDY-U02
&-U02
BOOKMAN-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO89518-U03
MG89556-U03
AS89582-U03
AS89583-U03
AI93653-U03
DO93883-U03
C5-U03
AGREEMENTS-U03
7/28/2010-U04
RIVASR-U04
15342-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AGREEMENT-U07
HOOPER,-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
7/19/2010-U011
LUNDY-U012
&-U012
BOOKMAN-U012
INDEPENDENT-U012
CONSULTING-U012
LEGAL-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$100,000-U012
PERIOD-U012
APRIL-U012
1,-U012
2010-U012
TO-U012
MARCH-U012
31,-U012
2011.-U012
AGREEMENT NO. A-11786 - HOOPE��PRODUCER
Mann Insurance Agency
10801 National BL, Suite 520
Los Angeles CA 90064
310)474-8424
INSURED
COVERAGES
CERTIFICATE OF LIABILITY INSURANCE
Hooper, Lundy & Bookman, Inc
1875 Century Park East, suite 1600
Los Angeles CA 90067
DATE MMIDDIYYW)
07/02/2010
THIS CERTIFICATION IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE
j INSURER A. Truck Insurance Exchange
INSURER B
INSURER C
INSURER 0
INSURER E
NAIC #
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR ADD'
INSR
TYPE OFINSURANCE POLICY NUMBER T POLICY EFFECTIVE
DATE MMID POLICY EXPIRATION
DATE MM/DD/YY LIMITS
GENERAL LIABILITY 06/16/10 06/16/11 EACH OCCURRENCE $ 2,000,000
A
X
COMMERCIAL GENERAL LIABILITY 093971 7145 DAMAGE TO R
PREMISES Ea occurence
S 75,000
CLAIMS MADE OCCUR MED EXP Any one person) $ 5,000
PERSONAL & ADV INJURY $ 2,000,000
GENERAL AGGREGATE $ 4,000,000
GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS COMP/OP AGG $ 2,000,000
POLICY PRO-
JECT LOC
$
AUT OMOBILE LIABILITY 09391 71 45 06(16110 06116/11 COMBINED SINGLE LIMIT 2,000,000
A X ANY AUTO Ea accident)
ALL OWNED AUTOS BODILY INJURY
$
SCHEDULED AUTOS Per person) j
X HIRED AUTOS BODILY INJURY $
X NON-OWNED AUTOS Per accident)
PROPERTY DAMAGE $
Per accident)
GARAGE LIABILITY AUTO ONLY EA ACCIDENT $
ANY AUTO EAACC $
OTHER THAN
1 AUTO ONLY: AGG
EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $
7 OCCUR 17 CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE $
RETENTION $ $
RY
S O
WORKERS COMPENSATION AND TO
IMIT
ER
EMPLOYERS' LIABILITY
ACCIDENT $
E L. EACH
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? E.L. DISEASE EA EMPLOYEE S
It yes, describe under
DISEASE POLICY LIMIT
EL
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Law Firm The County of Monterey, its officers, agents and employees named as Additional Insured per attached endorsement
10 day notice of cancellation for non-payment of premium`"`
CERTIFICATE HOLDER
County of Monterey
Contracts/Purchasing Division
168 West Alisal Street 3rd Floor
Salinas CA 93901
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
I
ACORD 25 2001/08) ACORD CORPORATION 1988
BIB]
40387-U01
AGREEMENT-U02
NO.-U02
A-11786-U02
U02
HOOPER,-U02
LUNDY-U02
&-U02
BOOKMAN-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO89518-U03
MG89556-U03
AS89582-U03
AS89583-U03
AI93653-U03
DO93883-U03
C5-U03
AGREEMENTS-U03
7/28/2010-U04
RIVASR-U04
15342-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AGREEMENT-U07
HOOPER,-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
7/19/2010-U011
LUNDY-U012
&-U012
BOOKMAN-U012
INDEPENDENT-U012
CONSULTING-U012
LEGAL-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$100,000-U012
PERIOD-U012
APRIL-U012
1,-U012
2010-U012
TO-U012
MARCH-U012
31,-U012
2011.-U012
AGREEMENT NO. A-11786 - HOOPE��POLICY NUMBER: 09391 71 45
BUSINESSOWNERS
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED OWNERS, LESSEES
OR CONTRACTORS
This endorsement modifies insurance provided under the following:
BUSINESSOWNERS POLICY
SCHEDULE*
Name Of Person Or Organization:
COUNTY OF MONTEREY
SEE E0002
Information required to complete this Schedule, if not shown on this endorsement, will be shown in the
Declarations.
The following is added to Paragraph C. Who Is An
Insured in the Businessowners Liability Coverage
Form:
4. Any person or organization shown in the Sched-
ule is also an insured, but only with respect to
liability arising out of your ongoing operations
performed for that insured.
BP 04 50 01 97 Copyright, Insurance Services Office, Inc., 1997 Page 1 of I
BIB]
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AGREEMENT-U02
NO.-U02
A-11786-U02
U02
HOOPER,-U02
LUNDY-U02
&-U02
BOOKMAN-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO89518-U03
MG89556-U03
AS89582-U03
AS89583-U03
AI93653-U03
DO93883-U03
C5-U03
AGREEMENTS-U03
7/28/2010-U04
RIVASR-U04
15342-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AGREEMENT-U07
HOOPER,-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
7/19/2010-U011
LUNDY-U012
&-U012
BOOKMAN-U012
INDEPENDENT-U012
CONSULTING-U012
LEGAL-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$100,000-U012
PERIOD-U012
APRIL-U012
1,-U012
2010-U012
TO-U012
MARCH-U012
31,-U012
2011.-U012
AGREEMENT NO. A-11786 - HOOPE��ACORU� CERTIFICATE OF LIABILITY INSURANC DATE M
YY)
t
/2011 0
6/29/2010
PRODUCER Lockton Insurance Brokers, LLC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
725 S. Figueroa Street, 35th Fl.
Figueroa ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
CA License
#OF 15767 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Los Angeles CA 90017
213) 689-0065
INSURERS AFFORDING COVERAGE NAIC #
INSURED Hooper, Lundy & Bookman, PC INSURER A: Columbia Casualty Company 31127
1328923 1875 Century Park East #1600 INSURER B:
Los Angeles CA 90067
INSURER C:
INSURER 0:
INSURER E:
J
THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTR ACT BETWEEN THE ISSUIN
G
COVERAGES
HOOLUOI
NC
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR DD'
NSR
TYPE OF INSURANCE
POLICY NUMBER POLICY EFFECTIVE
DATE MMIDDNYYY POLICY EXPIRATION
DATE MM/DDIYYYY
LIMITS
GENERAL LIABILITY EACH OCCURRENCE S XXXXXXX
COMMERCIAL GENERAL LIABILITY
NOT APPLICABLE DAMAGE TO R
PREMISES EaEoccurrencti
S XXXXXXX
CLAIMS MADE M OCCUR MED EXP Any one person) S XXXXXXX
PERSONAL & ADV INJURY S XXXXXXX
GENERAL AGGREGATE $ XXXXXXX
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGG $ XXXXXXX
1 7 POLICY PRO LOC
JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ XXXXXXX
ANY AUTO NOT APPLICABLE Ea accident)
ALL OWNED AUTOS BODILY INJURY $ XXXXXXX
SCHEDULED AUTOS Per person)
HIRED AUTOS BODILY INJURY $ XXXXXXX
NON-OWNED AUTOS Per accident)
PROPERTY DAMAGE
H Per accident) $ xxxxxxx
GARAGE LIABILITY AUTO ONLY EA ACCIDENT S XXXXXXX
H ANY AUTO NOT APPLICABLE OTHER THAN EA ACC $ XXXXXXX
AUTO ONLY: AGG $ XXXXXXX
EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ XXXXXXX
OCCUR EICLAIMS MADE NOT APPLICABLE AGGREGATE $ XXXXXXX
$ XXXXXXX
UMBRELLA
DEDUCTIBLE FORM $ XXXXXXX
RETENTION $ S XXXXXXX
WORKERS COMPENSATION WC STATU- 0TH_
AND EMPLOYERS' LIABILITY NOT APPLICABLE TORY LIMITS ER
YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ XXXXXXX
OFFICER/MEMBER EXCLUDED?
Mandatory In NH)
E.L. DISEASE EA EMPLOYEE
$ XXXXXXX
It yes, describe under
SPECIAL PROVISIONS below
E.L. DISEASE POLICY LIMIT
$ XXXXXXX
A OTHER 198278282 6/16/2010 6/16/2011 Per Claim: $5,000,0000
Lawyers' Professional Aggregate S5,000,000
Liability Retention: $150,000 each claim
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Evidence of Coverage.
CERTIFICATE HOLDER
10923323
County of Monterey
168 W. Alisal St., 3rd Floor
Salinas CA 93901
ACORD 25 2009/01)
M8-200 ACORD CORPORATION- All rights reserved.
The ACORD name and logo are registered marks of ACORD
For questions regarding this certificate, contact the number listed In the Producer' section above and specify the client code HOOLUa1'.
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 80 SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUT7 E JAT
P-f
INSURERS AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER.
BIB]
40387-U01
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MAEGAN-U09
RUIZ-IGNACIOM-U10
7/19/2010-U011
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&-U012
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INDEPENDENT-U012
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LEGAL-U012
SERVICES-U012
AT-U012
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EXCEED-U012
$100,000-U012
PERIOD-U012
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1,-U012
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TO-U012
MARCH-U012
31,-U012
2011.-U012
AGREEMENT NO. A-11786 - HOOPE��STATE
COMPENSATION
I N S U R A N C E
FUND
ISSUE DATE: 06-29-2010
GROUP: 000388
POLICY NUMBER: 0000623-2010
CERTIFICATE ID: 45
CERTIFICATE EXPIRES: 04-01-2011
04-01-2010/04-01-2011
COUNTY OF MONTEREY Sc JOB:ALL CALIFORNIA LOCATIONS
168 W ALISAL ST 3RD FL
SALINAS CA 93901-2439
This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the
California Insurance Commissioner to the employer named below for the policy period indicated.
This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer.
We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration.
This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded
by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document
with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance
afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy.
ve.t
Interim President and CEO
EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS:
ENDORSEMENT #1600
ENDORSEMENT #1600
ENDORSEMENT #1600
ENDORSEMENT #1600
ENDORSEMENT #1600
ENDORSEMENT #1600
ENDORSEMENT #1600
ENDORSEMENT #1600
ENDORSEMENT #1600
ENDORSEMENT #1600
EMPLOYER
PATRIC HOOPER PRES EXCLUDED.
ROBERT W.LUNDY SEC EXCLUDED.
LLOYD A.BOOKMAN TRES EXCLUDED.
W.BRADLEY TULLY VP EXCLUDED.
JOHN HELLOW VP EXCLUDED.
JAY N.HARTZ VP EXCLUDED.
LARRY D.GETZOFF VP EXCLUDED.
BYRON J.GROSS VP EXCLUDED.
TODD E.SWANSON VP EXCLUDED.
DAVID P.HENNINGER VP EXCLUDED.
HOOPER, LUNDY & BOOKMAN, INC DBA: HOOPER, SC
LUNDY & BOOKMAN
1875 CENTURY PARK E STE 1600
LOS ANGELES CA 90087
$1,000,000 PER OCCURRENCE.
NDI,CNj
POLICYHOLDER COPY
Page 001 of 002
P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807
CERTIFICATE OF WORKERS' COMPENSATION INSURANCE
SC
REV. 1-2010) PRINTED 06-29-2010
BIB]
40387-U01
AGREEMENT-U02
NO.-U02
A-11786-U02
U02
HOOPER,-U02
LUNDY-U02
&-U02
BOOKMAN-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO89518-U03
MG89556-U03
AS89582-U03
AS89583-U03
AI93653-U03
DO93883-U03
C5-U03
AGREEMENTS-U03
7/28/2010-U04
RIVASR-U04
15342-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AGREEMENT-U07
HOOPER,-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
7/19/2010-U011
LUNDY-U012
&-U012
BOOKMAN-U012
INDEPENDENT-U012
CONSULTING-U012
LEGAL-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$100,000-U012
PERIOD-U012
APRIL-U012
1,-U012
2010-U012
TO-U012
MARCH-U012
31,-U012
2011.-U012
AGREEMENT NO. A-11786 - HOOPE��STATE
COMPENSATION
I N S U R A N C E
FUND
ISSUE DATE: 06-29-2010
GROUP: 000388
POLICY NUMBER: 0000623-2010
CERTIFICATE Q. 45
CERTIFICATE EXPIRES:04-01-2011
04-01-2010/04-01-2011
COUNTY OF MONTEREY SC JOB:ALL CALIFORNIA LOCATIONS
168 W ALISAL ST 3RD FL
SALINAS CA 93901-2439
ENDORSEMENT #1600 MARK E.REAGAN VP EXCLUDED.
ENDORSEMENT #1800 DARON L TOOCH VP EXCLUDED.
ENDORSEMENT #1600 GLENNE E SOLOMON VP EXCLUDED.
ENDORSEMENT #1600 CRAIG J CANNIZZO VP EXCLUDED.
ENDORSEMENT #1600 SCOTT J KIEPEN VP EXCLUDED.
ENDORSEMENT #1800 JOHNATHAN P NEUSTADTER VP EXCLUDED.
ENDORSEMENT #1600 CARY W MILLER VP EXCLUDED.
ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-01-2004 IS
ATTACHED TO AND FORMS A PART OF THIS POLICY.
EMPLOYER
HOOPER, LUNDY & BOOKMAN, INC DBA: HOOPER, SC
LUNDY & BOOKMAN
1875 CENTURY PARK E STE 1600
LOS ANGELES CA 90067
Page 002 of 002
POLICYHOLDER COPY
P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807
ADDENDUM TO PAGE 1
sc
NDI,CNI
PRINTED 06-29-2010
REV.2-05)
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40387-U01
AGREEMENT-U02
NO.-U02
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U02
HOOPER,-U02
LUNDY-U02
&-U02
BOOKMAN-U02
LI21329-U03
FO21330-U03
FO85769-U03
FO89518-U03
MG89556-U03
AS89582-U03
AS89583-U03
AI93653-U03
DO93883-U03
C5-U03
AGREEMENTS-U03
7/28/2010-U04
RIVASR-U04
15342-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
EXECUTE-U07
AGREEMENT-U07
HOOPER,-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
7/19/2010-U011
LUNDY-U012
&-U012
BOOKMAN-U012
INDEPENDENT-U012
CONSULTING-U012
LEGAL-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$100,000-U012
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APRIL-U012
1,-U012
2010-U012
TO-U012
MARCH-U012
31,-U012
2011.-U012
AGREEMENT NO. A-11786 - HOOPE��MONTEREY COUNTY
VENDOR REGISTRATION FORM
RETURN THIS FORM TO:
Contracts Purchasing Division 168 W. Alisal St.3rd Floor Salinas CA 93901
PH 831) 755 4990 FAX 831) 755-4969
BUSINESS NAME
Name 41t0? I L At4pJ e- b'MrvHA1')l P(',
OBA
TAXPAYER IDENTIFICATION Federal Emplo er ID No or Social Security No.
Enter Applicable Number) qS-4 a q BUSINESS ORGANIZATION 13J Corporation TATAA & Check one and follow President Vice President
the instructions.) R4 T 11, VuNDY' LLD i Y
Secretary Treasurer
Subsidiary of
Parent Company)
Partnership
Partner Name Partner Name
Partner Name Partner Name
Sole Proprietorship
Owner Name
dba if applicable):
BUSINESS LOCATION Street Address p p k 71 p
Must be Completed) I p 15-
CityStat Zip Code
ab7
PO Box if applicable) E-mail address
Telephone No.
13J-D SS--7
PAYMENT TERMS
Fax No.
3~b 551-811
Discounts Offered:
BUSINESS TYPE Retail Minority /Woman Owned
Check applicable boxes.) Wholesale Veteran Owned k Yv%
Distributor 9rftrBasfirezs
Manufacturer
*NOTE; If you checked Minority/Woman Owned or Small Business, please register into our Small/Local Business
Outreach Program Online at www.co.monterey.ca.us.!admin/outreach.htm
LICENSES Contractor's License No.
Revised 10/28,08 1
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FO21330-U03
FO85769-U03
FO89518-U03
MG89556-U03
AS89582-U03
AS89583-U03
AI93653-U03
DO93883-U03
C5-U03
AGREEMENTS-U03
7/28/2010-U04
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15342-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
TO-U07
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HOOPER,-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
7/19/2010-U011
LUNDY-U012
&-U012
BOOKMAN-U012
INDEPENDENT-U012
CONSULTING-U012
LEGAL-U012
SERVICES-U012
AT-U012
NMC-U012
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AN-U012
AMOUNT-U012
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2011.-U012
AGREEMENT NO. A-11786 - HOOPE��
m W-9 Request for Taxpayer Give form to the
or
Rev. October 2007) Identification Number and Certification requester. Do not
send to the IRS.
Department of the Treasury
eternal Revenue Service
Name s shown onJtour income tax retyirpl r- f 1 J t
a)
s
a Business name, if different from above
c
0
o c
Check appropriate box: Individual/Sole proprietor Corporation Partnership
Exempt
E) Limited liability company. Enter the tax classification D=disregarded entity, C=corporation, P=partnership) payee
0 2 Other see instructions)
Address V r, street, and apt. or sul no.)/~ Requester's name and address optional)
C y t r /
City, st. ate end ZJ~ ccc t /
S
S
J Vt/ii 1
L
U) t
V
List account number(s) here optional)
Part I
Taxpayer Identification Number TIN)
Social security number
Enter your TIN in the appropriate box. The TIN provided must match the name given on Line 1 to avoid
backup withholding. For individuals, this is your social security number SSN). However, for a resident
alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is
your employer identification number EIN). If you do not have a number, see How to get a TIN on page 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose
number to enter.
Part 11
Certification
or
Employer i4de tii!ficaf ti n hb
od r
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: a) I am exempt from backup withholding, or b) I have not been notified by the Internal
Revenue Service IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or c) the IRS has
notified me that I am no longer subject to backup withholding, and
3. I am a U.S. citizen or other U.S. person defined below).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply.
For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement
arrangement IRA), and generally, payments other than interest and dividends, you are not required to sign the Certification, but you must
provide your correct TIN. See the instructions on page 4.
Sign
Here
General Instructions
Section references are to the Internal Revenue Code unless
otherwise noted.
Purpose of Form
A person who is required to file an information return with the
IRS must obtain your correct taxpayer identification number TIN)
to report, for example, income paid to you, real estate
transactions, mortgage interest you paid, acquisition or
abandonment of secured property, cancellation of debt, or
contributions you made to an IRA.
Use Form W-9 only if you are a U.S. person including a
resident alien), to provide your correct TIN to the person
requesting it the requester) and, when applicable, to:
1. Certify that the TIN you are giving is correct or you are
waiting for a number to be issued),
2. Certify that you are not subject to backup withholding, or
3. Claim exemption from backup withholding if you are a U.S.
exempt payee. If applicable, you are also certifying that as a
U.S. person, your allocable share of any partnership income from
a U.S. trade or business is not subject to the withholding tax on
foreign partners' share of effectively connected income.
Note. If a requester gives you a form other than Form W-9 to
request your TIN, you must use the requester's form if it is
substantially similar to this Form W-9.
Signature of
U.S. person
j' Date 12,311A I t3
Definition of a U.S. person. For federal tax purposes, you are
considered a U.S. person if you are:
An individual who is a U.S. citizen or U.S. resident alien,
A partnership, corporation, company, or association created or
organized in the United States or under the laws of the United
States,
An estate other than a foreign estate), or
A domestic trust as defined in Regulations section
301.7701-7).
Special rules for partnerships. Partnerships that conduct a
trade or business in the United States are generally required to
pay a withholding tax on any foreign partners' share of income
from such business. Further, in certain cases where a Form W-9
has not been received, a partnership is required to presume that
a partner is a foreign person, and pay the withholding tax.
Therefore, if you are a U.S. person that is a partner in a
partnership conducting a trade or business in the United States,
provide Form W-9 to the partnership to establish your U.S.
status and avoid withholding on your share of partnership
income.
The person who gives Form W-9 to the partnership for
purposes of establishing its U.S. status and avoiding withholding
on its allocable share of net income from the partnership
conducting a trade or business in the United States is in the
following cases:
The U.S. owner of a disregarded entity and not the entity,
Cat. No. 10231X Form W-9 Rev. 10-2007)
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FO21330-U03
FO85769-U03
FO89518-U03
MG89556-U03
AS89582-U03
AS89583-U03
AI93653-U03
DO93883-U03
C5-U03
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7/28/2010-U04
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15342-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
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CENTER-U07
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TO-U07
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AGREEMENT-U07
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960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
RUIZ-IGNACIOM-U10
7/19/2010-U011
LUNDY-U012
&-U012
BOOKMAN-U012
INDEPENDENT-U012
CONSULTING-U012
LEGAL-U012
SERVICES-U012
AT-U012
NMC-U012
IN-U012
AN-U012
AMOUNT-U012
TO-U012
EXCEED-U012
$100,000-U012
PERIOD-U012
APRIL-U012
1,-U012
2010-U012
TO-U012
MARCH-U012
31,-U012
2011.-U012
AGREEMENT NO. A-11786 - HOOPE��MONTEREY COUNTY
VENDOR REGISTRATION FORM
RETURN THIS FORM TO:
Contracts Purchasing Division 168 W. Alisal St.3rd Floor Salinas CA 93901
PH(831)755-4990 FAX(831)755-4969
Carefully examine the List of Commodities". List the DESCRIPTION and NUMERIC CODE of each Commodity
product &/or Service(s)] that you wish to provide the county. See NIGP Commodity Codes on our web site)
Numeric Code Description
r"r'~'
1 p l 1
4y jbV11
2
3
4
3
A*rl^4r-
4
5 5
6 6
7 7
8 8
9 9
10 10
Use the spaces below for Commodities / Merchandise not listed OR to clarify a commodity you have already selected.
Please feel free to attach any additional information you would like us to have. ie. Brochures, Line Cards, etc...
PREPARED BY: Printed I Npmei K A
Signature
PriN / Type,Fi Title fQ f
Telephone No. Date
c3 /LAt o
310)9-f f417
Revised 10/28/08 2
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LI21329-U03
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FO85769-U03
FO89518-U03
MG89556-U03
AS89582-U03
AS89583-U03
AI93653-U03
DO93883-U03
C5-U03
AGREEMENTS-U03
7/28/2010-U04
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15342-U05
1-U06
AUTHORIZE-U07
PURCHASING-U07
MANAGER-U07
NATIVIDAD-U07
MEDICAL-U07
CENTER-U07
NMC)-U07
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HOOPER,-U07
960-NMC-U08
RUIZ-IGNACIO-U09
MAEGAN-U09
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7/19/2010-U011
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