File #: 10-871    Name:
Type: Minutes Status: Passed
File created: 7/27/2010 In control: Board of Supervisors
On agenda: 7/27/2010 Final action: 7/27/2010
Title: Authorize the Purchasing Manager for Natividad Medical Center (NMC) to execute the Agreement with Hooper, Authorize the Purchasing Manager for Natividad Medical Center (NMC) to execute the Agreement with Hooper,
Attachments: 1. Completed Board Order, 2. Signed Board Report, 3. Agreement No. A-11786 - Hooper, Lundy & Bookman

 

 

 

 

 

 

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

h--

 

 

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e7cricr'aiiir'rrv}f}'hftfrii-ic-.--- u,z

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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

PSA 5100,000 or Less, Revised 10/09/08 3 of 8 Project ID:

 

 

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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

PSA $100,000 or Less, Revised 10/09/08 5 of 8 Project ID:

 

 

BIB]

 

40387-U01

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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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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.

 

 

BIB]

 

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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

 

 

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��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]

 

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��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

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

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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 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)

 

 

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��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

 

 

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��

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)

 

 

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

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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��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

 

 

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