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HomeMy WebLinkAboutC2014-430 - 11/17/2014 - NA RANDOM LIST GENERATION SERVICES AGREEMENT THIS RANDOM LIST GENERATION SERVICES AGREEMENT ("Agreement") is entered by and between the City of Corpus Christi, Texas, a Texas home rule municipal corporation ("City") and Lovvorn & Kieschnick, LLP, a Texas Limited Liability Partnership ("Provider") effective for all purposes the 1St day of September, 2014. 1.1 SERVICES. The Provider hereby agrees to perform the services described in this Agreement as an independent contractor for the City for those employee positions in the City subject to random drug and alcohol testing pursuant to the City's Alcohol and Drug Policies. Such services shall include the following: (a) Up-to-Date Lists The City's Director of Human Resources or designee ("Director") will give the Provider up-to-date lists each month of all employees in each department. Each list of those to be tested and alternates must be generated by Provider without "flags" to any employee as to when a list may be forthcoming. The term, "designee," in this paragraph includes the City's Police and Fire Chiefs. The list of fire stations and shifts within stations will not be given to the Provider monthly. The Provider will continue to use the last list submitted by the Fire Chief until the number of fire stations and/or shifts changes and a new list is submitted by the Fire Chief. Where questions or problems arise related to the list generation process, the Director must be consulted immediately. (b) Method of Delivery The Provider must have a fax machine and an e-mail address so that timely updates can be received. The Director will submit current monthly list information of all employees to be tested to the Provider by facsimile, e-mail, regular mail, or courier. These current lists will be used by the Provider to compile random lists of employees to be tested and random lists of alternates from each pool designated by the Director. The Provider must ensure that all random testing lists for the City are securely delivered to the Director by facsimile, e-mail, regular mail, or courier, or as otherwise directed in writing by the Director. This must be accomplished in a confidential manner using a means which protects the integrity of the lists and prohibits any other personnel from seeing them. 2014-430 11/17/14 1 of 16 Lovvorn & Kieschnick LLP INDEXED (c) Fees and Changes in Number of Pools The City must have flexibility to include contractors and subcontractors in the random testing program if they do not have their own program in compliance with City regulations. Attachment I to this Agreement (Fees) is designed to incorporate changes in the number of pools needing random lists and changes in the number of employees on each list without amending the Agreement or Attachment I. The number of pools may be changed upon written notification from the Director. The only time Attachment I will need to be amended is upon renewal or extension of the Agreement when increased fees not to exceed the Consumer Price Index as of December of the previous year may be charged as described in Section 2.1 of this Agreement. (d) Random-Generated Lists by ID The Provider will generate separate lists of randomly selected employees from the appropriate designated pools to be selected by a computer-based random number generator that is matched with each employee's City identification number. Regardless of the number of times a random list is generated from a specific pool, ALL covered employees are to be included in the random list pool each time a list is generated. ALL employees will continue to have a statistically equal chance of designation for testing each time a list is generated. (e) Percentages The Provider will generate random lists to meet the percentages of annual random testing requirements established in the City's Drug and Alcohol Testing Policies. Percentages are to be prorated over a twelve (12) month period. Required percentages may change as dictated annually by City regulations. These percentages will be communicated to the Provider but are not given in this Agreement. A pre-set percentage of employees will be randomly selected allowing an excess over the actual number needed to meet the required percentages. Selection of a greater number of employees for each list enables the City to reach the appropriate annualized rate despite employee unavailability for testing due to vacations, medical leave, or travel requirements even though Provider will furnish a number of randomly selected alternates for each list (except the Fire Department which tests "shifts" instead of "selected employees"). The Provider will be responsible for monitoring the number of employees to be tested on each monthly list to ensure that the annualized percentage rate is reached. (f) Formatting Lists provided for testing pools must include each employee's full name and City identification number sorted alphabetically, primarily by Department Names, secondarily by Job Titles (when available), and thirdly by Employees' Names. Each list will be formatted to include an area for comments under or beside each name for the Director to 2 of 16 indicate the reason for an employee not being available for testing. The format for lists is subject to approval by the Director. (g) Day and Week Selection The day of the week and week of the month the list is generated, shall be randomly selected by the list Provider. A minimum of twelve (12) lists per year will be required per pool. Only in extreme, unforeseen circumstances agreed to by both the Provider and the City will a month of testing be omitted and the required yearly percentage be met by adjusting the number tested in succeeding months. (h) Maintaining Records The Provider must maintain records for five (5) years after this Agreement terminates, which are related to maintenance and preparation procedures and copies of all lists generated which are to be available for review by the City's City Manager, or designee ("City Manager") and the Director for the purpose of monitoring the City's compliance with all city policy drug and alcohol testing regulations. (i) Confidentiality The Provider must maintain confidentiality regarding all affected employees and the lists generated, and when the lists are to be generated. (j) No Ties The Provider must ensure that individuals involved in the list compilation and generation process have no ties to or relationship with any employee in any of the pools. (k) Legal Testimony The Provider shall designate knowledgeable personnel ("Agent") to provide information to the City Manager and the Director and to testify in legal depositions, arbitration, courtroom, or Civil Service testimony as required by the City Manager in connection with related grievances, arbitrations, claims, and lawsuits involving the City's use of the random lists. The Agent's testimony, both in preparation for any proceeding and at the actual proceeding itself, which concerns any drug and alcohol random list provided by the Provider or the Agent is the essence of this Agreement ("Testimony"). Testimony from the Agent is absolutely essential for the City to defend any grievance, arbitration, or lawsuit that results from any Donor (defined below) challenging City's actions based on the results of that Donor's drug or alcohol specimen. The failure of the Provider or the Agent to appear in person to provide Testimony for any proceeding is grounds for the City Manager to terminate this Agreement, or alternatively, require the Provider to pay all of the City's costs in preparing for and defending said proceeding. At a minimum the costs of a proceeding include all legal staff time (attorney's time will be billed at standard community rates for attorneys of comparable experience; secretarial and paralegal time will be billed at standard community rates for secretaries and paralegals of comparable experience; copies made for exhibits prepared for the proceeding will be billed at standard rates) and costs, all Human Resources staff time and costs, all staff time and 3 of 16 costs for the department whose employee or applicant ("Donor") caused the proceeding to occur, including overtime costs in the case of Police and Fire Departments, and all expert witness fees, including the cost of any arbitrator's fees. The City's costs in an arbitration proceeding that is decided against the City include all the arbitration costs. 1.2 INDEPENDENT CONTRACTOR. The Provider shall perform the services hereunder as an independent contractor and shall furnish such services in its own manner and method, and under no circumstances or conditions will any agent, servant, or employee of the Provider be considered as an employee of the City. 1.3 USE OF SUB-CONTRACTORS. The Provider may use subcontractors in connection with the work performed under this Agreement. When using subcontractors, however, the Provider must obtain prior written approval from the Director. In using subcontractors, the Provider agrees to be responsible for all their acts and omissions to the same extent as if the subcontractor and its employees were employees of the Provider. All requirements set forth as part of this Agreement must be applicable to all subcontractors and their employees to the same extent as if the Provider and its employees had performed the services. 1.4 CONTRACT ADMINISTRATOR. The Contract Administrator designated by the City Manager is the person with authority to approve all phases of performance and operations under this Agreement including deductions for nonperformance and authorizations for payment. All notices or communications regarding this Agreement must be directed to the Contract Administrator. The Director is designated as the Contract Administrator for this Agreement. 2.1 FEES. The Provider's fees shall be as set out in Attachment I, except that if this Agreement is renewed, an increased fee, not to exceed the Consumer Price Index ("CPI") as of December of the previous year, per renewal, may be charged. If an increased fee is charged, a new Attachment I showing the increased fees will be attached to this Agreement and will become Attachment I. 3.1 TERM. The term of this Agreement is for one (1) year with one (1) one-year optional renewal period. If the City wishes to renew this Agreement, the Director shall notify the Provider of the City's 4 of 16 request at least thirty (30) days prior to expiration of the original term or any extension. The Provider may renew this Agreement for the same fee or may request a fee increase not to exceed the CPI in effect as of December of the previous year for the renewal period. A fee increase in excess of the CPI will be treated as the Provider's refusal to renew. If the Provider requests a fee increase, the Director may agree to it or may withdraw the City's request for renewal. If this Agreement is not renewed, or if a new service agreement is not in place at the expiration of the original term or any extension of this Agreement, the Provider shall continue to perform under the same terms, on a month-to-month basis not to exceed twelve (12) months from expiration of this Agreement. The fees for the services provided in such case would be the most current fee plus the current CPI. 3.2 RIGHT TO TERMINATE. The City may terminate the Agreement at any time with or without cause by sending written notice of cancellation by certified mail, return receipt requested, to the Provider. Upon receipt of such notice, the Provider shall immediately discontinue all services and work and the placing of all orders or the entering of contracts for supplies, assistance, facilities and material in connection with the performance of the Agreement and shall proceed to cancel all existing contracts insofar as they are chargeable to this Agreement between the City and the Provider. If the City terminates its Agreement under the foregoing paragraph, the City shall pay the Provider for services actually performed prior to such termination, less such payments as have been previously made. The Provider shall not be entitled to any further compensation for work performed by the Provider or anyone under its control or direction from the date of receipt of notice of cancellation. 3.3 RECORDS UPON TERMINATION. Upon termination of the Agreement, the Provider shall provide the City reproducible copies of all completed work or partially completed documents prepared under the Agreement, all such documents thereafter being owned by the City within thirty (30) days of such termination. The Provider must maintain all books, records, and other evidence pertaining to the services performed under this Agreement for five (5) years. All such records and files and such other materials shall be made available to the City Manager at all reasonable times during the term of this Agreement for inspection or audit by the City Manager. 4.1 INSURANCE. The Provider will maintain the respective insurance coverages described in the Insurance Requirements, Attachment III. 5 of 16 4.2 APPLICABLE LAWS AND VENUE. This Agreement is made subject to all applicable federal and state laws and all applicable rules and regulations promulgated by all local, state and federal agencies. This Agreement will be enforced in Nueces County, Texas, and must be governed by and construed in accordance with the laws of the State of Texas, since the Agreement was executed and will be performed in Nueces County, Texas. 4.3 LEGISLATIVE MODIFICATION. Notwithstanding any other provision to the contrary, in the event any federal, state or local law, rule, regulation or interpretation thereof at any time during the term of this Agreement prohibits, restricts or in any way materially changes the method or amount of reimbursement or payment for services under this Agreement, then this Agreement shall, in good faith, be amended by the parties to provide for payment of compensation in a manner consistent with any such prohibition, restriction or limitation; otherwise, this Agreement shall remain in full force and effect. With respect to any other prohibition, restriction or change that causes this Agreement to be impermissible or materially different in its effect than contemplated herein, the parties hereto will, in good faith, negotiate and amend this Agreement to cause their relationship to be as consistent as possible with that which is created herein; if this Agreement is not so amended in writing prior to the effective date of said prohibition, restriction or change, this Agreement shall terminate, unless otherwise agreed upon in writing. 4.4 WHOLE AGREEMENT. This Agreement contains all commitments and agreements of the parties hereto, superseding any previous agreements between the parties, and no modifications to this Agreement may be made except by written amendment executed by duly authorized representatives of the parties hereto. 4.5 NON-ASSIGNMENT. This Agreement must not be assigned or transferred by the Provider without the prior written consent of the City. The Provider shall at all times be solely responsible for the provision of the services and the competency of services provided hereunder, whether accomplished through its officers and employees or through its agents or subcontractors. The performance of this Agreement by the Provider is the essence of this Agreement and the City's right to withhold consent to such assignment shall be within the sole discretion of the City on any grounds whatsoever. 6 of 16 4.6 INDEMNIFICATION. THE PROVIDER SHALL FULLY INDEMNIFY, SAVE, AND HOLD HARMLESS THE CITY, ITS OFFICERS, EMPLOYEES, REPRESENTATIVES, AND AGENTS (COLLECTIVELY, "INDEMNITEES") AGAINST ANY AND ALL LIABILITY, DAMAGE, LOSS, CLAIMS, DEMANDS, AND ACTIONS OF ANY NATURE WHATSOEVER ASSERTED AGAINST OR RECOVERED FROM THE CITY ON ACCOUNT OF PERSONAL INJURIES INCLUDING, WITHOUT LIMITATION OF THE FOREGOING, WORKERS' COMPENSATION AND DEATH CLAIMS, PROPERTY LOSS OR DAMAGE OF ANY KIND, OR ANY OTHER KIND OF DAMAGES WHICH ARISE OUT OF, ARE CLAIMED TO ARISE OUT OF, OR ARE CLAIMED IN CONNECTION WITH THE PROVIDER'S NEGLIGENCE OR WILLFUL ACTS OR OMISSIONS WHILE IN PERFORMANCE OF THIS AGREEMENT AND INCLUDING ALL EXPENSES OF LITIGATION, COURT COSTS, AND ATTORNEYS' FEES WHICH ARISE OUT OF THE ASSERTED OR RECOVERED INCIDENT. THE TERMS OF THIS INDEMNIFICATION ARE EFFECTIVE WHETHER THE INJURY, LOSS, OR DAMAGE MAY RESULT FROM THE SOLE NEGLIGENCE, CONTRIBUTORY NEGLIGENCE, OR CONCURRENT NEGLIGENCE OF THE INDEMNITEES OR ANY OF THEM. THE PROVIDER COVENANTS AND AGREES THAT, IF THE CITY IS MADE A PARTY TO ANY LITIGATION AGAINST THE PROVIDER OR IN ANY LITIGATION COMMENCED BY ANY PARTY OTHER THAN THE PROVIDER RELATING TO THIS AGREEMENT, THE PROVIDER SHALL, UPON RECEIPT OF REASONABLE NOTICE REGARDING COMMENCEMENT OF LITIGATION AND AT ITS OWN EXPENSE, INVESTIGATE ALL CLAIMS AND DEMANDS, ATTEND TO THEIR SETTLEMENT OR OTHER DISPOSITION, DEFEND THE CITY IN ALL ACTIONS BASED THEREON WITH LEGAL COUNSEL ACCEPTABLE TO THE CITY, AND PAY ALL CHARGES OF ATTORNEYS AND ALL OTHER COSTS AND EXPENSES OF ANY KIND WHATSOEVER ARISING FROM ANY SAID LIABILITY, DAMAGE, LOSS, DEMAND, CLAIM, OR ACTION. NOTICE: THE DIRECTOR SHALL PROMPTLY NOTIFY THE PROVIDER IN WRITING OF ANY CLAIM ASSERTED AGAINST THE CITY FOR WHICH SUCH INDEMNIFICATION IS SOUGHT, AND SHALL PROMPTLY DELIVER TO PROVIDER A TRUE COPY OF ANY SUCH CLAIM INCLUDING, BUT NOT LIMITED TO, A TRUE COPY OF ANY SUMMONS OR OTHER PROCESS, PLEADING OR NOTICE ISSUED IN ANY LAWSUIT OR OTHER PROCEEDING TO ASSERT OR ENFORCE SUCH CLAIM. WHERE ACCEPTANCE OF ITS OBLIGATION TO INDEMNIFY IS DEEMED PROPER BY THE PROVIDER, THE CITY RESERVES THE RIGHT TO CONTROL THE INVESTIGATION, TRIAL AND DEFENSE OF SUCH LAWSUIT OR ACTION (INCLUDING ALL NEGOTIATIONS TO EFFECT 7of16 SETTLEMENT) AND ANY APPEAL ARISING THERE FROM AND TO EMPLOY OR ENGAGE ATTORNEYS OF ITS OWN CHOICE. THE CITY MAY, AT ITS OWN COST, PARTICIPATE IN SUCH INVESTIGATION, TRIAL AND DEFENSE OR SUCH LAWSUIT OR ACTION AND ANY APPEAL ARISING THERE FROM. THE INDEMNITEES SHALL PROVIDE FULL COOPERATION TO THE PROVIDER AT ALL TIMES DURING THE PENDENCY OF THE CLAIM OR LAWSUIT, INCLUDING, WITHOUT LIMITATION, PROVIDING THE PROVIDER WITH ALL AVAILABLE INFORMATION CONCERNING THE CLAIMS. 4.7 NON APPROPRIATION. The continuation of this Agreement after the close of any fiscal year of the City, which fiscal year ends on July 31 annually, is subject to appropriations and budget approval covering this Agreement as an expenditure in said budget; however, it's within the sole discretion of the City Council of the City to determine whether to fund this Agreement. The City does not represent that this budget item will be adopted, as said determination is within the City Council's sole discretion when adopting each budget. 4.8 NOTICE. Any notice required herein must be sent by certified mail, fax, overnight mail, e-mail, or personal delivery. All forms of delivery will be deemed received on the day the receipt is acknowledged in writing by the recipient. Any change of address shall be included in this "Notice" requirement. All notice must be sent as follows: IF TO CITY: IF TO PROVIDER: Designee Designee (currently: Tina Belock Janice Prewit E-Mail: TinaB@cctexas.com E-mail: iprewit@cpalk.net) or or Yasmine Chapman Director of Human Resources Michael Kieschnick, CPA City of Corpus Christi Lovvorn & Kieschnick, LLP P.O. Box 9277 418 Peoples St., Suite 308 Corpus Christi, Texas 78469-9277 Corpus Christi, Texas 78401 Fax No. (361) 880-3322 Phone: (361) 884-8897; Fax: 884-3457 E-mail: YasmineC@cctexas.com E-mail: mkieschnick@cpalk.net 8 of 16 4.9 DISCLOSURE OF INTERESTS. In compliance with Section 2-349 of the City's Code of Ordinances, the Provider shall complete the City's Disclosure of Interests form, which is attached to this Agreement as ATTACHEMNT IV, the contents of which, as a completed form, are incorporated in this document by reference as if fully set out in this Agreement. Executed in duplicate this the (h1' ` day of littikkaat. 2014. CITY OF CORPUS CHRISTI BY: atUflk-- Alma Casas Assistant Director of Financial Services Legal form approved on I V`y"ef` 6t 1 7 I 2014; BY: 1146k v& Buck Brice Assistant City Attorney For City Attorney LOVVORN & KIESCHNICK, LLP • BY: / 4141/11 .—"11011.11W Michael Kieschnick, CPA, Partner 9 of 16 ATTACHMENT I FEE SCHEDULE FOR RANDOM LIST GENERATION SERVICES AGREEMENT Between the City of Corpus Christi, Texas and Lovvorn& Kieschnick, LLP Effective September 1, 2014 The following fee schedule will apply to all random selection pools: $ 50.00 Per list generated $ 0.21 Per employee $150.00 Per hour—deposition/testimony services 10 of 16 ATTACHMENT II ROSTER OF CONTACT PERSONS 1. CITY OF CORPUS CHRISTI Yasmine Chapman Robert Rocha, Fire Chief Director of Human Resources Fire Department P.O. Box 9277 (78469) City of Corpus Christi 1201 Leopard 78401 2406 Leopard Street Corpus Christi, TX Corpus Christi, TX 78408 (361) 826-3300 (361) 826-3932 E-mail: YasmineC@cctexas.com E-mail: RRocha@cctexas.com Designee: Tina Belock Designee: Rick Ramos E-mail: TinaB@cctexas.com E-mail: RickR@cctexas.com Phone: 361-826-3309 Phone: (361) 826-3938 Debra Marroquin Floyd Simpson, Police Chief Gas Superintendent Police Department City of Corpus Christi City of Corpus Christi P.O. Box 9277 (78469) P.O. Box 9277 4225 S. Port Corpus Christi, TX 78469 Corpus Christi, TX (361) 886-2600 (361) 885-6924 E-mail: FloydS@cctexas.com E-mail: DebbieM@cctexas.com Designee: Designee: Tina Belock Designee: Anthony Sanders E-mail: TinaB@cctexas.com E-mail: AnthonyS@cctexas.com Phone: 361-826-3309 Phone: 461-4628 2. LOVVORN & KIESCHNICK, LLP Michael Kieschnick, CPA, Partner 418 Peoples Street, Suite 308 Corpus Christi, TX 78401 (361) 884-8897 E-mail: mkieschnick@cpalk.net Designee: Janice Prewit E-mail: jprewit@cpalk.net Phone: (361) 884-8897 Information on this roster of contact persons may be changed as stated in Section 4.8 NOTICE of this Agreement. 11 of 16 ATTACHMENT III INSURANCE REQUIREMENTS PROPOSER'S LIABILITY INSURANCE A. Proposer must not commence work under this agreement until all insurance required has been obtained and such insurance has been approved by the City. Proposer must not allow any subcontractor to commence work until all similar insurance required of any subcontractor has been obtained. B. Proposer must furnish to the City's Risk Manager, and Director of Human Resources, 2 copies of Certificates of Insurance with applicable policy endorsements showing the following minimum coverage by an insurance company(s) acceptable to the City's Risk Manager. The City must be listed as an additional insured on the General liability policy, and a blanket waiver of subrogation is required on all applicable policies. TYPE OF INSURANCE MINIMUM INSURANCE COVERAGE 30-written day notice of cancellation, Bodily Injury and Property Damage required on all certificates or by applicable Per occurrence - aggregate policy endorsements Commercial General Liability including: $1,000,000 Per Occurrence 1. Commercial Broad Form 2. Premises—Operations 3. Products/Completed Operations 4. Contractual Liability 5. Independent Contractors 6. Personal Injury-Advertising Injury AUTO LIABILITY (including) $1,000,000 Combined Single Limit 1. Owned 2. Hired and Non-Owned PROFESSIONAL LIABILITY $1,000,000 Per Claim—Aggregate If claims made, policy needs 24-month extension period post-termination or expiration date. Defense costs shall not be included in limit of liability. 12 of 16 WORKERS' COMPENSATION Applicable when on City Property Which Complies With The Texas Workers' Compensation Act And Section II Of This Exhibit. All states endorsement required if not domiciled in Texas. EMPLOYERS' LIABILITY $500,000/$500,000 /$500,000 C. In the event of accidents of any kind related to this lease agreement, Proposer must furnish the Risk Manager with copies of all reports of any accidents within 10 days of the accident. II. ADDITIONAL REQUIREMENTS A. Applicable for paid employees, Proposer must obtain workers' compensation coverage through a licensed insurance company. The coverage must be written on a policy and endorsements approved by the Texas Department of Insurance. The workers' compensation coverage provided must be in an amount sufficient to assure that all workers' compensation obligations incurred by the Proposer will be promptly met. B. Proposer shall obtain and maintain in full force and effect for the duration of this Contract, and any extension hereof, at Proposer's sole expense, insurance coverage written on an occurrence basis, by companies authorized and admitted to do business in the State of Texas and with an A.M. Best's rating of no less than A- VII. C. Proposer shall be required to submit a copy of the replacement certificate of insurance to City at the address provided below within 10 days of any changes to polices. Proposer shall pay any costs incurred resulting from said changes. All notices under this Article shall be given to City at the following address: City of Corpus Christi Attn: Risk Manager P.O. Box 9277 Corpus Christi, TX 78469-9277 D. Proposer agrees that with respect to the above required insurance, all insurance policies are to contain or be endorsed to contain the following required provisions: • List the City and its officers, officials, employees, volunteers, and elected representatives as additional insured by endorsement, as respects operations and activities of, or on 13 of 16 behalf of, the named insured performed under contract with the City, with the exception of the workers' compensation policy; • Provide for an endorsement that the "other insurance" clause shall not apply to the City of Corpus Christi where the City is an additional insured shown on the policy; • Workers' compensation and employers' liability policies will provide a waiver of subrogation in favor of the City; and • Provide thirty (30) calendar days advance written notice directly to City of any suspension, cancellation, non-renewal or material change in coverage, and not less than ten(10) calendar days advance written notice for nonpayment of premium. E. Within five (5) calendar days of a suspension, cancellation, or non-renewal of coverage, Proposer shall provide a replacement Certificate of Insurance and applicable endorsements to City. City shall have the option to suspend Proposer's performance should there be a lapse in coverage at any time during this contract. Failure to provide and to maintain the required insurance shall constitute a material breach of this contract. F. In addition to any other remedies the City may have upon Proposer's failure to provide and maintain any insurance or policy endorsements to the extent and within the time herein required, the City shall have the right to order Proposer to stop work hereunder, and/or withhold any payment(s) which become due to Proposer hereunder until Proposer demonstrates compliance with the requirements hereof. G. Nothing herein contained shall be construed as limiting in any way the extent to which Proposer may be held responsible for payments of damages to persons or property resulting from Proposer's or its subcontractor's performance of the work covered under this agreement. H. It is agreed that Proposer's insurance shall be deemed primary and non-contributory with respect to any insurance or self insurance carried by the City of Corpus Christi for liability arising out of operations under this agreement. I. It is understood and agreed that the insurance required is in addition to and separate from any other obligation contained in this agreement. 2014 Insurance Requirements Human Resources Dept. Drug and Alcohol Testing & Medical Services RFP 10/1/2014 ds Risk Management 14 of 16 SUPPLIER NUMBER it;ii TO BE ASSIGNED BY CITY PURCHASING DIVISION ATTACHMENT IV City of C rpu CITY OF CORPUS CHRISTI DISCLOSURE OF INTEREST Corpus Christi Code § 2-349, as amended, requires all persons or firms seeking to do business with the City to provide the following information. Every question must be answered. If the question is not applicable, answer with "NA". See next page for Filing Requirements, Certification and Definitions. COMPANY NAME: Lovvorn & Kieschnick, LLP STREET ADDRESS: 418 Peoples Street, Suite 308 P.O. BOX: CITY: Corpus Christi STATE: TX ZIP: 78401 FIRM IS: 1. Corporation ❑ 2. Partnership ❑ 3. Sole Owner ❑ 4. Association ❑ 5. Other X Limited Liability Partnership If additional space is necessary, please use the reverse side of this page or attach separate sheet. 1. State the names of each "employee" of the City of Corpus Christi having an "ownership interest" constituting 3% or more of the ownership in the above named "firm." Name Job Title and City Department (if known) N/A N/A N/A N/A N/A N/A N/A N/A 2. State the names of each "official" of the City of Corpus Christi having an "ownership interest" constituting 3% or more of the ownership in the above named "firm." Name Title N/A N/A N/A N/A N/A N/A N/A N/A 3. State the names of each "board member" of the City of Corpus Christi having an "ownership interest" constituting 3% or more of the ownership in the above named "firm." Name Board, Commission or Committee N/A N/A N/A N/A N/A N/A N/A N/A 4. State the names of each employee or officer of a "consultant" for the City of Corpus Christi who worked on any matter related to the subject of this contract and has an "ownership interest" constituting 3% or more of the ownership in the above named "firm." Name Consultant N/A N/A N/A N/A N/A N/A N/A N/A 15 of 16 FILING REQUIREMENTS If a person who requests official action on a matter knows that the requested action will confer an economic benefit on any City official or employee that is distinguishable from the effect that the action will have on members of the public in general or a substantial segment thereof, you shall disclose that fact in a signed writing to the City official, employee or body that has been requested to act in the matter, unless the interest of the City official or employee in the matter is apparent. The disclosure shall also be made in a signed writing filed with the City Secretary. [Ethics Ordinance Section 2-349 (d)]. CERTIFICATION I certify that all information provided is true and correct as of the date of this statement, that I have not knowingly withheld disclosure of any information requested, and that supplemental statements will be promptly submitted to the City of Corpus Christi, Texas, as changes occur. Certifying Person: Michael Kieschnick Title: Partner Signature of : ate: Certifying Person: / _ 11/4/14 DEFINITIONS a. "Board member." A member of any board, commission, or committee of the city, including the board of any corporation created by the city. b. "Economic benefit". An action that is likely to affect an economic interest if it is likely to have an effect on that interest that is distinguishable from its effect on members of the public in general or a substantial segment thereof. c. "Employee." Any person employed by the city, whether under civil service or not, including part- time employees and employees of any corporation created by the city. d. "Firm." Any entity operated for economic gain, whether professional, industrial or commercial, and whether established to produce or deal with a product or service, including but not limited to, entities operated in the form of sole proprietorship, as self-employed person, partnership, corporation, joint stock company, joint venture, receivership or trust, and entities which for purposes of taxation are treated as non-profit organizations. e. "Official." The Mayor, members of the City Council, City Manager, Deputy City Manager, Assistant City Managers, Department and Division Heads, and Municipal Court Judges of the City of Corpus Christi, Texas. f. "Ownership Interest." Legal or equitable interest, whether actually or constructively held, in a firm, including when such interest is held through an agent, trust, estate, or holding entity. "Constructively held" refers to holdings or control established through voting trusts, proxies, or special terms of venture or partnership agreements. g. "Consultant." Any person or firm, such as engineers and architects, hired by the City of Corpus Christi for the purpose of professional consultation and recommendation. 16 of 16 1 AD® CERTIFIDATE(MM/DDIYYYY) WR �t,:ATE OF LIABILITY INSUKANCE 07/08/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Eddie Martinez Eddie Martinez Agency, Inc DBA Allstate NC , NN,Ej; 3619936638 Ia,c`,Ne)3619939047 4942 Everhart Rd at DRIESs: eddiemartinez@allstate.com Corpus Christi, Texas 78411 INSURER(S)AFFORDING COVERAGE 1 NAIC# INSURER A: Allstate INSURED INSURER B: Loworn & Kieschnick LLP INSURER C: 418 Peoples St. Ste#308 INSURER D: Corpus Christi, Texas 78401 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR • POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MILD ) (MMIDDlYYYYL LIMITS GENERAL LIABILITY I 648640982 07/08/2014 i 07/08/2015 EACH OCCURRENCE ti $2,000,000 DAMAGE TO RENTED K COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $50,000 CLAIMS-MADE I OCCUR i I MED EXP(Any one person) $10,000 H PERSONAL&ADV INJURY $100,000 4,000,000 GENERAL AGGREGATE $ GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OP AGG s 4,000,000 7 POLICY Fl JE0 f LOC I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) 3 ANY AUTO I ' BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ��AUTOS AUTOS BODILY INJURY(Per accident) 5 NON-OWNED I PROPERTY DAMAGE $ I HIRED AUTOS AUTOS (Per accident) I s UMBRELLA UABI OCCUR I I I EACH OCCURRENCE 5 — EXCESS UAB CLAIMS-MADE AGGREGATE $ _ I DED RETENTIONS S WORKERS COMPENSATION I I WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N i i TORY LIMITS I I FR ANY PROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT i $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below I EL DISEASE-POLICY LIMIT $ I i DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) The"City of Corpus Christi" is named as an"additional insured". • CERTIFICATE HOLDER CANCELLATION City of Corpus Christi SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE O Box 9277 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P Corpus Cristi,Texas 78469 ACCORDANCE WITH THE POLICY PROVISIONS. AUTH5B.,ED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/13/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Higginbotham Insurance Agency, Inc. lacc.ONo.Exti:361-643-6596 FAX No):361-643-2649 601 Moore Ave E-MAIL Portland TX 78374 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Texas Mutual Insurance Company 22945 INSURED LOVVO INSURER B: Loworn&Kieschnick, LLP INSURER C: Attn: Michael Kieschnick INSURER D: 418 Peoples, Ste 308 Corpus Christi TX 78401 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1899134719 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED $ COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 7 POLICY PFCOT- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMI r (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) $ UMBRELLA UAB _ OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION SBP0001255843 8/20/2014 3/20/2015 X VVC STATU- TORY EMPLOYERS'UABIUTY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) The Workers'Compensation policy includes a blanket automatic waiver of subrogation endorsement that provides this feature only when there is a written contract between the named insured and the certificate holder that requires it. The Workers'Compensation policy includes an endorsement providing that 30 days'notice of cancellation will be furnished to the certificate holder except 10 days notice of nonpayment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Corpus Christi ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Risk Manager PO Box 9277 AUTHORIZED R PRESENTATIVE Corpus Christi TX 78469-9277 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD