HomeMy WebLinkAbout0316.094June 16, 1994
THB 1I01l0RABLE CIT~ COUNCIL
palo Alto, California
12
BOquist for Renewal 9f lieolth ResQurce coQrdinator Aq;[jtWn.L.,=
Dr. Illeo Kirschmao
Me~rs of the Council:
The police Department has contracted (0);" protesa:io,nl'll GOl."'1ices to
provido tor a stress management prograll since 1981. This t:CpOL"t
recommends renewal of tho Health Resourco coordinator contr~ct and
requests council approval of a t~o-year agrceNont.
The Health Resource Coordinator, approved by Counoll in April 19:81
as part of the stress manaqernent program, has baon Buccessful 1n
working with police personnel to iden~lfy and AinluilG thu
orqani2ational sources of stress. Since t.he pl."oqran was
implemented, only five off lee1."s have flIed str&99 ... t"ell'lilcd
disability claims; ten claims: lo/ere filed in tho tw('; years procodin9
the program. l''unds for tlle 1994-95 year, not to e)(ceed $40,931,00,
are inoluded in the 1994-95 Police Deportment budget. Fund!l\q.tor
the second year is contingent upon council approval ot the 19'$11S"96
budget.
t,cntractor
Ellen· Kirschman, the current Uealth nesource Coordinator, was
selecte.cl in June 198.'3, after competing in an o'Xtensivo(ll tl:SaOSBment
process. Her backqround inclUdes 23 years or oxperience as A
psychotherapist with an emphasis on police officara and' their
families. She is a licensed psychologist and in nation.!lilly
recognized as an expert on organi~ational behavior, ospecially in
law enforcement. Dr. Kirsohman's continuation in the pro9ra. is
recommended based upon her 11 years of exceptional service with the
Police Department.
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Page Two
The Health Resource Coordinator 8saiats In conflict resolution
betwQGn individuals and qt'oups, identifies sources ot
orqanizatlonal stress and conSUlts with work. units and individual
manaqers to t'esolve issues. Dr. Kb:schman also educates police
personnel in streBS reduction/health enhancement techniqueB~
Additionally, she designs and facilitates department tea~-bu11dlnq
and problem~solving meetings, and maintains a library of health
related mate'rials for use by all employees.
In March of 1994, the Police Department sent a request for proposal
to, numerouB clinical psychologists throughout the Bay Ar~a
soliciting applicants interested in the Health Resource COQrdinAtor
position. Attached to the rE?-~ueat was a list ot the BCOpS of
services and a number of nttribut~s the applicant must possess in
order to be considered a qualified candidate.
However, the Police Department received only one response and the
applic~T,t was not qualified in that she did not possess the
attributes needed as the Health Resource Coordinator.
Additionally, several outside psychologists as well as polle"
employees wrote letters of recomrnendatiolJ on behalf ot Dr. £llen
Kirschman. She 'Was commended 011 her special skills and abilities,
her professionalism, integrity and ethics, not to mention the high
level of qu<'tlity services she has provided.
With those letters, the Police Department sees Dr. Xirschman as an
,asset to the City of Palo Alto, as well as to the community ~t
large.
Recommendation
staff recommends that the Council authorize the Mayor to execute 8n
agreement with Dr. Kirschman to provide professional ser .... ices as
Health Resource Coordinator during the period of July 1, 1994 to
June JO I 199~. Funds for the 1994-95 year, not to exceed
$40,931.00, are included in the Police Department's budget and will
be. included in the, Department's 1995"'!)6 proposed budq9't tor the
S_9cond Yee.ar_'of-.-fhe agreemerl.t ..
Re 'i;.t ully eubmittecl,
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Chief
Attachment: Contract Agreement
Exhibit 'IAlI
eMIl: 316: 94
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AGREEMENT
BB~BBN THB CI~Y OP PAtO ALTO
AND BLLEN KI~SCHHAN
THIS AGREE'./oI&N'r is made and entered into this __ dar <It
,19 by .nd betwaen the CITY OF PALO ALTO, • munic pal
"'co=rp=o==-r=."'t"ion (TICITY") and ELL&/I IIIRSCHMAll (Ta.pay ... ldentifio.tion
Number 111-30-1884), an Independent Health Resource coordinator
witll offic~B at 3978 Lyman Road, Oakland, California 94602.
hereinr..fter referred to as "CONTRACTORI1;
WHEREAS, CITY' desires certain aervices in conjunction
with its Police street Management Program; alld
WHEREAS, CITY desires to engaqe CONTRACTOR to provide
these services by reason of its qualifications and experience for
perforatinq such ~ervicesj and CONTRACTOR has offered to provide the
required services on the terms and in the manner set fort~ hereinj
NOW, THEREFORE, in consideration of their mutual
c-ovenants, the parties hereto agree as follows:
SECTIotl 1 -DETIlnTIONS
The term "CIT'll! as used in this Agreement shall mean the
City of Palo Alto, l\ J!l.utlicipal corporation and body politic
orqenized and existinq 'Under the laws of the state of California.
1.2 ~ity Managex
Tho term IICity Manager lF shall mean the duly appointed
City Managor of the city of Palo. Alto, california, or her
dasiqnated representative.
1.3 City Attor~
The term r;C!ty Attorney" shall mean the duly appointed
city Attorney of the City of Palo Alto j California, or his/her
deaiqnated representative.
1. 4 City Clerk
The term ncity Clerkl! shall mean the duly appointed City
Clerk of the City of Palo Alto, California, or her designated
representative.
1.5 Project
The term
Exhibit nAil ontitled
part hereof.
UProject" means the servioes described in
uScope of Project'l attached hereto and made a
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~ECTION 2 -PRQJECT C09Z~'UAIlQN
~.1 ~
The City Han_gor shall bo representative of CITY tor all
purpoS&B under this A9ree~ont. l.lautenant Robert Brenllan is
de~i9nat.d •• the PR03F.CT MANAGER for the City Manager and shall
8~p.rvisB the proqres9 and ~xQcutlon or this Aqreement.
2.2 ~2ntrAQtQr
~he $eryices under this a9re~~ent are personal services
to b$ provJ,ded solely 'b)", Ellen .Kirschman and shall not be delegated
to or portQrAed by any· other parson.
ll.&crlQll'_L..::.JIJ.!TI ES or COtiTRACTQR
3.1 1l.g.[~tQ bo t))Xlllsllllli
·COH'I'AACl'OH shall provide all specified servicE'ls as set
forth In F.)(hlblt ~AH attached hereto lind made a part hereof.
3. ~ k:\.)ilL!;LIlQ..£J>l'..tlvcl
CONTAAC?OR sil",ll;
3.2.1 Procure all per~it9 and licenses, pay all
charqss and f~e8t and give all noticos which may ba necessary and
Incidont t~ the duo ~nd lawful prosecution of the services to bQ
per,orr=Gd by CQNl'AA<..."1'OR undor this Agreoment;
J.2.2 St~y fully informed of all existing and
future federal. stat-c, and local laws, ordinances, regulations,
orders.4 .and, docreos which lI:Iay affect the performance of the
$~rvloe9 Under this Agreo~ant;
3~2.l At all timos obsorve and comply with all
of eAid laws, ordinances, re9ulationL, orders and decrees mentioned
above/ lmd
i.n wri tiny
o'r(U l1anoQ:s,
relation to
3.2.4 . lruI>ediat"ly report to the PR03EC'£ MANAGER
~ny discrepancy or inconsistency in said laws,
regulations, orders, and decrGos mentioned above in
any provisions of this Agreement.
3. J RAle-AruL of RenQr\;s and Information
Any reports, information, data or other material given
to, or prepared Qr assornbled by, CONTRACTOR under this Agreement
shall bG the proparty of CITV and shall not be made aVailable to
any individual or organization by CONTRACTOR without the prior
written approval of the City Manager.
SECTIOtl 4 -COt!PENoVI,UQll
For the portorm~nce of th& services d~acrlbed herein by
CONTRACTOR, CIT~ shall pay CONTRA0XOR the su~ of three thou •• n4
tour hundred olevon dollars ($3,411) PQr nonth, pa.ya.ble upon
submiooion by COt/TRACTOR of .He"l •• d blUin<js in tripU<:ate;
provided, ho~.ver, that tho total .u~ payable to COtlTRACTQR ~h.ll
not .>:csed torty thousand nln. hundred thirty on. dollars
($40,931.00) ,
SECTION 5 -PlITt ES.9E-U.U
CIT~ ahall provide all specified service. and facillti ••
a. set forth belo~1
(a) cool.°dlnation and sche<lul1n9 by tho
COORDInATOR of ",11 arr.onger:::onts rOt'
lDan4q8~ent BC!'rVicC9 which CITV requires
performed by CONTRAcroR.
PROJECT
6tn~99
to be
(bJ Office space within the Police Oepaiteont~ it
available, or In othar CIT't (ac1l1t1(;i~, .at all
tlraes litton services are r£!fJulrsd to bo pertorrnod by
CONTRACT<)R.
Ce) Secrctpt'ial and oths.t" l091stical support as 'i1cedad.
SECTIOII 6 -TEIl/i
The services to be per-torr-ad hereunci'er ahall CQrnneraca OJ)
July 1, 1994, and shall extond throu9h and Inclu~in~ Juno 30, 1996.
SECTION 1 -TIlH2QMBY . ..liWli/l..llQ!!
The City Manager sholl havo tho authority tQsuspond this
A9reement, wholl.y or in paa;-t, for any periOd aB aha de.e:'s
neCeSSal"Y·
~.& -TtRtlINII'UruLQLM1!!.(moo
8,1 Bight t~
'fhe City :Manager may tElr~inate this A9reemont fol" any
relJ.son by qiving written notico to COllTAACTOR:. Upon receipt ot
such notice, CON':tAAC1'OR shall lrnrnediately disccmtinuQ performance
under this A9reement.
COUTRAC1'OR may terP.linate this Aqr-eofDent or suspend work
on the Project upon thirty (30) days liritton notice to Cit)',
8 , 2 ~J.1RQJL,fu'.~p ens I QO=_I"minill.2n
Upon such suspension or ter~ination by CITY, CONTRACTOR
shall be paid for all services actually ~ondsred to CI~Y to tho
date of euch suspension or termination; provided j how6vor, if thiu
Agreement is suspended or ter~inated for fault of CONTRACTOR, CITY
shall be oblig.t~d to compensate CONTRACTOR only for that portion
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of CONTRACTOR's services which'are of benefit to' CITY.
8.3 Betyru of ~terials
Upon such Buspension or termination, CONTRACl"OR shall
turn over to the City Hanag~r immediately any and all copies ot
l'epoxts' or other data, whether or not completed, propatnd hy
COIl'l'RACTOR or given to CONTRACTOR 1n connection with this
Aqreoment. Such materials shall become the permanent·property of
CITY~ CONTRACTOR, however, shall not be liable for CIT¥/~ usa of
incomplete materials or for CITY's use of cOnlpleto documents it
used for other than the Project contemplated by this A9reement.
seCTIoN 9 -ASSrGNM~
Both parti~e shall give their personal attention to tho
faithful performance of this J..qreement and ahall not "ssign,
transfer, convoy, or otherwise dispose of this Aqreement or IIOY
right, title or interest in or to the same or-any part thereot
without the prior written consent of the other party, and then only
subject to such terms and conditions as the other party may
requi~e. A consent to one assignment shall not be deemod to hu 8
consent to any subsequent assigllments. Any assignment without such
approval shall be void and, at the option of th~ othor party, shall
t-et'lllinate this Aqre!3l11ent and any lictmse or-privilego gr3r.tod
hel'ein. This .Agreement and an~' interest herein shall not be
assignable by opel'ation ot law without the prior written consent or
the other party.
~N 10 -.J!~
All notices to hereunder shall be given in writinq and
mailed, postage ~repaid, by certified mail, addressed as follcws:
To CITY: Office of the City Clerk
250 Hamilton Avonue
Palo Alto, CA 94303
To CONTRACTOR: Ellen l<irsch:man at the' addrGGB o(
CON~RACTOR recited above.
~CTIQN II -INTEREST OF CONTBAC12E
In accepting this Agreement, CONTRACTOR covenants that
she presently has no interest j and shall not acquire any interest,
direct, or indirect, financial or otherwise, 'Which 'Would conflict in
any mannel-or ds.gree with the performancG of the services
hereunder. CONTRACTOR fUi:ther covenants that, in the performance
of this Agreement, no person having such an interest shall 00
employed. CONTRACTOR cortifies that no one who has or will have
any financial interest under this Agreement is an officor or
e~ployee of CITY. It is expressly agreed that in the pertormanco
of the: professional services requir~d under this A9rc.emant
CONTRACTOR, and any employees, shall at all times be cons ide rod
independent contractors and not agents or employees of CI~V.
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SECTION 12 -INPEMN~
CONTRACTOR agress to indemnify, defand and hold harmless
CITY, itB offioers, agents and employees from any an~ all demands,
clai"., 0" liability of any nature, includin9 death or injury to
any person, property damag'8 or any other loss, caused by or arising
out -of COl~TRACTOR'EiI its officers~, agents', subcontractors' or
employees' negligent acts, sr,ro)""s, or omissions, or willful
lZIisoonduot, or conduct for which the ,law imposes strict liability
on C0N'l'PACTOR in the performance or failure to perform this
Agreement.
SECTION 13 -WORKERS' COMPENSATION
CONTRA("'TOR, by Elxec::utinq this Aql.~eement, certifies that
aha is aware of the provisions of the Labor Code of the State ot
Cnlifol'nia \"hich require every employer to be insured against
liability f.or \t,'orkers' compensation or to undertake self-insurance
in accordance with the prOVisions of that Code, and certifies that
she will comply with such provisJons before commencing the
performance of the work of this Agreement.
~IQp--A4 -INSURANCE
CONTRACTOR, at her sole cost and expense, shall obtain
nnd maintain in full force and effect throughout the ontire term of
this Agreement profossional errors and omissions insurance with
respect to activities and services performed by CONTRA~~R for or
on bahalf of CITY under the provisions of this Agreement. 'i'he City
of Palo Alto, J.ts officers, aqQnts~ and employees shall be endorsed
8S additional insured under this insurance coveraqe.
Ce~tificates of such insurance shall be filed with CITY's
PROJECT MANAGER concurrently with the execution of this Agreement
or, with CITY's PROJECT MANAGER's approval, within ten (10) 'Workinq
days thereafter.
SECTION 15 -AUpITS
CONTRACTOR aqrees to permit CITY to audit, at any'
reasQnable time during the term of this Agreement and for three (3)
years thereafter, CONTRACTOR's records pertaining to matters
covered by this Agreement ot.her than records the disclosure of
which is prohibited under the psychotherapist/patient privilege
pursuant to California Evidence Code or Principle 5 of the American
Psychological Association'S Ethical standards concerning Privacy
and Confidentiality. CONTRACTOR further agrees to maintain all
records pertaining to matters covered by this Agreement for at
least three (3) years after the term ot this Agreement .
. ~ECTION 16 -IIGREEHENT .lWIllllli.
The terms, covenants, and conditions of this Agreement
shall apply to, and shall bind, the heirs, successors, executors,
a.d:mi:-11Dt!'ator~j l'I~sigosi and subcontractors of both parties.
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RC'l'ION 17 -WA~
Th~ waiver by either party of any breach or violation of
any tern, covanant., or condition of this Agreement or of any
prov1.~1on, ordinance, or law shall Ilot be deemed to be a waiver of
an~ ,_othor terlU, covenant, cond1t1.on, ordinance, or law or of any
subs.oquent breach or violation of the same or of any other term,
coven~nt, condition, ordinance, or law. The subsoquent acceptance
qy .ither party of any tee or other money which may become due
hereunds_r ~hall not b,a deemed to be a waiver of any precedinq
breach or violation by the other party of any term, covenant, or
condition of this Agreement or of any applicable law or ordinance.
~IQN 18 -COSTS ANP ATTO~YS' FEES
'rhe pr~v.ailin9 party in any action brought to enforce the
tCft)J.S of this Agreement or arisinc;l out of this Agreement :may
reCOV6r its reasonable costs and attorney fees expended in
conn~ctlon \lith such an action from the othel" party.
No paynent, partial payroent, acceptanc~, or partial
acceptance by CITY shall op"J:rato as a 'Waiver on the part of CITY' of
any of its rights under this Agre~roent.
liKCTIOl! 20 -11ONIU~~llWlATION: PIl!!.lI.!iIT
20 • 1 l2Y\:.Y_...2f....J;QtU~
No discrimination shall be :made in the employment of
persons under this Agreement because of the race, color, national
origih, ancestry, re1i910n or sex of Ruch person. If the value of
this ~9r8ement is, or may be, Five Thousand Dollars ($5,000.00) or
.ore~ CONTRACTOR agrees to meet all requirements of the Palo Alto
)(unioipa.l Code pertaining to nondiscrimination in employment,
inoluding cOJ:lpleting the I1Comp11ance Report--Nondiscriruination
provisions of City of Palo Alto Contracts" on the form furnished by
CIT'i and attacha.d hal"eto as £xhibit "8" and made a part hereof by
this reference.
20.2 £!malty (or D)scrimJ...nAt.i2D
If CONTRACTOR is found in violation of the
nondiscrimination provisions of the state of California Fair
Employmont P~actices Act or similar provisions of federal law or
executivG order in the performance of this Agreement, it shall
thereby bo found in material breach of this Agreement. Thereupon,
CI'1'V shall have the power to cancel or suspend this Agreement, in
whole or in part, .or to deduct froll\ the atrLCHl.'nt p.",yable to
CONTRACTOR the sum of Twenty-Five Dollars ($25.00) for each person
tor each calendar day during 'Which such person was discriminated
against, as damages: fOl" said breach of contract, or both. Only a
finding of the State of California Fair Employment Practices
COMiGsion or tho equivalent federal agency or officer shall
constitute evidence of a violation of contract under this section.
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If CONTRACTOR is found in vIOlation of tile
nondl8cr1.ination proylelons ot this Agreement or the applicable
aCtirm<>tive aotion 9uidel1nes portetining to this Agre.ment,
CONTRACTOR 6hall be found In ~atori.l breach of this Agreement.
'thereupon, CITY shall' have the power to cancel or suspend this
~9rE!e.ent, 1n ... hole: or in part~ or to deduct trot!) the amount
pay.ble to COIITMCTOR the &U" of 'NQ Hundred FiCty Dolla".
($25Q.OO) f¢r •• ch calendar day during Which COIiTRAC'roR 1s found to
have been in 6\lch noncQl'>'pl lane-e -as dal!la.ges for said breach of
contr~ctt or both.
This-dccunent roprosentB th~ entire and inte9~4ted
4tjreoaont . be.twoon eXT"' and COJfTAAcron and Bupersedos all prior
neqotl~tionsJ rGpr~~ehtAtlon8, and agreements, oither written or
oral. Th.le dO(atRent l'H\Y be: lu!.onded only b~' writton instrument,
signod by both CITY and CO);'iRACrOR,
~cr.u;>JLn~_.§9YIllH VIC tJ\w
This ~9rce~ent sh~ll bo qoverned ~y the 1~w8 of the State or Calil'Ornia.
APPROVEO AS ~ FORN:
Sr. A88lstontcltTAtto"noy
APPROVED.
cIty lIanagar
oireotor of Flnance
APPROV£O AS TO COl/TENT:
PolIce Dopart~-~
Attachllents:
CITY Of' PALO ALTO
COIlTMCTOR:
ELLEN KIRSCHMAlI
Taxpayor Ident1ficoUon 110.
lU-30-1884
SCOPE OF PROJF.~
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o AGREEMENT o Nc. _
(Htm:~A REfEP.RF;O lOA$. CONTRACTOfl) 1..'11 C('of/SIQ€AATIO.'iOf JHlIA I}Ul1,J_.\,J. C(W("'I,. .... S,.lHE f>AAnfS ~A:lIOJ.:..RS.f A'; f(X.U)WS
• CONTRACTOR SHALL PAO'I/(lE OOf1JR11,'lSH mE I"QI_lQ~,'lNG ~OfJHI ~ih·.cE!) A. .... )(iIl,\I.'!EI'o.'AI,S $91(.:1<llO rlElX9:=l ___ "
AfTAQ{!O HEREtO »10 ~l[O Htru:~ BY TMS flEFEAIiH(...E-
To proV'ide professional services as Health ResQurce Coordin<1tor to
police department ~ersonneL
Exhibit IIAI'!: Contractor's Work Statement
Exhihit -IIB'I: Certificate of Nondi6crimination
• TERMS THE S[RVlCfS JJ:Q,ORMATERlAl,S ftlAA·~·'W l'M)(R IK.$ I-GREfvHif S>'.AH (X~i:......:.e o; .. r
ANOSHAtl & c:.o.,lf'lEHtI SCfOAE _________________ _
Upon receipt of invoice
[J CONfFlACfCflSHAllPAYCHY:
• PAYMENT RECORD 100PAIlTMENfUSE RE\"Ef'tSf: S~)
Police/Personnel & Training 0.: PT, __ •• _____ ~ ____ ~_" ___________ •• _~~ ______________________ _
P.O. BOX 10:250
P~lOAlTOfflffl9_2103
Te,~ . __ ... _____ -._._
• INVOICING SfNOAlL L.WO<Cf_S 10 mf em.AHN: I"OOJEC11.t1oRA(lEA
• CITY OF PALO ALTO APPROVALS: (ROUTE fOOS>(,,·:"TW'£S"C('O({.,.'}.f,~:;ro""-"":H'j ~OPAAO">·J.,-OO~lSf"..tt(}"SI
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EXHIBIT "A"
CONTRACTOR'S WORK STATEMENT· ElI.EN KIRSCHMAN
1. Provide counseling. critical Incident debrletlng and referrals for Individuals
experiencing high stress.
2. Provide contlict resolution for Individuals and groups.
3. Identify sources of organizational s(ress and consult wllh work ~nlt. and
Individual managers to resolve them.
4. Munltor management decisions with regard 10 their stress impacl~ search fOI
Implementation mothods whrch minimizo the stressful impact, end OdVrSB
management staff.
5. Train FTO~s. supervisors, and managers in communication .. problem solvinl1.
conflict resolution. and supervisory skHls which can minirnize stress for
suboldinates.
6. Counsel individual managers on stress producing practices and events wilhln
their units.
7. Educate all PAPD personnel in the range ot stress reductionl ,,"allh
enhancement techniques available in the Palo AIIO area, and oncouragethelr
use.
8. Desrgn and facilitate team bulrding and problem solving meetings for manage,s
and their work. units,
9. Counsel new ollieers and FTO staff regarding ways to minimlza stress end
optimize reaming,
10. Provide consultation to the peer support program and sponsor spaelel events
or workshops related to personal and organizational health.
11. Assist In program evaluation as it relates 10 personal and organizational health
and employee retention.
12. Maintain a health related bulletin board and health related materials available for
us. by all employees.
13, Provide career counseling and lite assessmer.1 guidance tor individuals.
14. Prepare a quarterly activity report.
15. Develop an obJective. measurable method to evaluate the HRC program.
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16. To perform 772 hours of consulting service" of which 672 shall be on·slle In
the fNm of 14 hours pe, week over a 48·week period. Tho remaining 100
hours may be used oft·slte fa, various service·related malters to include: tho
preparation of roports, handling of special assignments an~ telephone
con, u Itation,.
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PART U • SUPPlEMENTS TO FORMS SECTION 00410 (RFP)
CfRTIFICA TION OF NONDISCRIM/NA TION
Cerdflc8UQn pI «Qodl."rimloallpn: As 8uppller$ of Goods or .ervlces to the City III
Pato Alto, lhe firm eod Indlvlduol$ listed below CMifles that they do not
dlscrlmlruJte In employment wilt! regards to aGo, race, color, ,ellglo\" national
orlglrl, ,ncestry, disability, orsexuol preference; thel they ere In compliance with
ell Fed.ral, Stale lind !!Jcel directives Bnd e.eCUllva ordera rBgardlng
nondlsCllmlnetlQn In empklvmenl; and (hat they egree to deffi<lnstrata positively
end aggressively lhe principia 01 equal opportunity In omployment,
Th$ Propou( 8gr~$ "pacifically:
1.0 Too$toollol1 oroo.erveemploymenrpollcle. which affirmatiVely promote
oppOrtunities for minority persons at ell lob levels.
2.0 To communicate this policy to all parsons concerned, Including sll
employees, ()ut~lde recruiting servlcos, especially those serving minority
communltles, snd 10 Ihe minority communities at large.
3,0 Tc 'ake effirmetlvo aCllon slaps to hire mloorlty employees within tha
orQonllatlon.
4.0 To be knowlOdll~able of the local, slate, and federal lows and regulations
concerning aftirmallvo 80tlon pollclos and provlda oppor!unltles for
employees,
firm: \;:..1\'.0 0, \<. \.j)>,~" rAci fI\*,~ '~I*.
TItlo of OftIC#'J' \--0 ' -L I .
Signatvro __ 7AA-;;;:; ~1 v: tA-P 1\ (')
Dale f) -.2. .~ £11\
Please Include any addltTonal Information available re90rdlng equal opportunity
emplovm&nt programs now In affect within your compRnv.
END OF SECTION
SECTlON 00410IRFOH
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NMiVNAl UNlVN tlt-lt tN~VHAN1.A; (,;.(), Of PrJ !SOUAGU, f'A.
TlU~~IAlMS MADE POlley • PLEASE REhP.:""')I;lEFULl Y
2/10/94 PSYCHOLOGtS."' ROnSSIONAl LlAalLlTV pol.,,}v
NOnce: It LOWER lIUITOF llA8JUTY APPVE$ 'oJVOO ... f~~ ~flJ.fJ~)l~~~~ TH:(RE Art! AtllOA,.llQNS OF S£)(tIA(. UlSOONOVCT
(SEe Tt1E SPECtAl PRO~ ",st:XUAl ~ 1$ ;0/>01.:< r' \.'f fHE POuC'rl
Oe:CtARAlIONS
POUCYNO, PSY-3613~91 ACCOUNTNO: CA··KIRE:397-0 0086213
rTEM ~·(bl AOOffiOttA.!.. NAMEO INSVRfO$: ITEM 1.(a) NAMi: ANO AOORSSS OF INSUReD:
ELLEN F. KIRSCKMAN, Ptl,O
3ns LYMAN R0AO
OAKLAND, CA 9~602
ITEM 2 ),ODITIONAU~JSURfDS
CITy OF HAYW.A.RO
POLICE D[PARTNENT
300 II. ~tNTDN AVE~U~
HAYAARDt CA 94544
CITv DF PALO ALTO
POLICE UF1"A?,lti'(rof
21~ FD~fST ~ye~u~
P~lv ~lrOr (A 91)J\
(iTV Dr PALO ALTO
FJRe ,:H·PASHNU.T
115 F~RiS' AY~'lUf
PALO ALTer CA 9110l
ITEM 3 P0L1ey PEkIOD. FROM • 03/0\1.q~'-~ '0 03/01/95
1201 AM. S r ANO'-RO n"'f AT rifE ADDflESS Of r~E l"iSUHEO AS S1 A rEO IifAn~
ITEM 4. LIMITS OF UA~lITY; s 1 ,0 O~, 000 E ~Cll wnO~.GnJ\. ""CT OR SERIE~ Of C.O~Hll·"'UOUS, REPEATED
----, ---'-------OR INTfR.t:!hAl iD WHOlOGHJlIICrs OFt OCCURAENCE
s I 1000 100,) AGonf GA ~ E
ITEM 5 DEDUCTI Blf. S NO.~ t: fA-etC \·ixO:<.i(3.FU,1., AC r OR SERlES OF ·COllflf"UOUS. REPoSA. TEO
_. -----------------_ OR 111l" EI\AE LA 1 e 0 WRONG rut ACTS on OCCUhR£NCE
ITEM 6.
ITEM 1. RErAOA.CTIVE DArE: 03./01/92
17EM 13 exr(NOEO REPOffmiG PER~OO 0
ADDITIONAL PA EM1UM ~ r exerCJ$MJ:.s _~_:"._ .. ~9 __ ! __ Q..o __ _
ITEM 9. POLICY FORMS AnO ENDORSEMENTS
ATIACHED TO THIS POLICY:
JRM ~ 52'.}49 -0-91 fORM ~ 52338 6-91
THIS IS NOT A Bill" PREMIUM HAS BEEN PAID.
TOTAL PHfI.~IUM: 1 ,160.00,