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HomeMy WebLinkAboutCA Hearing Officer Services; A1 v. June 13, 2025 Page 1 AMENDMENT TO CONTRACT BY AND BETWEEN THE CITY OF SAN RAFAEL AND ________________________________ FOR ________________________________________________________ Original Contract Execution Date: ________________, Contract No._______________________ Amendment No. ___ THE ABOVE-NAMED CONTRACT is hereby amended by the parties as set forth herein by the checked boxes below and is effective on _____________________. ☐ SCOPE OF WORK: The Scope of Work is hereby amended in Exhibit A-__, attached hereto and incorporated by reference. ☐ COMPENSATION: The parties agree to increase the not-to-exceed amount by $____________, and to increase the total not-to-exceed amount under the Contract to $_________________. The parties agree to increase the Contractor’s hourly rate to $350 and to increase Contractor’s travel rate to $175 per hour. City agrees to compensate Contractor for up to four (4) hours preparation time for each noticed hearing unless City cancels such hearing date and notifies Contractor of such cancellation at least seven days (168 hours or more) prior to the scheduled commencement time for such hearing. ☐ TERM OF CONTRACT: For Contractor to perform the additional or amended work described herein, the term of this Contract shall be extended to ______________________. Except as specifically amended herein, all other provisions, terms and obligations of the Contract between the parties shall remain valid and shall be in full force. For City Clerk Use Only: Exp. 06/30/2026 1 25,000 Hearing Officer Services 10,000 X X CALIFORNIA HEARING OFFICERS, LLP January 6, 2025 June 30, 2026 N/A Docusign Envelope ID: D5FFCEAF-16A9-47C3-9B8B-151F1BE9447A January 16, 2026 L8.0107.A1 v. June 13, 2025 Page 2 IN WITNESS WHEREOF, the parties have executed this Amendment on the day, month, and year first specified below. CITY OF SAN RAFAEL: _________________________________ ________________________________, _________________________________ Executed on:_______________________ APPROVED AS TO FORM: Office of the City Attorney _________________________________ ________________________________, _________________________________ ATTEST: City Clerk _________________________________ ________________________________, _________________________________ CONTRACTOR: __________________________________ By: ____________________________ Name: ____________________________ Title: ____________________________ [If Contractor is a corporation, second corporate officer signature required] __________________________________ By: ____________________________ Name: ____________________________ Title: _____________________________ Docusign Envelope ID: D5FFCEAF-16A9-47C3-9B8B-151F1BE9447A Kamardeep Athwal Managing Partner California Hearing Officers, LLP Andrea Visveshwara Chief Assistant City Attorney Cristine Alilovich City Manager January 16, 2026 City Clerk Lindsay Lara CONTRACT ROUTING FORM INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below. All following documents are attached as reference material. RESPONSIBLE PARTY DESCRIPTION COMPLETED Project Manager Email PINS insurance request to Contractor ☐ City Attorney’s Office Review, revise as needed, and approve agreement as to form Department Director Review and approve agreement Risk Management Confirm insurance documentation is complete Finance Review and sign off on funding availability TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER: Contracting Department: Project Manager: Contractor Name: Contractor’s Contact: Contact’s Email: City Council Date: ☐ ___________________ or ☐ Not applicable ☐ FPPC: Check if Contractor must file Form 700 X Andrea Visveshwara California Hearing Officers, LLP City Attorney's Office X Deep Athwal dathwal@cahearingofficers.com Docusign Envelope ID: D5FFCEAF-16A9-47C3-9B8B-151F1BE9447A Jan 6, 2025 Docusign Envelope ID: D5FFCEAF-16A9-47C3-9B8B-151F1BE9447A Docusign Envelope ID: D5FFCEAF-16A9-47C3-9B8B-151F1BE9447A Docusign Envelope ID: D5FFCEAF-16A9-47C3-9B8B-151F1BE9447A Docusign Envelope ID: D5FFCEAF-16A9-47C3-9B8B-151F1BE9447A Docusign Envelope ID: D5FFCEAF-16A9-47C3-9B8B-151F1BE9447A Docusign Envelope ID: D5FFCEAF-16A9-47C3-9B8B-151F1BE9447A Brenna Nurmi (for) (Jan 6, 2025 16:01 PST) Brenna Nurmi (for) Docusign Envelope ID: D5FFCEAF-16A9-47C3-9B8B-151F1BE9447A Docusign Envelope ID: D5FFCEAF-16A9-47C3-9B8B-151F1BE9447A Docusign Envelope ID: D5FFCEAF-16A9-47C3-9B8B-151F1BE9447A Docusign Envelope ID: D5FFCEAF-16A9-47C3-9B8B-151F1BE9447A CONTRACT ROUTING FORM INSTRUCTIONS: Use this cover sheet to circulate all contracts for review and approval in the order shown below. Step RESPONSIBLE DEPARTMENT DESCRIPTION COMPLETED DATE REVIEWER Check/Initial 1 Project Manager a. Email PINS Introductory Notice to Contractor b. Email contract (in Word) and attachments to City Attorney c/o Laraine.Gittens@cityofsanrafael.org n/a 12/19/2024 2 City Attorney a. Review, revise, and comment on draft agreement and return to Project Manager b. Confirm insurance requirements, create Job on PINS, send PINS insurance notice to contractor 12/20/2024 RFE 3 Department Director Approval of final agreement form to send to contractor 4 Project Manager Forward three (3) originals of final agreement to contractor for their signature 5 Project Manager When necessary, contractor-signed agreement agendized for City Council approval * *City Council approval required for Professional Services Agreements and purchases of goods and services that exceed $75,000; and for Public Works Contracts that exceed $175,000 Date of City Council approval N/A Or PRINT CONTINUE ROUTING PROCESS WITH HARD COPY 6 Project Manager Forward signed original agreements to City Attorney with printed copy of this routing form 12/20/2024 7 City Attorney Review and approve hard copy of signed agreement 8 City Attorney Review and approve insurance in PINS , and bonds (for Public Works Contracts) 9 City Manager / Mayor Agreement executed by City Council authorized official 10 City Clerk Attest signatures, retains original agreement and forwards copies to Project Manager TO BE COMPLETED BY INITIATING DEPARTMENT PROJECT MANAGER: Contracting Department: City Attorney Project Manager: Rob Epstein Extension: 3080 Contractor Name: California Hearing Officers, LLP Deep Athwal, Managing Partner Contact Email: dathwal@cahearingofficers.com FPPC: Check if Contractor/Consultant must file Form 700 Docusign Envelope ID: D5FFCEAF-16A9-47C3-9B8B-151F1BE9447A California Hearing Officers PSA-Hearing Officer Services 2025 Final Audit Report 2025-01-07 Created:2025-01-06 By:Laraine Gittens (laraine.gittens@cityofsanrafael.org) Status:Signed Transaction ID:CBJCHBCAABAAmHxuIKAbSImYbROZoXmJ966pOSqWZgIj "California Hearing Officers PSA-Hearing Officer Services 2025" History Document created by Laraine Gittens (laraine.gittens@cityofsanrafael.org) 2025-01-06 - 11:09:56 PM GMT Document emailed to Brenna Nurmi (brenna.nurmi@cityofsanrafael.org) for approval 2025-01-06 - 11:12:05 PM GMT Email viewed by Brenna Nurmi (brenna.nurmi@cityofsanrafael.org) 2025-01-06 - 11:37:24 PM GMT Document approved by Brenna Nurmi (brenna.nurmi@cityofsanrafael.org) Approval Date: 2025-01-06 - 11:37:32 PM GMT - Time Source: server Document emailed to Angela Robinson Pinon (angela.robinson-pinon@cityofsanrafael.org) for signature 2025-01-06 - 11:37:34 PM GMT Email viewed by Angela Robinson Pinon (angela.robinson-pinon@cityofsanrafael.org) 2025-01-06 - 11:59:47 PM GMT Document e-signed by Angela Robinson Pinon (angela.robinson-pinon@cityofsanrafael.org) Signature Date: 2025-01-07 - 0:00:02 AM GMT - Time Source: server Document emailed to brenna.nurmi@cityofsanrafael.org for signature 2025-01-07 - 0:00:04 AM GMT Email viewed by brenna.nurmi@cityofsanrafael.org 2025-01-07 - 0:00:35 AM GMT Signer brenna.nurmi@cityofsanrafael.org entered name at signing as Brenna Nurmi (for) 2025-01-07 - 0:01:01 AM GMT Docusign Envelope ID: D5FFCEAF-16A9-47C3-9B8B-151F1BE9447A Document e-signed by Brenna Nurmi (for) (brenna.nurmi@cityofsanrafael.org) Signature Date: 2025-01-07 - 0:01:03 AM GMT - Time Source: server Agreement completed. 2025-01-07 - 0:01:03 AM GMT Docusign Envelope ID: D5FFCEAF-16A9-47C3-9B8B-151F1BE9447A Certificate Of Completion Envelope Id: D5FFCEAF-16A9-47C3-9B8B-151F1BE9447A Status: Completed Subject: DocuSign: First Amendment with California Hearing Officers, LLP Source Envelope: Document Pages: 16 Signatures: 4 Envelope Originator: Certificate Pages: 5 Initials: 4 Nataly Torres AutoNav: Enabled EnvelopeId Stamping: Enabled Time Zone: (UTC-08:00) Pacific Time (US & Canada) 111 Morphew St San Rafael, CA 94901 Nataly.Torres@cityofsanrafael.org IP Address: 2600:1700:9750: Record Tracking Status: Original 12/22/2025 11:27:04 AM Holder: Nataly Torres Nataly.Torres@cityofsanrafael.org Location: DocuSign Signer Events Signature Timestamp Nataly Torres Nataly.Torres@cityofsanrafael.org Legal Assistant City of San Rafael Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 2600:1700:9750:3df0:dd8c:5cb4:d46a:4e88 Sent: 12/22/2025 4:36:05 PM Viewed: 12/22/2025 4:36:26 PM Signed: 12/22/2025 4:36:33 PM Electronic Record and Signature Disclosure: Not Offered via Docusign Andrea Visveshwara Andrea.Visveshwara@cityofsanrafael.org Chief Assistant City Attorney City of San Rafael Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 199.88.113.8 Sent: 12/22/2025 4:36:06 PM Viewed: 12/22/2025 4:36:36 PM Signed: 12/22/2025 4:36:50 PM Electronic Record and Signature Disclosure: Not Offered via Docusign Van Bach Van.Bach@cityofsanrafael.org Signing Group: Finance Security Level: Email, Account Authentication (None)Signature Adoption: Pre-selected Style Using IP Address: 199.88.113.8 Sent: 12/22/2025 4:36:53 PM Viewed: 1/5/2026 9:49:31 AM Signed: 1/5/2026 9:51:15 AM Electronic Record and Signature Disclosure: Accepted: 1/5/2026 9:49:31 AM ID: 7fd0896f-f025-4d3e-953e-5f18e8ea0674 Kamardeep Athwal dathwal@cahearingofficers.com Managing Partner California Hearing Officers, LLP Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 71.202.216.236 Sent: 1/5/2026 9:51:21 AM Viewed: 1/9/2026 4:26:18 PM Signed: 1/9/2026 4:27:08 PM Electronic Record and Signature Disclosure: Accepted: 1/9/2026 4:26:18 PM ID: 05568f4d-8529-424a-ad35-7dea031f8768 Signer Events Signature Timestamp Andrea Visveshwara Andrea.Visveshwara@cityofsanrafael.org Chief Assistant City Attorney City of San Rafael Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 199.88.113.8 Sent: 1/9/2026 4:27:12 PM Viewed: 1/12/2026 10:03:39 AM Signed: 1/12/2026 10:03:50 AM Electronic Record and Signature Disclosure: Not Offered via Docusign Heather Davis Heather.Davis@cityofsanrafael.org Risk Manager City of San Rafael Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 199.88.113.8 Sent: 1/9/2026 4:27:12 PM Viewed: 1/12/2026 2:32:18 PM Signed: 1/14/2026 9:41:18 AM Electronic Record and Signature Disclosure: Not Offered via Docusign Cristine Alilovich Cristine.Alilovich@cityofsanrafael.org City Manager City of San Rafael Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 2601:645:e82:6d80:8155:2d51:c792:21ba Sent: 1/14/2026 9:41:22 AM Viewed: 1/16/2026 7:07:16 PM Signed: 1/16/2026 7:07:24 PM Electronic Record and Signature Disclosure: Accepted: 8/8/2025 5:50:59 PM ID: 92734b64-c5dc-4308-af7f-b0f4b9ffd306 Lindsay Lara Lindsay.Lara@cityofsanrafael.org City Clerk City of San Rafael Signing Group: City Clerk Security Level: Email, Account Authentication (None) Signature Adoption: Pre-selected Style Using IP Address: 199.88.113.8 Sent: 1/16/2026 7:07:27 PM Viewed: 1/20/2026 11:28:27 AM Signed: 1/20/2026 11:29:09 AM Electronic Record and Signature Disclosure: Not Offered via Docusign In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Nataly Torres Nataly.Torres@cityofsanrafael.org Legal Assistant City of San Rafael Security Level: Email, Account Authentication (None) Using IP Address: 2600:1700:9750:3df0:dd8c:5cb4:d46a:4e88 Sent: 12/22/2025 1:30:48 PM Viewed: 12/22/2025 4:32:04 PM Completed: 12/22/2025 4:36:04 PM Electronic Record and Signature Disclosure: Not Offered via Docusign Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 12/22/2025 1:30:48 PM Envelope Updated Security Checked 12/22/2025 4:36:05 PM Envelope Updated Security Checked 12/22/2025 4:36:05 PM Envelope Updated Security Checked 12/22/2025 4:36:05 PM Envelope Updated Security Checked 12/22/2025 4:36:05 PM Certified Delivered Security Checked 1/20/2026 11:28:27 AM Signing Complete Security Checked 1/20/2026 11:29:09 AM Completed Security Checked 1/20/2026 11:29:09 AM Payment Events Status Timestamps Electronic Record and Signature Disclosure ELECTRONIC RECORD AND SIGNATURE DISCLOSURE From time to time, City of San Rafael (we, us or Company) may be required by law to provide to you certain written notices or disclosures. 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