08-100.00 Financial Forensics: Law Enforcement Billing DisputeM
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TN INFORMATION PAGE
WEG WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY
INSURER:
HARTFORD ACCIDENT AND INDEMNITY COMPANY
HARTFORD PLAZA, HARTFORD, CONNECTICUT 06115
NCCI Company Number: 10448
Company Code: 5
POLICY NUMBER: 176 WEG TN9151
Previous Policy Number: 176 WEG TN9151
HOUSING CODE: 76
Named Insured and Mailing Address: DARRELL DORRELL PC DBA
(No., Street, Town, State, Zip Code)
FEIN Number: REDACTED
State Identification Number(s):
UIN:
5285 SW MEADOWS RD #340
LAKE OSWEGO, OR 97035
The Named Insured is: CORPORATION
Business of Named Insured: ACCOUNTING & AUDITING SERVICES
Otherworkplaces not shown above: 5285 SW MEADOWS RD #340
LAKE OSWEGO OR 97035
2. Policy Period: From 01/09/08 To 01/09/09
12:01 a.m_, Standard time at the insured's mailing address.
Producer's Name: PAYCHEX AGENCY INC
308 FARMINGTON AVE
FARMINGTON, CT 06032
Producer's Code: 210705
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Issuing Office: THE HARTFORD
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308 FARMINGTON AVE
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FARMINGTON CT 06032
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(B77) 287 -1312
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Total Estimated Annual Premium: $586
Deposit Premium:
Policy Minimum Premium: $350 OR (INCLUDES INCREASED LIMIT MIN.
PREM. )
Audit Period: ANNUAL Installment Term:
The policy is not binding unless countersigned by our authorized representative.
Countersigned by
` 1 ` i` `
12/01/07
Authorized Representative Date
Form WC 00 00 01 A (1) Printed in U.S.A. Page 1 (Continued on next page)
Process Date: 12/01/07 Policy Expiration Date: 01/09/09
ORIGINAL
AGREEMENT FOR PROFESSIONAL SERVICES
Financial Forensics
THIS AGREEMENT is made by and between the City of Spokane Valley, a code City of the State of
Washington, hereinafter "City" and Financial Forensics, hereinafter "Consultant," jointly referred to as
"parties."
IN CONSIDERATION of the terms and conditions contained herein the parties agree as follows:
1. Work to Be Performed. The Consultant will provide all labor, services and material to
satisfactorily complete the attached Scope of Services.
A. Administration. The City Manager or designee shall administer and be the primary
contact for Consultant. Prior to commencement of work, Consultant shill contact the City Manager or
designee to review the Scope of Work, schedule and date of completion. Upon notice from the City Manager
or designee, Consultant shall commence work, perform the requested tasks in the Scope of Work, stop work
and promptly cure any failure in performance under this agreement.
B. Representations. The City has relied upon the qualifications of the Consultant in
entering into this agreement. By execution of this agreement, Consultant represents it possesses the ability,
skill and resources necessary to perform the work and is familiar with all current laws, rules and regulations
which reasonably relate to the Scope of Work. No substitutions of agreed upon personnel shall be made
without the written consent of the City.
Consultant shall be responsible for the technical accuracy of its services and documents
resulting therefrom, and City shall not be responsible for discovering deficiencies therein. Consultant shall
correct such deficiencies without additional compensation except to the extent such action is directly
attributable to deficiencies in City famished information.
C. Modifications. The City may modify this agreement and order changes in the work
whenever necessary or advisable. The Consultant will accept modifications when ordered in writing by the
City Manager or designee. Compensation for such modifications or changes shall be as mutually agreed
between the parties. The Consultant shall make such revisions in the work as are necessary to correct errors or
omissions appearing therein when required to do so by the City without additional compensation.
2. Term of Contract. This Agreement shall be in full force and effect upon execution and shall
remain in effect until completion of all contractual requirements have been met.
Either party may terminate this Agreement by ten (10) days written notice to the other party.
In the event of such termination, the City shall pay the Consultant for all work previously authorized and
satisfactorily performed prior to the termination date.
3. Compensation. The City agrees to pay the Consultant on a time and material basis, not to
exceed $13,000.00 for forensic accounting services as described as Phase I in the attached Scope of Services.
A management reserve fund of $1,950.00 is also hereby established for a total contract amount of S 14,950 as
fuU compensation for everything done under Phase I in the attached Scope of Services in this agreement. In
Agreement for Professional Services with Financial Forensics
Page I of 5
C08 -100
the event the City requires additional services, a Phase II Scope of Work will be developed and the parties may
elect to enter into a written addendum to this agreement for the additional work.
4. Payment. The Consultant shall be paid monthly upon presentation of an invoice to the City.
Applications for payment shall be sent to the City Clerk at the below stated address.
The City reserves the right to withhold payment under this agreement which is determined in the
reasonable judgment of the City Manager or designee to be noncompliant with the Scope of Work, City
Standards, City ordinances and federal or state standards.
5. Notice. Notice: shall be given in writing as follows:
T T FI CI _ : TO THE CONSULTANT:
Name: Christine Bainbridge, City Clerk Name: Darrell D. Dorrell
Phone Number: (509)921 -1000 Phone Number: (503) 636 -7999
Address: 11707 East Sprague Ave, Suite 106 Address: Knee Woods 1
Spokane Valley, WA 99206 5285 SW Meadows Road, Suite 340
Lake Oswego, Oregon, 97035
6. Applicable Laws and Standards. The parties, in the performance of this agreement, agree
to comply with all applicable Federal, State, local laws, ordinances, and regulations.
7. Relationship of the Parties. It is understood, agreed and declared that the Consultant shall be
an independent Consultant and not the agent or employee of the City, that the City is interested in only the
results to be achieved, and that the right to control the particular manner, method and means in which the
services are performed is solely within the discretion of the Consultant. Any and all employees who provide
services to the City under this agreement shall be deemed employees solely of the Consultant. The Consultant
shall be solely responsible for the conduct and actions of all employees under this agreement and any liability
that may attach thereto.
8. Ownership of Docuwents. All drawings, plans, specifications, and other related documents
prepared by the Consultant under this agreement are and shall be the property of the City, and maybe subject
to disclosure pursuant to RCW 42.56 or other applicable public record laws.
9. Records. The City or State Auditor or any of their representatives shall have full access to
and the right to examine during normal business hours all of the Consultant's records with respect to all
matters covered in this contract- Such representatives shall be permitted to audit, examine and make excerpts
or transcripts from such records and to make audits of all contracts, invoices, materials, payrolls and record of
matters covered by this contract for a period of three years from the date final payment is made hereunder.
10. Insurance. Consultant shall procure and maintain for the duration of the Agreement
insurance against claims for injuries to persons or damage to property which may arise from or in connection
with the performance of the work hereunder by the Consultant, its agents, representatives, or employees.
Consultant's maintenance of insurance as required by the agreement shall not be construed to limit the
liability of the Consultant to the coverage provided by such insurance, or otherwise limit the City's recourse to
any remedy available at law or in equity.
Agreement for Professional Services with Financial Forensics
Page 2 of 5
Consultant shall obtain insurance of the types described below:
A. Automobile Liability insurance covering all owned, non - owned, hired and leased vehicles.
Coverage shall be written on Insurance Services Office (ISO) form CA 00 01 or a substitute
form providing equivalent liability coverage. If necessary, the policy shall be endorsed to
provide contractual liability coverage.
The automobile liability policy shall have a minimum combined single limit for bodily injury
and property damage of $1,000,000 per accident
B. Commercial General Liability insurance shall be written on ISO occurrence form CG 00
01 and shall cover liability arising from premises, operations, independent contractors and
personal injury and advertising injury. The City shall be named as an insured under the
Consultant's Commercial General liability insurance policy with respect to the work
performed for the City.
The commercial general liability insurance policy shall be written with limits no less than
$1,000,000 per claim and S2,000,000 policy aggregate limit.
C. Workers' Compensation coverage as required by the Industrial Insurance laws of the State
of Washington, as applicable to this agreement.
D. Professional Liability insurance appropriate to the Consultant's profession, with limits no
less than $1,000,000 per claim and $1,000,000 policy aggregate limit.
The insurance policies are to contain, or be endorsed to contain, the following provisions for
automobile liability, professional liability, and commercial general liability insurance:
A. The Consultant's insurance coverage shall be primary insurance as respect the City. Any
insurance, self - insurance, or insurance pool coverage maintained by the City shall be excess
of the Consultant's insurance and shall not contribute with it.
B. The Consultant's insurance shall be endorsed to state that coverage shall not be cancelled
by either party, except after thirty (30) days prior written notice by certified mail, return
receipt requested, has been given to the City.
Insurance is to be placed with insurers with a current A.M. Best rating of not less than A:VQ.
Consultant shall furnish the City with original certificates and a copy of the amendatory
endorsements, including but not necessarily limited to the additional insured endorsement, evidencing the
insurance requirements of the Consultant before commencement of work.
11. Indemnification and Hold Harmless. Each party shall indemnify and hold the other, its
officers, employees, agents and volunteers harmless from and against any and all claims, demands, orders,
decrees or judgments for injuries, death or damage to any person or property arising or resulting from any
negligent act or omission on the part of said party or its agents, employees or volunteers in the performance of
this Agreement.
Agreement for Professional Services with Financial Forensics
Page 3 of 5
12. Waiver. No officer, employee, agent or other individual acting on behalf of either party has
the power, right or authority to waive any of the conditions or provisions of this agreement. No waiver in one
instance shall be held to be waiver of any other subsequent breach or nonperformance. All remedies afforded
in this agreement or by law, shall be taken and construed as cumulative, and in addition to every other remedy
provided herein or by law. Failure of either party to enforce at any time any of the provisions of this agreement
or to require at any time performance by the other party of any provision hereof shall in no way be construed to
be a waiver of such provisions nor shall it affect the validity of this agreement or any part thereof.
13. Assignment and Delegation. Neither party shall assign, transfer or delegate any or all of the
responsibilities of this agreement or the benefits received hereunder without first obtaining the written consent
of the other party.
14. Subcontracts. Except as otherwise provided herein, the Consultant shall not enter into
subcontracts for any of the work contemplated under this agreement without obtaining prior written approval of
the City.
15. Confidentiality. Consultant may from time to time receive information which is deemed by
the City to be confidential. Consultant shall not disclose such information without the express written consent
of the City or upon order of a Court of competent jurisdiction.
16. Jurisdiction and Venue. This Contract is entered into in Spokane County, Washington.
Venue shall be in Spokane County, State of Washington.
17. Cost and Attorney's Fees. In the event a lawsuit is brought with respect to this Agreement,
the prevailing party shall he awarded its costs and attorney's fees in the amount to be determined by the Court
as reasonable. Unless provided otherwise by statute, Consultant's attorney fees payable by the City shall not
exceed the total sum amount paid under this agreement.
18. Entire Agreement. This written agreement constitutes the entire and complete agreement
between the parties and supercedes any prior oral or written agreements. This Agreement may not be changed,
modified or altered except in writing signed by the parties hereto.
19. Anti- kickback. No officer or employee of the City, having the power or duty to perform an
official act or action related to this Agreement shall have or acquire any interest in this Agreement, or have
solicited, accepted or granted a present or futwe gift, favor, service or other thing of value from any person
with an interest in this Agreement.
20. Business Registration. Consultant endeavors to comply with City business registration
requirements prior to completion of the work identified in the Scope of Services.
21. Severability. If any section, sentence, clause or phrase ofthis Agreement should be held to
be invalid for any reason by a court of competent jurisdiction, such invalidity shall not affect the validity of any
other section, sentence, clause or phrase of this Agreement.
22. Exhibits. Exhibits attached and incorporated into this agreement are:
1. Scope of services
2. Insurance Certificates
Agreement for Professional Services with Financial Forensics
Page 4 of 5
�'L
IN WITNESS WHEREOF, the parties have executed this Agreement this / day of
AL'o's7— , 2008.
CITY F SPOKANE VALLEY: Consultant:
David Me� i , City Manager er
Tax ID No. , - BEDAQTED_
ATTES
i
Christine Bainbridge, City Clerk
I
APPROVED AS TO FORM:
Office of thg4ity Attorne
This document contains confidential tax information and
has been redacted pursuant to RCW 82.32.330.
You may petition for a review of our findings pertaining to any
redacted or withheld documents pursuant to Spokane Valley
Municipal Code (SVMC) 2.75.080; and obtain judicial review
pursuant to RCW 42.56.550.
Agreement for Professional Services with Financial Forensics
Page 5 of 5
City of Spokane Valley
Spokane County — Law Enforcement Contract Settle and Adjust for 2006
August 20, 2008
TASK (HOURS RANGE ) I TARGET I COMMENTS
Overall Objective: Deliver one 2 -hour (approx.) work session to a composite group of City of Spokane Valley and Spokane County
representatives the findings and observations regarding an analysis of the Law Enforcement Services contract rate.
Have already conducted preliminary pre -
contract interviews with Dave Mercier,
Cary Driskell and Mike Jackson; more
detailed interview with Morgan Koudelka.
City of Spokane Valley
Expect continuing detailed conversation
with Morgan and high -level interviews with
Cary, Dave and Mike.
Possible additional targets include:
Ken Thompson, Fin. & Adm.
Interviews
(16 -30 hours)
Target group consists of:
High -Level Interviews:
Marshall Farrell, CEO
Downs Paul
Greg Connor, Undersheriff
Spokane County
Jim Emacio, Chief Civil Deputy
Prosecutor
Detailed Interviews:
Devra Brown
Nancy Spears
Kelly Rueff
Page 1 of 3
City of Spokane Valley
Spokane County — Law Enforcement Contract Settle and Adjust for 2006
August 20, 2008
TASK HOURS RANGE
TARGET
COMMENTS
In our possession:
Correspondence trail, dating from
Morgan's March 9, 2007 letter through the
July 25, 2008 letter from Dave Mercier.
Also, Morgan's PowerPoint outline of his
findings.
City of Spokane Valley
Law Enforcement Services and Jail
Services Contracts from 2003 and 2006,
Data Collection
respectively.
(4 -12 hours)
Jail Rate Plan
Sheriffs Cost Plan
Pertinent correspondence within the
timeframe above.
Spokane County
Kelly Rueff's 1 -page analysis, Jail
Distribution of Costs for 2007, Jail Housing
for 2006 and Daily Housing Rate for 2005.
Confirmation of definitions, standards, et
al.
Data Validation
(8 -16 hours)
City of Spokane Valley
Validation and confirmation (including
collection of source documents) tracing to
pertinent supporting documents.
Page 2 of 3
City of Spokane Valley
Spokane County — Law Enforcement Contract Settle and Adjust for 2006
August 20, 2008
TASK (HOURS RANGE)
TARGET
COMMENTS
Confirmation of definitions, standards, et
al.
Spokane County
Validation and confirmation (including
collection of source documents) tracing to
pertinent supporting documents.
City of Spokane Valley
Corroboration of findings and observations
with selected parties.
Data Validation
(inclusive)
Spokane County
Corroboration of findings and observations
with selected parties.
Delivery of findings and observations and
All -Hands Work Session
(12 -20 hours incl. prep)
A 2 -hour work session (approx.)
comprised of key representatives from
open discussion.
Written findingstconclusions delivered to
(Target Date: Sept. 19, 2008)
both the City and the County.
City
Page 3 of 3
ACORD CERTIFICATE OF LIABILITY INSURANCE
Dos/1812008 '
PR dZeAl IARM
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ELSON, AGENT STATE FARM INS
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
1 0 5 W MEADOWS RD STE 164
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
613pT3
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSUR ►f( OSWEGO, OR 97038
GENERAL LIABILITY
INSURERS AFFORDING COVERAGE
NAIC 9
INSURED
IN URERA: State Farm TAUtual Automo60o lmwance Core.pany 15178
S
DARRELL & CYNTHIA DORRELL
CQNI!-ERCIAL GENERAL LIABILITY
DBA FINANCIAL FORENSICS
INSURER 3:
MED EXP ane perun
S
873 COUNTRY COMMONS LN
INSURER C:
CLAIIAS MADE F-1 OCCUR
LAKE OSWEGO, OR 97034
LNSURERD:
$
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIRFSdENT. TERM OR CONOrrION OF ANY CONTRACT OR OTHER OOCUMENT 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 CLAUAS.
INSH
tTQ
DO'
POLICY NUMB EA
POLICY EFFECTIVE
POUCY EXPIRATION
,M
613pT3
GENERAL LIABILITY
EACH OCCURRENCE
S
DAMAGE TO RENTED
EMISGS a ocnua
S
CQNI!-ERCIAL GENERAL LIABILITY
MED EXP ane perun
S
CLAIIAS MADE F-1 OCCUR
PERSONAL d ADV ItIJURY
$
GENERAL AGGREGATE
f
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS.COMPrOPAGO
S
POLICY PRO- LOC
AUTOMOBILE LIABILITY
ANY AUTO
216 2825 -027 -371 &
2787681- E02 -37G
4/27108
&
10/27/08
&
COMBINED SINGLE LIMIT
(En ocalarAl
=
3000.Y INJURY
(Perpersan)
S 1,000,000.00
ALL OWNED AUTOS
SCHEDULED AUTOS
5 12108
1112/08
BODI Y;RY
S 1,000,000.00
HIREOAUTOS
NON•O'MNED AUTOS
PROPERTYDAALIGE
(Peracceerq
S 1,000,000.00
2005 FORD EXPED
X
2007 FORD EDGE
GARAGELIABILITY
AUTO ONLY - EA ACCIDENT
$
OTHER THAN EA ACC
S '
ANY AUTO
S
_
AUTO ONLY: AGG
EXCESSIUNBRELLA LIABILITY
EACH OCCURRENCE
S
AGGREGATE
$
OCCUR CLAIMS MADE
S
$
DEDUCTIBLE
S
RETENTION S
V!C STATU• OTH-
WORKERS COMPENSATION AND
E.L. EACH ACCIDENT
t
EMPLOYERS' LIABILITY
ANY PROP W tTORPARTT: ERfI=CUJT VE
WFICERIMENZEREXCLUDED?
F L DISEASE - EA EMPLOYEO
S
E.L. DISEASE • POLICY LLNrr
I S
V ye3. descibe under
SPECIAL PROVISIONS balaw
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
ADDITIONAL INSURED: THE CITY OF SPOKANE VALLEY 11707 EAST SPRAGUE AVE STE 106
SPOKANE VALLEY, WA 99206
CERTIFICATE HQLQEK L PkN{rcL L.K I IUJI
THE CITY OF SPOKANE VALLEY
ATTN: CHRISTINE BAINBRIDGE, CITY CLERK
11707 EAST SPRAGUE AVE STE 106
SPOKANE VALLEY, WA 99206
ACORD 25 (2001/08)
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 FAILU RP TO DO SO SHALL
IMPOSE NO OBUOATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGES75 OR
O ACORD CORPORATION 1988
CERTIFICATE OF INSURANCE
at
® STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois
STATE #ARM
❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois
-01
❑ STATE FARM FIRE AND CASUALTY COMPANY, Scarborough, Ontario
®
❑ STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven, Florida
INSURANCE
:l
El STATE FARM LLOYDS, Dallas, Texas
insures the Toi lowing policyholder for the coverages indicated below-
Name of policyholder DARRELL DORRELL
Address of policyholder DNA FINANCIAL FORENSICS
Location of operations 5285 SW MEAD(N)S RD STE 340 LAKE OSWEGO, OR 97035
Description of operations
The policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is
subject to all the terms exclusions, and conditions of those policies. The limits of liability shown may have been reduced by any paid claims.
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
If any of the described policies are canceled before
its expiration date, State Farm will try to mail a written
notice to the certificate holder 30 days before
Name and Address of Certificate Holder cancellation. If however, we fail to mail such notice,
no obligation or liability will be imposed on State
THE CITY OF SPOKANE VALLEY Farm or its agents or representatives.
11707 EAST S?RAGUE AVE STE 106
SPOKANE VALLEY, WA 99206
Signature f Authorized Representative
AGENT 2 /18/08
Title Date
Agent's Code Stamp
AFO Code F999
558 -e9. a.3 04.1999 Prsntedtn U.S.A.
POLICY PERIOD
LIMITS OF LIABILITY
POLICY NUMBER
TYPE OF INSURANCE
Effective Date ; Expiration Date
(at beginning of policy period)
Comprehensive
BODILY INJURY AND
97 -CS- 7085 -3
Business Uabili .. 7/27/06 7/27/09
.•-
PROPERTY DAMAGE
- - - --- --
This insurance includes:
. ......---- -- -- -- ---------
Products - Completed Operations
❑ Contractual Liability
❑ Underground Hazard Coverage
Each Occurrence $2,000,000
❑ Personal Injury
I❑ Advertising Injury
General Aggregate $4,000,000
❑ Explosion Hazard Coverage
❑ Collapse Hazard Coverage
Products — Completed $4,000,000
❑
Operations Aggregate
POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE
EXCESS LIABILITY Effective Date Expiration Date (Combined Single Limit)
❑ Umbrella Each Occurrence $
❑ Other ... , - $
- JIM NELSON; Agents --' V ,ATUTORY
STATE FARMYNSURANCE o9 jDILY INJURY
5285 ivieadows Rd,• Stc 164
Workers' Compensat6
Lake Osir"ego;;OR -97035
and Employers LiabiG� dent $
503:694.4008 phone
y, ; :.,; _ach Employee $
Disease - Policy Limit $
POLICY PERIOD
LIMITS OF LIABILITY
POLICY NUMBER
TYPE OF INSURANCE
Effective Date-: Expiration Date
(at beginning of policy period)
THE CERTIFICATE OF INSURANCE
IS NOT A CONTRACT
OF INSURANCE AND NEITHER
AFFIRMATIVELY NOR NEGATIVELY
AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN.
If any of the described policies are canceled before
its expiration date, State Farm will try to mail a written
notice to the certificate holder 30 days before
Name and Address of Certificate Holder cancellation. If however, we fail to mail such notice,
no obligation or liability will be imposed on State
THE CITY OF SPOKANE VALLEY Farm or its agents or representatives.
11707 EAST S?RAGUE AVE STE 106
SPOKANE VALLEY, WA 99206
Signature f Authorized Representative
AGENT 2 /18/08
Title Date
Agent's Code Stamp
AFO Code F999
558 -e9. a.3 04.1999 Prsntedtn U.S.A.
51 (Policy Provisions: WC 00 00 00 A)
91
TN INFORMATION PAGE
WEG WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY
INSURER: HARTFORD ACCIDENT AND INDEMNITY COMPANY
HARTFORD PLAZA, HARTFORD, CONNECTICUT 06115
NCCI Company Number: 10448
Company Code: 5
THE
HARTFORD
ORIGINAL
0
Sur iX
LARS RENRVAL
o
POLICY NUMBER:
76 WEG TN9151
O1
Previous Policy Number:
76 t•IEG TN9151
Ln
HOUSING CODE: 76
z
1.. Named Insured and Mailing Address: DARRELL DORRELL PC DBA
(No., Street, Town, State, Zip Code)
(SEE ENDT)
w
a
5285 Std MEADows RD #340
FEIN Number: 931280180 LAKE OSWEGO, OR 97035
*
State Identification Number(s):
UIN:
The Named Insured is: CORPORATION
Business of Named Insured: ACCOUNTING & AUDITING SERVICES
--
Other workplaces not shown above: 5285 SW MEADOWS RD #340
LAKE OSWEGO OR 97035
2. Policy Period: From 01/09/08 To 01/09/09
12:01 a.m., Standard time at the insured's mailing address.
Producer's Name: PAYCHEX AGENCY INC
308 FARMINGTON AVE
�..
FARMINGTON, CT 06032
Producer's Code: 210705
Issuing Office: THE HARTFORD
308 FARMINGTON AVE
FARMINGTON CT 06032
e
(877) 287 -1312
c
Total Estimated Annual Premium: $586
Deposit Premium:
=
Policy Minimum Premium: $350 OR (INCLUDES INCREASED LIMIT MIN.
PREM. )
—_
Audit Period: ANNUAL Installment Term:
The policy is not binding unless countersigned by our authorized representative.
c
Countersigned by
12/01/07
Authorized Representative
Date
Form WC 00 00 01 A (1) Printed in U.S-A. Page 1 (Continued on next page)
Process Date: 12/01/07 Policy Expiration Date: 01/09/09
ORIGINAL
PAGE (Continued)
rs Compensation Insurance:
listed here: OR
Policy Number: 76 WEG TN9151
Part one of the policy applies to the Workers Compensation Law of the
8. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A.
l' The limits of our liability under Pail Two are:
� Bodily injury by Accident $500, 000 each accident
' Bodily injury by Disease $500, 000 policy limit
;T Bodily injury by Disease $500,000 each employee
"r C. Other States Insurance: Part Three of the policy applies to the states, if any ,listed here:
o ALL STATES EXCEPT ND, OH, WA, WV, V7Y, AND
STATES DESIGNATED IN ITEM 3.A. OF THE INFORMATION PAGE.
D. This policy includes these endorsements and schedule:
we 00 01 13 Vic 00 03 08 %-.0 00 04 21A WC 00 04 22 wC 99 03 OOB
tn SEE ENDT
F 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating
Plans All information required below is subject to verification and change by audit.
N Premium Basis
Classifications Total Estimated Rates Per Estimated
Code Number and Annual $100 of Annual
Description Remuneration Remuneration Premium
8810 135,700 .23 312
DRAFTING EMPLOYEES
TOTAL ESTIMATED ANNUAL STANDARD PREMIUM 312
180
EXPENSE CONSTANT (0900)
OR WC ADMINISTRATIVE FUND 4.6000 PERCENT 26
FOREIGN TERRORISM (9740) 135,700 .030 41
DTEC (9741) 135,700 •020 27
TOTAL ESTIMATED ANNUAL PREMIUM 586
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Total Estimated Annual Premium: $586
Deposit Premium:
Policy Minimum Premium: $350 OR (INCLUDES INCREASED LIMIT MIN. PREM.)
Interstatelintrastate Identification Number:
NAICS:
Labor Contractors Policy Number. SIC: 8721
UIN:
NO. OF EMP: 000006
Form WC 00 00 01 A (1) Printed in U.S.A. Page 2
Process Date: 12/01/07 Policy Expiration Date: 01/09/09
P.O. Box 103548 NATIONAL INSURANCE COMPANY
GeneralStar
Stamford, Connecticut 06904
ACCOUNTANTS PROFESSIONAL LIABILITY INSURANCE POLICY
DECLARATIONS PAGE
This is a claims made and reported policy.
Please read this policy and all endorsements and attachments carefully.
Policy Number: NJA948WD
1. NAMED INSURED:
MAILING ADDRESS:
Darrell Dorrell PC dba Financial
Forensics
5285 SW Meadows Road Ste 340
Lake Oswego, OR 97035
Renewal of Number: NJA948046C
2. POLICY PERIOD: Inception Date: 02/24/2008 Expiration Date: 0212412009
Effective 12:01 a.m. Standard Time at the mailing address of the Named Insured.
3. LIMIT OF LIABILITY:
Each Claim: $ 1,000,000
Aggregate: $ 1,000,000
4. CLAIM EXPENSES:
b. Have a separate limit of liability.
5. DEDUCTIBLE:
Each Claim: S 15,000
a. The deductible amount specified above applies only to Damages.
6. PREMIUM:
$ 8,748.00
7. RETROACTIVE DATE: 02/2412000
If a date is indicated, this insurance will not apply to any regular act, error, omission or personal injury
which occurred before such date.
8. ENDORSEMENTS:
This policy is made and accepted such to the printed conditions in this policy together with the provisions,
stipulations and agreements contained in the following form(s) or endorsement(s).
GSN -O&AC -130 (08/2003) GSN -06 -PL -85308 (0412003)
GSN -07 -PL -375 (02/2006)
9. MANAGING AGENT
Herbert H. Landy Insurance Agency, Inc.
75 Second Avenue, Suite 410
Needham, Massachusetts 02494 -2876
Produces Code: 00026230
Date: 03/0512008
GSN -06 -AC -730 (0312004)
*4*19� ---
Authorized Representative
Class Code: 73102
SLA#: