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HomeMy WebLinkAboutPNR MEDICAL CONSULTING, INC.i;, SURANCE NOT ON FILE N-2021-253 JORK MAY NOT PROCEED f, CLERK OF COUNCIL 451 DATE: CONSULTANT AGREEMENT F(LCS CITY OF SANTA ANA �Spn A �•"' "1'HI3�AGREEMENT is made and entered into on this 16 day of December, 2021, by and between PNR Medical Consulting, Inc., a Nevada corporation ("Consultant'), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). RECITALS A. The City desires to retain a consultant having special skill and knowledge in the field of providing medics, first aid kits, and EMT services for the Santa Ana Winter Village from December 18, 2021, through January 2, 2022. B. Consultant represents that Consultant is able and willing to provide such services to the City. C. The City may utilize funds provided under the American Rescue Plan Act ("ARPA") for this Agreement. ARPA was signed into law in March 2021. ARPA provides funding for a number of different programs, including the Coronavirus State and Local Fiscal Recovery Fund ("SLFRF"), to provide monetary support to local governments to respond to, mitigate, and recover from the COVID-19 public health emergency. D. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in its field and that any services performed by Consultant under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional consulting firm in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES Consultant shall perform during the term of this Agreement, the tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately complete the services described and set forth in the Estimate attached hereto as Exhibit A and incorporated herein by reference. 2. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services for City, the rates and charges identified in Exhibit A. The total sum to be expended under this Agreement shall not exceed $14,982-.00 during the term of this Agreement. b. Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. C. As the recipient of ARPA SLFRF funds, Consultant will be required to comply with any and all compliance requirements for the use of SLFRF funds, any and all reporting requirements for expenditures of SLFRF funds, as well as compliance with 2 CFR 200.332 regarding pass -through entities. 3. TERM This Agreement shall commence on the date first written above and continue through January 7, 2022, unless terminated earlier in accordance with Section 15 below. The Term of this Agreement may be extended by a writing executed by the City Manager and the City Attorney. 4. INDEPENDENT CONTRACTOR Consultant shall, during the entire term of this Agreement, be construed to be an independent contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer -employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Consultant performs the services which are the subject matter of this Agreement; however, the services to be provided by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services. Consultant shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 5. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Consultant under this Agreement ("Documents & Data"). Consultant shall require all subcontractors to agree in writing that City is granted a non-exclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Consultant represents and warrants that Consultant has the legal right to license any and all Documents & Data. Consultant makes no such representation and warranty in regard to Documents & Data which were provided to Consultant by the City. City shall not be limited in any way in its use of the Documents and Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. 6. INSURANCE Consultant shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property which may arise from or in connection with 2 the performance of the work hereunder by the Consultant, its agents, representatives, employees or subcontractors. a. MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall beat least as broad as: 1. Commercial General Liability (CGL): Insurance Services Office Form CG 00 O1 covering CGL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall be twice the required occurrence limit. 2. Automobile Liability: ISO Form Number CA 00 01 covering any auto (Code 1), or if Contractor has no owned autos, hired, (Code 8) and non -owned autos (Code 9), with limit no less than $1,000,000 per accident for bodily injury and property damage. 3. Workers' Compensation: as required by the State of California, with Statutory Limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident for bodily injury or disease. 4. If the Consultant maintains broader coverage and/or higher limits than the minimums shown above, the City requires and shall be entitled to the broader coverage and/or the higher limits maintained by the Consultant. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City. b. Other Insurance Provisions — The insurance policies are to contain, or be endorsed to contain, the following provisions: 1. Additional Insured Status: The City, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Consultant including materials, parts, or equipment furnished in connection with such work or operations. General liability coverage can be provided in the form of an endorsement to the Consultant's insurance (at least as broad as ISO Form CG 20 10 1185 or both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 20 37 forms if a later revisions used). 2. Primary Coverage: For any claims related to this contract, the Consultant's insurance coverage shall be primary coverage at least as broad as ISO CG 20 0104 13 as respects the City, its officers, officials, employees, and volunteers. Any insurance or self-insurance maintained by the City, its officers, officials, employees, or volunteers shall be excess of the Consultant's insurance and shall not contribute with it. 3. Notice of Cancellation: Each insurance policy required above shall provide that coverage shall not be canceled, except with notice to the City. 4. Waiver of Subrogation: Consultant hereby grants to City a waiver of any right to subrogation which any insurer of said Consultant may acquire against the City by virtue of the payment of any loss under such insurance. Consultant agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation, but this provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. 5. Self -Insured Retentions: Self -insured retentions must be declared to and approved by the City. The City may require the Consultant to purchase coverage with a lower retention or provide proof of ability to pay losses and related investigations, claim administration, and defense expenses within the retention. The policy language shall provide, or be endorsed to provide, that the self - insured retention may be satisfied by either the named insured or City. 6. Acceptability of Insurers: Insurance is to be placed with insurers authorized to conduct business in the state with a current A.M. Best's rating of no less than A:VII, unless otherwise acceptable to the City. 7, Claims Made Policies: If any of the required policies provide coverage on a claims -made basis: 1. The Retroactive Date must be shown and must be before the date of the contract or the beginning of contract work. 2. Insurance must be maintained and evidence of insurance must be provided for at least five (5) years after completion of the contract of work. 3. If coverage is canceled or non -renewed, and not replaced with another claims -made policy form with a Retroactive Date prior to the contract effective date, the Consultant must purchase "extended reporting" coverage for a minimum of five (5) years after completion of contract work. 8. Verification of Coverage: Consultant shall famish the City with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage required by this clause) and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements to City before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive the Consultant's obligation to provide them. City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. 9. Special Risks or Circumstances: City reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. 7. INDEMNIFICATION Consultant agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, contractors, special counsel, and representatives from liability: (1) for personal 4 injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Consultant, its subcontractors, agents, employees, or other persons acting on its behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. The Consultant further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party challenging the validity of this Agreement, or asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing, to the extent Consultant's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Consultant. 8. INTELLECTUAL PROPERTY INDEMNIFICATION Consultant shall defend and indemnify the City, its officers, agents, representatives, and employees against any and all liability, including costs, for infringement of any United States' letters patent, trademark, or copyright infringement, including costs, contained in the work product or documents provided by Consultant to the City pursuant to this Agreement. P! 9 DCKI] tI I Consultant shall keep records and invoices in connection with the work to be performed under this Agreement. Consultant shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Consultant under this Agreement. All such records and invoices shall be clearly identifiable. Consultant shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours. Consultant shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Consultant under this Agreement. 10. CONFIDENTIALITY If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Consultant agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Consultant without reference to information disclosed by the City. 11. CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 12. NON-DISCRIMINATION Consultant shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 13. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Consultant. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Consultant or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which is not embodied herein. 14. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Consultant, Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other consultants retained by City. 15. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for all services performed by Consultant prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Executive Director may require Consultant to deliver to the City all work product(s) completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 16. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 17. JURISDICTION - VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 18. PROFESSIONAL LICENSES Consultant shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 19. NOTICE Any notice, tender, demand, delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail, postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: 7 To City: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax: 714- 647-6956 With courtesy copies to: City of Santa Ana 20 Civic Center Plaza (M-25) P.O. Box 1988 Santa Ana, California 92702-1988 Facsimile (714) 647-6549 To Consultant: PNR Medical Consulting, hie. 3320 E. Airport Way Long Beach, CA 90806 Sharma Ickler, Assistant Manager — Media Support (877)878-9185 x1012 Email: sickler@theamphibiousgroup.com A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four (24) hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 20. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. (signatures on followingpage) IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. Daisy domez Clerk of-*e Cnii-ficil APPROVED AS TO FORM: SONIA R. CARVALHO City By: Rya Assi FOR APPROVAL: Executive Director Parks, Recreation & Community Services Agency CITY OF SANTA ANA Kri fiine Ridge City Manager CONSULTANT , X'Z-su� WCA?4'& Sharma Ickler Assistant Manager — Media Support EXHIBIT A ESTIMATE EXHIBIT A PNR Medical Consulting, Inc. 4010 Watson Plaza Ste #150 Lakewood, CA 90712 Estimate ADDRESS City of Santa Ana 12/18/2021 Set Medic $65.00 per hour (8 hour minimum) 12/18/2021 Set Medic $75.00 per hour after 8 hours (Overtime) 12/18/2021 Iat Rental All inclusive, no single item charge 12/19/2021 Set Medic $65.00 per hour (8 hour minimum) 12/19/2021 Set Medic $75.00 per hour after 8 hours (Overtime) 12/19/2021 Kit Rental All inclusive, no single item charge 12/20/2021 Set Medic $65.00 per hour (8 hour minimum) 12/20/2021 Set Medic $75.00 per hour after 8 hours (Overtime) 12/20/2021 Kit Rental All inclusive, no single item charge 12/21 /2021 Set Medic $65.00 per hour (8 hour minimum) 12/21 /2021 Set Medic $75.00 per hour after 8 hours (Overtime) 12/21/2021 Kit Rental All inclusive, no single item charge ESTIMATE # 1187 DATE 12/01 /2021 QTY ^"'.'' RATE AMOUNT 8 65.00 520.00 4 75.00 300.00 1 50.00 50.00 8 65.00 520.00 4 75.00 300.00 1 50.00 50.00 8 65.00 520.00 4 75.00 300.00 1 50.00 50.00 8 65.00 520.00 4 75.00 300.00 1 50.00 50.00 ACTnITY y QT Cx „} ` ` R�; y•q{i3, w s a > I . :"� w�. .... >"..•f ...�..�5, . _ .. t.. \� ,._. . h < x. . , .. .: w.. a.�W>f: Lam.§ 12/22/2021 Set Medic 8 65.00 520.00 $65.00 per hour (8 hour minimum) 12/2212021 Set Medic 4 75.00 300.00 $75.00 per hour after 8 hours (Overtime) 12/22/2021 Idt Rental 1 50.00 50.00 All inclusive, no single item charge 12/23/2021 Set Medic 8 65.00 520.00 $65.00 per hour (8 hour minimum) 12/23/2021 Set Medic 4 75.00 300.00 $75.00 per hour after 8 hours (Overtime) 12/23/2021 IGt Rental 1 50.00 50.00 All inclusive, no single item charge 12/2412021 Set Medic 8 65.00 520.00 $65.00 per hour (8 hour minimum) 12/24/2021 10 Rental 1 50.00 50.00 All inclusive, no single item charge 12/25/2021 Set Medic 8 65.00 520.00 $65.00 per hour (8 hour minimum) 12/25/2021 Set Medic 4 75.00 300.00 $75.00 per hour after 8 hours (Overtime) 12/25/2021 IGt Rental 1 50.00 50.00 All inclusive, no single item charge 12/26/2021 Set Medic 8 65.00 520.00 $65.00 per hour (8 hour minimum) 12/26/2021 Set Medic 4 75.00 300.00 $75.00 per hour after 8 hours (Overtime) 12/26/2021 Kit Rental 1 50.00 50.00 All inclusive, no single item charge 12/27/2021 Set Medic 8 65.00 520.00 $65.00 per hour (8 hour minimum) 12/27/2021 Set Medic 4 75.00 300.00 $75.00 per hour after 8 hours (Overtime) 12/27/2021 IQ Rental 1 50.00 50.00 All inclusive, no single item charge 12/28/2021 Set Medic 8 65.00 520.00 $65.00 per hour (8 hour minimum) 12/28/2021 Set Medic 4 75.00 300.00 $75.00 per hour after 8 hours (Overtime) A DATE �yIT1�„ S.I AE.$4 12/28/2021 IQ Rental 1 50.00 50.00 All inclusive, no single item charge 12/29/2021 Set Medic 8 65.00 520.00 $65.00 per hour (8 hour minimum) 12/29/2021 Set Medic 4 75.00 300.00 $75.00 per hour after 8 hours (Overtime) 12/29/2021 16t Rental 1 50.00 50.00 All inclusive, no single item charge 12/30/2021 Set Medic 8 65.00 520.00 $65.00 per hour (8 hour minimum) 12/30/2021 Set Medic 4 75.00 300.00 $75.00 per hour after 8 hours (Overtime) 12/30/2021 lGt Rental 1 50.00 50.00 All inclusive, no single item charge 12/31 /2021 Set Medic 8 65.00 520.00 $65.00 per hour (8 hour minimum) 12/31 /2021 Set Medic 4 75.00 300.00 $75.00 per hour after 8 hours (Overtime) 12/31/2021 Kilt Rental 1 50.00 50.00 All inclusive, no single item charge 01 /01 /2022 Set Medic 8 65.00 520.00 $65.00 per hour (8 hour minimum) 01 /01 /2022 Set Medic 4 75.00 300.00 $75.00 per hour after 8 hours (Overtime) 01/01/2022 IQ Rental 1 50.00 50.00 All inclusive, no single item charge 01 /02/2022 Set Medic 8 65.00 520.00 $65.00 per hour (8 hour minimum) 01 /02/2022 Set Medic 4 75.00 300.00 $75.00 per hour after 8 hours (Overtime) 01 /02/2022 Idt Rental 1 50.00 50.00 All inclusive, no single item charge ------------------------- .._........__...._..-.............. ... -..... --------------------------- ------ -----_-- -------- ----- Rates per medic. per day: TOTAL $1 3r620.00 $65.00 per hour, minimum 8 hours Overtime after 12 hours ($75.00 per hour after 8 hours) Plus a $50.00 kit fee (our medics come with their own fully stocked BLS Bag to provide first aid) Francine R. Digitally signed by Francine R. Villareal � ® Villareal ACORO CERTIFICATE OF LIABILITY INSURANCE `/ DDMRNMMDA'YYY) 12/17/2021 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 have ADDITIONAL INSURED provisions or 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 Dodge Insurance Services, Inc. DBA Arroyo Insurance Services 3480 Torrance Blvd., Suite 301 CONTACT NAME: Nora Vazquez PHONE FAX 310-356-8207 ac No:310-356-1825 ADDRESS: norav@arroyoins.com Torrance CA 90503 INSURERS AFFORDING COVERAGE NAICIr INSURER A: National Fire & Marine Ins. Co 20079 INSURED INDUS-1 Industrial Medical Support, Inc. 3320 E. Airport Way INSURER B INSURER C: INSURER D: Long Beach CA 90806 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1519681559 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 LTR OF INSURANCE ADDLTYPE JIM SUBR POLICY NUMBER MMIOUYEFF MWPOLICY EXP DO LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR Y Y HN033337 3/15/2021 3/15/2022 EACH OCCURRENCE $1,000,000 -DAMAGETO PREMISESSEa occurrence) $50,000 MED EXP (Art, one person) $ 5,000 PERSONAL &ADV INJURY $1,000,000 AGGREGATE LIMIT APPLI ES PER: GENERAL AGGREGATE $3,000,000 GEN'L POLICY ❑ JECOT [XI LOG PRODUCTS-COMP/OP AGO $3.000.000 S OTHER: A AUTOMOBILE LIABILITY HN033337 3/15/2021 3/15/2022 COMBINED SINGLE LIMIT Ea acWtlenl $1,000.000 BODILY INJURY (Per person) $ AUTO JANY OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED P1 NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ A UMBRELLA LIAR X OCCUR EN033337 3/15/2021 3/15/2022 EACH OCCURRENCE $51000,000 AGGREGATE $5,000,000 X EXCESS LIAB CLAIMS -MADE LIED I X I RETENTION$ D $ WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY YIN PER OTH- STATUTE I I ER E.L. EACH ACCIDENT $ ANVPROPRIETOR/PARTNERIEXECUIIVE OFFICERIMEMBEREXCLUDED? NIA E.L. DISEASE - FA EMPLOYE $ (Mandatary in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ A Healthcare Processional Liability Claims Made HN033337 3M5/2021 3/15/2022 Par Event Limit Aggregate Limit Rather Data 1,000,000 3.000,000 03/31/2014 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may, be attached if more space is required) General Liability with Automobile Liability blanket additional insured applies when required by written contract but in no way will the additional insured status exceed the limits, terms or conditions of the policy. General Liability Primary and Non -Contributory coverage applies when required by written contract. General Liability and Automobile Liability blanket waiver of subrogation applies when required by written contract but in no way will the additional insured status exceed the limits, terms or conditions of the policy. Excess Liability policy follows form of underlying policy schedule. Underlying schedule includes General Liability, Hired and Non -Owned Auto and Professional Liability. Additional Insured includes City of Santa Ana its officers, officials, employees, and volunteers as respects General Liability arising out of work or operations See Attached... City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92702 ACORD 25 (2016103) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Vf.__D,W4J ©1988-2015 ACORD C The ACORD name and logo are registered marks of ACORD Risk Marugement Divisian RENEWED & APPROVED BY: Fa4Mti.1.! Imo. V:11.L4.�¢ ® Rlsk Managentenl Analyst AGENCY CUSTOMER ID: INDUS-1 ACOR" LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY Dodge Insurance Services, Inc. NAMED INSURED Industrial Medical Support, Inc. 3320 E. Airport Way Long Beach CA 90806 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE I by or on behalf of the named insured including materials, parts, or equipment furnished in connection with such work or operations. General Liabil is primary and non-contributory. General Liability Waiver of Subrogation applies. 30 days notice of cancellation except 10 days for non-payment of ACORD 1n1 t2nnR/MI The ACORD name and logo are registered marks of ACORD _ Risk MarugementDivisian _ REVIEWED E,IAPPR.�Oe�v�EO BY: r4mlcY �! R. V�Lr/l�iUll Rizk Nlrnrgeliren[ Analys[ Issuing Company: MedPro Group National Fire & Marine Insurance Company qn, Omaha, Nebraska THISENDORSEMENT CHANGES THEPOLICY. PLEASE READ ITCAREFULLY. Endorsement No.: 9 Forming Part of Policy No.: HN033337 Issued to: Industrial Medical Support Effective Date of Endorsement: 03/15/2021 at 12:01 a.m. at the address of the First Named Insured stated herein. BLANKET ADDITIONAL INSURED — PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT (GENERAL LIABILITY) Only with respect to coverage provided under this endorsement and under the General Liability Coverage Part, and in consideration of the payment of the additional premium due, if any, and in reliance upon the representations of all insureds, the company and the insureds agree to amend the policy as follows: The definition of additional insured in the Definitions section of the Common Policy Provisions and Conditions is deleted and replaced with the following: Additional insured means any person or organization with which the insured has entered into a written contract or agreement prior to the loss agreeing: 1. to add the person or organization as an additional insured; or 2. to hold harmless or indemnify such person or organization. However, such person or organization is not an additional insured with respect to losses arising from, or in connection with, any acts or omissions alleged to have been committed by that additional insured. The following subparagraph is added to the Other Insurance condition of the Conditions section of the Common Policy Provisions and Conditions: Only if required by written contract or agreement with the insured, coverage for any additional insured shall be primary and non-contributory as respects any other insurance policy issued to such additional insured. The following subparagraph is added to all Insuring Clauses of the General Liability Coverage Part policy: The company's duty to defend and pay losses or claims expense on behalf of any insured shall extend to any additional insured meeting the terms and conditions of this policy, but only with respect to any loss or claims expense payable as the result of the additional insured's vicarious liability for the acts or omissions of an insured otherwise covered under this Coverage Part. However, the coverage provided to an additional insured shall not be broader than that which an insured is required by written contract or agreement to provide to that additional insured. Additionally, coverage shall not apply to structural alterations, new construction or demolition operations performed by or on behalf of an additional insured. Risk MougenmdElMdwt REVIEWED F APPROVED BY: 1507-PGX-00-1215 Page 1 of 2 © 2015 Me % F40LR. Vtk'aout Risk Management Analyst The following provision is added to the Limits of Liability section of the General Liability Coverage Part: ADDITIONAL INSUREDS All additional insureds share the Limits of Liability applicable to any claim with any insured for which the additional insured is alleged to be vicariously liable with respect to that same claim. All other terms and conditions of the policy remain unchanged. 1507-PGX-00-1215 Page 2 of 2 © 2015 Me RkkMamgmwdDMsbn REVIEWED 6 APPROVED BY: -ROMMEMfMcn.oa.t Q, l<< .ocQ ® Risk Management Melyst MedPro Group ,, Bakddrs u�Mo-rz�m ranip�gr Issuing Company: National Fire & Marine Insurance Company Omaha, Nebraska THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Endorsement No.: Forming Part of Policy No.: Issued to: 10 HN033337 Industrial Medical Support Effective Date of Endorsement: 03/15/2021 at 12:01 a.m. at the address of the First Named Insured stated herein. BLANKET WAIVER OF SUBROGATION ENDORSEMENT (GENERAL LIABILITY) In consideration of the payment of the additional premium due, if any, and in reliance upon the representations of all insureds, the company and the insureds agree to amend the policy as follows: Only with respect to coverage provided under the General Liability Coverage Part, the following condition is added to the Conditions section of the Common Policy Provisions and Conditions: WAIVER OF SUBROGATION The company shall waive any right of recovery the company may have against a person or organization to the extent that the insured has agreed in writing prior to the date of loss to waive the insured's rights of recovery against that person or organization. All other terms and conditions of the policy remain unchanged. 1512-PGX-00-1215 Page 1 of 1 © 2015 Me RlekMn agemmt DMsbn REVIEWED&APPROVED BY: Al. - Ruk Management Mayst ACOR" CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) 1 lll./ 12/17/2021 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 have ADDITIONAL INSURED provisions or 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: Nora Vazquez Dodge Insurance SeNICOS, Inc. PHONE FAX DBA Arroyo Insurance Services , 310-356-8207 ac Na:310-356-1825 noDRess: norav@arroyoIns.com 3480 Torrance Blvd., Suite 301 INSURERS AFFORDING COVERAGE NAICff Torrance CA90503 INSURERA: StarStone Natonal Insurance Cc 25496 INSURED INDUS-1 INSURER B : Industrial Medical Support, Inc. 3320 E. Airport Way INSURER C: INSURER D: Long Beach CA 90806 INSURER E : INSURER F COVERAGES CERTIFICATE NUMBER: 486897329 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. LTR TYPE OF INSURANCE INSD D POLICYNUMBER MMDI POLICYEFF MMID�IYYXYY LIMITS COMMERCUILGENERALLUU$ILITY OCCUR EACH OCCURRENCE $ DAMAGCLAIMS-MADE ES[ RENTED PREMISES PREMISES RENT nonce 8 MED EXP (Any one person) $ PERSONAL& ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JEIJOT LOC OTHER: GENERAL AGGREGATE $ PRODUCTS-COMPIOPAGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per Person) $ BODILY INJURY(Peraccident) $ PROPERTY DAMAGE Per accident $ UMBRELLAUAB EXCESS LMB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOWPARTNER/EXECUTIVE F—y OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA T10211176 4N0/2021 4/10/2022 X I PER OTF4 STATUTE ER EL EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT 1 $1.000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) California Workers' Compensation Waiver of Subrogation applies as required by written contract. City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92702 ACORD 25 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED ` / REPRESENTATIVE �'7/' J . D/07IVJ ©1988-2015 ACORD C The ACORD name and logo are registered marks of ACORD Rielr MOlcgonmt DKtimi REVIEWED&pAPPROVED BY: ( ram. f'14t WbA"! ® RUk Management Malyst WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA WC 04 03 06 (Ed. 4-84) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from US.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be _'_% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description WHERE YOU ARE REQUIRED BY WRITTEN CONTRACT TO OBTAIN THIS AGREEMENT FROM US, PROVIDED THE CONTRACT IS SIGNED AND DATED PRIOR TO THE DATE OF LOSS TO WHICH THIS WAIVER APPLIES. IN NO INSTANCE SHALL THE PROVISIONS AFFORDED BY THIS ENDORSEMENT BENEFIT ANY COMPANY OPERATING AIRCRAFT FOR HIRE. 'The premium charge for this endorsement shall be 2% of the premium developed in the State of California, but not less than $500 policy minimum premium. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 04/10/21 Policy No. T10211176 Endorsement No. 18 Insured Industrial Medical Support, Inc. Policy Effective Date 04/10/21 Insurance Company StarStone National Insurance Company I Countersigned By I WC 04 03 06 ` (Ed. 4-84) ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. R181 ManagemodDaislot [RE\AEw &APPROVED BY: �� R6kblanagement Malysl 0 Industrial Medical Support, Inc. 12/17/2021 To Whom It May Concern: Forthe purpose of contracting, Industrial Medical Support, Inc. and PNR Medical Consulting, Inc. are related entities in such that they are 100% owned by a single individual, Michael Donoghue. From time to time one of these companies may subcontract the other to complete specific work on an as needed basis. Thankyou, Ryan La Bounty President Industrial Medical Support, Inc. PNR Medical Consulting, Inc. 3320 E. Airport Way Long Beach, CA 90806 Tel: (877) 878-9185 Fax: (877) 729-3210 Risk MnugementDiision �( REMEWED S{APPPIR�O/V�D BY. F441W,,;, Imo. Y�t�fNL/It Risk Management Analyst