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HomeMy WebLinkAboutFORENSIC NURSE SPECIALIST, INC.j INSURANCE NOT ON FILE WORK MAY NOT PROCEED CITY CLERK DATE: JAN 1 6 2024 o , pu (k) e webwi^"� AGREEMENT BETWEEN FORENSIC NURSE SPECIALISTS, INC AND THE CITY OF SANTA ANA FOR FORENSIC EXAMINATION SERVICES This Agreement for Forensic Examination Services is made and entered into as of the 19th day of December 2023 (the "Effective Date"), by and between FORENSIC NURSE SPECIALISTS, INC ("FNS") a privately owned minority professional corporation, 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"), on behalf of the Santa Ana Police Department ("Department"), with respect to the following: WHEREAS, the Department requires the collection of forensic evidence with respect to victims of sexual assault and other forms of interpersonal violence; WHEREAS, this is a mandatory expense as failure to provide a victim of sexual assault with an examination by a qualified healthcare professional would be a violation of the California Penal Code; WHEREAS, the Department does not have the capability to collect the aforesaid forensic WHEREAS, FNS has specialized training and expertise in the forensic examination services and the Department desires to contract such services from FNS; WHEREAS, FNS is the sole source providing this service in Orange County and there are no specific registries that utilizes forensic nurses solely for the purpose of exams; NOW, THEREFORE, in consideration of the mutual promises, covenants and conditions contained herein, the parties hereto agree as follows: 1. Services FNS agrees to provide the following services ( "Services") to the Department: 1.1. Examination. FNS agrees to provide the Department approved forensic -medical exams 2417 to sexual assault, strangulation, domestic violence, and other types of victims, consistent with the terms of this Agreement as identified by the Department, with a 1- hour response to a mutually agreed upon examination location. The examination will include digital imaging of injuries and physical findings. The examination will be conducted by forensic nurses who are trained and competent in the California State Protocol established by California Office of Emergency Services.("CALOES") 1.2 Evidence All evidence collected during the examination will be packaged, labeled and sealed according to the state and local crime lab requirements and submitted to the on - site evidence storage refrigerator with appropriate chain of custody documentation. Evidence for mobile exams (off -site) or courtesy cases will be relinquished at the conclusion of that examination to the authorizing Department. Digital photographs will be available upon request by Department investigators. A-2023-232 1.3. g"Inment and Sunulles FNS will provide all equipment and supplies to conduct all services listed in Exhibit A. IA restimQuy FNS agrees to provide competent court testimony as requested by the Department (upon receipt of a lawful or properly served summons or subpoena). 2. Comaensation in exchange for the Services provided by FNS pursuant to Section I above, the Department shall compensate FNS according to Exhibit A, "FNS Fee Schedule" attached hereto and incorporated herein. Services can be added at any time. per the Department's request and negotiated rates. The total amount of compensation to FNS shall not exceed $350,000. Any increase over this amount, for any services provided by this agreement, shall be effectuated by written amendment between parties subject to approval by the Santa Ana City Council. 2.1 Adjustment The Department acknowledges and agrees that FNS is entitled to adjust the rates set forth in this Section 2, Exhibit A, from time to time and at any time. FNS shall use reasonable efforts to give Department at least sixty (60) days advancewritten notice of any increase or adjustment to rates, subject to the not -to -exceed compensation amount in Section 2, above. 3. INYInent. 3.1 FNS shall invoice the Department monthly for all Services performed in each previous month. Department shall remit payment to FNS within thirty (30) daysof receipt of an invoice. 3.2 City shall compensate FNS for any services provided since September 1, 2023 until the effective date of this Agreement, as defined in the effective date above 4, Ter This Agreement shall be for a term of five (5) years commencing on December 19, 2023 and expiring on August 31, 2028. 4.1, Terminatlon Either party may terminate this Agreement without cause at any time during the term of this Agreement by providing the other party at least thirty (30) days prior written notice of termination 5. Indemnification The parties each shall indemnify, defend, and hold the other party harmless from and against any and all liability, loss, damages, costs, and expenses (including reasonable attorneys' fees) caused by the negligence or wrongful acts or omissions of such indemnifying party or its employees, officers or agents. The provisions of this paragraph shall survive termination of this Agreement 6. Insuragc FNS shall procure and maintain for the duration of the contract insurance against claimsfor injuries to persons or damages to property which may arise from or in connection with theperformance of the work hereunder and the results of that work by FNS , its agents, representatives, employees or subcontractors. MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall be at least as broad as follows: 1. Commercial General Liability (COL): Insurance Services Office Form CO 00 01 covering COL on an "mourrence" basis, including property damage, bodily injury andporsonal & advertising injury with limits no less than $2,00%0.00 per occurrence.. If a general aggregate limit applies, either the general aggregate limit shall apply separatelyto this project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall betwice the required occurrence limit. 2. Automobile Liability. Insurance Services Office Form Number CA 0001 covering. Code 1(any auto), or if FNS has no owned autos, Code 8 (hired) and 9 (non- owned), with limits no less than $11000,000 per aeeldeut for bodily injury and propertydainage. (Not required if FNS provides written verification vehicles are not required to perform service.) Statutory Limits, and Employer's Liability Insurance witb. limit of no less than $1,000,000 per accident for bodily injury or disease. 4. Sexual Abuse or Molestation (SAM) Liability; If the work will include contact witbminors, and the COL policy referenced above is not endorsed to include affirmative coverage for sexual abuse or molestation, FNS shall obtain and maintain a policyeovering Sexuat Abuse and Molestation with a limit no less than $1,000,000 per occurrence or claim. If FNS 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 lim4.tsmaintained by the Instructor. Any available insurance proceeds in excess of the specified mutimunn limits of insurance and coverage shall be available to the City. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions: 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 bohalf of the FNS including materials, parts, or equipment furnished in connectionwith such work or operations. General liability coverage can be provided in the form of an endorsement to the I�NS's insurance (at least as broad as ISO Porm CG 2010 I1 85 or if notavailable, through the addition of both CG 2010, CG 20 26, CG 20 33, or CC 20 38; and CG 2037 if a later edition is used.). Primary Coverage For any claims related to this contract, the FNS's insurance :coverage shall be primary coverage at least as broad as ISO CO 20 01 04 13 as respects the City, Its officers, officials, employoos,. and volunteers. Any insurance or solf 4nsuranco maintained by the City, its officers 'officials, employees, or volunteers shall be excess of the 1. FNS's insurance and shall .not contrl'bute with it. Notice of. Cancellation Each insurance policy required above shall provide that coverage shall not be canceled, except with notice to the City. waiver ofSulbrogation FFNS hereby grants to City a waiver of any right to subrogation which any insurer of said DAIS may acquire against the City by virtue of the payment of any loss under such. insurance. F N S agrees to obtain any endorsement that may be necessary to affect this waiverof subrogation, but this provision applies regardless of wtrether or not the City has received a waiver of subrogation endorsement from the insurer. 5eit=lasured'iletentions Sett=insured retentions must be declared to and approved by the City. The City may require FND to purchase coverage with a lower retention or provide pier£ o£ ability to pay losses and related haveatigationa, claim administration, and defense a pa th t within the retention. The policy language sball provide, or lac endorsed to provide, that the yell -insured retention may be saosfled by either the named Insured or City. j Acceptability of Insurers Insurance is to be placed with insurers authorized to conduct business in the state with a curront A.M. Beat's rating of no leas than ANII, unless otherwise acceptable to the City. Claims blade Policies (note — should be applicable only to prot'bssional liability) see below) If any of the required policies provide claims -made coverage; i. The Retroactive Date must be shown, and must be before the date of the contract or thebegirming of contract work insurance must be maintained and avfdance of insurance must be provided 2. for least five (5) years gfier compt`etlon of the contract gfworlt. 3. if coverage is canceled or am -renewed, rind not replaced with souther claims -made policy.form with a Retroactive .gate prior to the contract effective date, the FNS must purchase "extended reporting" coverage for a minimum of five (9) years after completion of work. Verification of Coverage FNS shall furnish the, City with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage requiredby this clause) and a copy of the Declarations and Endorsement Page ofthe COL policy listing allpolicy endorsements to City before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive the FNS's obligation to provide them. The City reserves the right to require complete, certified copies of all required insurance policies,including endorsements required by these specifications, at any time. Special Risks or Circumstances reserves the right to modify these requirements, including limits, based on the nature of the 7. Confiderptlalitj of Patient Information None of the parties shall disclose any confidential patient health information to any third party, except where permitted or required by law or where the patient expressly approves such disclosure. FNS and the Department shall comply with all federal and state laws and regulations regarding the confidentiality of such information, including without limitation the Health Insurance Portability and Accountability Act (91PPA) of 1996. 8, Nan Discriminatlon By signing this Agreement, FNS certifies that it does not discriminate .in hiring or treatment on the basis of race, color, oreed, religion, sex, sexual orientation, age, mental status, national origin, ancestry, physical handicap or medical condition 9, Non ExcltMsivity This Agreement is not exclusive, and nothing herein shall preclude either party from contracting with any other person or entity for any purpose. 10. 1V t ees 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 followingpersons: To City. City Clerk City of Santa Ana 20 GAO Center Plaza (M-30) P.4..BoX 1988 Santa Ana, CA 92702-1988 Fax,714-647-6956 With courtesy copies to: Chief of Police City of Santa Ana 60 Civic Center Plaza P.O. Box 1998 Santa Ana, CA 92702 Fax:714-245-8116 To FNS; Forensic Nurse Specialists Inc. PD. Box 2273 Los Alamitos, CA 90720 [Signatures on following page] IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. i / r APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney By: TAMARA BOGOSIAN Senior Assistant City Attorney FORENSIC NURSE SPECIALIST INC. (FNS) a Professional Corporation in the State of California MALINDA WHEELER President CITY OF SANTA ANA A 0 THOMAS HATCH Interim City Manager RECOMMENDED FOR APPROVAL: IS—. ROBE"RODRIGUEZActing EXHOT A- FEE 5CHEDUH -- 2023-2024 5ervite Definition Rate Sexual Assault Forensic Evidence collection, clothing, DNA reference $1200.00 Exam samples, blood and urine collection, digital photography,. medical -forensic documentation (All ages, reported or non- using state mandated forms, healthcare reported cases to law treatment for STI prevention, HIV prevention enforcement) and pregnancy prevention provided at the time of the exam. Mobile Traurno Exam Aforensic exam conducted at any Orange $1400.00 County hospital in the ER or ICU when a patient is severely injured and admitted to that other hospital for on -going medical care. (Requests for Mobile exams In nursing homes and psychiatric facilities will be considered on a case -by -case basis.( Dry Run Department calls out the on -call $300.00 ftnnsic nurse to perform a case and through no fault of WS, the victim changes tlieir mind, refuses to perry t the examination, floes not want the examination; or does not permit forensic nurse to conduct the examination. Domestic Violence/ A foronsic exam focused on body injury and $600.00 Strangulation Exam assessment with specific written and photographic documentation on strangulation injury. Testimony Expert witness testimony bytheforensicnurse $500.00/day upon receipt of subpoena form the District In court on Attorney's office the stand / A� " CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/16/2025 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 Malinda Wheeler NAME: Pie Insurance Services, Inc. 1755 Blake St, STE 500t Denver, CO 80202 PHONE FAX : vc, No E-MAIL -M E-MAIL L fnsmalinda@gmail.com ADDRESS: @g INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: The Pie Insurance Company 21857 Pie Insurance Services, Inc. INSURED INSURER B : Forensic Nurse Specialists Inc INSURER C INSURER D 10412 Los Alamitos Blvd Los Alamitos, CA 90720 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE OCCUR DAMAGE S(RENTED PREMISES Ea occurrence) ccurrence)$ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY ❑ PRO- JECT LOC ❑ PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? ❑Y (Mandatory in NH) N/A Y WC PI 1575253-001 10/02/2025 10/02/2026 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000.00 E.L. DISEASE - EA EMPLOYEE $ 1 ,000,000.00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 000 000.00 Digitallysigned DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) yu ranNguyen Outpatient nursing Nguyen Date:2025.n.04 "City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers" 10:4ea i-oa'oo' APPROVED By Tu Tran Nguyen at 10:45 am, Nov 04, 2025 CERTIFICATE HOLDER CANCELLATION City of Santa Ana 20 Civic Center Plaza SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Santa Ana, CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA 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 0.02 % of the California workers' compensation premium otherwise due on such remuneration. Schedule Person Or Organization Job Description Any person or organization as required by written contract within states covered under this policy. 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 10/02/2025 Policy No. WC PI 1575253-001 Endorsement No. Insured Forensic Nurse Specialists Inc insurance Company The Pie Insurance Company Countersigned By 9Ac. WC 04 03 06 (Ed. 04-84) AC4RDF CERTIFICATE ©F LIABILITY INSURANCE DATE IMMfODIYYYYI f 01/08/2026 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 1NSURER(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: JAMES DRl 1FUS PHONE Ent) 562 430-4704 FAX Na): Southeast Counties Insurance E-MAIL ADDRESS: famesdreifus msn.cOm @ 10405 Los Alamitos Blvd INSURERS AFFORDING COVERAGE _ NAIC 0 INSURER A: Hartford Insurance Company 0022323 Los Alamitos CA 90720 INSURED INSURER B _ INSURERC: Forensic Nursing Specialist, Inc. INSURERO: 10413 Las Alamitos Blvd INSURER E : _ Los Alamitos Ca 90720 INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTI_D BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM CR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURrkNCE 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 L TYPE OF INSURANCE ADDL SUBR�rLICY NUMBER POLICY k LDDNYY EXP I AiMIDDJYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000. � CLAIMS -MADE OCCUR l� `�l $ 1,000,D00. AM `�MN PREMISES Ea occurrence MED EXP (Any one person) $ 10,000. PERSONAL &ADV INJURY A X X 57 SBA BG8EGA 01/09/2026 01/0912027 $ 2,000,000. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000. POLICY � PRO LOC JECT $ 4,000,000. PRODUCTS - COMPIOP AGG OTHER: Is AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY f Per accident) $ v PROPERTY DAMAGE JPer accident 5 HIRED NON -OWNED AUTOS ONLY AUTOS ONLY + UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE EXCESS LIAB CLAIMS -MADE $ $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN 'ANYPROPRIETOR7PARTNER EXECUTIVE PER OTH- STATUTE ER $ E.L. EACH ACCIDENT OFF ICERIMEMBEREXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Nursing office City of Santa Ana 20 Civic Center Plaza, Santa Ana, CA 92701 and elected and appointed boards, officers, officials, agents, employees, and representatives added as an additional insured to the General Liability effective 0' -09-2024 per the policy's terms and conditions APPROVED CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 9:32 am, Jan 28, 2026 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WrrH THE POLICY PROVISIONS. City of Santa Ana AU RIZED REPAFI E 20 Civic Center Plaza Santa Ana, CA 92701 i �`� ���/y O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Declarations: THE Business Owner's Policy HARTFORD Policy Number: 57 SBA BC8EGA Policy Period: 01/09/2026 to 01/09/2027, 12:01 a.m., Standard time at your mailing address shown here. Exception: 12 noon in New Hampshire. Insurer: Hartford Underwriters Insurance Company, a property and casualty company of The Hartford. One Hartford Plaza, Hartford, CT 06155 Named Insured and Mailing Address: Forensic Nursing Specialist, Inc. 10413 LOS ALAMITOS BLVD LOS ALAMITOS, CA 90720-2111 Type of Business: Medical Office - Physicians & Surgeons Name of Agency/Broker: AMWINS ACCESS INS SERVICES LLC 1410 ROCKY RIDGE DR STE 335 ROSEVILLE, CA 95661 Code: 57121637 Previous Policy Number: 57 SBA BC8EGA Organization Type: Corporation Audit Period: Non-Auditable Insurance Provided: In return for the payment of the premium and subject to all of the terms of this policy, we agree with you to provide insurance as stated in this policy. Total Premium Includes the premium for all Coverage Parts issued to you in this policy, as well as any companion policies delivered with this policy. Total Premium includes any applit:able fees and surcharges, Total Premium may change based on coverage changes made through endorsement or if your policy is sut Sect to Premium Audit. Countersigned by: Authorized Representative 11 /30/2025 Date A Business Owner's Policy typically covers property and business liability risks. Generally, Property insurance pays you if a covered cause of loss damages property that you own, rent or lease. Business liability insurance pays in certain cases where something you do or something you own causes injury or damage to someone This Spectrums Business Owner's Policy consists of the Declarations, Coverage Forms, Coverage Pans, Common Policy Conditions and any other Forms and endorsements Issued to be a part of the Policy. The Aartfords is Hartford Fife insurance Company and its alfilialed property and casualty insurance companies. Form: SG DO 01 10 18 THIS ENDORSEMENT CHANGES THE POLIuY. PLEASE READ IT CAREFULLY. A THE HARTFORD -�1 BLANKET ADDITIONAL INSURED BY CONTRACT This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM Except as otherwise stated in this endorsement, the terms and conditions of the Policy apply. A. The following is added to Section C. WHO IS AN INSURED: Additional Insureds When Required By Written Contract, Written Agreement Or Permit The person(s) or organization(s) idertifred in Paragraphs a. through f. below are additional insureds when you have agreed, in a written contract or written agreement, or when required by a written permit issued by a state or governmental agency or subdivision or political subdivision that such person or organization be added as an additional insured on your Coverage Part, provided the injury or damage occurs subsequent to the execution of the contract or agreement, or the issuance of the permit. A person or organization is an additional insured under this provision only for that period of time required by the contract, agreement or permit. However, no such person or organization is an additional insured under this provision if such person or organization is included as an additional insured by any other endorsement issued by us and made a part of this Coverage Part. The insurance afforded to such additional insured will not be broader than that which you are required by the contract, agreement, or permit to provide for such additional insured. The insurance afforded to such additional insured only applies to the extent permitted by lays. The limits of insurance that apply to additional insureds are described in Section D. LIABILITY AND MEDICAL EXPENSES LIMITS OF INSURANCE. How this insurance applies when other insurance is available to an additional insured is described in the Other Insurance Condition in Section E. LIABILITY AND MEDICAL EXPENSES GENERAL CONDITIONS. a. Vendors Any person(s) or organization(s) (referred to below as vendor), but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business and only if this Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products -completed operations hazard". (1) The insurance afforded to the vendor is subject to the following additional exclusions: This insurance does not apply to: (a) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made intentionally by the vendor, (d) Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; (e) Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; (f) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product: Form SL 30 32 06 21 Page 1 of 3 0 2021, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) THE A HARTFORD (1) You or any additional Insured under this Coverage Part that is an individual; (2) Any partner, if you or an additional insured under this Coverage Part is a partnership; (3) Any manager, if you or an additional insured under this Coverage Part is a limited liability company; (4) Any "executive officer' or insurance manager, if you or an additional insured under this Coverage Part is a corporation; (5) Any trustee, if you or an additional insured under this Coverage Part is a trust; or (6) Any elected or appointed official, if you or an additional insured under this Coverage Part is a political subdivision or public entity. This Paragraph f. applies separately to you and any additional insured under this Coverage Part, 3. Legal action Against Us No person or organization has a right under this Coverage Part: a. To join us as a party or otherwise bring us into a "suit" asking for damages from an insured; or b. To sue us on this Coverage Part unless all of Its terms have been fully complied with. A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured; but we will not be liable for d amages that are not payable under the terms of this insurance or that are in excess of the applicable limit of insurance. An agreed settlement means a settlement and release of liability signed by us, the insured and the claimant or the claimant's legal representative. 4. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Policy to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom a claim Is made or "suit" is brought. 5. Representations a. When You Accept This Policy By accepting this Policy, you agree: (1) The statements in the Declarations are accurate and complete; (2) Those statements are based ipon representations you made to us; and (3) We have issued this Policy in reliance upon your representations. b. Unintentional Failure To Disclose Hazards If unintentionally you should fail to disclose all hazards relating to the conduct of your business at the inception date of this Coverage fart, we shall not deny any coverage under this Coverage Part because of such failure. £. Other Insurance If other valid and collectible insurance is available for a loss we cover under this Coverage Part, our obligations are limited as follows: a. Primary Insurance This insurance is primary except when b. below applies. If other insurance is also primary, we will share with all that other insurance by the method described in c. below. b. Excess Insurance This insurance is excess over any of the other insurance, whether primary, excess, contingent or an any other basis: (1) Your Work That is Fire, Extended Cove -age, Builder's Risk, Installation Risk, Owner Controlled Insurance Program or OCIP, Contractor Controlled insurance Program or CLIP, Wrap Up insurance or similar coverage for .your work"; Form SL 00 00 1018 Page 16 of 22 U 2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) rHE HARrFaaa (2) Premises Rented To You That is fire, lightning or explosion insurance for premises rented to you or temporarily occupied by you with permission of the owner; (3) Tenant Liability That is insurance purchased by you to cover your liability as a tenant for "property damage" to premises rented to you or temporarily occupied by you with permission of the owner; (4) Aircraft, Auto Or Watercraft If the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Section B. Exclusions. (5) Property Damage To Borrowed Equipment Or Use Of Elevators If the loss arises out of "property damage" to borrowed equipment or the use of elevators to the extent not subject to Exclusion k. of Section B. Exclusions. (6) When You Are Added As An Additional Insured To Other Insurance That is other insurance available to you covering liability for damages arising out of the premises or operations, or products and completed operations, for which you have been added as an additional insured by that insurance; or (7) When You Add Others As An Additional Insured To This Insurance That is other insurance available to an additional insured. However, the following provisions apply to other insurance available to any person or organization who is an additional insured under this Coverage Part: (a) Primary Insurance When Required By Contract This insurance is primary if you have agreed in a written contract, written agreement or permit that this insurance be primary. If other insurance is also primary, we will share with all that other insurance by the method described in c. below. (b) Primary And Non -Contributory To Other Insurance When Required By Contract If you have agreed in a written contract, written agreement or permit that this insurance is primary and non-contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance. Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured. When this insurance is excess, we will have no duty under this Coverage Fart to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". if no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers, When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of. (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self -insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Method Of Sharing If all the other insurance permits contribution by equal shares, we will follow this method also. finder this approach, each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. Form SL 00 00 10 18 Page 17 of 22 © 2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) TH£ HARTFOR© If any of the other insurance does, not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers, 7. Transfer Of Rights Of Recovery Against Others To Us a. Transfer Of Rights Of Recovery If the insured has rights to recover all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. This condition does not apply to Medical Expenses Coverage. b. Waiver Of Rights Of Recovery (Waiver Of Subrogation) If the insured has waived any rights of recovery against any person or organization for all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, we also waive that right, provided the insured waived their rights of recovery against such person or organization in a contract, agreement or permit that was executed prior to the injury or damage. F. LIABILITY AND MEDICAL EXPENSES DEFINITIONS 1. "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers or supporters. For the purpose of this definition: a. Notices that are published include material placed on the Internet or on similar electronic means of communication; and b. Regarding web sites, only that part of a web site that is about your goods, products or services for the purpose of attracting customers or supporters is considered an advertisement. 2. "Advertising idea" means any idea for an "advertisement". 3. "Asbestos hazard" means an exposure or threat of exposure to the actual or alleged properties of asbestos and includes the mere presence of asbestos in any form. 4. "Auto" means: a. A land motor vehicle, trailer or semi -trailer designed for travel on public roads, including any attached machinery or equipment; or b. Any other land vehicle that is subject to a compulsory or financial responsibility law or other motor vehicle insurance or motor vehicle registration law where it is licensed or principally garaged. However, "auto" does not include "mobile equipment". 5. "Bodily injury" means physical: a. Injury; b. Sickness; or c. Disease sustained by a person and, if arising aut of the above, mental anguish or death at any time. 6. "Coverage territory" means: a. The United States of America (including its territories and possessions), Puerto Rica and Canada; b. International waters or airspace, but only if the injury or damage occurs in the course of travel or transportation between any places included in a. above; c. All other parts of the world if the injury or damage arises out of: (1) Goods or products made or sold by you in the territory described in a, above; (2) The activities of a person whose home is in the territory described in a. above, but is away for a short time on your business; or Form SL 00 00 10 18 Page 18 of 22 2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission)