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Home My WebLink AboutCONCERTA MEDICAL CENTER (OCCUPATIONAL HEALTH CENTERS, INC)INSURANCE ON FILE A-2024-011 WORK MAY PROCEED UNTILrDfAM02hybI066 A66F16C0-1E47-4E4E-AD3E-816FB09D12D8 C�ynAx CITY CLERK DATE: JAN 2 4 2024 AGREEMENT WITH CONCENTRA MEDICAL CENTER THIS AGREEMENT is made and entered into on this 16th day of January, 2024 by and between Occupational Health Centers of California, Inc., A Medical Corporation doing business as Concentra Medical Center ("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 pre -employment medical examinations and screenings, post -exposure medical examinations and screenings, fitness for duty examinations, Department of Motor Vehicles ("DMV") commercial classification driver's license physical examinations, certain Department of Transportation ("DOT") related drug and alcohol examinations and screenings, and California Occupational Safety and Health Act ("OSHA') occupational testing. To that end, City released Request for Proposal ("RFP") 23-115. B. Consultant represents that Consultant is able and willing to provide such services to the City and submitted a proposal in response to RFP 23-115• C. City evaluated all proposal submitted in response to RFP 23-115 based on the vendor's qualifications and experience, demonstrated knowledge of a variety of medical services, ability to fulfill scope of work, availability and convenience of services, cost competitiveness and responsiveness and selected Consultant. 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 Scope of Services - Exhibit A, attached hereto and incorporated 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 Compensation - Exhibit B. The total amount to be expended during the term of this Agreement shall not exceed $750,000 consisting of $450,000 for the Initial Term and $150,000 for each of the optional one (1) year Page 1 of 9 #335916vl DocuSign Envelope ID: A55Fl5C0.1 F47.4E4E-AD3E-815FB99Dl2D3 renewals. b. The pricing set forth in Exhibit B shall be eligible for an increase of up to five percent (51/o) at the beginning of the third year and any potential option years with communications to the City of intent to increase with at least six (6) months' notice in writing. c. Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. City and Consultant agree that all payments due and owing under this Agreement shall be made through Automated Clearing House (ACH) transfers. Consultant agrees to execute the City's standard ACH Vendor Payment Authorization and provide required documentation. Upon verification of the data provided, the City will be authorized to deposit payments directly into Consultant's account(s) with financial institutions. d. 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. [t Y111SullI This Agreement shall oommence on January 31, 2024 for a three (3) year term ending January 30, 2027 with the option for the City to grant up to a two (2) one (I) -year renewals, exercisable by a writing signed by the Consultant, City Manager, and the City Attorney, unless terminated earlier in accordance with Section 15, below. 4. INDEPENDENT CONTRACTOR Consultant shall, during the entire term of this Agreement, be construed to be an independent Consultant and not an employee of the City. This Agreement is not intended not 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 requite all subcontractors to agree in writing that City is granted a non-exclusive and Page 2 of 9 #335916v2 DOCUSIgn Envelope ID: A55F15C0.1E47-4E4E-AD3E,816Fn09012D8 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 die 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 the performance of the work hereunder and the results of that work by the Consultant, its agents, representatives, employees or subcontractors. Coverage shall be at least as broad as: I. Commercial General Liability (CGL): insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CO 25 03 05 09 or 25 04 05 09) or the genera] 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 Consultant has no owned autos, covering 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. Professional Liability (Errors and Omissions): Insurance appropriate to the Consultant's profession, with limit no less than $1,000,000 per occurrence or claim, $2,000,000 aggregate. 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 higher limits maintained by the Consultant. Other Insurance Provisions The insurance policies are to contain, or be endorsed to contain, the following provisions: Additional Insured Stratus 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 Page 3 of 9 #335916v1 Docuftn Envobpo ID: A55F1500-IE47-4E4E-AD3E-515FB09D12D5 the Consultant's insurance (at least as broad as ISO Form CO 20 10 1185 or both CG 20 10, CG 20 26, CO 20 33, or CG 20 38; and CG 20 37 forms if later revisions used). Primary Coverage For any claims related to this contract, the Consultant's insurance coverage shall be primary insurance coverage at least as broad as ISO CG 20 01 04 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 Contractor's insurance and shall not contribute 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 of Subragation 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, 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. 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 AXII, unless otherwise acceptable to the City. Claims Made Policies If any of the required policies provide claims-mado coverage: 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 work. Page 4 of 9 9335916v1 DocuSign Envelope ID: A66F16CO-1 E47.4E4E-AD3E-816F60DD12D8 Verification of Coverage Consultant shall furnish the City with original certificates and amendatory endorsements or copies of the applicable policy language effecting coverage required by this clause. All certificates and endorsements are to be received and approved by the City before work commences. However, failure to obtain the required documents prior to the work beginning shall not waive the Consultant'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 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 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 Contractor, 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 Contractor'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 Contractor. 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. Page 5 of 9 #335916vl Docu5lgn Envelope ID: A55F1600.1E47-4E4E-AD3E-815FBagD12D8 9. RECORDS 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-uso 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, gender idontity, gender expression, gender, medical conditions, genetic information, or military and veteran status, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, teaching, training, utilization, promotion, termination or other employment related activities or any services provided under this Agreement. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. Page 6 of 9 #335916v1 DocuBlgn Envelope ID: A66F16CO-1E47-4E4E-AD3E-816FBOOD12D6 13. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Contractor, 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 Contractor, 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 Contractor, 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 Contractors 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 tormination, 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 shalt 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. Page 7 of 9 #335916vl DoouSlgn Envelope ID: ABBF15CO-1E47.4E4E-AD3E-876FBO9D72DB 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, PROFESSIONA14 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: To City: Cleric 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: Executive Director, Human Resources Agency City of Santa Ana 20 Civic Center Plaza (M-24) P.O. Box 1988 Santa Ana, California 92702 To Contractor: Kathy T. Le, M.D. MPH President and Treasurer Occupational Health Centers of California, a Medical Corporation dba Concentra Medical Centers 5080 Spectrum Drive, 1200 West Tower Addison, Texas 75001 DocuSign Envelope ID: A55F15C0-1E474E4E-AD3E-815FB09012D8 A-2024-011 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, communicationshallbe 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. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: APPROVED ' SONIA R. CARVALHO City Attorney By: acu� V"-" Laura A. Rossini Chief Assistant City Attorney RECOMMENDED FOR APPROVAL: F ce v Ramon Figueroa Executive Director (A&Kkii Hunan Resources Agency CITY OF SANTA ANA ;4 �4w Tom H tch Interim City Manager CONSULTANT: occupational health centers of California, A Medical corporation, dba concentra medical centers uoousgneaey: IGWry7."Et, M.D. MPH President and Treasurer Page 9 of 9 #335916v1 DocuSfgn Envelope ID: A55F15CO-1 E47-4E4E-AD3E•815FBOOD12D8 EXMBIT A SCOPE OF SERVICES DocuSign Envelope ID: A56F15C0-1E47AE4E-AD3E-815FB09D72D8 4' CITY OF SANTA ANA EXHIBIT SCOPE OF SERVICES Consultant shall perform services as set forth below: GENERAL REQUIREMENTS Consultant shall be an independent contractor capable of providing experienced, knowledgeable, licensed and professional staff. Consultant shall be responsive and maintain excellent working relationships with City residents, businesses, government officials and City staff. Consultant shall provide adequate staffing levels at all times and adhere to established schedules. Consultant shall comply with all federal, state and local laws, rules, regulations, ordinances, and statutes, including but not limited to the Americans with Disabilities Act (ADA), the Health Insurance Portability and Accountability Act (HIPAA), the Federal Motor Carrier Safety Administration (FMCSA) rules and regulations, the U.S. Department of Transportation (DOT) rules and regulations, and the California Public Records Act (Cal. Govt. Code Sections 6250 et seq.) DESCRIPTION AND SCOPE OF SERVICES A. The City of Santa Ana is issuing this RFP for a medical services review program; such program to include organizing, scheduling, managing, and/or evaluating a comprehensive range of medical services and examinations, including but not limited to: 1. For prospective and current City employees to perform the duties of the position for which they are being considered (pre -employment assessments), using pre -determined medical protocols for each job classification such protocols may be modified by the physician, in consultation with the City's Executive Director of the Human Resources Department, or his/her designee, as is necessary to make a determination as to suitability for employment; 2. For current City employees being considered for employment in DOT and non -DOT positions requiring pre -placement or pre -assignment drug screens; 3. Fitness for Duty examinations (industrial and non -industrial), and provide reports and recommendations regarding the suitability of current employees to continue to perform their duties; 4. Urine and breath specimen collection, laboratory analysis and Medical Review Officer (MRO) responsibilities; 5. DMV Driver's License physical examinations; 6. DOT -mandated drug and alcohol testing of employees considered 'safety sensitive' as defined under DOT regulations and City policy. Consultant shall ensure all such testing complies with DOT testing procedures as per 49 CFR, Part 40; such testing to include pre -employment and pre -assignment. B. City shall be responsible for the organization, scheduling, and management of DOT and non -DOT random and reasonable suspicion drug and alcohol testing, and DOT post -accident drug and alcohol testing. Consultant shall evaluate results of said testing, in accordance with the provisions of the Agreement and relevant laws and regulations. 23-115 Pre -Employment Medical Screening Services Page 17 of 34 DocuSign Envelope ID: A55F15Cg-1E47-4E4E-AD3E-815FBg9D12D8 0 CITY OF SANTA ANA C. Consultant shall ensure clinic(s) used for DOT -related drug and alcohol testing maintain a current valid contract with a Substance Abuse and Mental Health Services Administration (SAMSHA)- certified laboratory that is agreed upon with the City of Santa Executive Director of Human Resources throughout the entire term of the awarded agreement, including any extension periods. Consultant shall ensure turn -around time from specimencollectionto obtained test results shall be a maximum of three (3) working days for a negative test, and a maximum of five (5) working days for a positive test. D. As part of the medical services review program, Consultant shall: 1. Analyze current job classification specifications and make recommendations for the City's use in the pre -employment medical examination and drug testing process, random drug screen inclusion for safety sensitive positions inclusive of Department of Justice (DOJ) regulations, and occupational injury medical examination for return-to-work/fitness for duty. 2. Provide training to Human Resources personnel in administration procedures of Consultant's medical services review process. 3. Communicate with City Human Resources staff regarding applicants' or employees' progress throughout the medical services review process. 4. Communicate directly with applicants and City Human Resources staff throughout the pre- employment or pre -assignment process in regard to results and medical conditions as ascertained through the medical or physical examinations. 5. Provide an electronic final report in a format established by City Human Resources staff at its sole discretion, outlining each candidate's pre -employment placement medical evaluation and results. 6. Provide quarterly electronic activity reports, in a format established by Human Resources in its sole discretion, on the nature and number of examinations conducted, including but not limited to results and final dispositions. 7. Provide a detailed quarterly explanation and summary of charges incurred. 8. Provide all quarterly and annual summaries as required under the DOT. 9. Provide consultation as needed to Human Resources staff regarding medical services provided and outlined in the Agreement. 10. Consultant solely shall review all pre-employment/pre-placement medical evaluation services and maintain records, pursuant to the Agreement, in accordance with State and Federal laws, or as otherwise reasonably required by the City, and to the fullest extent permitted by law. 11. Consultant agrees to permit duly -authorized agents and employees of the City to review such records. 12. Consultant shall maintain all books, documents, papers, accounting records, and other evidence pertaining to the fee paid under this Agreement. Consultant will make materials available at their offices at reasonable times and notice, during the period of the Agreement and for three (3) years after date of final payment under the Agreement for inspection by the City or by any other governmental entity or Department participating in the funding of the Agreement, or any authorized agents thereof. 13. Consultant's documents shall not be used, duplicated, or disclosed to any other third party without written permission from the City, unless such disclosure is required by law. Consultant shall not be required to create or maintain books and records not required in the ordinary course of Consultant's business operations, nor will the Consultant be required to disclose any information, including but not limited to product cost or pricing data, which Consultant considers confidential or proprietary. 14. Any Agreement changes which are mutually agreed upon by and between the parties shall be incorporated in written amendments to the Agreement. 23-115 Pre -Employment Medical Screening Services Page 18 of 34 DocuSign Envelope ID: A55F15CO-1E47-4E4E-AD3E-815FB09D12DB aCITY OF SANTA ANA 15. If the circumstances on a particular hearing and/or court proceeding warrant the presence of a competent and knowledgeable representative of the Consultant, in the sole discretion of the City, City will request and contractor shall provide such representative, at no additional cost to City. E. Additionally, as part of the medical services review program, Consultant shall: 1. Maintain a network of qualified and trained medical providers and medical specialists for necessary exams; 2. Orient City staff in the legal/medical/risk management and human resources aspects of Consultant services; 3. Communicate directly with applicants to obtain the confidential medical information that is needed for clearance for a particular job; 4. Manage all bill review functions for the medical exams performed by clinics; and, 5. Provide access for City staff to Consultant's tracking system. Depending on job classification, pre -employment, and pre -assignment medical examination components may include: 1. job profile review; 2. review of medical history; 3. check vital signs; 4. detailed vision exam, including check of near/far/peripheral vision, Ishihara 14 and primary color; 5. audiogram (if classification has specific occupational noise exposure or critical hearing demands); 6. chest x-ray; 7. EKG or treadmill stress EKG; 8. Spirometry; 9. chem panel 20; 10. CBC w/diff; 11. dipstick UA, or UA w/Micro (to lab); 12. venipuncture & collection. G. Individual medical exams, such as post exposure, fit for duty, or others, may include one or more of the following: 1. Audiogram 2. Back X-ray 3. Blood Lead Level 77P 4. Blood screens - 7 panel drug screen 5. Blood chemistry profile (SMA 24 or equivalent) 6. Complete blood count (CBC w/diff) 7. Chest X-ray S. DMV Physicals 9. Electrocardiogram 10. Hepatitis "A" blood screen 11. Hepatitis "B" blood screen 12. Hepatitis "B" booster 13. Hepatitis "B" titer 14. Hepatitis "B" Vaccine 15. Hepatitis "A" Vaccine 23-115 Pre -Employment Medical Screening Services Page 19 of 34 DocuSign Envelope ID: A55F75CD-i E474E4E-AD3E-815FB09D12D8 (a CITY OF SANTA ANA 16. Hepatitis "C" blood screen 17. HIV blood screen 18. Pulmonary function test 19. Respirator Fit test 20. Respirator Physical 21. Respirator Questionnaire if PX is not required with clearance 22. TB test 23. Urinalysis with microscopy (UA w/micro) 24. Urinalysis with dipstick (Dipstick UA) III. IMPLEMENTATION Upon award of the Agreement, City shall work with Consultant to develop effective implementation protocols to ensure Services commence on January 31, 2024. 23-115 Pre -Employment Medical Screening Services Page 20 of 34 DccuSlgn Envelope ID: A55F15CO-1 E47-4E4E-AD3E-815Fa09D12b8 EXHIBIT B COMPENSATION - - -- Fee Proposal including hourly rates if applicable - — - - DocuSign Envelope ID: A55F15C0-1E47-4E4E-AD3E-815FB09D12D8 #T• 4)t CITY OF SANTA ANA ATTACHMENT A PROPOSER'S CERTIFICATION, PROPOSAL PRICING Certification -1 certify that I have read, understand and agree to the terms and conditions of this Request for Proposals. I have examined the Scope of Services (Exhibit 1) and am qualified to provide services being requested as specified herein. I understand and agree that I am responsible for reporting any errors, omissions or discrepancies to the City for clarification prior to the submission of my proposal. Proposal Item Price - Pricing shall be based on the services performed, for services described in Exhibit I. Fee must be inclusive of all costs, including but not limited to, direct and indirect costs for labor, overhead, incidental supplies, travel, mileage, and fuel. Attach additional pages as needed. PROPOSER'S STATEMENT: I have read, understood and agree to the terms and conditions on all pages of the Request for Proposals. Upon request, I will transfer and deliver goods or services to the City in accordance with said terms and conditions. TYPE OF MEDICAL PROCEDURE ESTIMATED # OF TESTS COST PER TEST ESTIMATED TOTAL COST Audiogram 77 $40.00 $3.080 Back X-Ray Unknown $60.00 Per Test Blood Lead Level ZZP Unknown $64.00 Per Test Breath Alcohol Test Unknown $38.00 Per Test Blood Chemistry Profile (SMA 24/Equivalent) 86 $83.00 $7,138 Complete Blood Count (CBC w/Dift) 86 $55.00 $4,730 Chest X-Rey 1 View 92 $74.00 $6,808 Occupational Health Centers of California, a Medical Corporation dba Concentia Medical Centers 714.288.8303 714 744.1991 LEGAL NAME OF COMPANY PHONE AND FAX NUMBERS 1045 North Tustin St., Orange, CA 92867 BUSINESS ADDRESS Kathy T. Le, MD, MPH President and Treasurer Pfft Tet9rNAME OF AUTHORIZED AGENT TITLE August30,2023 dhaubner@concenka_co S1 REOF AUTHORIZED AGENT DATE E-MAIL ADDRESS - NA (IFAPPLICABLE) THIS FORM MUST BE COMPLETED AND INCLUDED WITH THE PROPOSAL. PROPOSALS THAT DO NOT CONTAIN THIS FORM WILL BE CONSIDERED NONRESPONSIVE. 23-115 Pre -Employment Medical Screening Services Page 28 of 34 DocuSlgn Envelope ID: A55F15C0-1E47-4E4E-AD3E-815Fa09D12DB Additional Pricing Concentra appreciates the opportunity to present our proposed fee schedule. We affirm all information contained herein is current, complete, accurate, and remains valid for 180 days following the date of our submittal Estimated # of tests based on T12 actual where applicable " )I 11 �M �rM S3�} ilr 3�}�yaT-y i Y - 1 II 7 P t[� i "', di , Lid- ' ^"� ?�,_;.d ._` 4a�.y�_ `.E:� +r^' TB Test $39 168 Urinalysis with microscopy (UA w/micro) $29 86 Urinalysis with dipstick (dipstick UA) $29 Unknown Court Fee Proceedings $250.00 per Unknown hour Vision (Titmus) $39 Unknown Vision (Ishihara 14 panel) $23 118 Treadmill Stress Test $150 Unknown Chem Panel23 $83 86 CBC w/cliff $55 86 Venipuncture $35 Unknown Collection Fee $23 2 Lipid Panel $60 86 Physical PrePlacement $84 365 Rapid 10 panel UDS $95 18 Non Reg UDS 10 Panel $75 190 Note regarding any applicable immunization services: After the first twelve months of an awarded and executed contract, if the current market price for the above services change due to market conditions, demand(s) and/or shortage(s), the City would be billed the then current market rate. Docuftn Envelope ID: A55F15CO-1E47-4E4E-AD3E-815FB99D12DB Additional Pricing Concentra appreciates the opportunity to present our proposed fee schedule. We affirm all information contained herein is current, complete, accurate, and remains valid for 180 days following the date of our submittal. Estimated # of tests based on T12 actual where applicable DMV Physical $104 Unknown Electrocardiogram (EKG) $68 38 Hepatitis "A" blood screen $67 Unknown Hepatitis "B" blood screen $67 Unknown Hepatitis B Surface Antigen 498SB $63 Unknown Hepatitis "B" booster $83 Unknown Hepatitis "B" titer $65 Unknown Hepatitis "B" vaccine $105/x3 Per shot/set of 3 Hepatitis "A" vaccine $145/x2 Per shottset of 2 Hepatitis "C" blood screen $65 Unknown HIV blood screen $86 Unknown Pulmonary Function Test (Spirometry) 546 87 Respirator Fit Test $53 Unknown Respirator Physical $92 Unknown Respirator Questionnaire $33 Unknown Blood Screens-7 Panel Drug Screen NIA N/A Note regarding any applicable immunization services: After the first twelve months of an awarded and executed contract, if the current market price for the above services change due to market conditions, demand(s) and/or shortage(s), the City would be billed the then current market rate. Lynch, Breanna From: City of Santa Ana <certificate-request@ctrax jdidata.com> Sent: Thursday, January 4, 2024 1:21 PM To: Lynch, Breanna; Concentra_unit@grahamco.com; Nguyen, Danvi; HR Admin; info@grahamco.com; Murray, James, Schnaider, Lori Subject: Internal Notice of Compliance Follow Up Flag: — - Follow up Flag Status; Flagged NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL Contractor Occupational Health Centers of California, A Medical Corporation Name: Project A-2019-006-02 Number: Project A-2019-006-02 Name: The Certificate of Insurance (COI) submitted indicates that the coverages are in compliance with the insurance requirements. No further action is required at this time. The compliant coverage(s) are: TYPE OF INSURANCE �. POLICY NUMBER EXPIRATION, COI , F ' i` NA1 . DATE DATE; 3 r- , CITY-OF-SANTA- " ANA_Occupational- EXCESS LIABILITY CO23701009 01/01/2025 : 12/29/2023 : He 1-1-24-1-1- -! 20 12-29- 2023 386481816.pdf,i CITY-OF-SANTA- ANA_Occupational- GENERAL LIABILITY HAZ40322445818 01/01/2025 12/29/2023 He_1-1-24-1.1- 20-12-29- 2023.386481816.pdf WORKERS - CERTCERT9.pdf COMPENSATION AND WA763D510199353WC2631510199263 04/01/2024 03/27/2023 130 EMPLOYERS' LIABILITY 1 Lynch, Breanna From: City of Santa Ana <certificate-request@ctrax jdidata.com> Sent: Thursday, January 4, 2024 1:21 PM To: Lynch, Breanna; Concentra_unit@grahamco.com; Nguyen, Danvi; HR Admin; info@grahamco.com; Murray, James; Schnaider, Lori Subject: Internal Notice of Compliance NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL Contractor Occupational Health Centers of California, A Medical Corporation Name: Project A-2019-006-02 Number: Project A-2019-006-02 Name: The Certificate of Insurance (COI) submitted indicates that the coverages are in compliance with the insurance requirements. No further action is required at this time. The compliant coverage(s) are: TYPE OF INSURANCE EXCESS LIABILITY GENERAL LIABILITY WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Thank you, POLICY NUMBER CO23701009 HAZ40322445818 EXPIRATION COI DATE DATE 01 /01 /2025 12/29/2023 FILE NAME CITY-OF-SANTA- ANA_Occupational- He_1-1-24-1-1- 20 12-29- 2023_386481816.pdf CITY-OF-SANTA- ANA_Occupational- 01/01/2025 12/29/2023 He_1-1-24-I-1- 20 12-29- 2023_386481816.pdf WA763D510199353WC2631510199263 04/01/2024 03/27/2023 CERT- 1309430899.pdf 1 76/20/2024 (MM/DD/YYYY) ,a`oRo° CERTIFICATE OF LIABILITY INSURANCE 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 endor ement s . PRODUCER CONTACT Graham Company,PHONE °rce ra I a Marsh & McLennan A n LL co a A/c No Ex _1-15 - 5 E-MAIL One Penn Square Wes ADDRESS: )ncentra_Unit@grahamco.com Philadelphia PA 1910 Eg(s)4%pwwPawgAr% A,—,-.. sows INSURERA C 'UALIA suJtyUrn pa I%. I A %_0 V U9A INSURED CONCGRO-01 INSURER Llbt `Y Mutual Fire Ins. Co. 23035 Occupational Health Centers of California, URE c : Libe n p ra � A Medical Corporation, c/ elect Medical Corporat dba Concentra Medical rs OF .RD: Allie w 4716 Old Gettysburg Ro - ployers Insura-- ^f tMausau 21458 Mechanicsburg PA 170 P\/P u RF: I C 3 00 COVERAGES N IL CIF N ER:, 16 V U*R THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELL ✓V H ,dE BEEN ISSUED O T7ETN7URED NAMED ABOVE FOR THE PO ICY ERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR COS -)IT' ,N 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 I SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y HAZ4032244581-8 1/1/2024 1/1/2025 EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 X MED EXP (Any one person) $ Professional Lia X $1 M Claim/$3M Ag PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY ❑ PRO ❑ JECT LOC X PRODUCTS - COMP/OP AGG $ 3,000,000 $ OTHER: B AUTOMOBILE LIABILITY Y Y AS2-631-510199-324 4/1/2024 4/1/2025 COMBINED SINGLE LIMIT Ea accident $2,000,000 X 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 A X UMBRELLALIAB X OCCUR Y Y HMC4032235752 1/1/2024 1/1/2025 EACH OCCURRENCE $9,000,000 AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION $ $ C F WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE Y WA7-63D-510199-354 WA5-63D-510199-314 4/1/2024 4/1/2024 4/1/2025 4/1/2025 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ NIA E.L. DISEASE- EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ 1,000,000 E Property YAC-L9L-477341-014 1/1/2024 1/1/2025 SEE BELOW D Excess Liability CO23701-009 1/1/2024 1/1/2025 $10M Each Occurrence $10M Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) PRIMARY LIABILTY POLICY includes General Liability Coverage on an Occurrence Basis and Professional Liability Coverage on a Claims Made Basis. UMBRELLA LIABILITY COVERAGE includes Excess General Liability on an Occurrence Basis and Excess Professional Liability on a Claims Made Basis. Both Coverages are excess of a $3,000,000 Self -Insured Retention each Occurrence/Claim subject to a $18,000,000 Aggregate. INDIANA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE - Continental Casualty Company - Policy #HAZ 4032244595-10; Effective 1/1/2024-1/1/2025 - $500,000 Each Medical Incident/$1,500,000 Aggregate Per Insured or Surgeon See Attached... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICF WILL FIF DELIVERED IN CITY OF SANTA ANA ACCORDANCE WITH THE POLICY PRC Risk Management Division a „.° "F RUManagernenfDMsian 20 CIVIC CENTER PLAZA AUTHORIZED FPRESENTATIVE REVIEWED &APPROVED BY. SANTA ANA CA 92702 4g;e Aecv44 ® Risk Management Specialist @ 1988-2015 ACORD ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 712/16/2024 E(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE �� 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: Concentra Unit Graham Company, PHONE FAX a Marsh &McLennan Agency, LLC company vC No Ext: 215-567-6300 vc,No:215-405-2694 E-MOne Penn Square West ADDRESS: Concentra_Unit@grahamco.com Philadelphia PA 19102 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Columbia Casualty Company 31127 INSURED CONCGRO-01 INSURER B: Liberty Mutual Fire Ins.Co. 23035 Occupational Health Centers of California, A Medical Corporation INsuRERc:Allied World Assurance Company,AG dba Concentra Medical Centers INSURERD: Employers Insurance of Wausau 21458 5080 Spectrum Drive, Suite 1200 West INSURERE: LM Insurance Corporation 33600 Addison TX 75001 INSURER F COVERAGES CERTIFICATE NUMBER:1935939188 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY Y Y HAZ4032244581-8 1/1/2024 1/1/2025 EACH OCCURRENCE $1,000,000 CLAIMS-MADE � OCCUR PREMISES DAMAGE TO PREMISES Ea occurrence) ccurrence $500,000 X Professional Lia MED EXP(Any one person) $ X $1M Claim/$3M Ag PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 PRO POLICY JECT ❑ LOC PRODUCTS-COMP/OP AGG $3,000,000 X OTHER: $ B AUTOMOBILE LIABILITY Y Y AS2-631-510199-324 4/1/2024 4/1/2025 COMBINED SINGLE LIMIT $2,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED FIR ER DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident L $ A X UMBRELLALIAB X OCCUR Y Y HMC4032235752 1/1/2024 1/1/2025 EACH OCCURRENCE $9,000,000 EXCESS LAB CLAIMS-MADE AGGREGATE $10,000,000 DED X RETENTION$ $ B WORKERS COMPENSATION Y WA7-63D-510199-354 4/1/2024 4/1/2025 X PER OTH- E AND EMPLOYERS'LIABILITY Y/N WA5-63D-510199-314 4/1/2024 4/1/2025 STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICE R/M EMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 D Property YAC-L9L-477341-014 1/1/2024 1/1/2025 SEE BELOW C Excess Liability CO23701-009 1/1/2024 1/1/2025 $10M Each Occurrence $10M Aggregate DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) PRIMARY LIABILTY POLICY includes General Liability Coverage on an Occurrence Basis and Professional Liability Coverage on a Claims Made Basis. UMBRELLA LIABILITY COVERAGE includes Excess General Liability on an Occurrence Basis and Excess Professional Liability on a Claims Made Basis. Both Coverages are excess of a$3,000,000 Self-Insured Retention each Occurrence/Claim subject to a$18,000,000 Aggregate. INDIANA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244595-10; Effective 1/1/2024-1/1/2025- $500,000 Each Medical Incident/$1,500,000 Aggregate Per Insured or Surgeon p See Attached... APPROVED CERTIFICATE HOLDER CANCELLATION By Cynthia Mora at 1:34 pm, Dec 16, 2024 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF SANTA ANA ACCORDANCE WITH THE POLICY PROVISIONS. Risk Management Division 20 CIVIC CENTER PLAZA AUTHORIZED REPRESENTATIVE SANTA ANA CA 92702 M ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CONCGRO-01 LOC#: ,a`oRo ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Graham Company, Occupational Health Centers of California, A Medical Corporation POLICY NUMBER dba Concentra Medical Centers 5080 Spectrum Drive, Suite 1200 West Addison TX 75001 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE KANSAS PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244600-10; Effective 1/1/2024-1/1/2025- $500,000 Each Medical Incident/$1,500,000 Aggregate Per Insured or Surgeon LOUISIANA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Columbia Casualty Company-Policy#HAZ 4032244614-10; Effective 1/1/2024-1/1/2025- $100,000 Each Medical Incident/$300,000 Aggregate Per Insured or Surgeon NEBRASKA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244628-10; Effective 1/1/2024-1/1/2025 -$500,000 Each Medical Incident/$1,000,000 Aggregate Per Insured or Surgeon PENNSYLVANIA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Columbia Casualty Company-Policy#HAZ 4032244631-10; 1/1/2024-1/1/2025- $500,000 Each Medical Incident/$1,500,000 Aggregate Per Insured or Surgeon WISCONSIN PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244659-10; 1/1/2024-1/1/2025- $1,000,000 Each Medical Incident/$3,000,000 Aggregate Per Insured or Surgeon PROPERTY COVERAGE: Risk of Physical Loss or Damage to Covered Property subject to policy terms and conditions. WORKERS COMPENSATION-Occupational Health Centers of California,A Medical Corporation-Liberty Mutual Insurance Corp.-Policy #WA5-63D-510199-314; Effective:4/1/2024-4/1/2025 WORKERS COMPENSATION-Occupational Health Centers of Southwest, P.A.-Liberty Insurance Corp.-Policy#WA7-63D-510199-404; Effective: 4/1/2024-4/1/2025 WORKERS COMPENSATION-Occupational Health Centers of Southwest, P.A.-Liberty Mutual Insurance Corp.-Policy#WC5-631-510199-254(WI); Effective:4/1/2024-4/1/2025 ADDITIONAL WORKERS COMPENSATION POLICIES: OHC of Arkansas—Liberty Insurance Corp.-Policy#WC7-631-510199-284; Effective:4/1/2024-4/1/2025 OHC of Southwest(AZ/UT)—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-244; Effective:4/1/2024-4/1/2025 OHC of Delaware—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-334; Effective:4/1/2024-4/1/2025 OHC of Georgia/Hawaii—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-384; Effective:4/1/2024-4/1/2025 OHC of Illinois—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-414; Effective:4/1/2024-4/1/2025 OHC of Louisiana—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-294; Effective:4/1/2024-4/1/2025 OHC of Michigan—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-274; Effective:4/1/2024-4/1/2025 OHC of Nebraska—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-374; Effective:4/1/2024-4/1/2025 OHC of New Jersey—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-264; Effective:4/1/2024-4/1/2025 OHC of North Carolina—Liberty Insurance Corp.-Policy#WC7-631-510199-344; Effective:4/1/2024-4/1/2025 OHC of Southwest(KS)—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-424; Effective:4/1/2024-4/1/2025 Therapy Centers of Southwest I, PA(OR)-Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-394; Effective:4/1/2024-4/1/2025 Therapy Centers of South Carolina, PA-Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-304; Effective:4/1/2024-4/1/2025 OHC of Minnesota-Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-454; Effective:4/1/2024-4/1/2025 OHC of Alaska-Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-444; Effective:4/1/2024-4/1/2025 CYBER LIABILITY- Arch Specialty Insurance Company-Policy#NPL2001106-00; Effective: 11/25/2024-11/25/2025-Limit:$10,000,000 EXCESS CYBER LIABILITY-Homeland Insurance Company of New York-Policy#720002431-0000; Effective: 11/25/2024-11/25/2025- Limit:$10,000,000 Excess of$10,000,000 CRIME COVERAGE—National Union Fire Insurance Company of Pittsburgh, PA—Policy#02-173-18-50, Effective 11/25/2024—1/1/2026—Limit$10,000,000 Coverage is provided for all medical professionals currently or previously employed or contracted by the above Named Insured,but only for professional services performed for or on behalf of the above Named Insured. RE: OHC OF CA/CMC HAS AN AGREEMENT UNDER#A-2019-006 TO PROVIDE MEDICAL SERVICES TO THE EMPLOYEES OF THE NAMED CLIENT. CITY OF SANTA ANA, ITS OFFICERS,AGENTS,VOLUNTEERS AND EMPLOYEES are all included as additional insureds on the above General Liability, Auto Liability and Umbrella Liability Policies and coverage shall apply on a Primary and Non-Contributory basis if required by written contract. Prior to loss,and if required by written contract,Waiver of Subrogation is provided on General Liability,Auto Liability, Umbrella Liability and Workers Compensation Policies for work performed under contract if permissible by state law. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Additional premium is a percent of the California Manual Workers Compensation premium. Subject to a minimum premium charge of$250 Person or Organization Job Description Where required by contract or written agreement prior to loss and allowed by law. Issued by Liberty Insurance Corporation 21814 For attachment to Policy No.WA7-63D-510199-354 Effective Date: 4/1/2024 Premium$ Issued to Concentra Group Holding Parent, LLC WC 04 03 06 Page 1 of 1 Ed: 04/1984 POLICY NUMBER:AS2-631-510199-324 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement identifies person(s) or organization(s)who are "insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization whom you have agreed in writing to add as an additional insured, but only to coverage and minimum limits of insurance required by the written agreement, and in no event to exceed either the scope of coverage or the limits of insurance provided in this policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured"for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured"under the Who Is An Insured provision contained in Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 282 Policy Number: AS2-631-510199-324 COMMERCIAL AUTO CA 04"1013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respectto coverage provided by this endorsement,the provisionsof the Coverage Form apply unless modified by the endorsement. SCHEDULE Name(s)Of Person(s)Or Organization(s): Any person or organization for whom you perform work under a written contract if the contract requires you to obtain this agreement from us, but only if the contract is executed prior to the injury or damage occurring. Premium: $ INCL Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident' or the 'loss" under a contract with that person or organization. CA 04 44 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 249 POLICY NUMBER: HAZ 4032244581-8 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR TO WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS IN A WRITTEN CONTRACT OR AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III— Limits Of Insurance: with respect to liability for "bodily injury", "property If coverage provided to the additional insured is damage or personal and advertising injury required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in theDeclarations. insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a c ontract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: HAZ 4032244581-8 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an add itional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 CNA WAIVER OF RIGHTS OF RECOVERY APPLICABLE TO GENERAL LIABILITY COVERAGE FORM The changes set forth below are applicable only to the Commercial General Liability Coverage Form G- 145566-A, G-145567-A). The Healthcare Liability Policy Common Conditions (G-144102-A) are amended as set forth below: Condition XII., Transfer of Rights of Recovery is amended by the addition of the following: • Solely within the scope of this endorsement as indicated above, we waive any right of recovery we may have against any person or organization that you have agreed with, in writing, prior to the date of loss, to waive your right to recover against because of payments we make under the Commercial General Liability Coverage Form for injury or damage arising out of your ongoing operations. This endorsement applies only to: All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. GSL6554XX (4-11) Policy No: HAZ 4032244581-8 Page 1 Endorsement No: Effective Date: 1/1/2024 Insured Name: Concentra Group Holdings Parent, LLC ©CNA All Rights Reserved. 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Jotvsfst-!ublft!fggfdu!po!uif!fggfdujwf!ebuf!pg!tbje!Qpmjdz!bu!uif!ipvs!tubufe!jo!tbje!Qpmjdz-!vomftt!bopuifs! fggfdujwf!ebuf!jt!tipxo!cfmpx-!boe!fyqjsft!dpodvssfoumz!xjui!tbje!Qpmjdz/ HTM7665YY!)5.22* Qpmjdz!Op;!IB\[!5143355692.: Foepstfnfou!Op; Qbhf!2 Fggfdujwf!Ebuf;!22031 6 Jotvsfe!Obnf;Dpodfousb!Hspvq!IpmejohtQbsfou-!MMD ª!DOB!Bmm!Sjhiut!Sftfswfe/ XBJWFS!PG!PVS!SJHIU!UP!SFDPWFS!GSPN!PUIFST!FOEPSTFNFOU!. DBMJGPSOJB Tdifevmf 5 XD!15!14!17 5 DPNNFSDJBM!BVUP DB!31!59!21!24 UIJT!FOEPSTFNFOU!DIBOHFT!UIF!QPMJDZ/!!QMFBTF!SFBE!JU!DBSFGVMMZ/ EFTJHOBUFE!JOTVSFE!GPS DPWFSFE!BVUPT!MJBCJMJUZ!DPWFSBHF TDIFEVMF Obnf!Pg!Qfstpo)t*!Ps!Pshboj{bujpo)t*; B/2/JJ. E/3/ J. DB!31!59!21!24Qbhf!2!pg!2 282 4 73/27/2025 (MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 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: Concentra Unit Graham Company, PHONE FAX a Marsh& McLennan Agency, LLC company A/C No Ext: 215-567-6300 vc,No):215-405-2694 30 S 15th Street, 20th Floor ADDRESS: Concentra_Unit@grahamco.com Philadelphia PA 19102 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Columbia Casualty Company 31127 INSURED CONCGRO-01 INSURERB: Liberty Mutual Fire Ins. Co. 23035 Occupational Health Centers of California, A Medical Corporation INSURER C:Allied World Assurance Company,AG dba Concentra Medical Centers INSURER D: Employers Insurance of Wausau 21458 5080 Spectrum Drive, Suite 1200 West INSURER E: LM Insurance Corporation 33600 Addison TX 75001 INSURERF: Liberty Insurance Corporation 42404 COVERAGES CERTIFICATE NUMBER:375098255 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR I POLICY NUMBER MM/DD/YYYY MM/DDIYYYY A X COMMERCIAL GENERAL LIABILITY Y Y HAZ4032244581-9 1/1/2025 1/1/2026 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea or $500,000 X Professional Lia MED EXP(Any one person) $ X $1 M Claim/$3M Ag PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY❑ PRO ❑ $3,000,000 LOC PRODUCTS-COMP/OP AGG X JECT OTHER: $ B AUTOMOBILE LIABILITY Y Y AS2-631-510199-325 4/1/2025 4/1/2026 COMBINED SINGLE LIMIT $2,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A X UMBRELLALIAB X OCCUR Y Y HMC4032235752 1/1/2025 1/1/2026 EACH OCCURRENCE $9,000,000 EXCESS LIAB X CLAIMS-MADE AGGREGATE $10,000,000 DED X RETENTION$ $ F WORKERS COMPENSATION Y WA7-63D-510199-355 4/1/2025 4/1/2026 X PER OTH- E AND EMPLOYERS'LIABILITY YIN WA5-63D-510199-315 4/1/2025 4/1/2026 STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 ❑ OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 D Property YAC-L9L-477341-015 1/1/2025 1/1/2026 SEE BELOW C Excess Liability CO23701/010 1/1/2025 1/1/2026 $10M Each Occurrence $10M Aggregate DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) PRIMARY LIABILTY POLICY includes General Liability Coverage on an Occurrence Basis and Professional Liability Coverage on a Claims Made Basis. UMBRELLA LIABILITY COVERAGE includes Excess General Liability on an Occurrence Basis and Excess Professional Liability on a Claims Made Basis. Both Coverages are excess of a$3,000,000 Self-Insured Retention each Occurrence/Claim subject to a$18,000,000 Aggregate. INDIANA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244595-11; Effective 1/1/2025-1/1/2026- $500,000 Each Medical Incident/$1,500,000 Aggregate Per Insured or Surgeon See Attached... APPROVED CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen of 10:15 am,May 12,2025 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana Tu Tran °ugTranysignened by ACCORDANCE WITH THE POLICY PROVISIONS. Human Resources N Date:2°25.05.12 u en 1°:15:5°- ° 20 Civic Center Plaza, M-24 A TYORIZED PRESENTATIVE Santa Ana CA 92701 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CONCGRO-01 LOC#: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Graham Company, Occupational Health Centers of California, A Medical Corporation POLICY NUMBER dba Concentra Medical Centers 5080 Spectrum Drive, Suite 1200 West Addison TX 75001 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE KANSAS PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244600-11; Effective 1/1/2025-1/1/2026- $500,000 Each Medical Incident/$1,500,000 Aggregate Per Insured or Surgeon LOUISIANA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Columbia Casualty Company-Policy#HAZ 4032244614-11; Effective 1/1/2025-1/1/2026- $100,000 Each Medical Incident/$300,000 Aggregate Per Insured or Surgeon NEBRASKA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244628-11; Effective 1/1/2025-1/1/2026 -$800,000 Each Medical Incident/$3,000,000 Aggregate Per Insured or Surgeon PENNSYLVANIA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Columbia Casualty Company-Policy#HAZ 4032244631-11; 1/1/2025-1/1/2026- $500,000 Each Medical Incident/$1,500,000 Aggregate Per Insured or Surgeon WISCONSIN PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244659-11; 1/1/2025-1/1/2026- $1,000,000 Each Medical Incident/$3,000,000 Aggregate Per Insured or Surgeon PROPERTY COVERAGE: Risk of Physical Loss or Damage to Covered Property subject to policy terms and conditions. WORKERS COMPENSATION-Occupational Health Centers of California,A Medical Corporation-Liberty Mutual Insurance Corp.-Policy #WA5-63D-51 01 99-31 5; Effective:4/1/2025-4/1/2026 WORKERS COMPENSATION-Occupational Health Centers of Southwest, P.A.-Liberty Insurance Corp.-Policy#WA7-63D-510199-405; Effective: 4/1/2025-4/1/2026 WORKERS COMPENSATION-Occupational Health Centers of Southwest, P.A.-Liberty Mutual Insurance Corp.-Policy#WC5-631-510199-255(WI); Effective:4/1/2025-4/1/2026 ADDITIONAL WORKERS COMPENSATION POLICIES: OHC of Arkansas—Liberty Insurance Corp.-Policy#WC7-631-510199-285; Effective:4/1/2025-4/1/2026 OHC of Southwest(AZ/UT)—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-245; Effective:4/1/2025-4/1/2026 OHC of Delaware—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-335; Effective:4/1/2025-4/1/2026 OHC of Georgia/Hawaii—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-385; Effective:4/1/2025-4/1/2026 OHC of Illinois—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-415; Effective:4/1/2025-4/1/2026 OHC of Louisiana—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-295; Effective:4/1/2025-4/1/2026 OHC of Michigan—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-275; Effective:4/1/2025-4/1/2026 OHC of Nebraska—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-375; Effective:4/1/2025-4/1/2026 OHC of New Jersey—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-265; Effective:4/1/2025-4/1/2026 OHC of North Carolina—Liberty Insurance Corp.-Policy#WC7-631-510199-345; Effective:4/1/2025-4/1/2026 OHC of Southwest(KS)—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-425; Effective:4/1/2025-4/1/2026 Therapy Centers of Southwest I, PA(OR)-Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-395; Effective:4/1/2025-4/1/2026 Therapy Centers of South Carolina, PA-Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-305; Effective:4/1/2025-4/1/2026 OHC of Minnesota-Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-455; Effective:4/1/2025-4/1/2026 OHC of Alaska-Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-445; Effective:4/1/2025-4/1/2026 CYBER LIABILITY- Arch Specialty Insurance Company-Policy#NPL2001106-00; Effective: 11/25/2024-11/25/2025-Limit:$10,000,000 EXCESS CYBER LIABILITY-Homeland Insurance Company of New York-Policy#720002431-0000; Effective: 11/25/2024-11/25/2025- Limit:$10,000,000 Excess of$10,000,000 CRIME COVERAGE—National Union Fire Insurance Company of Pittsburgh, PA—Policy#02-173-18-50, Effective 11/25/2024—1/1/2026—Limit$10,000,000 Coverage is provided for all medical professionals currently or previously employed or contracted by the above Named Insured, but only for professional services performed for or on behalf of the above Named Insured. RE:OHC OF CA/CMC HAS AN AGREEMENT UNDER#A-2019-006 TO PROVIDE MEDICAL SERVICES TO THE EMPLOYEES OF THE NAMED CLIENT. CITY OF SANTA ANA, ITS OFFICERS,AGENTS,VOLUNTEERS AND EMPLOYEES are all included as additional insureds on the above General Liability, Auto Liability and Umbrella Liability Policies and coverage shall apply on a Primary and Non-Contributory basis if required by written contract. Prior to loss,and if required by written contract,Waiver of Subrogation is provided on General Liability,Auto Liability, Umbrella Liability and Workers Compensation Policies for work performed under contract if permissible by state law. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: HAZ 4032244581-9 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an add itional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: HAZ 4032244581-9 COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR TO WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS IN A WRITTEN CONTRACT OR AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III— Limits Of Insurance: with respect to liability for "bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury" required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. Required by the contract or agreement; or 1. In the performance of your ongoing operations; or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in the insured only applies to the extent permitted by Declarations. law; and 2. If coverage provided to the additional insured is required by a c ontract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 04 13 ©Insurance Services Office, Inc., 2012 Page 1 of 1 CNA WAIVER OF RIGHTS OF RECOVERY APPLICABLE TO GENERAL LIABILITY COVERAGE FORM The changes set forth below are applicable only to the Commercial General Liability Coverage Form G- 145566-A, G-145567-A). The Healthcare Liability Policy Common Conditions (G-144102-A) are amended as set forth below: Condition XII., Transfer of Rights of Recovery is amended by the addition of the following: • Solely within the scope of this endorsement as indicated above, we waive any right of recovery we may have against any person or organization that you have agreed with, in writing, prior to the date of loss, to waive your right to recover against because of payments we make under the Commercial General Liability Coverage Form for injury or damage arising out of your ongoing operations. This endorsement applies only to: All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. GSL6554XX (4-11) Policy No: HAZ 4032244581-9 Page 1 Endorsement No: Effective Date: 1/1/2025 Insured Name: Concentra Group Holdings Parent, LLC ©CNA All Rights Reserved. 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 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Additional premium is a percent of the California Manual Workers Compensation premium. Subject to a minimum premium charge of$250 Person or Organization Job Description Where required by contract or written agreement prior to loss and allowed by law. Issued by Liberty Insurance Corporation 21814 For attachment to Policy No.WA7-63D-510199-355 Effective Date:4/1/2024 Premium$ Issued to Concentra Group Holding Parent, LLC WC 04 03 06 Page 1 of 1 Ed: 04/1984 POLICY NUMBER:AS2-631-510199-325 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement identifies person(s) or organization(s)who are "insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE Name Of Person(s) Or Organ ization(s): Any person or organization whom you have agreed in writing to add as an additional insured, but only to coverage and minimum limits of insurance required by the written agreement, and in no event to exceed either the scope of coverage or the limits of insurance provided in this policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured"for Covered Autos Liability Coverage, but only to the extentthat person or organization qualifies as an "insured"under the Who Is An Insured provision contained in Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2.of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 282 Policy Number: AS2-631-510199-325 COMMERCIAL AUTO CA04441013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respectto coverage provided by this endorsement,the provisionsof the Coverage Form apply unless modified by the endorsement. SCHEDULE Name(s)Of Person(s)Or Organization(s): Any person or organization for whom you perform work under a written contract if the contract requires you to obtain this agreement from us, but only if the contract is executed prior to the injury or damage occurring. Premium: $ INCL Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the 'loss" under a contract with that person or organization. CA 04 44 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 249 712/29/2025 E(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE �� 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: Concentra Unit Graham Company, PHONE FAX a Marsh &McLennan Agency, LLC company vC No Ext: 215-567-6300 vc,Noy 215-405-2694 E-M30 S 15th Street, 20th Floor ADDRESS: MMAEastGrahamConcentraUnit@MarshMMA.com Philadelphia PA 19102 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Columbia Casualty Company 31127 INSURED CONCGRO-01 INSURERB: Liberty Mutual Fire Ins.Co. 23035 Occupational Health Centers of California, A Medical Corporation INsuRERc:Allied World Assurance Company,AG dba Concentra Medical Centers INSURERD: Employers Insurance of Wausau 21458 5080 Spectrum Drive, Suite 1200 West INSURERE: LM Insurance Corporation 33600 Addison TX 75001 INSURERE: Liberty Insurance Corporation 42404 COVERAGES CERTIFICATE NUMBER:1172062483 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY Y Y HAZ 4032244581-10 1/1/2026 1/1/2027 EACH OCCURRENCE $1,000,000 CLAIMS-MADE � OCCUR PREMISES DAMAGE TO PREMISES Ea occurrence) ccurrence $500,000 X Professional Lia MED EXP(Any one person) $ X $1M Claim/$3M Ag PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 PRO POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $3,000,000 X OTHER: $ B AUTOMOBILE LIABILITY Y Y AS2-631-510199-325 4/1/2025 4/1/2026 COMBINED SINGLE LIMIT $2,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED FIR ERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident L $ A X UMBRELLALIAB X OCCUR Y Y HMC4032235752 1/1/2026 1/1/2027 EACH OCCURRENCE $9,000,000 EXCESS LAB X CLAIMS-MADE AGGREGATE $10,000,000 DED X RETENTION$ $ F WORKERS COMPENSATION Y WA7-63D-510199-355 4/1/2025 4/1/2026 X PER OTH- E AND EMPLOYERS'LIABILITY Y/N WA5-63D-510199-315 4/1/2025 4/1/2026 STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICE R/M EMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 D Property YAC-L9L-477341-016 1/1/2026 1/1/2027 SEE BELOW C Excess Liability CO23701/011 1/1/2026 1/1/2027 $10M Each Occurrence $10M Aggregate DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) PRIMARY LIABILTY POLICY includes General Liability Coverage on an Occurrence Basis and Professional Liability Coverage on a Claims Made Basis. UMBRELLA LIABILITY COVERAGE includes Excess General Liability on an Occurrence Basis and Excess Professional Liability on a Claims Made Basis. Both Coverages are excess of a$3,000,000 Self-Insured Retention each Occurrence/Claim subject to a$18,000,000 Aggregate. INDIANA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244595-11; Effective 1/1/2026-1/1/2027- $500,000 Each Medical Incident/$1,500,000 Aggregate Per Insured or Surgeon See Attached... TU Trdrl signed APPROVED CERTIFICATE HOLDER Hy Date:2026.01.06 CANCELLATION By Tu Tran Nguyen at 2:18 pm,Jan 06,2026 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Human Resources 20 Civic Center Plaza, M-24 AUTHORIZEDRPPRESENTATIVE Santa Ana CA 92701 I M ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CONCGRO-01 LOC#: ,a`oRo ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Graham Company, Occupational Health Centers of California, A Medical Corporation POLICY NUMBER dba Concentra Medical Centers 5080 Spectrum Drive, Suite 1200 West Addison TX 75001 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE KANSAS PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244600-11; Effective 1/1/2026-1/1/2027- $500,000 Each Medical Incident/$1,500,000 Aggregate Per Insured or Surgeon LOUISIANA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Columbia Casualty Company-Policy#HAZ 4032244614-11; Effective 1/1/2026-1/1/2027- $100,000 Each Medical Incident/$300,000 Aggregate Per Insured or Surgeon NEBRASKA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244628-11; Effective 1/1/2026-1/1/2027 -$800,000 Each Medical Incident/$3,000,000 Aggregate Per Insured or Surgeon PENNSYLVANIA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Columbia Casualty Company-Policy#HAZ 4032244631-11; 1/1/2026-1/1/2027- $500,000 Each Medical Incident/$1,500,000 Aggregate Per Insured or Surgeon WISCONSIN PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244659-11; 1/1/2026-1/1/2027- $1,000,000 Each Medical Incident/$3,000,000 Aggregate Per Insured or Surgeon PROPERTY COVERAGE: Risk of Physical Loss or Damage to Covered Property subject to policy terms and conditions. WORKERS COMPENSATION-Occupational Health Centers of California,A Medical Corporation-Liberty Mutual Insurance Corp.-Policy #WA5-63D-510199-315; Effective:4/1/2025-4/1/2026 WORKERS COMPENSATION-Occupational Health Centers of Southwest, P.A.-Liberty Insurance Corp.-Policy#WA7-63D-510199-405; Effective: 4/1/2025-4/1/2026 WORKERS COMPENSATION-Occupational Health Centers of Southwest, P.A.-Liberty Mutual Insurance Corp.-Policy#WC5-631-510199-255(WI); Effective:4/1/2025-4/1/2026 ADDITIONAL WORKERS COMPENSATION POLICIES: OHC of Arkansas—Liberty Insurance Corp.-Policy#WC7-631-510199-285; Effective:4/1/2025-4/1/2026 OHC of Southwest(AZ/UT)—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-245; Effective:4/1/2025-4/1/2026 OHC of Delaware—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-335; Effective:4/1/2025-4/1/2026 OHC of Georgia/Hawaii—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-385; Effective:4/1/2025-4/1/2026 OHC of Illinois—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-415; Effective:4/1/2025-4/1/2026 OHC of Louisiana—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-295; Effective:4/1/2025-4/1/2026 OHC of Michigan—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-275; Effective:4/1/2025-4/1/2026 OHC of Nebraska—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-375; Effective:4/1/2025-4/1/2026 OHC of New Jersey—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-265; Effective:4/1/2025-4/1/2026 OHC of North Carolina—Liberty Insurance Corp.-Policy#WC7-631-510199-345; Effective:4/1/2025-4/1/2026 OHC of Southwest(KS)—Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-425; Effective:4/1/2025-4/1/2026 Therapy Centers of Southwest I, PA(OR)-Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-395; Effective:4/1/2025-4/1/2026 Therapy Centers of South Carolina, PA-Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-305; Effective:4/1/2025-4/1/2026 OHC of Minnesota-Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-455; Effective:4/1/2025-4/1/2026 OHC of Alaska-Liberty Mutual Fire Insurance Company-Policy#WC2-631-510199-445; Effective:4/1/2025-4/1/2026 CYBER LIABILITY- Arch Specialty Insurance Company-Policy#NPL2001106-01; Effective: 11/25/2025-01/01/2027-Limit:$10,000,000 EXCESS CYBER LIABILITY-Homeland Insurance Company of New York-Policy#720002431-0001; Effective: 11/25/2025-01/01/2027- Limit:$10,000,000 Excess of$10,000,000 CRIME COVERAGE—National Union Fire Insurance Company of Pittsburgh, PA—Policy#04-173-83-24, Effective 01/01/2026—01/01/2027—Limit $10,000,000 Coverage is provided for all medical professionals currently or previously employed or contracted by the above Named Insured,but only for professional services performed for or on behalf of the above Named Insured. RE: OHC OF CA/CMC HAS AN AGREEMENT UNDER#A-2019-006 TO PROVIDE MEDICAL SERVICES TO THE EMPLOYEES OF THE NAMED CLIENT. CITY OF SANTA ANA, ITS OFFICERS,AGENTS,VOLUNTEERS AND EMPLOYEES are all included as additional insureds on the above General Liability, Auto Liability and Umbrella Liability Policies and coverage shall apply on a Primary and Non-Contributory basis if required by written contract. Prior to loss,and if required by written contract,Waiver of Subrogation is provided on General Liability,Auto Liability, Umbrella Liability and Workers Compensation Policies for work performed under contract if permissible by state law. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: HAZ 4032244581-10 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an add itional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER HAZ 4032244581-10 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR TO WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS IN A WRITTEN CONTRACT OR AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III— Limits Of Insurance: with respect to liability for "bodily injury", "property If coverage provided to the additional insured is damage or personal and advertising injury required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in theDeclarations. insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a c ontract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 CNA WAIVER OF RIGHTS OF RECOVERY APPLICABLE TO GENERAL LIABILITY COVERAGE FORM The changes set forth below are applicable only to the Commercial General Liability Coverage Form G- 145566-A, G-145567-A). The Healthcare Liability Policy Common Conditions (G-144102-A) are amended as set forth below: Condition XII., Transfer of Rights of Recovery is amended by the addition of the following: • Solely within the scope of this endorsement as indicated above, we waive any right of recovery we may have against any person or organization that you have agreed with, in writing, prior to the date of loss, to waive your right to recover against because of payments we make under the Commercial General Liability Coverage Form for injury or damage arising out of your ongoing operations. This endorsement applies only to: All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. GSL6554XX (4-11) Policy No: HAZ 4032244581-10 Page 1 Endorsement No: Effective Date: 1/1/2026 Insured Name: Concentra Group Holdings Parent, LLC ©CNA All Rights Reserved. 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 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Additional premium is a percent of the California Manual Workers Compensation premium. Subject to a minimum premium charge of$250 Person or Organization Job Description Where required by contract or written agreement prior to loss and allowed by law. Issued by Liberty Insurance Corporation 21814 For attachment to Policy No.WA7-63D-510199-355 Effective Date: 4/1/2025 Premium$ Issued to Concentra Group Holding Parent, LLC WC 04 03 06 Page 1 of 1 Ed: 04/1984 POLICY NUMBER:AS2-631-510199-325 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement identifies person(s) or organization(s)who are "insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization whom you have agreed in writing to add as an additional insured, but only to coverage and minimum limits of insurance required by the written agreement, and in no event to exceed either the scope of coverage or the limits of insurance provided in this policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured"for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured"under the Who Is An Insured provision contained in Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 282 Policy Number: AS2-631-510199-325 COMMERCIAL AUTO CA 04"1013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respectto coverage provided by this endorsement,the provisionsof the Coverage Form apply unless modified by the endorsement. SCHEDULE Name(s)Of Person(s)Or Organization(s): Any person or organization for whom you perform work under a written contract if the contract requires you to obtain this agreement from us, but only if the contract is executed prior to the injury or damage occurring. Premium: $ INCL Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident' or the 'loss" under a contract with that person or organization. CA 04 44 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 249 DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 4/28/2026 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 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: Concentra Unit Graham Company, PHONE FAX a Marsh &McLennan Agency, LLC company vC No Ext: 215-567-6300 vc,Noy 215-405-2694 E-M30 S 15th Street, 20th Floor ADDRESS: MMAEastGrahamConcentraUnit@MarshMMA.com Philadelphia PA 19102 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Columbia Casualty Company 31127 INSURED CONCGRO-01 INSURERB: Employers Insurance of Wausau 21458 Occupational Health Centers of California, INSURERC: Manufacturers Alliance Insurance Company 36897 A Medical Corporation dba Concentra Medical Centers INSURERD: Pennsylvania Manufacturers Association 12262 5080 Spectrum Drive, Suite 1200 West INSURERE: Addison TX 75001 INSURER F COVERAGES CERTIFICATE NUMBER:1614345528 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY Y Y HAZ 4032244581-10 1/1/2026 1/1/2027 EACH OCCURRENCE $1,000,000 CLAIMS-MADE � OCCUR PREMISES DAMAGE TO PREMISES Ea occurrence) ccurrence $500,000 X Professional Lia MED EXP(Any one person) $ X $1M Claim/$3M Ag PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 PRO POLICY JECT ❑ LOC PRODUCTS-COMP/OP AGG $3,000,000 X OTHER: $ C AUTOMOBILE LIABILITY Y Y 152600-1689413 4/1/2026 4/1/2027 COMBINED SINGLE LIMIT $2,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident L $ A X UMBRELLALIAB X OCCUR Y Y HMC4032235752 1/1/2026 1/1/2027 EACH OCCURRENCE $$9,000,000 EXCESS LAB X CLAIMS-MADE AGGREGATE $$10,000,000 DED X RETENTION$ $ D WORKERS COMPENSATION SEE BELOW 4/1/2026 4/1/2027 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICE R/M EMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 B Property YAC-L9L-477341-016 1/1/2026 1/1/2027 SEE BELOW DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) PRIMARY LIABILTY POLICY includes General Liability Coverage on an Occurrence Basis and Professional Liability Coverage on a Claims Made Basis. UMBRELLA LIABILITY COVERAGE includes Excess General Liability on an Occurrence Basis and Excess Professional Liability on a Claims Made Basis. Both Coverages are excess of a$3,000,000 Self-Insured Retention each Occurrence/Claim INDIANA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244595-12; Effective 1/1/2026-1/1/2027- $500,000 Each Medical Incident/$1,500,000 Aggregate Per Insured or Surgeon See Attached... APPROVED CERTIFICATE HOLDER CANCELLATION I By Tu Tran Nguyen at 8:28 am,Apr 29,2026 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Human Resources 20 Civic Center Plaza, M-24 AUTHORIZEDRPPRESENTATIVE Santa Ana CA 92701 I M ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CONCGRO-01 LOC#: ,a`oRo ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Graham Company, Occupational Health Centers of California, A Medical Corporation POLICY NUMBER dba Concentra Medical Centers 5080 Spectrum Drive, Suite 1200 West Addison TX 75001 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE KANSAS PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244600-12; Effective 1/1/2026-1/1/2027- $500,000 Each Medical Incident/$1,500,000 Aggregate Per Insured or Surgeon LOUISIANA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Columbia Casualty Company-Policy#HAZ 4032244614-12; Effective 1/1/2026-1/1/2027- $100,000 Each Medical Incident/$300,000 Aggregate Per Insured or Surgeon NEBRASKA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244628-12; Effective 1/1/2026-1/1/2027 -$800,000 Each Medical Incident/$3,000,000 Aggregate Per Insured or Surgeon PENNSYLVANIA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Columbia Casualty Company-Policy#HAZ 4032244631-12; 1/1/2026-1/1/2027- $500,000 Each Medical Incident/$1,500,000 Aggregate Per Insured or Surgeon WISCONSIN PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Continental Casualty Company-Policy#HAZ 4032244659-12; 1/1/2026-1/1/2027- $1,000,000 Each Medical Incident/$3,000,000 Aggregate Per Insured or Surgeon PROPERTY COVERAGE:$5,000,000 Limit for Unnamed/Unscheduled Locations; Specified Limits for Scheduled Locations. SEPARATE WORKERS'COMPENSATION POLICIES FOR INSURED ENTITIES AS FOLLOWS: WORKERS COMPENSATION-Concentra Health Services, Inc.-Pennsylvania Manufacturers Association Insurance Company-Policy#202675-1689413A(All Other States) ; Effective:4/1/2026-4/1/2027 WORKERS COMPENSATION-Concentra Health Services, Inc.-Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689413B (WI); Effective:4/1/2026-4/1/2027 WORKERS COMPENSATION-Occupational Health Centers of California,A Medical Corporation-Pennsylvania Manufacturers Association Insurance Company -Policy#202675-1689421; Effective:4/1/2026-4/1/2027 WORKERS COMPENSATION-Occupational Health Centers of Southwest, P.A.-Pennsylvania Manufacturers Association Insurance Company-Policy #202675-1689439A(All Other States); Effective:4/1/2026-4/1/2027 WORKERS COMPENSATION-Occupational Health Centers of Southwest, P.A.-Pennsylvania Manufacturers Association Insurance Company-Policy #202600-1689439B(WI); Effective:4/1/2026-4/1/2027 ADDITIONAL WORKERS COMPENSATION POLICIES: OHC of Alaska—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689686; Effective:4/1/2026-4/1/2027 OHC of Arkansas—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689694; Effective:4/1/2026-4/1/2027 OHC of Southwest(AZ/UT)—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689660; Effective:4/1/2026-4/1/2027 OHC of Delaware—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689702; Effective:4/1/2026-4/1/2027 OHC of Georgia/Hawaii—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689629; Effective:4/1/2026-4/1/2027 OHC of Illinois—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689637; Effective:4/1/2026-4/1/2027 OHC of Louisiana—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689744; Effective:4/1/2026-4/1/2027 OHC of Michigan—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689751; Effective:4/1/2026-4/1/2027 OHC of Nebraska—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689777; Effective:4/1/2026-4/1/2027 OHC of New Jersey—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689710; Effective:4/1/2026-4/1/2027 OHC of North Carolina—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689652; Effective:4/1/2026-4/1/2027 OHC of Southwest(KS)—Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689645; Effective:4/1/2026-4/1/2027 Therapy Centers of Southwest I, PA(OR)-Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689678; Effective: 4/1/2026-4/1/2027 Therapy Centers of South Carolina, PA-Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689736; Effective:4/1/2026-4/1/2027 OHC of Minnesota-Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689769; Effective:4/1/2026-4/1/2027 OHC of West Virginia-Pennsylvania Manufacturers Association Insurance Company-Policy#202600-1689728; Effective:4/1/2026-4/1/2027 CYBER LIABILITY- Arch Specialty Insurance Company-Policy#NPL2001106-01; Effective: 11/25/2025-01/01/2027-Limit:$10,000,000 CRIME COVERAGE—National Union Fire Insurance Company of Pittsburgh, PA—Policy#04-173-83-24, Effective 01/01/2026—01/01/2027—Limit $10,000,000 Coverage is provided for all medical professionals currently or previously employed or contracted by the above Named Insured,but only for professional services performed for or on behalf of the above Named Insured. RE: OHC OF CA/CMC HAS AN AGREEMENT UNDER#A-2019-006 TO PROVIDE MEDICAL SERVICES TO THE EMPLOYEES OF THE NAMED CLIENT. CITY OF SANTA ANA, ITS OFFICERS,AGENTS,VOLUNTEERS AND EMPLOYEES are all included as additional insureds on the above General Liability, Auto Liability and Umbrella Liability Policies and coverage shall apply on a Primary and Non-Contributory basis if required by written contract. Prior to loss,and if required by written contract,Waiver of Subrogation is provided on General Liability,Auto Liability, Umbrella Liability and Workers Compensation Policies for work performed under contract if permissible by state law. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Additional premium is a percent of the California Manual Workers Compensation premium. Subject to a minimum premium charge of$250 Person or Organization Job Description Where required by contract or written agreement prior to loss and allowed by law. Issued by Pennsylvania Manufacturers Association For attachment to Policy No. 202675-1689413A Effective Date: 4/1/2026 Premium$ Issued to Concentra Group Holding Parent, LLC WC 04 03 06 Page 1 of 1 Ed: 04/1984 POLICY NUMBER:152600-1689413 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement identifies person(s) or organization(s)who are "insureds"for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization whom you have agreed in writing to add as an additional insured, but only to coverage and minimum limits of insurance required by the written agreement, and in no event to exceed either the scope of coverage or the limits of insurance provided in this policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured"for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured"under the Who Is An Insured provision contained in Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 282 Policy Number: 152600-1689413 COMMERCIAL AUTO CA 04"1013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respectto coverage provided by this endorsement,the provisionsof the Coverage Form apply unless modified by the endorsement. SCHEDULE Name(s)Of Person(s)Or Organization(s): Any person or organization for whom you perform work under a written contract if the contract requires you to obtain this agreement from us, but only if the contract is executed prior to the injury or damage occurring. Premium: $ INCL Information required to complete this Schedule, if not shown above,will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident' or the 'loss" under a contract with that person or organization. CA 04 44 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 249 POLICY NUMBER HAZ 4032244581-10 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR TO WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS IN A WRITTEN CONTRACT OR AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III— Limits Of Insurance: with respect to liability for "bodily injury", "property If coverage provided to the additional insured is damage or personal and advertising injury required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement; or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in theDeclarations. insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a c ontract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: HAZ 4032244581-10 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an add itional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG 20 01 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1 CNA WAIVER OF RIGHTS OF RECOVERY APPLICABLE TO GENERAL LIABILITY COVERAGE FORM The changes set forth below are applicable only to the Commercial General Liability Coverage Form G- 145566-A, G-145567-A). The Healthcare Liability Policy Common Conditions (G-144102-A) are amended as set forth below: Condition XII., Transfer of Rights of Recovery is amended by the addition of the following: • Solely within the scope of this endorsement as indicated above, we waive any right of recovery we may have against any person or organization that you have agreed with, in writing, prior to the date of loss, to waive your right to recover against because of payments we make under the Commercial General Liability Coverage Form for injury or damage arising out of your ongoing operations. This endorsement applies only to: All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated in said Policy, unless another effective date is shown below, and expires concurrently with said Policy. GSL6554XX (4-11) Policy No: HAZ 4032244581-10 Page 1 Endorsement No: Effective Date: 1/1/2026 Insured Name: Concentra Group Holdings Parent, LLC ©CNA All Rights Reserved.