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HomeMy WebLinkAboutC. CESARIO MEDICAL CONSULTING, LLC INSURANCE ON FILE WORK MAY PROCEED`I I`NSI NCE EXPIRES JUN 17 30Z4 N-2024-197 2.9 CITY LERK 0 : (TIATAi c C l' AGREEMENT WITH C CESARIO MEDICAL CONSULTING,LLC AND ( K. W t,ard)� THE CITY OF SANTA ANA FOR AUDIT SERVICES 1 THIS AGREEMENT is made and entered into on this 1st day of July 2024, by and between C. Cesario Medical Consulting,LLC, a Florida limited liability company("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 audit services pertaining to correctional healthcare operations and contracting. B. In undertaking the performance of this Agreement, Consultant represents that it is able and willing to provide such services to the City and is knowledgeable in its field. C. Consultant represents 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 audit the performance of the City's correctional medical provider including but not limited to contractual, operational, clinical and administrative deliverables and compliance with relevant laws and regulations, observance of best practices, staffing,billing,utilization, pharmacy, inmate access to care, and medical records. Consultant will perform onsite auditing services for not less than two (2)business days, and will perform supplemental remote document and chart review services as necessary. Consultant will produce a written report containing full audit results, review the written report with City staff and provide recommendations as indicated. 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. 2. COMPENSATION a. The total amount to be expended during the term of this Agreement shall not exceed $18,000.00, inclusive of expenses and travel. b. Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. 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. 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. 3. TERM This Agreement shall commence on the date first written above for a term of six(6)months,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 contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer-employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Consultant performs the services which are the subject matter of this Agreement;however,the services to be provided by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services. Consultant shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 5. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy,use,modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Consultant under this Agreement ("Documents & Data"). Consultant shall require all subcontractors to agree in writing that City is granted a non-exclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Consultant represents and warrants that Consultant has the legal right to license any and all Documents & Data. Consultant makes no such representation and warranty in regard to Documents & Data which were provided to Consultant by the City. City shall not be limited in any way in its use of the Documents and Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. 6. INSURANCE Prior to undertaking performance of work under this Agreement, Consultant shall maintain and shall require any subcontractors to obtain and maintain insurance as described below for the entire Term of this Agreement against claims for injuries to persons or damage to property which may arise from or in connection with services, products and materials supplied to City. Total cost of such insurance shall be borne by Consultant. MINIMUM SCOPE AND LIMIT OF INSURANCE 1. Commercial General Liability (CGL): Insurance Services Office Form CG 00 Olcovering CGL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence and$2,000,000 aggregate. Required policy limits can be met with primary and umbrella/excess insurance policies. 2. Automobile Liability: Insurance Services Office Form CA 00 01 covering Code 1 (any auto), with limits no less than$1,000,000 combined single limits. In the event Consultant does not maintain commercial automobile liability insurance, City will accept evidence of personal automobile insurance. 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,policy or employee, for bodily injury or disease. Coverage is not required if Consultant has no employees and signs request to waive such insurance. 4. Professional Liability Insurance: with limits no less than$1,000,000 per occurrence or claim, and$2,000,000 aggregate. If Consultant maintains broader coverage and/or higher limits than the minimum requirements for each line of coverage shown above, City requires and shall be entitled to the broader coverage and/or the higher limits maintained by Consultant. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to City. Other Insurance Provisions The above required insurance policies are to contain or be endorsed to contain the following provisions: 1. City, its City Council, its officers, officials, employees, agents, and volunteers are to be covered as additional insureds, under Consultant's CGL, Professional Liability, and Automobile Liability policies, with respect to any liability arising out of work or operations performed by or on behalf of the Instructor including materials,parts, equipment, and personnel furnished in connection with such work or operations. 2. Consultant's Insurance company(ies) agrees to waive all rights of subrogation against City, its City Council, its officers, officials, employees, agents, and volunteers for losses paid under the terms of any policy which arise from work performed by Consultant under this Agreement. 3. For any claims related to this contract, Consultant's insurance coverage shall be primary and any insurance maintained by City, its City Council, its officers, officials, employees, agents, or volunteers shall not contribute with it. 4. A severability of interest provision must apply for all the additional insureds, ensuring that Consultant's insurance shall apply separately to each insured against whom a claim is made or suit is brought, except with respect to the insurer's limits of liability. 5. Insurance policies required herein shall provide that coverage shall not be canceled, suspended, voided,reduced in coverage or in limits,non-renewed by the carrier, or materially changed except after thirty(30) days prior written notice has been given to City. Ten(10) days prior written notice shall be provided to City for policy cancellation or non-renewal due to non- payment of premium. 6. Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa Ana, Attention: Jose Cruz, 20 Civic Center Plaza M-88, Santa Ana, CA 92701. The name and location of project must be included in the Description of Operations section of each certificate. 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. Acceptability of Insurers Insurance is to be placed with insurers authorized to conduct business in the State of California with a current A.M. Best rating of no less than A:VII, unless otherwise acceptable to City. Verification of Coverage Consultant shall furnish City with original Certificates of Insurance including all required amendatory endorsements(or copies of the applicable policy language effecting coverage required by this clause) and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive Consultant's obligation to provide them. City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. 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. 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-use and nondisclosure shall not apply to any information that(a)has been disclosed in publicly available sources; (b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Consultant without reference to information disclosed by the City. 11. CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 12. NON-DISCRIMINATION Consultant shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, gender identity, 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. 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 termination, subject to the following conditions: a. As a condition of such payment, the Executive Director may require Consultant to deliver to the City all work product(s) completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 16. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 17. JURISDICTION-VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation,performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 18. PROFESSIONAL LICENSES Consultant shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 19. NOTICE Any notice,tender, demand,delivery,or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail,postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: City Clerk 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: Chief of Police City of Santa Ana 60 Civic Center Plaza(M-97) P.O. Box 1981 Santa Ana, California 92702 Facsimile (714) 245-8007 To Contractor: C Cesario Medical Consulting, LLC Attn.: Carla Cesario PO Box 510693 Key Colony Beach, FL 33051 A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified,with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four(24)hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above. For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 20. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not,in fact,held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. [Signatures on following page] IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: CITY OF SANTA AN ZeZrl.'d NNIFE HA ALVARO NUglEZ Citler Acting City Manager APPROVED AS TO FORM: C CESARIO MEDICAL CONSULTING SONIA R. CARVALHO LLC: City Attorney l � By: TAMARA BOGOSIAN CARLA CESARIO Senior Assistant City Attorney RECOMMENDED FOR APPROVAL: ROBERT RODRIGUEZ Acting Chief of Police AC R CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `,/ 04/30/2024 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: FAX Hiscox Inc. e!�° �A��BkUy uj C No): 5 Concourse Park y n g I eDig _ v contcoeAt iscox.com Suite 2150 ADDRESS: Atlanta GA,30328 INSURERIS)AFFORDING COVERAGE NAICM yF�,I`Hiscox Insurance Company Inc 10200 INSURED A caved C D Medical l L ACC' t ;0 200 14th 74th street Key Colony Beach,FL 33051 INSUR D���J������� D a R 1 �I-06 INSURER F COVERAGES CERTIFICATE EBT ( REVISION B HS IS TO ERTIFY T- �-1E POL C EOF N JR/ iC STED BEL A EE I4UE DTO711-11 DRDNAMD ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIR IMF'.r, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAlk 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 EFF POLICY EXP T TYPE OF INSURANCE INSET SUBR POLICY NUMBER (MMIDDY/YYYY) (MMIDD/YYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 100,000 MED EXP(My one person) $5,000 A X Primary&Noncontributory Y Y UDC-2110737-CGL-23 11/17/2023 11/17/2024 PERSONAL BADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PET LOC PRODUCTS-COMP/OP AGG $ S/T Gen.Agg OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED —I NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY 1 AUTOS ONLY (Per accident) 1 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION§ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ OFF ICER/MEMBEREXCW DEDP (Mandatory In NHi E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) City of Santa Ana,its City Council,officers,employees,agents and volunteers are added as additional insured under the general liability and professional liability.It is endorsed with a Waiver of Subrogation in favor of the additional insured subject to policy terms and conditions.Insurance shall be primary and non-contributory.Hiscox will endeavor to provide 3 0-day notice of cancellation subject to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Attention:Kenneth Willard 20 Civic Center Plaza M-88,Santa Am,CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOr •'' """ "S ----- — fp ACCORDANCE WITH THE POLICY PR( "•• ,,wee.\ Risk Management Division I AUTHORIZED REPRESENTATIVE �I(�/�a/({ , REVIEWED&APPROVED BY: r y`t/ L�k rrk��e$$$ �f-r cevu(a !{-(�' Risk Management Specialist 4! . ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD ACCPRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 04/30/2024 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: Hiscox Inc. ONE IA/C.No Extl: (888)202-3007 FAX No): 5 Concourse Parkway E-MAIL. S: contact@hiscox.com Suite 2150 Atlanta GA,30328 INSURER(S)AFFORDING COVERAGE NAIC4 INSURER A: Hlscox Insurance Company Inc 10200 INSURED INSURER B C Cesario Medical Consulting LLC 200 14th street INSURER C: Key Colony Beach,FL 33051 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OFINSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR _ INSD WVD POLICY NUMBER (MMIDDIYYWI (MMIDDWYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY I I PRO ECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) 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) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATIONOTH- AND EMPLOYERS'LIABILITY STATUTE ER ANYPROPRIETORJPARTNERIEXECUTIVE Y/N NIA E.L.EACH ACCIDENT $ OFFICER/MEMBEREXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Professional Liability Y UDC-2110737-EO-23 11/17/2023 11/17/2024 Each Claim: $1,000,000 Aggregate: $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) City of Santa Ana,its City Council,officers,employees,agents and volunteers are added as additional Insured under the general liability and professional liability.It is endorsed with a Waiver of Subrogation in favor of the additional insured subject to policy terms and conditions.Insurance shall be primary and non-contributory.Hlscox will endeavor to provide 3 0-day notice of cancellation subject to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION City of Santa Ana Attention:Kenneth Willard 20 Civic Center Plaza M-88,Santa Ana,CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOr "" "' """""' ACCORDANCE WITH THE POLICY PR(\ O N, RlekMana,gernentONisw1 g. 9 ec REVIEWED&APPROVED BY AUTHORIZED REPRESENTATIVE +/ 'I ;'T qq� qq yy ti &sp Adwtgta ^{` Risk Management Specialist y$ ©1988-2015 ACORDC• ..a.... :::.......... ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Hiscox Insurance Company Inc. h�f+ H I SCOX COMMERCIAL GENERAL LIABILITY COVERAGE FORM TABLE OF CONTENTS SECTION I-COVERAGES COVERAGE A- BODILY INJURY AND PROPERTY DAMAGE LIABILITY COVERAGE B - PERSONAL AND ADVERTISING INJURY LIABILITY COVERAGE C -MEDICAL PAYMENTS SUPPLEMENTARY PAYMENTS-COVERAGES AAND B SECTION II-WHO IS AN INSURED SECTION III-LIMITS OF INSURANCE SECTION IV-COMMERCIAL GENERAL LIABILITY CONDITIONS SECTION V-DEFINITIONS \ rA,PAIN RiekMaragementDivisiun i+,l REVIEWED&APPROVED By: (Psi Risk Management Specialist '.. CGL NO01 FL(03/10) et) HI SCOX. Hiscox Insurance Company Inc. Policy Number: UDC-2110737-CGL-23 Name Insured: C Cesario Medical Consulting LIc Endorsement Number: 18 Endorsement Effective: April 29,2024 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) City of Santa Ana 20 Civic Center Plaza M-88 Santa Ana,CA 92701 Information required to complete this Schedule, if not shown above,will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or organi- zation(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omis- sions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. \ 4 y,,, RJBkMemgnnent Division M . W. REVIEWED SE APPROVEDO BY: &;a` rg a Ap Aaw4 Risk Management Specialist CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 I,' HI SCOX Hiscox Insurance Company Inc. ECONOMIC AND TRADE SANCTIONS POLICYHOLDER NOTICE Hiscox is committed to complying with the U.S. Department of Treasury Office of Foreign Assets Control (OFAC) requirements. OFAC administers and enforces economic sanctions policy based on Presidential declarations of national emergency. OFAC has identified and listed numerous foreign agents,front organizations, terrorists, and narcotics traffickers as Specially Designated Nationals (SDN's) and Blocked Persons. OFAC has also identified Sanctioned Countries. A list of Specially Designated Nationals, Blocked Persons and Sanctioned Countries may be found on the United States Treasury's web site http://www.treas.00v/offices/enforcement/ofac/. Economic sanctions prohibit all United States citizens (including corporations and other entities) and permanent resident aliens from engaging in transactions with Specially Designated Nationals, Blocked Persons and Sanctioned Countries. Hiscox may not accept premium from or issue a policy to insure property of or make a claim payment to a Specially Designated National or Blocked Person. Hiscox may not engage in business transactions with a Sanctioned Country. A Specially Designated National or Blocked Person is any person who is determined as such by the Secretary of Treasury. A Sanctioned Country is any country that is the subject of trade or economic embargoes imposed by the laws or regulations of the United States. In accordance with laws and regulations of the United States concerning economic and trade embargoes, this policy may be rendered void from its inception with respect to any term or condition of this policy that violates any laws or regulations of the United States concerning economic and trade embargoes including, but not limited to the following: (1) Any insured under this Policy, or any person or entity claiming the benefits of such insured, who is or becomes a Specially Designated National or Blocked Person or who is otherwise subject to US economic trade sanctions; (2) Any claim or suit that is brought in a Sanctioned Country or by a Sanctioned Country government,where any action in connection with such claim or suit is prohibited by US economic or trade sanctions; (3) Any claim or suit that is brought by any Specially Designated National or Blocked Person or any person or entity who is otherwise subject to US economic or trade sanctions; (4) Property that is located in a Sanctioned Country or that is owned by, rented to or in the care, custody or control of a Sanctioned Country government, where any activities related to such property are prohibited by US economic or trade sanctions;or (5) Property that is owned by, rented to or in the care, custody or control of a Specially Designated National or Blocked Person, or any person or entity who is otherwise subject to US economic or trade sanctions. Please read your Policy carefully and discuss with your broker/agent or insurance professional. You may also visit the US Treasury's website at http://www.treas.gov/offices/enforcement/ofac/. \ 41 Risk Managenent Division REVIEWED&APPROVED By: , Alte Advada LE ME MI S Risk Management Specialist INT N001 CW0109 -- HISCOX Policyholder Notice - FLORIDA Electronic Delivery Disclosure Electronic Delivery Disclosure You are currently receiving electronic delivery of your insurance policy and related documents to the email address you provided to us. Pursuant to Section 627.421(1), Florida Statutes, if you communicate to us, in writing or electronically, that you do not agree to delivery by electronic means, at your request, you may receive a paper copy of the policy via United States mail. In the event that your email address should change, it is your responsibility to provide us with an updated electronic mail address as soon as practicable. You may update your information by calling 888-202-3007. \ ,F ,y_ RlekManagement D(Weion • n n REVIEWED di APPROVED BY: ,. a A4kp AuuR Risk Management Specialist INT N0009 FL(12/18) �tr HI SCOX Hiscox Insurance Company Inc. Policy Number: UDC-2110737-CGL-23 Name Insured: C Cesario Medical Consulting Llc Endorsement Number: 19 Endorsement Effective: April 29, 2024 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. MODIFIED WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV—Conditions: You may waive your rights against another party so long as you do so in writing prior to: (i) an offense arising out of your business that caused a "personal and advertising injury"; or (ii) an "occurrence' that caused"bodily injury"or"property damage". RlakManagonentavislun REVIEWED&APPROVED BY: CGL E5402 CW(03/10) A÷Nato Risk Management Specialist `i5 Includes copyrighted material of Insurance Services Office, Inc.,with its permit.:... 1 1*s HI SCOX Hiscox Insurance Company Inc. Policy Number: UDC-2110737-CGL-23 Name Insured: C Cesario Medical Consulting Lk Endorsement Number: 16 Endorsement Effective: November 17,2023 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 A. The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy, pro- vided: 1. you have agreed in a written contract or agreement to add such additional insured to a policy providing the type of coverage af- forded by this policy; and 2. you have agreed in a written contract or agreement with such additional insured that this insurance would be primary and would not seek contribution from any other insur- ance available to the additional insured. t.. pa. 4 RtekMeiugnnentDivisio n/ e REVIEWED&.APPROVED BY: k Ap Acav`da Risk Management Specialist CGL E5581 CW(03/16) Includes copyrighted material of Insurance Services Office, Inc.,with its permission C. Cesario Medical Consulting LLC 2024/2�p Affidavit of Exemption for Wp000rrfkkers' Compensation Insurance I, barb 0,,,t9, w�P�1i,`��t Hereby affirm under penalty of perjury, the (Name/Title) following declaration: /� 1 l�I- 1 I certify on behalf of C l e`cQa'lo lace\('1 JUl�i tfiat during the term (Consultant/Company Name) U of my contract for CtY 1a1)H-t ' alEt*-services with the City of Santa Ana, (Type of serrr c provided) I will not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith comply with the provisions and provide proof of workers' compensation coverage immediately. I,,� l Date: all a-t-11_ Print Name: C or\ 5 C'l Print Title: nat Signature: L, L � Telephone: 305 3a( t-713 WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSA- TION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND AT- TORNEY'S FEES. patt 1 WekMamgementDMsion�(, REVIEWED&APPROVED BY: t P.O. Box 510693 I KeyColonyBeach, FL I33051 1 305 389 £ 4 ( I 4,t�p ,l=% fi Acavik ccesariomc@gmail.com 9 Risk Management Specialist sR C. Cesario Medical Consulting LLC �/i� ('IAffidavit of Exemption for Automobile Liability Insurance I,lz `basiett.0 x7PPcpttei hereby affirm under penalty of perjury, the (Name/Title) following declaration: fI ' I certify on behalf of e c ��lo cowPtK(s 4[uat during the term (Con ultant/ o pany Name) JJ / of my contract for 3 at) services with the City of Santa Ana, (Type of service provided) I will not use/drive any vehicle during the course and scope of the services provided in the agreement/contract. I will not use any owned/rented/leased vehicles during the course and scope of the services provided in the agreement/contract. Our consultants/independent contractors/employees utilize their personal vehicles/non- company owned, borrowed, or rented/leased vehicles for transportation to and from work and if applicable carry their own automobile insurance. By signing below, I attest that I possess the legal authority to enter into an agreement with the City of Santa Ana as well as t e legal au iority to est to the 1s atements above. If at any time it is found that Qileca6lO� d)hjL& kitis not (Consultant/Company Name)✓ adhering to any/all statements in this document and has not provided the minimum Auto liability insurance coverage of $1 million per occurrence, the contract will be considered null and void and the company will be held fully liable for any and all damages. `� Date: SW�9j � � a ., n Print Name: \.45.1�\ U/ f�AAk) Print Title: "e Signature: �r ) OI Telephone: , v6 5Sq n 7I s, R1ekMcnmgementD[Wsbn _ P.O. Box 510693 I Key Colony Beach, FL 133051 I (305) 389 8 RENEWEo&MPROV®BY: Actudo ccesariomc@gmail.com ' Risk Manayemen[Spedalist C. Cesario Medical Consulting LLC Cada Carla Cesario C Cesario Medical Consulting LLC 305 389 8713 ccesariomc@gmail.com Risk MaregcntentDivieion P.O. Box 510693 I Key Colony Beach, FL 133051 I (305) 389 = REVIEWED&MPRov®Br` 7,1 ccesariomc@gmail.comAW C }1111tr1. A,• ce Aavek Risk Management Specialist -,r..