The URL can be used to link to this page

Home My WebLink AboutCORRECTIONAL MANAGED CARE MEDICAL CORP. 2B (2)~J AGREEMENT TERMINATION n, Please complete this form when the attached agreement is no longer in effect. r>> ~~ Return form to the Sr. Deputy Clerk of the Council (M-30), fall 647-5238 ifyo~have any questions. The agreement with C.~l,!-~l~~i~~!°y~Gi'C~ ~C1tle, jUleE~~~Q , No.~ ~,OS-~ was completed on ~~~ ~'~ ~ ,and final payment has been made. Department: ~ ,- - Signature: (( -~~(~, Date: ~ f~'-~ `1'~~~ City of Santa Ana Revised 8-7-03 Clerk of the Council INSURANCE UN FILE A-2005-221 WORK MAY PROCEED UNTIL INSURANCE EXPIRES - I -li (c CLERK OF COUNCIL DAiE: ly ~ iy - as ~~~ FIRST AMENDMENT TO AGREEMENT FOR THE PROVISION OF D. 1r~5~L INMATE MEDICAL SERVICES BETWEEN CITY OF SANTA ANA AND CORRECTIONAL MANAGED CARE MEDICAL CORPORATION THIS FIRST AMENDMENT TO AGREEMENT, is entered into this 19`h day of September, 2005, by and between 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"), and Correctional Managed Care Medical Corporation ("Contractor") RECITALS: A. City and Contractor entered into Agreement #A-2004-231, dated October 18, 2004, for the Provision of Inmate Medical Services, hereinafter referred to as "said Agreement". B. The Parties desire to renew the term of said Agreement and approve the maximum obligation to be expended for services. NOW, THEREFORE, in consideration of the mutua- and respective promises, and subject to all the terms and conditions of said Agreement, and Amendments to Agreement, except as herein modified, the parties agree as follows: Section 1, TERM, shall be extended to August 31, 2006. 2. The Maximum Baseline Obligation shall be increased to $1,036,406.00, as set forth in Section 3.b. COMPENSATION, of said Agreement. Except as hereinabove modified, all terms and conditions of said Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the day and year first above written, APPROVED AS TO FORM: JOSEPH W.FLETCHER City Atto;ney By: Laur Sheedy Assistant City Attorney CITY OF SANTA ANA ~~ - .-7 t-t~~~. DAVID N. REAM City Manager /1TTEST; ~ t~"`'v-'t--' PATRIC/A E. HF.ALY CLERI( OF THE' CdUNC/L MINUTES OF THE REGULAR MEETING OF THE CITY COUNCIL OF THE CITY OF SANTA ANA SANTA ANA, CALIFORNIA SEPTEMBER 19, 2005 CALLED TO ORDER POLICE COMMUNITY ROOM 60 CIVIC CENTER PLAZA 6:10 P.M. ATTENDANCE: Councilmembers present: MIGUEL PULIDO, Mayor LISA BIST, Mayor Pro Tem CLAUDIAALVAREZ CARLOS BUSTAMANTE ALBERTA CHRISTY MIKE GARCIA JOSE SOLORIO STAFF Present: DAVID N. REAM, City Manager, JOSEPH W. FLETCHER, City Attorney PATRICIA E. HEALY, Clerk of the Council PLEDGE OF ALLEGIANCE MAYOR PULIDO INVOCATION Roger Aragon, Police Chaplain CONSENT CALENDAR Mayor Pulido announced the following modifications to the Consent Calendar: • Mayor Pulido abstained from Item 11.A. • Mayor Pulido pulled Items 13.C.: and 25.J. • Mayor Pro Tem Bist pulled Items 22.F. 23.A. and 31.A. • Mayor Pro Tem Bist abstained from Item 31.C. • Councilmember Christy voted no on Item 31.6. Motion: Approve staff recommendations on the following Consent Calendar items. MOTION: Solorio SECOND: Garcia VOTE: AYES: Alvarez, Bustamante, Pulido, Bist, Christy, Garcia, Solorio (7) NOES: None (0) CITY COUNCIL MINUTES 321 SEPTEMBER 19, 2005 CONSENT CALENDAR ABSTAIN: None (0) ABSENT: None (0) Items removed the actual vote, ADMINISTRATIVE MATTERS MINUTES Motion: Approve minutes. 10.A. ADJOURNED REGULAR MEETING OF SEPTEMBER 6, 2005 10.B. REGULAR MEETING OF SEPTEMBER 6, 2005 ORDINANCES SECOND READING show 11.A. AMENDMENT APPLICATION NO. 2005-04 TO ALLOW A ZONE CHANGE FROM COMMERICAL-MUSEUM DISTRICT TO SPECIFIC DEVELOPMENT NO. 78 - 2032 NORTH MAIN STREET Placed on first reading at the September 6, 2005 Council Meeting and approved by a 5-0 vote (Garcia absent and Pulido abstained) Published in the Orange County Reporter on September 9, 2005 Motion: 1. Place ordinance on second reading and adopt. ORDINANCE NO. NS-2696 - An ordinance of the City Council of the City of Santa Ana adopting The Bowers Museum Specific Development District No. 78 (SD-78) and rezoning the property located at 2032 North Main Street from Community Commercial-Museum District (C1-MD) to Specific Development No. 78 (SD-78) (AA No. 2005-04) 2. Adopt a resolution. CITY COUNCIL MINUTES 322 SEPTEMBER 19, 2005 CONSENT CALENDAR 25.D. AGMT 2005-220- ANIMAL SHELTER SERVICES - Execute an agreement with the County of Orange in an annual amount not to exceed $359,384 -Police Department 25.E. AGMT 2005-221- INMATE MEDICAL SERVICES -Renew the agreement with Correctional Managed Care Medical Corporation for aone-year period in an amount not to exceed $1,036,406 -Police Department 25.F. AGMTS -SERVICES RELATING TO FORMATION OF COMMUNITY FACILITIES DISTRICTS AT THE MACARTHUR PLACE SOUTH PROJECT SITE -Finance & Management Services Agency Motion: 1. Direct the City Attorney to prepare and authorize the City Manager and Clerk of the Council to execute agreements. AGMT 2005-222 - With Coastal Rim Properties, Inc., Nexus Development Corporation, Integral Partners, LLC for the reimbursement of costs . AGMT 2005-223 -With Fieldman Rolapp and Associates for financial advisory services and project management assistance to the City. AGMT 2005-224 -With Bruce W. Hull and Associates for appraisal services detailing the feasibility of issuing bonds consistent with the establishment. AGMT 2005-225 -With David Taussig & Associates, Inc. for special tax consulting services. AGMT 2005-226 -With Empire Economics for price point analysis and market absorption study. AGMT 2005-227 - Execute a Legal Services agreement with Quint & Thimmig, LLP for bond consulting services. 2. Approve appropriation adjustment. (Requires five affirmative votes.) APPROPRIATION ADJUSTMENT NO. 06-029 - Recognizing all deposits to be provided by developers into the Capital Outlay Fund and appropriating the same into the Capital Outlay expenditure account for appropriating developer contributions. CITY COUNCIL MINUTES 331 SEPTEMBER 19, 2005 08/02/2006 10:01 19493056166 COLONIAL PRA PAGE 01/02 A~~JS~t C~RTiFIGATE C,~F LIA~IL [~R6D000R (949)305-6161 FAX (9a9)30S-fi66 Colonial Western Insurance Agen[y 25691 Plaz21 prive, Suite 220 Mission Viejo, CA 92691 INSURED Corrections 1 alanaged x+211 E. La Palma Ave. Anaheim, CA 92807 -~~~~ ,~-~j~j",2)"~ an rnvcRd DATE {AI>pI1DD1YYYY) TY INSURA,~CE o$/oi/2oo5 'PHIS CERTIFICATE IS iSSUEp A3 A MATTER DF INFORMATION ONLY AND CONFERS Nd RIGHTS UPON THE CERTIFICATE HaLDER. TH13 CERTIFlCATE DdES NOT AMENd, EXTf:ND aR A~.7ER THE COVERAGE AFFORDFA BY THE POLICIES BELOW. INSURERS AF1=0RDING COVERAGE NAIL # INSURER A: Lexington Insurance Conlg~any INSURER B: St . Pau ravel ers Ins . Co . INSURER c: Everest Insurance Company INSURER D: INSURER E: ~~ GQ THE POLICES OF MSURANCE LISTED 9fl~,Uw HAVE BEEN ISSUEp Tp THE IIVSWRED NAMED ABOVE FOR 7H@ POLICY PERIOD INbICATED. NOTwITksrnNbWG TERM OR CONDITION OF ANY CQNTRACT OR OTWER DOCUMENT WITW RESPECT TD WHICH THIS CERTIFICATE MAYBE ISSUED OR ANY REQUIREMENT , THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS QF SUCH MAY PERTAIN , POLICEES. AGGREGATI: LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ':IN9R 00' T7PE OF INSURANCE POLICY NUMBER L1CY EFFECTIVE POLICY EXPIRATION LIMITS GENERALL1A81LITY O~Y47'S1 O8/Ol/ZOO6 O8/Ol/2007 EACH OCCURRENCE S j,00~,000 X C.OMMERCtAL GENERAL LIABILITY DAMAGE TO RENTER x ClA1M3 MADE ~ OCCUR MED EXP {ARy 0118 IINr39n} $ 5 A PER80NAi, A AOV INJURY $ ~, r QQQ , GENERAL AGGREGATE $ 3 , nnn oon t3EN'L AGGREGATELIMIT APPLIES PFR: PRODUCTS • COMFlOP A00 $ ], OQQ 00 POLICY PRO. LOC JECT AUT OMOBILE LIABILITY b809447H746 0~2~04{ZOOt3 42/Oa/2407 COM8INED$INGLELIMIT § ANY hUTO (Ea aCCklent) 1 e Q~, p4 ALL OWNED AUTOS BODILY tNJURY BDHEAUC.ED AUTOS leer Dgrgon} ... B _........._ ._. X HIRED AUTOS B001LY INJURY ~ 7( niDN-bwnir_n ni,lTnc {Pwrucddent} _._..... PROPERTY DAMAGE $ {Per acddent) GARAGELIABILTfY AUTOON>wY-GACCIDENT J6 ANY AUTO OTHER THAN EA ACC $ .. . AUTO ONLY: AGG . $ FD[CE881UMBRELLA LIABILITY ~ ~ ~ FJ1GH OCCURRENCE 5 occua ~ ClaMr3 MADE ~ A60REQATE $ _ S OF•DUCTIBLE _ $ RETENTION $ $ WUH1UCHS r:UMYENBATIt7N AND CA~4414955061 07/Ol,/z006 07f01/2407 7C WC STATU- OTM. ..... _ _Tt~RYLIM17,5. t:R,_ , ~ . __ EMPIAYERB'LIABILm E,I., EACNACCIDENT $ 1 OOO,OO C OFFICERIMEMBER+PEXCLU~~ECUTIVE E.L. DISEASE. EA EMPLOYE. $ ~. r QQa, (}~ tf yoa, aoawl6...,~dv' SPECIAL PI~OVI810NG 6alow E,L. CIt3EaSE • F'ULIL:Y LIMI I „ 1 400 0 TH bili ~ i 03147&1 08/01/2b06 08/41/2007 Prpf Liability: Slmil/$3n1i1 a ty ro essional L il $ i1 A aTwagwd Care E&O Liab. 03I~4761 0$/01/2006 08/0]./2007 j 3m Managed Care E810: $Inl DESCRIPTION OF OP ATtONS ~dCAY'10H~ VEHIQLE9! CLUSIONS AOOEtl AY ENDOR EMENTlSj~ECIAL PROV1910N8 t ~ ~ ~ prennum. ],o Days no lat~on For nan-payment o ice o cance7 ertifieate Bolder i5 an Additional Insured Yor general liability 2tTTGI prUress-ional liability per ndorsement #14 attached. reonelrwTe unr nre returml I wTlnul SHOULD ANY OF THE ABOVE DEBGRIBED POLICIES 8E CANCELLED 9EFORE THE EXPIRATION GATE THEREOF, TWE ISSUING INSURER ln(ILr. ENDEAVOR TO 141AIL C~ ty of Santa Ana * 3O LEFT Santa Ana City Tail , DAYS WRITTEN NOTICE TO THE CERTiF10ATE HOLDER NAMED TO THE '--- T Attent ion • Chris Laugenaur, Contracts UT FlUI.URE T4 Mr+iL SUCH NOTICe SHALL IMPOSE NC 09LIGATtoN OR LIABILITY 52 [l Vl C Center Plaza NY KIND UPON TWE INSURER, ITS AGENTS OR REPRESENTATIVES. Santa Ana. CA 92742 AUT E1TREPRE3 ATIYE Do E ACORD 25 (20a1~08) r`j I ~ 1 9 C~ [""~ q,,, i r ~ ~ f ®ACORD CORPORATION 1988 08/02/2006 10:07 07-Zt-2006 12:14 19493056166 COLONIAL PRA fRO1drGEihAC & ASSOCIATES i-ITT is.Olp/012 F-i2b ENDI~1~31;,M~NT N0,14 Thfsr ~dars~ment, ~ftectfve 7S:Oi Alifi: Aupu~ 7, 20D8 i 11+o1m5 a part Qt pnilc~r tna,e 4324 r ~'I I~stted tn: CQF~REC7TQI~AL MAAlACI:D CAR1= ME~1CAl, CO1~P. ~ By: LEKINGTON IfJSURANGE GOMPAlVY D17I'I'lQ_NRL I Sl! JED~~1BpRS~1111~N7 The Pal14y 1s ame~nQad as follows: Soctlcn Ii, 1NH0 18 AN Ih18l1RED of the H!»ALTIiCAf~f: PRCII=ESSIOIVAi. LiABll,17'Y CUVERAGIc pAFT ie amended by edditlg the fvlfowing: 8AN7A At~,4 Cl~'Y JAIL 62 CIVIC Cl;A1TE"R PLfi~ZA SANTA ANA, CA B2i02 COUNTY CF MAClERA 'l~i7S ROAR 28 nnAa1=RA, c~, ~as~a ' Coverage provided under this policy fs limited to Metlicai Incident{s] whrea providing professiphal set vfvee rrt the medical clinic or while in uanspart vrtly, Thle pafiay does nvt provide aauerepe crialRg vent of ants uy171eh CGCUr beyond the pcop6 of bus+IRess of the trtndlcai clinic. ' 8ecticrt 11.1NHta f8 AN INSURED cf the HEALTN~ARI" GENERAi. LIA81L1TY G01~1=liA~E PART is Atrlended hY eddirlg the faliowing: SANTA ATVA Cf1'Y JAlL B2 CIVIC frENTbf~ P'LA~A SANTA AN11, CA 92?C2 COUNTY OF MADEFlA 419 ROAD 78 MADERA, CA 9368 Covarbgs previdecl under this poJiay is limited praiQCSionel earviaas at the medical allntc ar Wfaila in transport vniy. This policy tines na't I~rovida oovar~e any f3ptltly injury at~dlor IPrcpartY Qemage~ arising out o~P acre uvhich oncur baycnd the scape cf bU:tltless o~=ha rnadical clinte. Ap giber tettres, candifiAtis and t~~tuslons df the pulicjr remain unchan~d. (~y ~ _ / ~ ar PAGE 02/02 where ri~quirecl by lewj ~ CERTHOLDER COPY gp STATE P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 COMPENSATION I N S U R A N C E FUND CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 07-01-2006 GROUP: 000834 POLICY NUMBER: 0000870-2006 CERTIFICATE ID: 3 CERTIFICATE EXPIRES: 07-01-2007 07-01-2006/07-01-2007 CITY OF SANTA ANA, SANTA ANA CITY JAIL SP ATTN CHRIS LAUGENAUR 62 CIVICS CENTER PLAZA SANTA ANA CA 92702 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. THORIZED REPRESENTATI PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. EMPLOYER ~r~~~ CORRECTIONAL MANAGED CARE SP 4211 E LA PALMA AVE ANAHEIM CA 92807 (REV.2-05) PRINTED 06-19-2006 M0408 08/82/2005 10:01 T \ I 19493055155 e COLONIAL PRA e PAGE 01/02 ~~ CERTIFICATE OF LIABILITY INSURANCE \ DATE IMll1/DDNYYY) 0&/01/2006 roRODUCIliA (949)30S-6161 FAX (949)~05-61~~ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Colonial W@stern Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTlflGA r1: HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 26691 Plaza Drive, Suite Z20 AL fER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Aission Viejo, CA 92691 INSURERS AFFORDING COVERAGE NAlC# INSURED Correctional Managed Care Medica1' Corporation Lexington Insurance Company - INSURER A: 4211 E. La Palma Ave. fl. ~oS -.)d.J INSURER B: St. Pau~ Travel ers Ins. co. Anaheim, CA 92807 INSURER c: Everest Insurance Company A-;xo{p-~1 INSURI:R D' IN$URI:R E: ES THe POliCieS OF INSURANce L.ISTeO 6F:::LUVII HAVt:o t$EEN ISSUI;O TO THE IN~UR!O NAMeD ABOVE FOR THE F>OL.ICY peRIOD INDICATEC. NOTWITI-IST^NOING ANY REQUIREMENT, Te~M OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THis CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HI;RE1N IS SUBJECT TO ALL THE TERMS. EXCI.USIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATEI.IMITS SHOWN MAY HAVe SEEN REDUCED BY PAlO CLAIMS. '!'l$~ ~~~! .",.. . POLICV EFFECTIVE P~~!fJ EXPlRATIO,.. lYPE Of IN$URANCE POLICY NUMBER LIMITS GENERAL UABlLITY 0314761 08/01/2006 08/01/2007 EACH OCC~~eNCI: S 1,000,000 X COMM~RCIAL GENERAL LIABILITY DAMAGE TO RE~m,.o $ _ _ ~_<1,~ - ~ CLAIMS MADe 0 OCCUR t'i':'I"'IU'T.'I"r!JIl) MED EXP (Any one ~91"lon) $ S,OOO A - l,OOO,OO(] PeRSONAl. Il AOV INJURY $ - OENI:RALAGGREGATE $ l,Onn,Ooo - GeN'L AGGREGATE LIMIT APPLIES peR; I"~OCUCTS . COMPIOP AQO S 1. 000,000 n .nI"RO. n POLICY JeeT lOC AUTOMOBILE LIABILITY 6809447H706 02/04/2006 02/04/2007 cOMelNEO SINGll: LIMIT f-- S ANY AUTO (Ea QCCId<lnl) 1,000,000 - - ALL OWNED ""UTOS aODlL Y INJUfl.Y S SCHEiDULJ;O AUTOS 1I'"6r"",r~cn) B X -"" u_ ., HIRED AUTOS OOOll Y INJURY X $ ~IO~I-()1J11NJ;i:I 41 .Tn<: (1"Ar"""lde~l) r--- n..... '-- PROPE~rY DAMAGE S (Per acclde~t) GARAGE LIAalLrlV ^UTO ON.. Y - ~ ACCIDENT a ==J ANY ",I,JTO ~ OTHER THAN E'IACC ~ .- F . AUTO ONLY: AGG $ EXCESalUMBRELLA LIABILITY r J /Le~--ct -/ /Ic eACH OCCURRENCE $ ~ OCCUR D C~AIMS MAOE I AGGReGATE; $ $ R DeCUCTIBlE $ RI:TI:NTION $ $ WUfCI\I:.K:J r,;OM,.eNl;lATlQN AND C^200109!iS061 07/01/2.006 07/01/2007 X-L WCSTAlU-ic=TITH. EMI'l.OVeRS' UABIUTY m _ _TOB:r_UMIL$. l:~, 1'.-- C ANY pROPRleTOR/PARTNERlEXECUTIVE e.~. i:ACI-I ACCIDENT $ 1,000.000 OFFICEMo1eMBER J:XCLUDE07 E;L OISEASE. EA,EMPLOYEF. $ 1,000,000 It ,,/00, c:r""Qflbo und'af SPECIAL PROviSIONS bolo.v e;.L. OII;1E;AsE. f'ULIL;Y L1MII $ I. 000. OOC ~;~~essional Liability 0314761 08/01/2006 08/01/2007 Prof liability: $lmi11$ 3rllil A ~a"ag~d Car~ E&o Liab. 0314761 08/01/2006 08/01/2007 Managed Care E&O: $lnril/$3mil DEaC~IPTION OF OP~^TION5f LOCA110~ ~\I~r~LJ;lIl ?tCLUSIONS AoDtoll ay J;NDORleMENT I SpECIAL PROVISIONS lO Day~ not ~~ 0 cance at,on or non-payment 0 premnum. ertjticate Holder is an Additional Insured for general 1 iabi' ity <'1m.! p~'ores5';ol1al 1 iabil i1:y pel" ndorsement #14 attached. ION SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED aEiFO~E. THE EXPIRATION DATE TI-ltoREOF, THE ISSUING INSUReR WI.... ~NDEAVOR TO MAIL _:J~L DAYS WRITTEN NOTIce TO THE; CERTlFICA TE HOLDER NAMeD TO tHE LEFT, UT FAlI.URJO TO Il/lAll eUCH NOTICI! SHALL IMPOSE: NO OaUGATION OR LIABILITY NY KIND UPON THE INSURER, IfS AGENTS OR REPRESENTATIVes. ~ REPRES A TIVE City of Santa Ana Sant:a Ana City Jail Attention: Chris Laugenaur, Contracts 62 Civic Center Plaza Santa Ana. CA 92702 ACORD 25 (2001108) ol~S-'BI(l.o @ACORDCORPORATION1988 ',~i4 19493055155 e rROvrLE~C ~ ~SSOC\~iE~ COLONIAL PRA PAGE 02/02 ~i.4TT P.010/Ol, f-T25 08/@2/2005 10:01 , 07~~7-mE I 1 ENDOASEMENT NO.14 Thts Rndorsementj ~ffectlve 12~01 AMl Auguat 1. 2006 F01~ A part tit polle" no.~ O~147S1 .,sued to: COARECnONAL MANAGSD CARE MeDICAL CORP. By: LEXINGTON INSURANCE CqMPANY ADompNAL IftSURED E:NDOflSEMENT The Po)lp,y 1s amended as tollows: SGctlon II. WHO IS AN INSURED Qfthe HEAlTHCAFl.c PROFESSIONAL LlABll.ITY COVERAGE PART i~ amended by llIdding tha folfowil1g: SANTA ANA cITY JAIL 62 CIVIC CENTER PLAZA SANTA ~A1 CA 9270.2 coUNTY OF MA05RA 1419 ROAD 28 MAD~RA, CA 93639 Coventj;JEl provided Lloder this policy is limned to Medlcm In\:ldel'lthd whila providing prQfessiQt\fl1 sel ViCB6 at the metilcal clinic tlf while in lranspO" onlY, Thl~ policy does not Pfr:lvldr;l Qoverage arislns o\.lt of acts whlcn Qceut beyond th~ Icope of bl.llill'\8~ of tn. madlcal clinic. ' Section II. WHO IS AN INSURED of the HEAI.THCARE GENERAlllABILlTY COVEflAGf: PART Is em~nded wedding the folTowinSl SANTA ANA CITY JAIL e2 CIVIC CENTliR PLAZA SANTA ANA. CA 92102 COUNTI OF MADERA 1419 ROAD 28 MADERA. CA 9363B Cowrag& proVided unde!' thl~ pollClY is IimEtad profljl~>>ion~r ~Grvio9t 31: tho meclioal olinlc Qr wfllll>' io tnmapDrt (lnly. This pOIll:Y does ml'l: ]:Irovide ooverage ilny aodl/Y injury and/or Prop"rtv Qamsse erlsing out of acts which 1;IaCUr beyond the scope of busIness at the medical ellnlc. AU ather tarms. conditions ancl excluslcns Of the pOlicY remain unchanged. ( I ) 7,r ~/7<O/L r~~ntgtlvl;l f1ture (where requIred by Jaw) , CERTHOLDER COpy e STATE COMPENSATION INSURANCE FUND e P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 07-01-2006 GROUP: 000834 POLICY NUMBER: 0000870-2006 CERTIFICATE ID: 3 CERTIFICATE EXPIRES: 07-01-2007 07-01-2006/07-01-2007 CITY OF SANTA ANA, SANTA ANA CITY JAIL SP ATTN CHRIS LAUGENAUR 62 CIVICS CENTER PLAZA SANTA ANA CA 92702 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days advance written notice to the employer. We will also give you 10 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. a:::- REPAl'SENT ATI EMPLOYER1S LIABILITY LIMIT INCLUDING DEFENSE COSTS: ~ PRESIDENT $1,000,000 PER OCCURRENCE. EMPLOYER ~ ' ~r, ~'~ CORRECTIONAL MANAGED CARE 4211 E LA PALMA AVE ANAHEIM CA 92807 SP (REV.2-05) PRINTED 06-19-2006 SP M0408