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HomeMy WebLinkAboutKAISER FOUNDATION HEALTH PLAN, INC. (3)N-2025-074 INSURANCENOT ON FILE WORK MAY NOT 'PROCEED CITY CLERK DATE: MAR 2 7 2025 CONSULTANT AGREEMENT WITH KAISER FOUNDATION HEALTH PLAN, INC. FOR KAISER PERMANENTE MOBILE HEALTH VEHICLE THIS AGREEMENT is made and entered into on this 17"' day of March, 2025, by and between Kaiser Foundation Health Plan, Inc., a California corporation ("Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"). City and Consultant are referred to collectively as the "Parties" or singularly as a "Party." RECITALS A. The City desires to retain a consultant having special skill and knowledge in the field of providing mobile health vehicle services for biometric screenings (blood pressure, BMI, glucose, and cholesterol). B. Consultant represents that it is able and willing to provide such services to the City. C. 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 a. Consultant shall perform during the term of this Agreement, the tasks and obligations including all labor, materials, tools, equipment, and incidental custornary work required to fully and adequately complete the services described and set forth in the attached Service Forms from Consultant for the following locations, dates, and times attached hereto as Exhibit A and as further described below: • Santa Ana Civic Center; 20 Civic Center Plaza; April 1, 2025 • City Yard; 215 S. Center St.; April 2, 2025 • Santa Ana Police Department; 60 Civic Center Plaza; April 9, 2025 b. City and Consultant agree that the dates above can be rescheduled during the Agreement term upon mutual written agreement of the Parties. 2. COMPENSATION a. The City agrees to pay and Consultant agrees to accept the event specific costs outlined in the attached Exhibit A. The total amount available for payment of the costs outlined in the attached Exhibit A, shall not exceed Eleven Thousand Two Hundred Dollars ($11,280.00) over the term of the Agreement. b. Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. 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 and continue until the services in Exhibit A are fully performed but no longer than March 16, 2026, unless terminated earlier in accordance with the Cancelation Policy for All Event Types outlined in Exhibit A. 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. PJ G. 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 by the Consultant, its agents, representatives, employees or subcontractors. a. MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall beat least as broad. as: 1. Commercial General Liability (CGL): Insurance Services Office Form CG 00 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 $1,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall be twice the required occurrence limit. 2. Automobile Liability: ISO Form Number CA 00 01 covering any auto (Code 1), or if Consultant has no owned autos, hired, (Code 8) and non -owned autos (Code 9), with limit no less than $1,000,000 per accident for bodily injury and property damage. 3. Workers' Compensation: as required by the State of California, with Statutory Limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident for bodily injury or disease. 4. If the Consultant maintains broader coverage and/or higher limits than the minimums shown above, the City requires and shall be entitled to the broader coverage and/or the higher limits maintained by the Consultant. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City. b. Other Insurance Provisions — The insurance policies are to contain, or be endorsed to contain, the following provisions: Additional Insured Status: The City, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Consultant including materials, parts, or equipment furnished in connection with such work or operations. General liability coverage can be provided in the form of an endorsement to the Consultant's insurance (at least as broad as ISO Form CG 20 t0 11 85 or both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 20 37 forms if a later revisions used). 2. Primary Coverage: For any claims related to this contract, the Consultant's insurance coverage shall be primary coverage at least as broad as ISO CG 20 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 Consultant's insurance and shall not contribute with it. 3. Notice of Cancellation: Each insurance policy required above shall provide that coverage shall not be canceled, except with notice to the City. Waiver of Subrogation: Consultant hereby grants to City a waiver of any right to subrogation which any insurer of said Consultant may acquire against the City by virtue of the payment of any loss under such insurance. Consultant agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation, but this provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. 5. Self -Insured Retentions: Self insured retentions must be declared to and approved by the City. The City may require the Consultantto 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 narned insured or City. 6. Acceptability of Insurers: Insurance is to be placed with insurers authorized to conduct business in the state with a current A.M. Best's rating of no less than A:VII, unless otherwise acceptable to the City. 7. Claims Made Policies: If any of the required policies provide coverage on a claims -made basis: 1. The Retroactive Date must be shown and must be before the date of the contract or the beginning of contract work. 2. Insurance must be maintained and evidence of insurance must be provided for at least five (5) years after completion of the contract of work. 3. If coverage is canceled or non -renewed, and not replaced with another claims -made policy form with a Retroactive Date prior to the contract effective date, the Consultant must purchase "extended reporting" coverage for a minimum of five (5) years after completion of contract work. 8. Verification of Coverage: Consultant shall furnish the City with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage required by this clause) and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements to City before work begins. However, failure to obtain the required documents prior to the work. beginning shall not waive the Consultant's obligation to provide them. City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. 9. Special Risks or Circumstances: City reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. V 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 Consultant, its subcontractors, agents, employees, or other persons acting on its behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered, by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. The Consultant further agrees to indemnify, hold harmless, and pay all costs for the defense of the City, including fees and costs for special counsel to be selected by the City, regarding any action by a third party challenging the validity of this Agreement, or asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing, to the extent Consultant's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Consultant. $. 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. 0-110001111 DWI]';717.� Consultant shall keep records and invoices in connection with the work to be performed under this Agreement. Consultant shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Consultant under this Agreement. All such records and invoices shall be clearly identifiable. Consultant shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours. Consultant shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Consultant under this Agreement. 10. CONFIDENTIALITY If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Consultant agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Consultant without reference to information disclosed by the City. 11. CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 12. NON-DISCRIMINATION Consultant shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 13. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Consultant. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Consultant or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which is not embodied herein. 14. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Consultant, Consultant may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City andany 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 Iimit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other consultants retained by City. 15. 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. 16. 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. 17. 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. 18. 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 7 Santa Ana, CA 92702-1988 Fax: 714- 647-6956 With courtesy copies to: Executive Director, Human Resources Department 20 Civic Center Plaza (M-25) P.O. Box 1988 Santa Ana, California 92702-1988 Facsimile (714) 647-6549 To Consultant: Kaiser Foundation Health Plan, Inc. Dalia Villasenor-Guillen, Territory Manager Address: 1851 East First Street, Suite 1100, Santa Ana, CA 92705 Phone: 562-833-1832 Email: dalia.v.guillen@kp.org 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 snail, 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. 19. 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] M SIGNATURE PAGE TO CONSULTANT AGREEMENT WITH KAISER FOUNDATION HEALTH PLAN, INC. FOR KAISER PERMANENTE MOBILE HEALTH VEHICLE IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST ennifer L. at APPROVED AS TO FORM SONIA R. CARVALHO City Attorney By: daimL � . R"�" Laura A. Rossini Chief Assistant City Attorney RECOMMENDED FOR APPROVAL Lori Schnaidcr Executive Director Human Resources Department CITY ZFSWAAINNA Alvaro Nunez City Manager CONSULTANT By: Dalia Guillen CaIPERS Territory Manager EXHIBIT A Service Forms Pi KAISER PERMANENTE. Date: 1I29125 Southern California Mobile Health Vehicle Services for City of Santa Ana Group wishes to engage Kaiser Foundation Health Plan, Inc. ("KP") to arrange for the Kaiser Permanente Mobile Health Vehicle (MHV) to provide the services described below at Group's worksite (the "Services"), and KP wishes to provide such Services: ®Biometric Screenings ❑Limited Screenings ❑Care Gap Closure to members of KP ❑Community Event ❑Primary Care services to members of KP fully -insured health plans BY ENGAGING THE SERVICES DESCRIBED IN THIS CONFIRMATION, GROUP AGREES TO AND INTENDS TO BE BOUND BY THE FOLLOWING TERMS AND CONDITIONS. TERMS & CONDITIONS FOR KAISER PERMANENTS WORKSITE SERVICES i FEES: Biometric Screenings (blood pressure, BMI, glucose and cholesterol) Biometric screenings are charged at $47 per participant for both KP members and non- members. Limited Screenings (blood pressure, BMI and glucose) ■ Limited screenings are at no cost to the employer. No fees apply. Care Gap Closures to members of KP ■ Care Gap Closures are at no cost to the employer. Standard member copayments may apply if a non -preventive service is delivered on the mobile health vehicle. Primary Care to members of KP fully -insured health plans ■ Primary Care services are at no cost to the employer. Standard member copayments and deductibles apply and will be collected either at the time of service or via mailed invoice. PARTICIPATION GUIDELINES: Biometric Screenings ■ Minimum 6 participants per hour and at least 32 participants in total for Biometric screenings, or $1,504 will be assessed. Limited Screenings ■ Minimum of 6 participants per hour for limited screenings. Care Gap Closures ■ Minimum 2 participants per hour for Care Gap services. Service includes a review of the member's medical record to check if the member is up to date with recommended care, to close any gaps in care and to provide limited biometric screenings. Primary Care ■ Minimum 2 participants per hour for primary care services. SCAL MHV LOA 04.28.2023 04 MSER PERMANENTE• CANCELLATION POLICY FOR ALL EVENT TYPES: ■ Cancellations received by the MHV Product Manager at least 30 calendar days prior to the event are allowed and will not be assessed a penalty. • Cancellations fewer than 30 calendar days prior to the event date but greater than 14 calendar days can be rescheduled for an alternate location and for the same services on a different date. If the event is not able to be rescheduled a cancelation fee of $2,600 will be assessed. ■ Cancellations within 14 calendar days will be assessed a cancellation fee of $2,600. ■ Cancellations due to circumstances beyond the control of either party (natural disaster, fire, etc.) will not be assessed a penalty. ■ If the MHV is inoperable, alternative options will be offered. Alternatives could include but are not limited to providing the service in a conference room or setting up a standalone station using pop-up tents. ■ Note: Cancellation notice is not effective until it is received by the Mobile Health Vehicle Product Manager or a similar role. Date(s) on which Services will be provided: 411125 Estimated number of participants receiving Services: 60 Location where Services will be provided: 20 Civic Center Plaza, Santa Ana, CA, 92701 Funding source if applicable: City of Santa Ana 50% $1,410.00 and Kaiser Permanente to pay 50% $1,410.00 SCAL MHV LOA 09.28.2023 M KAISER PERMANENIE., Date: 1129/25 Southern California Mobile Health Vehicle Services for City of Santa Ana Group wishes to engage Kaiser Foundation Health Plan, Inc. ("KP") to arrange for the Kaiser Permanente Mobile Health Vehicle (MHV) to provide the services described below at Group's worksite (the "Services"), and KP wishes to provide such Services: ®Biometric Screenings ❑Limited Screenings ❑Care Gap Closure to members of KP ❑Community Event ❑Primary Care services to members of KP fully -insured health plans BY ENGAGING THE SERVICES DESCRIBED IN THIS CONFIRMATION, GROUP AGREES TO AND INTENDS TO BE BOUND BY THE FOLLOWING TERMS AND CONDITIONS. TERMS & CONDITIONS FOR KAISER PERMANENTE WORKSITE SERVICES FEES: Biometric Screenings (blood pressure, BMI, glucose and cholesterol) ■ Biometric screenings are charged at $47 per ;participant for both KP members and non- members. Limited Screenings (blood pressure, BMI and glucose) ■ Limited screenings are at no cost to the employer. No fees apply. Care Gap Closures to members of KP ■ Care Gap Closures are at no cost to the employer. Standard member copayments may apply if a non -preventive service is delivered on the mobile health vehicle. Primary Care to members of KP fully -insured health plans ■ Primary Care services are at no cost to the employer. Standard member copayments and deductibles apply and will be collected either at the time of service or via mailed invoice. PARTICIPATION GUIDELINES: Biometric Screenings ■ Minimum 6 participants per hour and at least 32 participants in total for biometric screenings, or $1,504 will be assessed. Limited Screenings ■ Minimum of 6 participants per hour for limited screenings. Care Gap Closures Minimum 2 participants per hour for Care Gap services. Service includes a review of the member's medical record to check if the member is up to date with recommended care, to close any gaps in care and to provide limited biometric screenings. Primary Care ■ Minimum 2 participants per hour for primary care services. SCAL MHV LOA Q9.2.8.2D23 04 KAISER PERMANENTE CANCELLATION POLICY FOR ALL EVENT TYPES: ■ Cancellations received by the MHV Product Manager at least 30 calendar days prior to the event are allowed and will not be assessed a penalty. ■ Cancellations fewer than 30 calendar days prior to the event date but greater than 14 calendar days can be rescheduled for an alternate location and for the same services on a different date. If the event is not able to be rescheduled a cancelation fee of $2,600 will be assessed. • Cancellations within 14 calendar days will be assessed a cancellation fee of $2,600. ■ Cancellations due to circumstances beyond the control of either party (natural disaster, fire, etc.) will not be assessed a penalty. • If the MHV is inoperable, alternative options will be offered. Alternatives could include but are not limited to providing the service in a conference room or setting up a standalone station using pop-up tents. ■ Note: Cancellation notice is not effective until it is received by the Mobile Health Vehicle Product Manager or a similar role. Date(s) on which Services will be provided: 4/2/25 Estimated number of participants receiving Services: 40 Location where Services will be provided: 215 S Center Street, Santa Ana, CA, 92703 Funding source if applicable: City of Santa Ana 100% $1,880.00 SCAL MHV LOA 09.28.2©23 Pi KAISER P€RMANENTE. Date: 1129I25 Southern California Mobile Health Vehicle Services for City of Santa Ana Group wishes to engage Kaiser Foundation Health Plan, Inc. ("KP") to arrange for the Kaiser Permanente Mobile Health Vehicle (MHV) to provide the services described below at Group's worksite (the "Services"), and KP wishes to provide such Services: MBiometric Screenings ❑Limited Screenings ❑Care Gap Closure to members of KP ❑Community Event ❑Primary Care services to members of KP fully -insured health plans BY ENGAGING THE SERVICES DESCRIBED IN THIS CONFIRMATION, GROUP AGREES TO AND INTENDS TO BE BOUND BY THE FOLLOWING TERMS AND CONDITIONS.. TERMS & CONDITIONS FOR KAISER PERMANENTS W©RKSITE SERVICES FEES: Biometric Screenings (blood pressure, BMI, glucose and cholesterol) Biometric screenings are charged at $47 per participant for both KP members and non- members. Limited Screenings (blood pressure, BMI and glucose) Limited screenings are at no cost to the employer. No fees apply. Care Gap Closures to members of KP ■ Care Gap Closures are at no cost to the employer. Standard member copayments may apply if a non -preventive service is delivered on the mobile health vehicle. Primary Care to members of KP fully -insured health glans Primary Care services are at no cost to the employer. Standard member copayments and deductibles apply and will be collected either at the time of service or via mailed invoice. PARTICIPATION GUIDELINES: Biometric Screenings ■ Minimum 6 participants per hour and at least 32 participants in total for biometric screenings, or $1,504 will be assessed. Limited Screenings ■ Minimum of 6 participants per hour for limited screenings. Care Gap Closures Minimum 2 participants per hour for Care Gap services. Service includes a review of the member's medical record to check if the member is up to date with recommended care, to close any gaps in care and to provide limited biometric screenings. Primary Care Minimum 2 participants per hour for primary care services. KAL MHV LOA 04.2&.2023 KAISER PERMANENTE-, CANCELLATION POLICY FOR ALL EVENT TYPES: ■ Cancellations received by the MHV Product Manager at least 30 calendar days prior to the event are allowed and will not be assessed a penalty. ■ Cancellations fewer than 30 calendar days prior to the event date but greater than 14 calendar days can be rescheduled for an alternate location and for the same services on a different date. If the event is not able to be rescheduled a cancelation fee of $2,600 will be assessed. • Cancellations within 14 calendar days will be assessed a cancellation fee of $2,600. ■ Cancellations due to circumstances beyond the control of either party (natural disaster, fire, etc.) will not be assessed a penalty. ■ If the MHV is inoperable, alternative options will be offered. Alternatives could include but are not limited to providing the service in a conference room or setting up a standalone station using pop-up tents. • Note: Cancellation notice is not effective until it is received by the Mobile Health Vehicle Product Manager or a similar role. Date(s) on which Services will be provided: 419125 Estimated number of participants receiving Services: 50 Location where Services will be provided: 60 Civic Center Plaza, Santa Ana, CA, 92701 Funding source if applicable: City of Santa Ana 100% $2,350.00 2 SCAL MHV LOA 09.28.2023 A�--�C 1 �® V � CERTIFICATE OF LIABILITY INSURANCE DATE IYYYY) 03/27/20257/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: MARSH RISK & INSURANCE SERVICES PHONE FAX FOUR EMBARCADERO CENTER, SUITE 1100(A/C, No Ext : A/C, No): E-MAIL CALIFORNIA LICENSE NO. 0437153 SAN FRANCISCO, CA 94111 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Safety National Casualty Corp. 15105 CN 101 483686-SCAL-CAS-25-26 GLALW CA INSURED KAISER FOUNDATION HEALTH PLAN, INC. INSURER B : INSURER C : KAISER FOUNDATION HOSPITALS 393 EAST WALNUT STREET PASADENA, CA 91188 INSURER D INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: SEA-003811693-15 REVISION NUMBER: 8 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR OF INSURANCE ADDLSUBRTYPE INSD WVD POLICY NUMBER POLICY EFF MM/DDIYYYYI POLICY EXP iMMIDDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY GL4048017 01/01/2025 01/01/2026 EACH OCCURRENCE $ 5,000,000 CLAIMS -MADE X� OCCUR RENTEDDAMAGE TO FIR SES(E.."; Ea occrre... $ 5,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 5,000,000 POLICY ❑ PRO ❑ LOC JECT X PRODUCTS-COMP/OPAGG $ 5,000,000 $ OTHER: A AUTOMOBILE LIABILITY CA6675880 01/01/2025 01/01/2026 COMBINED SINGLE LIMIT Ea accident $ 4,000,000 BODILY INJURY (Per person) $ A X ANY AUTO $1,000,000 SIR OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTYDAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY L $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N❑ (Mandatory in NH) NIA SP4067916 S.I.R. $5,000,000 01/01/2025 01/01/2026 PER OTH- X STATUTE ER E.L. EACH ACCIDENT $ 5,000,000 E.L. DISEASE - EA EMPLOYEE $ 5,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) REQUEST #RC010620 THE CITY OF SANTA ANA, ITS OFFICERS, OFFICIALS, EMPLOYEES AND VOLUNTEERS ARE INCLUDED AS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY TO THE EXTENT REQUIRED BY WRITTEN CONTRACT. THE GENERAL LIABILITY POLICY IS PRIMARY AND NON-CONTRIBUTORY WHERE REQUIRED BY WRITTEN CONTRACT. POLICIES INCLUDE A WAIVER OF SUBROGATION WHERE REQUIRED BY WRITTEN CONTRACT AND ALLOWED BY LAW. Digitallysigned....................................................................................................................................................... , Tu Train by Tu Tran Nguyen APPROVED I� N Q U ven Date: 2025.03.27 _ 8`k..... Y...'K"­umw.. MB—..a...d.,.e....n ..r A—C&". , — AA .'17 CERTIFICATE HOLDER CITY OF SANTA ANA 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 CANCELLATION.. � . K aap� m m a�,r�:aVGGIN , �­ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL 4048017 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance protided u nder t h e fol I owin g: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name Of Additional Insured Persons) Or Organ! zation(s): As required by written contract or agreement when such written contract or agreement is executed prior to an occurrence, offense or loss to which this endorsement applies, but only for the limits agreed to in such contract or the Limits of Liability provided by this policy, whichever is less. Any individually scheduled additional insureds shall not be construed to override nor negate this blanket additional insured. 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 include as an additional insured the person(s) or organization(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 omissions of those acting on your behalf: 1. In the performance ofyour ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies tothe extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract 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. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the mast we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contractor agreement; or 2. A\ailable under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 04'13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: GL 4048017 COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. iisil ki ! ffizkli 'Ov'hel %I-kl 0*10 *kA io A,, I i 1401 ! RI-ki This endorsement modifies insurance prodded u nder t h e fol I owin g: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART �-163:1:�IlIJ4M Name Of Additional Insured Person(s) Or Organ! zations Location And Description Of Com eted Operations As required by written contract or All locations of Insured's Operations agreement when such written contract or agreement is executed prior to an occurrence, offense or loss to which this endorsement applies, but only for the limits agreed to in such contract or the Limits of Liability provided by this policy, whichever is less. Any individually scheduled additional insureds shall not be construed to override nor negate this blanket additional insured. Information re uired to cam lete this Schedule if not shown above will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". Howe\,er: 'I. The insurance afforded to such additional insured only applies tothe extent permitted by law; and 2. If coverage prodded to the additional insured is required by a contract 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 prodde for such additional insured. B. With respect to the insurance afforded to these additional insureds, the fdlowing is added to Section III — Limits Of Insurance: If coverage prouded to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 'I. Required by the contract or agreement; or 2. A\ailable under the applicable Limits of Insurance shown in the Declarations; whiche\,er is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04'13 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: GL 4048017 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY ► ► This endorsement modifies insurance prouded u nder t h e fol I owin g: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Person(s) or Organization(s) as required by written contract when such written contract is executed prior to an occurrence, offense or loss to which this endorsement applies. Any individually scheduled Waivers shall not be construed to override nor neaate this blanket Waiver. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV —Conditions: We wai\,e any right of recovery we may hake against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "yourwork" done under a contract with that person or organization and included in the " produ cts-c omp I eted operations hazard". This wailer applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 © Insurance SeNces Office, Inc., 2008 Page 1 of 1 0456 Qa 0113 (XWC) ENDORSEMENT BLANKET WAIVER OF SUBROGATION Effective 12:01 AM., Local Time, January 01, 2025 In consideration of the payment of premium and adherence by both parties to the terms of this Agreement, it is hereby understood and agreed that the Recove[y From Others section of this Agreement is amended to include the following additional language: The CORPORATION has the right to pursue subrogation recoveries from anyone liable far an injury covered by this Agreement. The CORPORATION will not enforce its right against any person or organization for whom the EMPLOYER performs work under a written contract that requires the EMPLOYER to obtain this agreement from the CORPORATION. All other terms, conditions, agreements and stipulations remain unchanged. Attached to and forming a part of Excess Workers' Compensation and Employers' Liability Insurance Agreement No. SP 4D67916, issued by SAFETY NATIONAL CASUALTY CORPORATION of St. Louis, Missouri to KAISER FOUNDATION HEALTH PLAN, INC., ET AL, dated January 01, 2025. Endorsement No. 0456 DD 0113 (XWC) SAFETY NATIONAL CASUALTY CORPORATION President Secretary