HomeMy WebLinkAboutKAISER FOUNDATION HEALTH PLAN (2) ?NSURANCE ON FIF
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DX1E:MAR 2 5 2026
CONSULTANT AGREEMENT BETWEEN KAISER FOUNDATION HEALTH PLAN
7�tii9 NUA LDz) AND CITY OF SANTA ANA FOR BIOMETRIC SCREENINGS
THIS AGREEMENT is made and entered into on this 9th day of February, 2026 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").
RECITALS
A. The City desires to retain a Consultant having special skill and knowledge in the field of
providing mobile health vehicles for Biometric Screenings (blood pressure, BMI, glucose
and cholesterol.)
B. Consultant represents that Consultant 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 customary work
described and set forth in the attached Service Forms from Consultant for the following locations,
dates:
Date Location
April 2,2026 Santa Ana City Hall, 20 Civic Center Plaza, Santa
Ana, CA 92701
April 8, 2026 Santa Ana City Yard, 215 South Center Street, Santa
Ana, CA 92703
April 9, 2026 Santa Ana Police Department, 60 Civic Center Plaza,
Santa Ana, CA 92701
b. City and Consultant agree that the dates above can be rescheduled or moved to
other locations during the term of the Agreement with mutual written agreement of both Parties.
The Parties also agree that they will mutually agree in writing on the times for the events listed
above.
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2. COMPENSATION
a. City agrees to pay, and Consultant agrees to accept as total payment for its services for
City,the rates and charges identified in the Service Agreements attached as Exhibit A.
The total amount to be expended during the term of this Agreement shall not exceed
nine thousand two hundred and ten dollars and zero cents ($9,210.)
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 April 1, 2026 through March 31, 2027 for a one (1)
year term unless terminated earlier in accordance with Section 15, below.
4. INDEPENDENT CONTRACTOR
Consultant shall, during the entire term of this Agreement, be construed to be an
independent Consultant and not an employee of the City. This Agreement is not intended 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
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421508010
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.
G. INSURANCE
Insurance requirements are attached hereto as Exhibit B.
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 parry
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.
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
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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
a. 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.
b. No immediate family members of either the Mayor, City Council Member, or any
appointed City Official, including appointed board and commission members, as
defined under the City's Municipal Code, whose position with the City shall award or
influence the award of this Agreement, or any competing contract or amendment
thereof, shall be employed in any capacity by the Consultant or have any other direct
or indirect financial benefit or interest in this Agreement.
c. The section also prohibits the awarding of any agreement, contract, grant, or any
amendment to those awards, to any former full-time employee for one-year from date
of employee separation except for any Ca1PERS retiree as authorized by City Council
resolution
d. The Consultant must comply with all conflict of interest laws, ordinances, and
regulations now in effect or hereafter to be enacted during the term of this Agreement.
The Consultant warrants that it is not now aware of any facts which conflict with the
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prohibitions defined above.If the Consultant hereafter becomes aware of any facts that
might reasonably be expected to create a conflict of interest, it must immediately make
full written disclosure of such facts to the City. Full written disclosure must include,
but is not limited to, identification of all persons implicated and a complete description
of all relevant circumstances. Failure to comply with the provisions of this paragraph
will be a material breach of this Agreement.
e. Consultant covenants that none of its directors, officers, employees, or agents shall
participate in selecting or administrating any subcontract supported(in whole or in part)
by City funds stemming from the Agreement where the awarding of the subcontract
has any direct or indirect financial benefit or interest to any individual, as defined in
subsections (b) and(c) above.
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
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 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 Consultants retained by City.
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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:
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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:
Executive Director, Human Resources
Agency
City of Santa Ana
20 Civic Center Plaza(M-24)
P.O. Box 1988
Santa Ana, California 92702
To Consultant:
Kaiser Foundation Health Plan, Inc.
Kristin Howell
1851 East First Street, Suite 1100
Santa Ana, CA 92705
916-715-1694
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.
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IN WITNESS WHEREOF,the parties hereto have executed this Agreement the date and year first
above written.
ATTEST: CITY O SANTA AN
II Alvaro Nuftez
City Clerk City Manager
APPROVE FORM:
SONIA R. CARVALHO CONSULTANT:
City Attorney
Laura A. Rossini Dalia Villa enor-Guillen
Chief Assistant City Attorney Territory Manager
RECOMMENDED FOR APPROVAL:
17
Lori Schnaider
Executive Director
Human Resources Agency
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EXHIBIT A
SCOPE OF SERVICES and RATES
#21508010
04, KAISER PERMANENTE,
Date: 12/23/2025
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:
ZBiometric Screenings []Community Event
OCare Gap Closure to members of KP ❑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.
Care Gap Closures
■ Care Gap Closures are at no cost to the employer.
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.
Care Gap Closures
■ Up to 3 participants every 15 minutes. 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.
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.
1 SCAL MHV LOA 12/10/2025
KAISER PERMANENTE,;
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: 4/2/2026
Estimated number of participants receiving Services: 60
Location where Services will be provided: City Hall — 20 Civic Center Plaza Santa Ana 92701
Funding source if applicable:
.50/50 split between Kaiser and City of Santa Ana
Kaiser to fund $1,410.00
City to fund $1, 410.00
2 SCAL MHV LOA 12/10/2025
t KAISER PERMANEME,.,
Date: 12/23/2025
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 ❑Community Event
❑Care Gap Closure to members of KP ❑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.
Care Gap Closures
■ Care Gap Closures are at no cost to the employer.
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.
Care Gap Closures
Up to 3 participants every 15 minutes. 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.
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.
1 SCAL MHV LOA 12/10/2025
!` KAISER PERMANENTEr,
■ 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: 4/8/26
Estimated number of participants receiving Services: 40
Location where Services will be provided: 215 S Center Street Santa Ana 92703
Funding source if applicable:
Kaiser will fund 100% $1,880.00
2 SCAL MHV LOA 12/10/2025
0,41 KAISER PERMANENTE.
Date: 12/23/2025
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 ❑Community Event
❑Care Gap Closure to members of KP ❑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.
Care Gap Closures
■ Care Gap Closures are at no cost to the employer.
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.
Care Gap Closures
■ Up to 3 participants every 15 minutes. 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.
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.
1 SCAL MHV LOA 12/10/2025
KAISER PERMANENTS;<.
■ 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: 4/9/26
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:
Kaiser will fund 100% $2,350.00
2 SCAL MHV LOA 1.2/10/2025
EXHIBIT B
INSURANCE REQUIREMENTS
#2150801v3
Consultant shall procure and maintain for the duration of the agreement, the following insurance
coverages:
MINIMUM SCOPE AND LIMIT OF INSURANCE
Consultant shall maintain limits of insurance coverage in the following minimum amounts and
shall be at least as broad as:
• 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 and $2,000,000 aggregate.
• Automobile Liability (AL): Insurance Services Office Form CA 00 01 covering Code 1
(any auto), with combined single limits of $1,000,000. In the event Consultant does not
maintain commercial automobile liability insurance, City will accept evidence of personal
automobile insurance, provided that such policy is endorsed for business use and provides
coverage with a minimum limit of $1,000,000. Required policy limits can be met with
primary and umbrella/excess insurance policies.
• Workers' Compensation (WC): 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, per employee, per policy for bodily injury or disease. This requirement can be
waived if Consultant has no employees.
If Consultant maintains broader coverage and/or higher limits than the minimums 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 insurance policies are to contain, or be endorsed to contain, the following provisions:
1. CGL and AL policies: City of Santa Ana, its City Council, its officers, officials,
employees, agents, and volunteers are to be covered as additional insureds with
respect to liability arising out of work or operations performed by or on behalf of the
Consultant including materials, parts, equipment, and personnel furnished in
connection with such work or operations.
2. CGL, AL, and WC policies: 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 for City.
3. All required insurance policies: 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. All required insurance policies: 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. Each insurance policy 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.
6. Certificate Holder on each Evidence of Insurance certificate shall be: City of Santa
Ana,Attention: Julie Hoang, City of Santa Ana, Human Resources Agency, 20 Civic
Center Plaza, M-24, P.O. Box 1988, Santa Ana, CA 92701. The name and location
of the event should 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. City may require
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 to Entity 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.
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 work.
2. Insurance must be maintained and evidence of insurance must be provided for at least
three (3) years after completion 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, Consultant must
purchase "extended reporting" coverage for a minimum of three (3) years after completion of
work.
Subcontractors
.Consultant shall require and verify that all sub-contractors maintain insurance
meeting all the requirements stated herein, and Consultant shall ensure that City
is an additional insured on insurance required from sub-contractors.
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.
DATE(MMIDDIYYYYI
A��EP CERTIFICATE OF LIABILITY INSURANCE
02)1 olza2s
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(les) 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 - NTA T
NAME:
MARSH RISK&INSURANCE SERVICES
FOUR EMBARCADERO CENTER,SUITE 1100 PHONE
N t: FAX
No):
CALIFORNIA LICENSE NO.0437153 EMAIL
SAN FRANCISCO,CA 94111 ADDRESS:
INSURERS AFFORDING COVERAGE NAIC#
CN101483688-SCAL-CAS-26=27 GLALW CA INSURERA: Safety National Casualty Cori). 151D5
INSURED INSURER B:
KAISER FOUNDATION HEALTH PLAN,INC.
KAISER FOUNDATION HOSPITALS INSURER c:
393 EAST WALNUT STREET INSURER D:
PASADENA,CA 91180
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: SEA-003811693-21 REVISION NUMBER: 13
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.
EXP
INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDDYIYYYY MM pDYIYYYY LIMITS
LTR
A X COMMERCIAL GENERAL LIABILITY GL 4046017 0110112026 D110112027 EACH OCCURRENCE $ 5,000,D00
DAMAGE TO RENTED
CLAIMS-MADE 57 OCCUR PREMISES Ea Dccu ence $ 5,000,000
I MED EXP(Any one person) $ 10,D00
PERSONAL&ADVINJURY $ 5,000,000
GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 5,000,000
X POLICY 0 PRO ❑
JECT LOC PRODUCTS-COMPIDP AGG $ 5,000,000
OTHER: $
A AUTOMOBILE LIABILITY CA6675S80 01/01/2026 0110112027 Ea aBc EDD SINGLE LIMIT $ 4,000,000
A X ANY AUTO i$1,000,000 SIR I BODILY INJURY(Per person) $
OWNED SCHEDULED
AUTOS ONLY AUTOS - BODILY INJURY(Per acddent) $
HIRED NON-OWNED PROPERTYDAMAGE $
AUTOS ONLY AUTOS ONLY Per awident
$
UMBRELLALIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE AGGREGATE $
DIED RETENTION$ $
A WORKERS COMPENSATION [ SP4067916 01101/2026 01/01/2027 X I STATUTE E
S,LR.$5,000,000 RH
AND EMPLOYERS'LIABILITY YIN
ANYPROPRIETCRIPARTNERIEXECUTIVE ' E.L.EACH $ 5,000,00D
EN] NIA
OFFICERIMEMBEREXCLUDED7
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 5,000,000
If yes,describe under 5,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
i
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required)
REQUEST#RC011714
THE CITY OF SANTA ANA,ITS OFFICERS,OFFICIALS,EMPLOYEES AND VOLUNTEERS ARE INCLUDED AS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY AND AUTOMOBILE LIABILITY
TO THE EXTENT REQUIRED BY WRITTEN CONTRACT. THE GENERAL LIABILITY POLICY IS PRIMARY AND NON-CONTRIBUTORY WHERE REQUIRED BY WRITTEN CONTRACT. POLICIES INCLUDE,!
WAIVER OF SUBROGATION WHERE REQUIRED BY WRITTEN CONTRACT AND ALLOWED BY LAW.
APPROVED
CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 30:55 am,Mar 11,2026
CITY OF SANTA ANA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
20 CIVIC CENTER PLAZA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
SANTA ANA,CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh Risk&Insurance Services
O 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO U
This endorsement modifies insurance provided under the following:
COMMERCIAL AUTOMOBILE COVERAGE PART
SCHEDULE
Narne Of Person Or Organlzailon:
Perswt(4) pr ,organization(s) as required by written oontraot when suoh written
contract is executed prior to an accident to which this endorsement applies.
Any individually scheduled Waivers shall not be construed to override nor Negate
this blanket Waiver.
Information required to complete this Schedule if not shown:above will be shown in the Declarations.
CHANGE
We waive any right 0 recovery we may have against the person or organization shown in the Schedule above
bemuse of payments we.make for"bodily injury".or"property damage"to which this insurance.applies,.caused by
an"accident"and resulting from the ownership, maintenance or use of a covered "auto` This wanrer applies only
to the person or organization Shown in the.Schedule above.
This endorsement changes the policy to which It is attached and Is effective an the date Issued unless otherwise statecl.
(The Inibr ratlon below Is required only widen this endorsement Is.lasued oubse luont to preparation of the policy.)
Endorsement Effective 01/01/20245 Policy No. CA 6675880 Endomerr*ntNo.
Named.Insured KAISER FOUNDATION HEALTH PLAN, INC. Premium$ Included
Insurance Company safaty National Casualty Corporation
Countersigned By
SNCA 0271013 Safety National.Casualty Corporation Page I of I
POLICY NUMBER:. GL 4048017 COMMERCIAL GENERAL LIABILITY
CG 20 26 04 13
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED — DESIGNATED
PERSON. OR ORGAN EAT ION
This endorsement modifies insurance prodded under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Nance Of Additional Insured Person(s)'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 ams.ureds shall not be construed. to override :nor negate this
blanket additional insured.
Information required to com lete.this Schedule, if not shown above will be shown in the Declarations.
A. Section 11 Who. 19 An Insured is amended to B. With respect to the insurance afforded to these.
include as an additional insured the person(s) or additional insureds, the Blowing is added to
organization(s) shown in the Schedule, but only Section Ill—LImitsOfInsuirance:
with respect to liability for"bodily injury","property If coverage provided to the additional insured is
damage" or "personal and. 'advertising injury" required by a:contract or agreement,the most: we
caused, in whole or in part; by your acts or will pay on behaif of the additional insured is the
omissions orthe acts or omissions of those acting amount of insurance:
.on your behalf
1. In the performance of your ongoing operations; 1 'required by the contract or agreement;or
or 2. Available under the applicable Limits of
2. In connection with your premises owned by or Insurance shown in the Declarations;
rented to you. whichever is less.
However: This endorsement shall.not increase the applicable
1. the insurance afforded to such additional
Limits of Insurance shown in the Declarations.
insured'only applies to the 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
proude for such additional insured.
CG 20 26 0413 (D Insurance SeNces Office,.Inc_, 2012 Page 1 of 1
POLICY.NUMBER: GL 4048017 COMMERCIAL GENERAL LIABILITY
CG 20 37 0413
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies insurance pro\Aded under th e fol I owing:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s).
nrf%rriian Location And Description Of Completed O eratims As required by written contract or All. locations .of Insureds Operations
agreement when such written contract or
agreement is �xocuted prior to an
occurr.ence., 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; whicheve r is 1 es s. Any
individually scheduled additional
insureds s'nall not be construed to
override. nor negate .this blanket
additional. insured,.
Information re aired tocomplete tl is Schedul if not shown above will be shown in the Declarations.
A. Section II —Who.Is An Insured is.amended to B. With respect to the insurance afforded to these
include as an additional insured the person(s) or additional insureds, the blowing is added to
organization(s) shown in the Schedule, but only Section III Limits Of Insurance:
with respect to liability for "bodily injury" or if co\erage provided to the additional insured is
"property damage'`caused, in whole or in part, by required by a contract or agreement,the most.we
If work at the location. designated and. will pay on behalf of the additional insured is the
described in the Schedule of this endorsement amount ofinsurance:
performed for that additional insured and included
in the"products-completed operations hazard". 1• Required by the contract or agreement;or
Hovuew, 2. A,.eilable under the applicable. Limits of
1. The insurance afforded to such additional Insurance shown in the Declarations;
insured only.applies to the extent permitted by whicheNer is less.
law;and This endorsement shall not increase the
2. If coverage prodded to the additional insured is applicable Limits of Insurance shown in the
required by a contract or agreement, the Declarations.
insurance afforded to such additional insured
will not be broader than that which you are
required .by the contract or agreement to
provide for such additional insured.
CG 20 37 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 1
POLICY NUMBER, GL 4048017 COMMERCIAL GENERAL LIABILITY
CG 24 04 05 09
WAKIER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance prodded under the.folIowing:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Person Or.Organization:
Persons) 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 app lies
Any individually scheduled Waivers .shall not be construed to override nor
negate this bianket Waiver.
Information re aired to complete this Schedul if not shown above Will be shown in the Declarations:
The fbIlowing is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of
Section IV--Conditions:
We waive any right of recce+ ary we may hare 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 udder a contract with that person or
organ zation.and included in the"products-compl eted:
operations hazard". This waiver applies only to the
person or organization shown in the Schedule abave.
CG 24 04:05 W 0 Insurance.SeNces Office, Inc., 2008 Page 1 of 1
0456 00 0113 (XWC)
ENDORSEMENT
BLANKET WAIVER OF SUBROGATION
Effective 12:01 A.M., Laical Time, January 01,2026
In consideration of the payment of premium and adherence by bath parties to the terms of this Agreement; it is
hereby understood and agreed that the Recovery From Others section of this Agreement is amended to include
the following.add Moral language:
The CORPORATION.has the right to pursue subrogation recoveries from anyone liable for an
injury covered by the s-Agreement. The CORPORATION will not enforce its right against any
person or organization f r wham 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 st€pulat€ons remain unchanged.
Attached to and:forming a part of Excess Workers'Compensation and Employes` Liability Insurance Agreement.
No: SP 4067.916, issued by SAFETY NATIONAL CASUALTY CORPORATION of St. Louis,. Missouri to RAISER.
FOUNDATION HEALTH PLAN, INC:, ET AL, dated January 01, 2026. Endorsement No. 0456 00 0113 (XWC)
SAFETY NATIONAL CASUALTY CORPORATION
President
Secretary
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED ADDITIONAL INSURED
This endorsement modifies insurance provided under the Fallowing:
COMMERCIAL AUTOMOBILE COVERAGE PART
SCHEDULE
Name of Additional Insured Persons or Or an"tion s :
Person(s) or Organization(s) as required by written contract.
Any individually scheduled Designated Additional Insured shall not he
construed to override nor negate this blanket Designated Additional Insured.
CHANGE
The person(s) or organization(s) shown in the Schedule above with whom you have agreed in a written
contract to provide insurance such as is afforded under this Coverage Form, is included as an Additional
Insured subject to the below:
11) Insurance for such Additional Insured(s)scheduled above shall be afforded only to the extent that such
Additional Insured is liable for °bodily injury" or 'property damage" arising out of your operations and
resulting from the ownership, maintenance or use of covered "autos" by you while the covered'autos are
on premises owned or leased by the above scheduled Additional Insured(s).
(2) The insurance afforded under this Coverage Form to such Additional Insured(s)applies only:
(aj If the"accident"takes place subsequent to the execution and effective date of such written contract:
and,
(b) While such written contract is in force, or until the end of the policy period, which ever occurs first.
(3) How Limits Apply to Additional Insureds)
The most we will pay on behalf of the Additional Insured(s) scheduled above is the lesser of
(a} The limits of insurance specified in the written contract or written agreement; or,
(b) The Limits of Insurance provided by the Coverage Form_
SNCA 026 10 13 Safety National Casualty Corporation Page 1 of 2
The amount we will pay on behalf of.such Additional Insured(s)shall be a part of, and not in addition to,
the Limits of Insurance shown in the Coverage Form Declarations and described in this section. Such
amount will thus not Increase the Limits of Insurance shown far the Coverage Form.
(4) Exoluslons
(a) This endorsement does not apply to liability of the Additional Insured which arises out of the
ownership of transportation operating rights granted to the Additional Insured by public authority.
(b) This endorsement does not apply to the liability of the owner or anyone else from whom you hire or
borrow a covered auto.
(5) Obligations at the Addttlonal insured's town Coat
No Additional Insured will, except at their own tit; voluntarily make a payment, assume any obligation,
or incur any Wense,other than for first aid,without our consent
The Additional Insured(s)scheduled above shall be subject to all other conditions set forth in the.Coverage Form.
This endorsement does not alter coverage provided in.the Coverage Farm.
This endorsement changes.the pdicy to which it is attached and is effective an the date issued unless otherwise stated
(The Information below Is required only when this endorsement Is Issued subsequent to preparation of the policy.)
Endorsement Effective 01/01/2026 Policy No. CA WbBoo Endorsement No.
Named Insured KAISER FOUNDATION HEALTH PLAN, INC. Premiurrr$ Included
insurance Company safety National Casualty Corporation
Countersigned By
Page 2 of 2 Safety National Casualty Corporation SNCA 0241013