HomeMy WebLinkAboutTUSTIN-IRVINE MEDICAL GROUP 1B-2011?jl
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INSURANCE ON FILE
WORK MAY PROCEED
UNTIL INSURANCE EXPIRES
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CLERK OF COUNCIL
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SECOND ANILNDMENT TO AGRFRMENT
A-2011-131
THIS SECOND AMENDMENT TO AGREEMENT is entered into on I" clay of July,
2011, by and between Tustia Irvine Medical Group, a professional 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 Califomia ("City").
RECITALS
A. The parties entered into that certain Agreement, dated August 3,2009,(A-2009-1 10),
(hereinafter "said Agreement") by which Consultant has provided physical examination and
treatment services to all sworn Fire personnel and select Police personnel .
Q, In accordance with the terms and conditions of said Agreement, the parties wish to extend the
term of the Agreement for an additional one-year period.
WHEREFORE, in consideration orthe covenants contained in snit: Agreement, and subject to all
the terms and conditions of said Agreement, except those amended in this First Amendment to
Agreement, the parties agree as follows:
1. Section 3, "PERM, shall be amended to state as follows:
This amended Agreement shall commence on July 1, 2011 and tcrininate on June 30, 20 t2,
uniess terminated earlier in accordance with Section 12. Should the maximum agreed upon
compensation as set forth in Section 2, COMPENSATION, no, be exhausted during this
additional term this amended Agreetnent may be extended uport a writing executed by the
Fire Chief and the City Attorney.
2. Except as hereinabove amended, all terms and conditions of said Agreement shall remain in
full force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this Second Amendment to
Agreement on the date and year first written above,
ATI'EST:
MARIA D. IJUIZAR
Clerk of the Council
APPROVED AS TO FORM:
JOSFPH STR"A
ActingC %a ttorney
By:
Me is rosthwaite
Deputy City Attorney
CITY OF SANTA ANA
DAVID N. REAM
City Manager
VINE MEDICAI, GROUP
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.?c.vrciv GEIRTIFIGATE OF LIABILITY INSURANCE ovlD cs
06/07/.200111 TRU 10:17 FAX 0002/002
?RD " CERTIFICATE OF`LIABILITY INSURANCE oPID cs
11 03/22/11
THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLYANOCONFERS:NO RIGHTS UPON HE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY-OR NEGATIVELY AMEND,.EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES
BELOW. THIS CERTIFICATE OFaNSURA.NCE:DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING:IN5URER(S), AUTHORIZED
REPRESENTATIVE ORPRODUCER
, AND THE. CERTIFICATE HOLDER. _
IMPUKJ at • e:CE S'a e o an ADDITIONAL I e'pD es mus e.en OM . It -SUBRO ; s et o
the terms and conditions of the policy, ce rtat0.; policies may require an endorsement. A statement on this:ceAlRcale does not confer rights to the
certificate holder in lieu of such endorsement(s)L
PRODUCER -
Rosmos :Insurance -- COCIA -
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License tOE93671. P E r- vAIC, fie:
1913 E. 17th Street, Suite 213
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Santa Ana CA 92705. cusTONEWs' AEEVI'2.
Phone;714-972-0950 Fax:714-541-5597
_-1NSURERIS)AFk. 1mcoVIRADE _.: NAIL+_.
INSURED -- NSURERA: Oregon . Xatual Ins. Co. 14907
John G Alevizos D. 0.. Inc.
1530 °E- Edi
er Avenue #7 ,INSURERS': Oak River insurance CO
- 34630
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Santa Ana CA 92705 INSURERC: Pro aeatiw SnFUCance' C. way
INSURERO: -
INSURERS:
1PCUM RF :. .
L.uvr-HFactra GEN I IFIQATE NUMBER; - -- REVISION.. NUMBER:
THIS IS 70CERTIFY'THAT THE POLICIES OF INSURAN
INDICATEO NOTWIT.HSTMIDINOANY'REOUIRENENT,
CERTIFICATE MAY BE ISSUED 0RMAY PERTAIN; TFE I
EXCLUSIONS AND CCNDITIONS OF SUCH POLICIES. LI
LTR' TYPI:OF PIeURANCE NSW' CE -LISTEDBELOWHA IS - HE-INSURED '.'R. HE POLICY B IOD-
TERM OR'CONDITIONOFANY CONTRACT OR OTHER, DOCUMENT WITH RESPECT TO WHICH THIS
NSURANCE AFFORDED BY THE POLICIES DESCRIBEDHEREIN IS SUBJECT TO ALL THE TERMS;
MITS SHOWN IAAY HAVE9EEN REDUCED:BY PAID CLAIMS:..
POLICY NLalER' (NMIDD(YYYI) (MMIDOAYYY)
GENERAL LIABERY .ACT{ OCCJRRENCE. S2000000
A R .NERCw GENERAL UABIUTY BSP704154 DS/12/10 IDS42/1. PREMISESEaecc. a 6100000
EAMSMADE ? O=R NED EXP (Arw aN Lamar) 6 5000.
PERSONAL a ADV N. 1200000.0
R Non owned $2,000, 1 I GENERAL AGCREG1,- $4000000.-
GEA'LAG6REGATEUMRAPPLIESPER: k PRODUCTS-COMP/D-AGG 540000D.D
POLICY. JEG LOC j E
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Proof oofVN of Ur ur CoververarLVLA1?Vna 1, venlclW IRrtaCII RGORD:Tm, PeaNeMl'RrmXUSUad?e, emen apau.h rpryirl0l
age
SHOULDANY OF TNEABOVE DESCRIBEDPOLICIES BECANCELLEDBEFORE
ALEV'L2,1 TICDIPRAMNDATET!!REOF,NOTICEriLLSEDEUVEAEDIN'
ACCORDANCE RDTN THEBOLICY PROVISIONS.
John G ASevizos. D.O. Inc.
800 N. Tustin Ave., Suite A
Santa Ana CA 92705
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ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD