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PACIFIC MEDICAL CLINIC N -2012
INSURANCE ON FILE WORK MAY PROCEED N-2012-078 UNTIL INSURANCE EXPIRES l0 - 6 -X-3 CLERK OF COUNCIL DATF- JUL 1 6 ZWZ CONSULTANT AGREEMENT tv" r y THIS AGREEMENT, made and entered into this f-day of i IV-, 2012 by and between Pacific Medical Clinic, a professional corporation (hereinafter "Co sultant"), 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 (hereinafter "City"). RECITALS A. The City desires to retain a medical consultant having special skill, knowledge and expertise in the field of health services to provide comprehensive physical evaluations and related medical services. B. Consultant represents that Consultant is able and willing to provide such services to the C 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 conons hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES Consultant shall perform comprehensive pre-employment and miscellaneous physical examinations, including: a) For prospective City employees to perform the duties of the position for which they are being considered (pre-employment assessments), using pre-determined medical protocols for each job classification (such protocols may be modified by the physician, in consultation with the City's Executive Director of the Personnel Services Department, or his/her designee, as is necessary to make a determination as to suitability for employment); b) Pre-employment drug screens; c) "Reasonable Suspicion" drug and alcohol testing; d) Department of Motor Vehicles (DMV) Driver's License physical examinations; e) Fitness for Duty examinations (industrial and non-industrial), and provide reports and recommendations regarding the suitability of current employees to continue to perform their duties; f) Urine and breath specimen collection, laboratory analysis and Medical Review Officer (MRO) responsibilities; g) Department of Transportation (DOT) drug and alcohol testing, following DOT-mandated testing procedures as per 49 CFR, Part 40; such testing to include: i. Pre-Employment; ii. Pre-Assignment; iii. Random; iv. Reasonable Suspicion; and V. Post-Accident. Consultant shall maintain a current valid contract with a Substance Abuse and Mental Health Services Administration (SAM SHA)-certifled laboratory. Turn-around time from specimen collection to obtained test results shall be two (2) working days for a negative test, and five (5) working days for a positive test. 2. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services, the rates and charges identified in Exhibit A, attached hereto and incorporated by this reference. The total sum to be expended under this Agreement shall not exceed $25,000.00 during the term of this Agreement. b. Payment by City shall be made within thirty (30) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. 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 July 1, 2012 and terminate on June 30, 2013, unless terminated earlier in accordance with Section 12, below. The term of this Agreement may be extended upon a writing executed by the Executive Director of the Personnel Services Department and the City Attorney. 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. INSURANCE Prior to undertaking performance of work under this Agreement, Consultant shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. i. Consultant shall maintain commercial general liability insurance naming the City, its officers, agents, volunteers, and employees as additional insureds) and shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Consultant's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. ii. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1,000,000 per occurrence. Consultant shall supply City with a fully executed additional insured endorsement in substantially the form attached hereto as Exhibit B upon execution of this Agreement and shall be approved in form by the City Attorney. c. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the Labor Code, Consultant, if Consultant has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance. Prior to commencing the performance of the work under this Agreement, Consultant agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. d. Errors and Omissions. Consultant shall maintain professional liability (errors and omissions) insurance, with a combined single limit of not less than $1,000,000 per claim. e. The following requirements apply to the insurance to be provided by Consultant pursuant to this section: (i) Consultant shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. (ii) Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved in form by the City Attorney. (iii) Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. f. If Consultant fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the City with required proof that insurance has been procured and is in force and paid for, the City shall have the right, at the City's election, to forthwith terminate this Agreement. Such termination shall not affect Consultant's right to be paid for its time and materials expended prior to notification of termination. Consultant waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 6. INDEMNIFICATION Consultant agrees to and shall indemnify and hold harmless the City, its officers, agents, employees, consultants, 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 health, and claims for property damage, which may arise from the direct or indirect operations of the Consultant or its contractors, subcontractors, agents, employees, or other persons acting on their 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. 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. 7. CONFIDENTIALITY Consultant shall conform to all HIPAA requirements regarding examinations performed by Consultants. 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. 8. 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. 4 9. 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 telefacsimile or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Telefacsimile [Fax]: (714) 647-6956 With courtesy copies to: Executive Director of the Personnel Services Department City of Santa Ana P.O. Box 1988 Santa Ana, California 9270 1-1 98 8 Telefacsimile [Fax]: (714) 647-6930 and, City Attorney City of Santa Ana 20 Civic Center Plaza (M-29) P.O. Box 1988 Santa Ana, California 92702 Telefacsimile [Fax]: (714) 647-6515 To Consultant: Dr. Gary Linnemann, M.D. 1534 East Warner Avenue, Suite A Santa Ana, CA 92705 Telefacsimile [Fax]: (714) 557-5005 A party may change its address by giving notice in writing to the other party. Thereafter, any notice, tender, demand, delivery, or other communication shall be addressed and transmitted to the new address. If sent by mail, any notice, tender, demand, delivery, or other 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 telefacsimile, any notice, tender, demand, delivery, or other 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. 10. 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, that terms and conditions hereof, shall not bind or obligate Consultant nor 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 are not embodied herein. 11. 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. 12. 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 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. 13. DISCRIMINATION Consultant shall not discriminate because of race, color, creed, religion, sex (including gender identity and gender expression), marital status, sexual orientation and genetic characteristics (including genetic tests of the individual or the individual's family, and manifestation of a disease or disorder in the individual's family members, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in 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. 14. JURISDICTION -VENUE This Agreement and all questions relating to its validity, interpretation, performance, and enforcement shall be government and construed in accordance with the laws of the State of California. 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. 15. 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 her inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 16. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature hereinbelow 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. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: MARIA D. HUIZAR Clerk of the Council CITY OF SANTA ANA ?? ?? ?.- C PAUL M. WALTERS City Manager APPROVED AS TO FORM: SONIA R. CARVALHO City Atto ey sy: J se St a of Assistant City Attorney RECOMMENDED FOR APPROVAL: Edward S. aya ° Executive Director of the Personnel Services Department CONSULTANT r. G innemann, M.D. P c Medical Clinic Individual SS # sec( I? X ?? 3? 0-5C,6 S / (? EXHIBIT "A" (PAGE 1 OF 1) MEDICAL SERVICES PROVIDER PRE-EMPLOYMENT/MISCELLANEOUS/DOT PRICE SUMMARIES TYPE OF MEDICAL PROCEDURE ESTIMATED # OF TESTS COST PER TEST ESTIMATED COST CORE 69 $25 $1 , 725 CORE + 22 $30 $660 GROUP 1 7 $145 $1,015 GROUP 11 25 $110 $2,750 DMV 30 $25 $750 TB 105 $8 $840 CHEST X-RAY 15 $15 $225 URINE COLLECTION FEE 125 $10 $1,250 AUDIOGRAM (AS PART OF PRE-EMPLOYMENT MEDICAL 100 $8 $800 AUDIOGRAM (SEPARATE FROM PRE- EMPLOYMENT MEDICAL 50 $8 $400 BACK X-RAY 2 $30 $60 BLOOD SCREENS 15 $145 $2,175 BLOOD LEAD LEVEL 0 $85 $0 HEPATITIS B - VACCINATION 4 $50 $200 HEPATITIS B - POST VACCINATION 0 $28 $0 HEPATITIS B - BOOSTER 2 $50 $100 DOT PRE-EMPLOYMENT DRUG SCREEN 4 $25 $100 DOT RANDOM DRUG SCREEN 30 $25 $750 DOT RANDOM ALCOHOL SCREEN 10 $18 $180 DOT POST ACCIDENT D&A SCREEN 0 $0 $0 TOTAL COST: $13,980 EXHIBIT B ADDITIONAL INSURED ENDORSEMENT Insurance Company: This endorsement modifies such insurance as is afforded by the provisions of Policy # '? ?8 ? ? `t5?'S???relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regard to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the Clerk of the Council, City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) ??RD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 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 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 Ileu of such endorsement(s). PRODUCER Advanced Risk Solutions CONTACT NAME: 92980 Metcalf, Suite 490 _ _ __ _ Overland Park, KS 66293 PHOr±g 1A[?r.?•-En'I?-_ --- nic N°j=- - EJuIAIL ADDRESS: _ _ _ _ 1_NSU RER(5) AFFORDING COVERAGE NAIC R www.advancedrisksolutions.com _.__"-. ._ ______-_- __._ -..__ _- __ __ INSURER A - um ermen's Underwriting Alliance _ _ - _ ___ INSURED Emplo ers Resource Mana ement Co INSURER B --- -------- ----------- y g . - For: Pacific Medical Clinic wsulxeR c : __- ____ 9 534 East Warner Avenue,#A INSURER D "- - - --- - Santa Ana CA 92705 --- INSURER E : ___ __ INSURER F 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER -- POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYW .___- _. - --- __... ___.__--- LIMITS GENERAL LIABILITY Not Applicable EACH OCCURRENCE __ - $ XXXXXX COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED ? ? PREMISES (Ea occurrence __ _ ? ? ? - XXXXXX $___ _ _ ? CLAIMS-MADE ? OGGUR MED EXP (Any one person) $ XXXXXX PERSONAL 8 ADV INJURY $ XXXXXX __ GENERAL AGGREGATE $ XXXXXX ___ __ __ ____ GEN'L AGGREGATE LIMIT APPLIES PER: _ O PRODUCTS -COMP/OP AGG -- - - XXXXXX $ ?- POLICY PRO- LOC I lO $ XXXXXX AUT OMOBILE LIABILITY Not Applicable MBINED SINGLE LIMIT Ea accident $ _ _XXXXXX ANY AUTO ? ?O - BODILY INJURY (Pe person) -,_-, $ XXXXXX _ ALL OWNED SCHEDULED AUTOS AUTOS 1? C? _ t tT ?? e? BODILY INJURY (Pe accitlenl) - -- $ XXXXXX NON-OWNED HIRED AUTOS AUTOS • `- . • r`?? . PROPERTY DAMAGE Per acctlent $ XXXXXX __ _ J ? ? a` . - - sac = ;` - --_-_ _ $ - ---- UMBRELLA LIAR OCCUR Not Applicable EACH OCCURRENCE --' -- $ J(J(j(J(j(J( - EXCESS LIAB GLAIMS-MADE AGGREGATE - $ XXXXXX DED RETENTION $ $ XXXXXX $ XXXXXX $ XXXXXX A WORKERS COMPENSATION 424506 7/f /2012 7/9/2013 WC STATU- OTM AND EMPLOYERS' LIABILITY Y / N TORY LIMITS - _E_R_ _ ANY PROPRIETOR/PARTNER/EXECUTI V E OFFICER/MEMBER EXCLUDED? ? N / A E.L. EACH ACCIDENT _____ $ 1,000,000 (Mandatory In NH) es escnbe untler E.L. DISEASE - EA EMPLOYEE $ _1 00? QQQ y , DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ ? ,000,QQ() DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach AC ORO 101, Additional Remarks Schedule, if more space Is requlretl) THIS CERTIFICATE CONFERS NO ADDITIONAL INSURED RIGHTS UPON THE CERTIFICATE HOLDER. Only the co-employees of Pacific Medical Clinic ? 534 East Warner Avenue,#A Santa Ana CA 92705, but not subcontractors of: Pacific Medical Clinic Waiver of subrogation applies for workers' compensation in favor of City of Santa Ana SPEC 04-042 CERTIFICATE HOLDER CANCELLATION 040695 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Purchasing Division M-96 ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza Santa Ana CA 92702 AUTHORIZED REPRESENTATIVE y?/? ?J/ ?i T / Robert M Ga ne ©'1988-20'10 ACORD CORPORATION. All rights reserved. ACORD 25 (20'10/05) The ACORD name and logo are registered marks of ACORD CLI(1 NU 133S021S .]ill NP.V ti/1S/2012 B'90.00 LM L?.3ge? l of 1 COOPERATIV`F OF A1?IERICAN PHYSICIANS CERTIFICATE OF COVERAGE Covera<e t6roagh Deoetnber 31, 2012 Member: Gary A. Linnemann, MD Address: 1534 E WatnerAve SteA Santa Ana, CA 92705-5420 This oeniflcale confima [hat on the date below, the above-tuuned physician is a member of the Cooperative of American PhYSicians, lttc. (CAP) and a participant in the Mrnual Protection Trust (MPT). MPT is an unincorporated interindemnity arrangement organimd under California Itssutartce Code section 1280.7. This ccnifiCate confers no rights upon the member and does not amend, extend or alter ehc coverage afrorded under the terms, tbnditions and exclusions of the MPT Agreement. IlMmbsrahlp Number 13895 Madleal Speeblty Occupational Medicine COVMps Oats April 1, 2004 R?troaCLw Gowrsya Dates June 1, 1993 9ubapaclalty Famiy Medicine, With Minor Surgery Covsrapa (Clslms made and paid) Currsrtt Llmlta of LWDllay 51,000,000 for all Claims based Medical Professional Liability Coverage upon an Occurrence 53,000,000 each caltmdar year aggregate The member moat remain a Member in good standing or arrange for Tail Coverage for any open or potemiel Claim that may erase during the Coverage Period. Neither CAP nor MPT undertake any obligation to advise any party, other than the named member, of any changes to or termination of this coverage. Cooperative of American Physicians, Inc. Hammon P. Acune Yce President, Membership Services Mutual Pfoiection Trust . O FARM `' 4 i AY RO"? ? a v :. aKs ?,.: ,i:g A?orneY Assist'' Date November 17, 207 1 ''? l^? (?'' 1 -E? r V_ - r ? 7-' ?? '``` °? °® CERTIFICATE OF LIABILITY INSURANCE 6i2;;2o1' 2 "' 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 ba endorsed. If SUBROGATION IS WANED, 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 Ifeu of such endorsemerrt(si. PRODUCER CONTACT Teresa Cr112 2NSIIRANCE 30LIIT10NS PNONE (949) 346-7400 F'0`X (949)348-2373 License #0746539 E?uIAIL .t:erQSaC®].aB-SOlut].OaB.COm D 33302 va 110 Rd, Su1te: 200 INSURERS AFFORDING COVERAGE NA San Juan Capistrano CA 92675 INSURERA AIILCO Snsur anca Co 19: INSURED INSURER B DR GARY A L2NNIIKANN 1!?SD INSURER C 1534 E WATZ>v>.R AVE STE A INSURER D - INSURER E - SANTA ANA CA 92705-5475 INSURERF- COVERAGES CFRTIFICATG IJI IMCe Cta-l 2 /T i 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 TR TYPE OF INSURANCE POLICY NUMBER POLIp EFF POLICY EXP LIMITS GENERAL LULBILITY EACH OCCURRENCE $ 1, 000, 000 X COMMERCIAL GENERAL LIABILITY p I N g 300. 000 A CLAIMS-MADE X?OCCVR CP7671675916 /6/2012 6/6/2013 MED EXP (An one person) $ 5,000 PERSONALS ADV INJURY $ Sr 000, 000 GENERAL AGGREGATE $ 2, 000 r 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2 r 0 0 O , 0 00 X POLICY PRO LOC $ AUT OMOBILE LIABILRY COMBINtlEDISINGLE LIMI 1 000 000 A ANV AUTO BODILY INJURY (Par person) $ ALL OWNED AUTOS SCHEDULED AUTOS CP7671H 75918 6/6/2012 6/6/2013 BODILY INJURY Per accident ( ) $ X HIRED AUTOS X NON-0WNED AUTOS PROPERTY DAMAGE P r accld t $ UMBRELLA LIAB OGCVR EACH OCCURRENCE $ EXG E33 LIAB CLAIMS-MADE ? v?? AGGREGATE $ ?I DED RETENTION $ g WO RKERS COMPENSATON WG STATU- OTH- AND EMPLOYERS' IJABILJTY ?? Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE a t? OFFICER/MEMBER EXCLUDED'! ? N / A b ?? EL. EACH ACCIDENT $ M nd t M NH ?ep ? ? ( a a ory ) ? E.L. DISEASE - EA EMPLOYE $ If 3, tlascTiba Untlef d DESCRIPTION OF OPERATIONS below ta E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Adtlitlonal Remarks Schedule, R more space Is required) The City o£ Santa Aaa, its ot:ficara, amployaea, agents and voluateara era named as additional insured par the Comtnarcial General Liability Coverage Form CG 00 OS 12 07 attached to the policy. MICelleyc?s ante-ann. org City o£ Santa Ana 20 Civic Center Plaza Santa Ana, CA 92702 25 (2010/05) 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 REPRE3ENTATVE T Alassaadra/PHTERS ? ?- _ ©'1988-20'10 ACORD CORPORATION- All rights reserved. r.??- 1' r? V\ INSn2s Inn,nnc, n, The erriwn .,?...e and L.r. r, ire ror?:vte.erl m?r?a n4 AC!-ll?ll Additional Named Insureds Other Named Insureds PACIFIC MEDICAL CLSNIC Doing Business A5 OFAPPINF (02/2007) _ _ COPYRIGHT 2007, AMS SERVICES INC ADDITIONAL COVERAGES Ref # Description Non-owned Coverage Code NOWND Form No. Edition Date Limit 1 1,000,000 Limit 2 Limit 3 Deductibte Amount Deductible Type Premium $41.00 Ref # Description Hired Auto Coverage Code HRDBB Form No. Edition Date Limit 1 1,000,000 Limit 2 Limit 3 Deductible Amount Deductible Type Premium $41.00 Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductlble Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit Limit 2 Limit 3 Deductible Amount Deductible Type Premium Ref # Description Coverage Code Form No. Edition Date Limit 1 Limit 2 Limit 3 Deductible Amount Deductible Type Premium OFADTLCV Copyright 2001, AMS Services, Inc. (b) Conduct and control the defense of the indemnitee in such "suit". So long as the above conditions are met, attor- neys' fees incurred by us in the defense of that in- demnitee, necessary litigation expenses incurred by us and necessary litigation expenses incurred by the indemnitee at our request will be paid as Supplementary Payments. Notwithstanding the provisions of Paragraph 2.b.(2) of Section I - Cov- erage A -Bodily Injury And Property Damage Li- ability, such payments will not be deemed to be damages for "bodily injury" and "property damage" and will not reduce the limits of insurance. Our obligation to defend an insured's indemnitee and to pay for attorneys' fees and necessary litiga- tion expenses as Supplementary Payments ends when we have used up the applicable limit of in- surance in the payment of judgments or settle- ments or the conditions set forth above, or the terms of the agreement described in Paragraph f. above, are no longer met. SECTION II -WHO IS AN INSURED 1. If you are designated in the Declarations as: a. An individual, you and your spouse are insur- eds, but only with respect to the conduct of a business of which you are the sole owner. b. A partnership or joint venture, you an= an in- sured. Your members, your partners, and their spouses are also insureds, but only with re- spect to the conduct of your business. c. A limited liability company, you are an insured- Your members are also insureds, but only with respect to the conduct of your business. Your managers are insureds, but only with respect to their duties as your managers. d. An organization other than a partnership, joint venture or limited liability company, you are an insured- Your "executive officers" and directors are insureds, but only with respect to their du- ties as your officers or directors. Your stock- holders are also insureds, but only with respect to their liability as stockholders. e. A trust, you are an insured. Your trustees are also insureds, but only with respect to their du- ties as trustees- CG 00 01 12 07 2. Each of the following is also an insured: a. Your "volunteer workers" only while performing duties related to the conduct of your business, or your "employees", other than either your "executive officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, none of these "em- ployees" or "volunteer workers" are insureds for. (1) "Bodily injury" or "personal and advertising injury": (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited li- ability company), to a co-"employee" while in the course of his or her em- ployment or performing duties related to the conduct of your business, or to your other "volunteer workers" while perform- ing duties related to the conduct of your business; (b) To the spouse, child, parent, brother or sister of that co-"employee" or "volun- teer worker" as a consequence of Para- graph (1)(a) above; (c) For which there is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1)(a) or (b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. (2) "Property damage" to property: (a) Owned, occupied or used by, (b) Rented to, in the care, custody or con- trol of, or over which physical control is being exercised for any purpose by you, any of your "employees", "volunteer workers", any partner or member (if you are a partnership or joint venture), or any mem- ber (if you are a limited liability company). CG 0001 1207 Page9of16 CG 00 01 12 07 b. Any person (other than your "employee" or "volunteer worker', or any organization while acting as your real estate manager. c. Any person or organization having proper temporary custody of your property if you die, but only: (1) With resped to liability arising out of the maintenance or use of that property; and (2) Until your legal representative has been appointed. d. Your legal representative if you die, but only with respect to duties as such. That represen- tative will have all your rights and duties under this Coverage Part. 3. Any organization you newly acquire or form, other than a partnership, joint venture or limited liability company, and over which you maintain ownership or majority interest, will qualify as a Named In- sured if there is no other similar insurance avail- able to that organization. However: a. Coverage under this provision is afforded only until the 90th day after you acquire or form the organization or the end of the policy period, whichever is earlier; b. Coverage A does not apply to "bodily injury" or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal and advertising injury" arising out of an offense committed before you acquired or formed the organization. No person or organization is an insured with resped to the condud of any current or past partnership, joint venture or limited liability company that is not shown as a Named Insured in the Declarations. SECTION 111 -LIMITS OF INSURANCE 7. The Limits of Insurance shown in the Declarations and the rules below fix the most we will pay re- gardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits"_ 2. The General Aggregate Limit is the most we will pay for the sum of: a. Medical expenses under Coverage C; b. Damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "produds-completed operations hazard"; and c. Damages under Coverage B. 3. The Produds-Completed Operations Aggregate Limit is the most we will pay under Coverage A for damages because of "bodily injury" and "property damage" included in the "produds-completed op- erations hazard". 4_ Subjed to Paragraph 2. above, the Personal and Advertising Injury Limit is the most we will pay un- der Coverage B for the sum of all damages be- cause of all "personal and advertising injury" sus- tained by any one person or organization. 5. Subjed to Paragraph 2. or 3. above, whichever applies, the Each Occurrence Limit is the most we will pay for the sum of: a_ Damages under Coverage A; and b_ Medical expenses under Coverage C because of all "bodily injury" and "property dam- age" arising out of any one "occurrence". 6_ Subjed to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under Coverage A for damages because of "property damage" to any one premises, while rented to you, or in the case of damage by fire, while rented to you or temporarily occupied by you with permission of the owner. 7_ Subjed to Paragraph 5. above, the Medical Ex- pense Limit is the most we will pay under Cover- age Cfor all medical expenses because of "bodily injury" sustained by any one person. The Limits of Insurance of this Coverage Part apply separately to each consecutive annual period and to any remaining period of less than 12 months, starting with the beginning of the policy period shown in the Declarations, unless the policy period is extended after issuance for an additional period of less than 12 months. In that case, the additional period will be deemed part of the last preceding period for purposes of determining the Limits of Insurance. SECTION IV -COMMERCIAL GENERAL L1.4BILITY CONDITIONS 1. Bankruptcy Bankruptcy or insolvency of the insured or of the insured's estate will not relieve us of our obliga- tions under this Coverage Part. 2. Duties In The Everrt Of Occurrence, Offense, Claim Or Suit a_ You must see to it that we are notified as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent pos- sible, notice should include: (1) How, when and where the "occurrence" or offense took place; (2) The names and addresses of any injured persons and witnesses; and Page 1 O of 16 CG 00 01 12 07 CG 00 01 12 07 (3) The nature and location of any injury or 4. Other Insurance damage arising out of the "occurrence" or If other valid and collectible insurance is available offense. to the insured fora loss we cover under Cover- b. If a claim is made or "suit" is brought against ages A or B of this Coverage Part, our obligations any insured, you must: are limited as follows: (1) Immediately record the specifics of the a. Primary Insurance claim or "suit" and the date received; and This insurance is primary except when Para- (2) Notify us as soon as practicable. graph b. below applies. If this insurance is pri- You must see to it that we receive written no- mary, our obligations are not affected unless tice of the claim or "suit" as soon as pradica- any of the other insurance is also primary. ble. Then, we will share with all that other insur- c. You and any other involved insured must: ance by the method described in Paragraph c. (1) Immediate) send us co y pies of any de- below. b. Excess Insurance mands, notices, summonses or legal pa- pers received in connection with the claim (1) This insurance is excess over: or "suit"; {a) Any of the other insurance, whether (2) Authorize us to obtain records and other primary, excess, contingent or on any information; other basis: (3) Cooperate with us in the investigation or (i) That is Fire, Extended Coverage, settlement of the claim or defense against Builder's Risk, Installation Risk or the "suit"; and similar coverage for "your work"; (4) Assist us, upon our request, in the en- (ii) That is Fire insurance for premises forcement of any right against any person rented to you or temporarily occu- or organization which may be liable to the pied by you with permission of the insured because of injury or damage to owner; which this insurance may also apply. (iii) That is insurance purchased by you d_ No insured will, except at that insured's own to cover your liability as a tenant for cost, voluntarily make a payment, assume any "property damage" to premises obligation, or incur any expense, other than for rented to you or temporarily occu- first aid, without our consent. pied by you with permission of the 3. Legal Action Against Us owner; or No person or organization has a right under this (iv) If the loss arises out of the mainte- ' " Coverage Part: nance or use of aircraft, autos or watercraft to the extent not subject to a. To join us as a party or otherwise bring us into " " Exclusion g. of Section 1 -Coverage a suit asking for damages from an insured; or A -Bodily Injury And Property Dam- b. To sue us on this Coverage Part unless all of age Liability. its terms have been fully complied with. (b) Any other primary insurance available to A person or organization may sue us to recover on you covering liability for damages aris- an agreed settlement or on a final judgment ing out of the premises or operations, or against an insured; but we will not be liable for the products and completed operations, damages that are not payable under the terms of for which you have been added as an this Coverage Part or that are in excess of the ap- additional insured by attachment of an plicable limit of insurance. An agreed settlement endorsement. means a settlement and release of liability signed (2) When this insurance is excess, we will have by us, the insured and the claimant or the claim- no duty under Coverages A or B to defend ant's legal representative. the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit". If no other insurer de- fends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. CG 00 01 12 07 Page 11 of 16 CG 0001 1207 (3) When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (b) The total of all deductible and self- insured amounts under all that other in- surance_ (4) We will share the remaining loss, if any, with any other insurance that is not de- scribed in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Method OF Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer con- tributes equal amounts until it has paid its ap- plicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits- Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. 5. Premium Audit a. We will compute all premiums for this Cover- age Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as ad- vance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. c. The first Named Insured must keep records of the information we need for premium computa- tion, and send us copies at such times as we may request. 6. Representations By accepting this policy, you agree: a. The statements in the Declarations are accu- rate and complete; b. Those statements are based upon representa- tions you made to us; and c. We have issued this policy in reliance upon your representations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this in- surance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part, those rights are transferred to us. The in- sured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expi- ration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V -DEFINITIONS 1. "Advertisement" means a notice that is broadcast or published to the general public or specfic mar- ket segments about your goods, products or ser- vices for the purpose of attracting customers or supporters. For the purposes of this definition: a. Notices that are published include material placed on the Internet or on similar electronic means of communication; and b. Regarding web-sites, only that part of a web- site that is about your goods, products or ser- vices for the purposes of attracting customers or supporters is considered an advertisement. 2. "Auto" means: a. A land motor vehicle, trailer or semitrailer de- signed for travel on public roads, including any attached machinery or equipment; or b. Any other land vehicle that is subject to a com- pulsory or financial responsibility law or other motor vehicle insurance law in the state where it is licensed or principally garaged. However, ^auto" does not include "mobile equip- ment". Page 72 of 16 CG 00 01 12 07