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HomeMy WebLinkAboutWESTERN MEDICAL CENTER OF SANTA ANA (WMC-SA) (2) - 2012,1JORK '4 - lh,?li ' ,1?l?ZlJ/Z CLERk 1 OkTE 49 A-2012-028 THIS first amendment is entered into this 1st day of March, 2012 by and between WMC-SA, Inc., a California corporation DBA Western Medical Center Santa Ana (hereinafter "Provider"), 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 Provider having special skill and knowledge in providing medical pharmaceuticals to paramedic vans in need of restocking. B. Provider represents that Provider is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Provider represents that it is knowledgeable in its field and that any services performed by Provider under this Agreement will be performed in compliance with such standards as may reasonably be expected from a professional 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 Provider shall keep each paramedic unit in full supply of medical pharmaceuticals. 2. COMPENSATION a. City agrees to pay, and Provider agrees to accept as total payment for its services, the rates and charges identified in Exhibit A. The total sum to be expended under this Agreement shall not exceed $40,000.00, annually, 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 authorize and cover activities undertaken starting March 1, 2012 and shall terminate on March 1, 2013, unless terminated earlier in accordance with Section 12, below. The parties agree that the term of this Agreement may be renewed for two successive one-year periods upon a writing executed by the Fire Chief and City Attorney, for City, and the CEO for Provider. I Z Z d S I b"M Z I OZ 4. INDEPENDENT CONTRACTOR Provider 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 Provider performs the services which are the subject matter of this Agreement; however, the services to be provided by Provider shall be provided in a manner consistent with all applicable standards and regulations governing such services. Provider 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, Provider shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Provider shall maintain commercial general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insured(s) 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 Provider's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. 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. Provider 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. b. Reserved. c. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the Labor Code, Provider, if Provider 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, Provider agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. d. Professional liability (errors and omissions) insurance, with a combined single limit of not less than $1,000,000 per claim. -2- e. The following requirements apply to the insurance to be provided by Provider pursuant to this section: (i) Provider 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 Provider 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 effect Provider's right to be paid for its time and materials expended prior to notification of termination. Provider 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 Provider agrees to and shall indemnify and hold harmless the City, its officers, agents, employees, consultants, special counsel, and representatives from liability 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 Provider 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. The Provider 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 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 If Provider receives from the City information which due to the nature of such Information is reasonably understood to be confidential and/or proprietary, Provider 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 -3- of the Provider disclosed in a publicly available source; (c) is in rightful possession of the Provider without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Provider without reference to information disclosed by the City. 8. CONFLICT OF INTEREST CLAUSE Provider 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. 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 (714) 647-6956 With courtesy copies to: Fire Chief City of Santa Ana 1439 S. Broadway (M-80) Santa Ana, California 92702 telefacsimile (714) 647-5779 and City Attorney City of Santa Ana 20 Civic Center Plaza (M-29) P.O. Box 1988 Santa Ana, California 92702 telefacsimile (714) 647-6515 To Provider: Western Medical Center 1001 North Tustin Santa Ana, California 92705 telefacsimile (714) 953-3613 Attn: Dan Brothman -4- A party may change its address by giving notice in writing to the other party. Thereafter, any other 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 telefacsimile, 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 Provider, 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 Provider. 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 Provider 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 Provider, Provider 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, Provider shall be entitled to receive and the City shall pay Provider compensation for all services performed by Provider prior to receipt of such notice of termination. However, payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 13. DISCRIMINATION Provider shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other -5- employment related activities. Provider 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 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 Provider 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. Provider 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. -6- IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: MARIA HUIZA) Clerk of the Council CITY OF SANTA ANA: PAUL M WALTERS Interim City Manager APPROVED AS TO FORM: JOSEPH ST ,AkA Acting C. Ay tto y 13 : '? Meliss . rost w it Deputy City Attorney RECOMMENDED FOR APPROVAL PROVIDER WESTERN MEDICAL CENTER DAVID THOMAS Fire Chief D BROTHMAN CEO Tax ID# 55-0883862 EXHIBIT B ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company This endorsement modifies such insurance as is afforded by the provisions of Policy # 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 insured ("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 insured. 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 insured, 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 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.) Effective, Policy # Issued to , this endorsement form as a part of Name Insured Countersigned by Authorized Representative -8- AC"RUF CERTIFICATE OF LIABILITY INSURANCE /YYYY) DATE5/2011 zo1 04/05/2011 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 lieu of such endorsement(s). PRODUCER CONCT NAME:TA Marsh Risk & Insurance Services FAX PHONE 4695 MacArthur Court, Suite 700 (AC. Nol: (949) 399-5800 IIAAIL A RESS: License #0437153 PRODUCER Newport Beach CA 92660 , 113206-CAS-11-12 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A : Columbia Casualty Company 31127 Western Medical Center t d H lth ldi I H I Lexington Insurance Company INSURER B : 19437 egrate ea care o ngs, nc. n 1301 North Tustin Avenue INSURER C : Philadelphia Insurance Company 23850 Santa Ana, CA 92705 INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: LOS-001128122-08 REVISION NUMBER: 3 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 ADDL CY EFF POLICY EXP L TYPE OF INSURANCE POLICY NUMBER MM/D LIMITS A GENERAL LIABILITY HMU 2097477891-4 04/01/2011 04/01/2012 EACH OCCURRENCE $ X RETED A E O oc COMMERCIAL GENERAL LIABILITY P EM S S a currence $ CLAIMS-MADE FTIOCCUR MED EXP (Anyone person) $ X Healthcare CLAIMS MADE PERSONAL & ADV INJURY $ Professional Liab 3-8-05 GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ SEE BELOW POLICY PRO LOC $ C AUT OMOBILE LIABILITY PHPK702938 0410112011 04/01/2012 COMBINED SINGLE LIMIT $ 1,000,000 X (Ea accident) ANY AUTO -'- BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS $ $ A X UMBRELLA LIAB X OCCUR HMU 2097477891-4 04/0112011 0410112012 EACH OCCURRENCE $ 10,000,000 Excess LIAB X excess of $2,000,0001$10,000,000 10 000 000 CLAIMS-MADE SIR P f i l Li bilit & GL AGGREGATE , , $ DEDUCTIBLE ro ess ona a y SIR $ See Left X RETENTION RETRO DATE 3-8-05 $ WORKERS COMPENSATION W C STATU- OTH- AND EMPLOYERS' LIABILITY FEL_ Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B EXCESS UMBRELLA 6796942 04/01/2011 04/01/2012 Each Occurrence 15,000,000 RETRO 3-8-05 Aggregate 15,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES ARE INCLUDED AS ADDITIONAL INSUREDS WHERE REQUIRED BY WRITTEN CONTRACT. ,-r-m I IriL A I e CLERK OF THE CITY COUNCIL CITY OF SANTA ANA 20 CIVIC CENTER PLAZA (M-30) PO BOX 1988 SANTA ANA, CA 92702-1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services John Graef ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26 (2009/09) The ACORD name and logo are registered marks of ACORD Santa Ana Fire Department 1439 South Broadway Street Santa Ana, CA 92707 (714) 647-5700 Pricing from Western Medical Center Santa Ana Pharmacy February 2012 Item Description OLD AWP 2011 AWP 2012 NEW AWP + 10% Adenosine 6mg/2ml vial 7.92 13.14 14.45 Albuterol 3 mL (2.5 mg) Unit Dose Box/25 0.88 1.25 1.38 Amiodarone 450mg/9ml vial 19.80 5.25 5.77 Atropine Vial 1 mg / 1 ml 1.45 2.50 2.75 Atropine Syringe 1 mg 10 ml (Prefilled) 4.80 4.80 5.28 Bacitracin Zinc Oint 1/32oz Unit Dose 0.17 0.12 0.13 Chemstrip Blood Sugar Bottle 25 / bottle 62.04 60.65 66.72 Dextrose 50% Syringe, 50 ml 25 gm 7.20 7.20 7.92 Diphendydramine Prefilled Syringe 50mg/ml 1.47 1.47 1.62 Diphendydramine 50mg/ml vial 0.98 3.30 3.63 Dopamine 400 mg / 5 ml vial 3.92 4.06 4.47 Epinephrine Vial 1-1000 2.02 2.02 2.22 Epinephrine Syringe 1-10,000 short (prefilled) 4.79 4.79 5.27 Epinephrine 1-1000 (1 mg / ml) 30m1 vial 8.40 8.40 9.24 Glucagon 1 mg / 1 ml vial 96.00 120.00 132.00 Glucose Solution 10 oz / 100 gm 2.80 2.80 3.08 Lidocaine Syringe 100 mg / 5 ml (prefilled) 4.80 4.80 5.28 Narcan Syringe 2 mg / 2 ml vial 20.34 20.34 22.37 Narcan 0.4 mg ml-IOml vial 44.71 51.60 56.76 Nitroglycerine Spray Gr 1/150 182.76 175.00 192.50 Normal Saline 10ml vial 0.77 0.77 0.85 Sodium Bicarbonate 44.6 meq / 50 ml vial 1.02 1.02 1.12 Zofran 4mg ODT #30 Pack xxxxxxx xxxxxxxx 15.00 A?RD? CERTIFICATE OF LIABILITY INSURANCE 04!005/20151201 DATDD/VYYn 1 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 lieu of such endorsement(s). PRODUCER M h Ri k & I CONTACT N ME: ars s nsurance Services PHONE 4695 MacArthur Court, Suite 700 aC No): (949) 399-5800 E-MAIL AD RES : License #0437153 PRODUCER Newport Beach CA 92660 , 113206-CAS-11-12 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A : Columbia Casually Company 31127 Western Medical Center Inte rated Healthcare Holdin s Inc Lexington Insurance Company INSURER B : 19437 g g , . 1301 North Tustin Avenue INSURER C : Philadelphia Insurance Company 23850 Santa Ana, CA 92705 INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: LOS-001128122-08 REVISION NUMBER: 3 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 ADDL SUBR Y EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD LIMITS A GENERAL LIABILITY HMU 2097477891-4 04/01/2011 04101/2012 EACH OCCURRENCE $ X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY - PREMISES Ea occurrence $ X CLAIMS-MADE I I OCCUR MED EXP An one person) $ X Healthcare CLAIMS MADE PERSONAL & ADV INJURY $ Professional Liab 3-8-05 GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ SEE BELOW POLICY PRO LOC $ C AUT OMOBILE LIABILITY PHPK702938 04/01/2011 04/01/2012 COMBINED SINGLE LIMIT $ 1,000,000 X (Ea accident) ANY AUTO BODILY INJURY (Per person) $ ALLOWNEDAUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ $ A X UMBRELLA LIAB X OCCUR HMU 2097477891-4 04/0112011 04101/2012 EACH OCCURRENCE $ 10,000,000 EXCESS I X excess of $2,000,000/$10,000,000 ' L AB CLAIMS-MADE SIR P f i l L bili AGGREGATE 10,000,000 $ DEDUCTIBLE ro ess ona ia ty & GL SIR $ See Left X RETENTION RETRO DATE.3-8-05 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFIC M NIA E. L. EACH ACCIDENT $ ER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ B EXCESS UMBRELLA 6796942 04/01/2011 04/01/2012 Each Occurrence 15,000,000 RETRO 3-8-05 Aggregate 15,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, If more space Is required) THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES ARE INCLUDED AS ADDITIONAL INSUREDS WHERE REQUIRED BY WRITTEN CONTRACT. CLERK OF THE CITY COUNCIL CITY OF SANTA ANA 20 CIVIC CENTER PLAZA (M-30) PO BOX 1988 SANTA ANA, CA 92702-1988 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh Risk & Insurance Services John Graef ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26 (2009/09) The ACORD name and logo are registered marks of ACORD Santa Ana Fire Department 1439 South Broadway Street Santa Ana, CA 92707 (714) 647-5700 Pricing from Western Medical Center Santa Ana Pharmacy February 2012 Item Description OLD AWP 2011 AWP 2012 NEW AWP + 10% Adenosine 6mg/2m1 vial 7.92 13.14 14.45 Albuterol 3 mL (2.5 mg) Unit Dose Box/25 0.88 1.25 1.38 Amiodarone 450mg/9ml vial 19.80 5.25 5.77 Atropine Vial 1 mg / 1 ml 1.45 2.50 2.75 Atropine Syringe 1 mg 10 ml (Prefilled) 4.80 4.80 5.28 Bacitracin Zinc Oint 1/32oz Unit Dose 0.17 0.12 0.13 Chemstrip Blood Sugar Bottle 25 / bottle 62.04 60.65 66.72 Dextrose 50% Syringe, 50 ml 25 gm 7.20 7.20 792 Diphendydramine Prefilled Syringe 50mg/ml 1.47 1.47 1.62 Diphendydramine 50mg/ml vial 0.98 3.30 3.63 Dopamine 400 mg / 5 ml vial 3.92 4.06 4.47 Epinephrine Vial 1-1000 2.02 2.02 2.22 Epinephrine Syringe 1-10,000 short (prefilled) 4.79 4.79 5.27 Epinephrine 1-1000 (1 mg / ml) 3 Oml vial 8.40 8.40 9.24 Glucagon 1 mg / 1 ml vial 96.00 120.00 132.00 Glucose Solution 10 oz / 100 gm 2.80 2.80 3.08 Lidocaine Syringe 100 mg / 5 ml (prefilled) 4.80 4.80 5.28 Narcan Syringe 2 mg / 2 ml vial 20.34 20.34 22.37 Narcan 0.4 mg ml-10ml vial 44.71 51.60 56.76 Nitroglycerine Spray Gr 1/150 182.76 175.00 192.50 Normal Saline IOH vial 0.77 0.77 0.85 Sodium Bicarbonate 44.6 meq / 50 ml vial 1.02 1.02 1.12 Zofran 4mg ODT #30 Pack xxxxxxx xxxxxxxx 15.00