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HomeMy WebLinkAboutFORENSIC NURSE SPECIALIST, INC.-2013INSURANCE; ON FILE WORK MAY PROCEED N-2014 -455 UNTIL INSURANCE EXPIRES 4 -// f v CLERK OF COUNCIL MAY Q Z 2014 DATE: CONSULTANT AGREEMENT FAA D C _Z) THIS AGREEMENT, made and entered into this 1 st day of November, 2013 by and between Forensic Nurse Specialists, Inc., a California Corporation (hereinafter "Consultant "), and the City of Santa Ana, a charter city and municipal corporation organized and existing under CNP the Constitution and laws of the State of California (hereinafter "City "). RECITALS A. The City desires to retain a consultant having special skill and knowledge in the field of conducting child abuse evidence collection examinations, These examinations are done by a County of Orange specified vendor (Consultant) at the County of Orange CAST facility. 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 fellows: SCOPE OF SERVICES Consultant shall perform on -call child, abuse evidence collection examinations at the request of Santa Ana Police Department staff at the County of Orange CAST facility and shall document the evidence and their medical findings in a report. 2. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services 5650 per examination. The total sum to be expended under this Agreement shall not exceed $8,333 for each of the three (3) years of the Agreement for a total Agreement amount not to exceed $25,000.00. 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 the date first written above and continue for a three (3) year period which terminates on October 31, 2016, rmless terminated earlier in accordance with Section 12, below. 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 Agreerent 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. Contractor 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 Contractor'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. Contractor shall supply City with a fully executed additional insured endorsement upon execution of this Agreement and shall be approved in form by the City Attorney. b. 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. c. Professional liability (errors and omissions) insurance specifically covering medical services, with a combined single limit of not less than $1,000,000 per claim. d. 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. e. 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 effect 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 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. 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. 7. 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. 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. 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 facsimile 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 Fax (714) 647 -6956 With courtesy copies to: and City of Santa Ana Police Department Attention: Chief of Police 60 Civic Center Plaza (M -97) P.O. Box 1981 Santa Ana, California 92702 Fax (714) 245 -8090 City Attorney City of Santa Ana 20 Civic Center Plaza (M -29) P.O. Box 1988 Santa Ana, California 92702 Fax (714) 647 -6515 To Consultant: Malinda Wheeler Forensic Nurse Specialists, Inc. P.O. Box 2273 Los Alamitos, CA 90720 Fax (562) 431 -3947 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 facsimile, 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, the 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 either party upon thirty (30) days written notice of termination to the other party. 13. DISCRIMINATION Consultant shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 14. JURISDICTION - VENUE This Agreement and all questions relating to its validity, interpretation, perfonnance, and enforcement shall be governed 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, continuing education, 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. HUJZAR Clerk of the Council CITY OF SANTA ANA �a DA D A AZO City Manager APPROVED AS TO FORM; SOMA R, CARVALHO City Attorney Laura A. Rossini Senior Assistant City Attorney RECOMMENDED FOR APPROVAL; CARLOSROJAS CONSULTANT Malinda Wheeler Forensic Nurse Specialists, Inc. ACORD M CERTIFICATE OF LIABILITY INSURANCE . DAT040212014YYY) PRODUCER Phone: (714)901 -3494 Fax: (714)9013495 BEACHVIEW INSURANCE BROKERAGE 5011 ARGOSY AVENUE #15 HUNTINGTON BEACH CA 92649 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED By THE POLICIES BELOW. POLICY NUMBER POLICY EFFECTIVE DATE MMIDO POLICY E %PIRATION DATE MMIOOIYY INSURERS AFFORDING COVERAGE NAIC # A enc Lic #: OG47892 GENERAL LIABILITY INSURED INSURER A: General Casualty Insurance 06/04114 FORENSIC NURSE SPECIALIST, INC. 3373 Cerritos Avenue INSURER B: X INSURER C: $ 300,000 Los Alamitos, CA 90720 INSURER D: COMMERCIAL GENERAL LIABILITY CLAIMSMADEF7 OCCUR INSURER E: 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADD ITT INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDO POLICY E %PIRATION DATE MMIOOIYY LIMITS GENERAL LIABILITY CFB1058360 06/04/13 06/04114 EACH OCCURRENCE $ 2,000,000 X DAMAGET —RENTED PREMISES( a occurenca) $ 300,000 COMMERCIAL GENERAL LIABILITY CLAIMSMADEF7 OCCUR MED. EXP(Anyone person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 A GENERAL AGGREGATE $ 4,000,000 GENLAGGREGATE LI MIT APPLIES PER POLICY PRO LOG ECT PRODUCTSAOMP /OP AGO. $ 4,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO ALL OWNED AUTOS A W APPROV D p S TO FO %/'MOaA AC n141rc A1WA (Ea accident) $ BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS NON -OWNED AUTOS a �d���l . Ropsysini (err accident) $ 55ns��ffii City At torn PROPERTY DAMAGE Peraccitlenq $ GARAGE LIABILITY AUTO ONLY m EAACCIDENT $ THAN EA ACC $ ANVAUTO $ AUTO ON AUTO ONLY AGG EXCESS / UMBRELLA LIABILITY OCCUR 1-1 CLAIMS MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WCSTATU- OTHER TORY uMITs E.L. EACH ACCIDENT $ ANY PROPRIETOMPARTNERIE%ECUTIVE OFFICEWMEMBER EXCLUDED? Byes, describe under E.L. DISEASE -EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER: DESCRIPTION OF OPERATIONS /LOCATIONSIVEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Certificate holder is named as an additional insured per the attached 154875 endorsement. Waiver of sub also applies in favor of certificate holder per attached form SP 0497 CERTIFICATE HOLDER r.ANOPI I ATInN City of Santa Ana 60 Civic Center Plaza Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. AUTHORIZED REPRESENTATIVE Attention: a j`°r° / Donna MICy�phers ACORD 25 (200VU8) certificate # 9667 ©ACORD CORPORATION 1988 COMMERCIAL GENERAL LIABILI NONCONTRACTOR'S ADDITIONAL INSUREDS ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART TY), A. WHO IS AN INSURED (Section II) is amended to include as an insured any person or organization (called additional insured) described in Paragraphs A.I. through A.8. below whom you are required to add as an additional insured on this policy under a written contract or written agreement; but the written contract or written agreement must be currently in effect or becoming effective during the term of this policy; executed prior to the "bodily injury", "property damage" or "personal injury and advertising Injury ", but this paragraph does not apply to any additional insured more specifically identified elsewhere in the policy, ADDITIONAL INSURED - STATE OR POLITICAL SUBDIVISIONS - PERMITS A state or political subdivision subject to the following provisions: a. A state or political subdivision is an additional insured only with respect to the following hazards for which the state or political subdivision has issued a permit in connection with premises you own, rent, or control to which this insurance applies: (1) The existence, maintenance, repair, construction, erection, or removal of advertising signs, awnings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoistaway openings, sidewalk vaults, street banners, or decorations and similar exposures; or (2) The construction, erection, or removal of elevators; or (3) The ownership, maintenance, or use of any elevators covered by this insurance. b. A state or political subdivision is an additional insured only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit, This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed by or for you for the state or political subdivision. 2. ADDITIONAL INSURED -CONTROLLING INTEREST Any person or organizations with a controlling interest in you but only with respect to their liability arising out of: a. Their financial control of you; or b. Premises they own, maintain or control while you lease or occupy these premises. This insurance does not apply to structural alterations, new construction and demolition operations performed by or for such additional insured. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, 154375 1207 Includes copyrighted material of Insurance Services Office. Inc., with its permission. Page 1 of 3 3, ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES A manager or lessor of premises but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the premises leased to you and subject to the following additional exclusions: This insurance does not apply to; a. Any "occurrence" which takes place after you can cease to be a tenant in that premises: or b. Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. 4. ADDITIONAL INSURED - MORTGAGEE, ASSIGNEE OR RECEIVER A mortgagee, assignee or receiver but only with respect to their liability as mortgagee, assignee or receiver and arising out of the ownership, maintenance, or use of a premises by you. This insurance does not apply to structural alterations, new construction or demolition operations performed by or for such additional insured. S. ADDITIONAL INSURED - OWNERS OR OTHER INTERESTS FROM WHOM LAND HAS BEEN LEASED An owner or other Interest from whom land has been leased by you but only with respect to liability arising out of the ownership, maintenance or use of that specific part of the land leased to you and subject to the following additional exclusions: This insurance does not apply to: a. Any "occurrence" which takes place after you cease to lease that land; or b. Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. 6. ADDITIONAL INSURED - CO -OWNER OF INSURED PREMISES A co -owner of a premises co -owned by you and covered under this Insurance but only with respect to the cc- owners liability as co -owner of such premises. 7. ADDITIONAL INSURED - LESSOR OF LEASED EQUIPMENT Any person or organization from whom you lease equipment. Such person or organization are insured only with respect to their liaiblity arising out of the maintenance, operation or use by you or equipment leased to you by such person or organization. A person's or organization's status as an insured under this endorsement ends when their contract or agreement with you for such leased equipment ends. With respect to the insurance afforded these additional insureds, the following additional exclusions apply: This insurance does not apply: a. To any "occurrence" which takes place after the equipment lease expires; or b. To "bodily injury" or "property damage" arising out of the sole negligence of such additional insured. Any insurance provided to an additional insured designated under Paragraphs A.1. through A.B. above does not apply to "bodily injury" or "property damage" included within the "products- completed operations hazard." Page 2 of 3 154875 1207 8. ADDITIONAL INSURED -VENDORS Any "vendor ", but only with respect to "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business, subject to the following additional exclusions: 1. The insurance afforded the vendor does not apply to: a. 'Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the vendor would have in the absence of the contract or agreement; b. Any express warranty unauthorized by you; c. Any physical or chemical change in the product made intentionally by the vendor; d. Repackaging, except when unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instructions from the manufacturer, and then repackaged in the original container; e. Any failure to make such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products; f. Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises in connection with the sale of the product; g. Products which, after distribution or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or h. 'Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However, this exclusion does not apply to: (1) The exceptions contained in Sub - paragraphs d. or f.; or (2) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. 2. This Insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. B. As respects the coverage provided under this endorsement, Paragraph 4.b.(3.) SECTION IV - COMMERCIAL GENERAL LIABILITY CONDITIONS is added; 4.16.(3.) This Insurance is excess over any other insurance covering the additional insured as an insured whether primary, excess, contingent or on any other basis, unless a written contract or written agreement specifically requires that this insurance be either primary or primary and noncontributing. 154875 1207 Page 3 of 3 Policy Number, A0946 -12_09 Date Entered: Odlis/2ni is AC"R C i'IFICAT O LIABILITY INSURANCE I , /Iq r,YYY, d / r'. /7Rt .i 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 polley(tes) 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 Ilan of such endorsoment(s ). PRODUCER Koissian InsTxr nca Agency, Ina, 11602 Knott St. Suite $4A Garden Grove, Cis 92841 Y7 {StJ. )CO%96ianin3UX'aiACB. CAA% CONTACT MAME `° PHONE (714)901 -5400 x,(714)901 -5 -5008 EdL nkoissian @men, cam wuss: &�B)AFFOIitHiiG.COVERE ; NhICd _fNSiIRt INSURERA: MIA-CEt1"$URY iN5t1TI7tNCB CCt @flt7Y I 1REn FORENSIC NURSE SPECIALISTS, INC. 3378 CERRI'TOS AVL, LOS .ALAMITOS, CA 90720 INSURER a: INSURER C:"` wSUaEa O: w$IfRER P: � CUVERAUFS CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAAFID CLAIMS, LTR t TYPEOFINSURANCE .� LNSR O POLICY NUMBER I a3 E%P UNITS GENERALLUUILITY t�UdEiiCA4t GENERAL LWaatTY CIJUMSidARE ❑ OCCUR APPROVED AS �.,RUCW A. TO FO ®SSiH1A lvi � EACH OCCURRENCE 5 PREARRES a ^curTexca S M W EXP am ) 5 PERaaNALaADVeuvaY 5 _ GENt AGGRECiATEUMtAFFVCSPMJ � F-1 PaICY I—I PRO- F-1 La: rMT GENERALAGGRFGATE PROOVCTS- C[XAPANa AG4 S 5 DR.E LVIMUTY ANY AUTO O!h23EO SCHEDULED TOS AUTOS EDAUTiS A� En A58Y5$M➢1$ CD$�' $$OT'Y1C GISSIHIhEO Tti<` I I}�tisfT� Esc s FS'JOILY R13lfRV (PerPxsen} S WIHLY ENlURY (P$r aisHav} Is FRQP 5 R:A URELLAUAH OCCUR ESS LIAR CEAIIA^ -MODE U RETCNIM $ EACH CCCURRENCZ S AGGREGATE 5 S COMPENSATION LOYERS` LIAB R.ITY EkrExECUrsvE Y� tMF R ENMU W2 "{ mEL �` WOMOP9+AMMs RIA A.0946 -12 -09 X!2/2Gta /2/2015 � . . T UM ED MI SE -EA EMPLOYEE S1 440 „044 ELF- rxxecY Uxnr 51 004.400 OESCRn*notlofoPEhnnmuslLacanaNS )VEHICLES tAHSCnacaROInI. AVdIIwr�IRemawu $P>%awwllnxea.as�tsreywr�et SHOULD ANY OF THE ABOVE DESCRIBED FOUCES BE CANCELLED BEFORE CITY OF SANTA ANA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 60 CIVIC CZNTBR PLAZA ACCORDANCE WITH THE POLICY PROVIS IONS. SANTA ANA, CA 92701 _ .........,. ACORD 25 (2010146) The ACORD name and logo are registered marks of ACORD ir�a FamsEmsP§axse.KUw,Fsxm�vsx &YSZiXL19Ti Producer Branch Prefix 018098 970 HPG Named Insured and Address: Melinda J Wheeler Po Box 2273 Los Alamitos, CA 90720 -7273 HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP Certificate of Tottrance OCCURENCE POLICY FORM Policy Number 0583424467 Medical Specialty: Code: Pediatric /Neonatal /Fam Practice Nurse Practit 80965 Print Date: 4/14/2014 mnso i Policy Period from 02/13/14 to 02113/15 at 12:01 AM Standard Time Program Administered by: Nurses Service Organization 159 E. County Line Road Hatboro, PA 1 9040 -1 21 8 1- 800 -247 -1500 www. nso. com Insurance is provided by: American Casualty Company of Reading, Pennsylvania 333 S. Wabash Avenue, Chicago, IL 60604 Excludes Cosmetic Procedures Professional Liability $1,000,000 each claim $ 6,000,000 aggregate Your professional liability limits shown above include the following: • Good Samaritan Liability . Malplacement Liability Personal Injury Liability • Sexual Misconduct Included in the PL limit shown above subject to $ 25,000 aggregate sublimit Coverage Extensions License Protection Defendant Expense Benefit Deposition Representation Assault Includes Workplace Violence Counseling Medical Payments First Aid Damage to Property of Others Information Privacy (HIPAA) Fines and Penalties Workplace Liability Workplace Liability Fire & Water Legal Liability Personal Liability Total: 3 1,133.00 Base Premium $1,133.00 $ 25,000 per proceeding $ 25,000 aggregate $ 1,000 per day limit $ 25,000 aggregate $ 10,000 per deposition $ 10,000 aggregate $ 25,000 per incident $ 25,000 aggregate $ 25,000 per person $ 100,000 aggregate $ 10,000 per incident $ 10,000 aggregate $ 10,000 per incident $ 10,000 aggregate $ 25,000 per incident $ 25,000 aggregate Included in Professional Liability Limit shown above Included in the PL limit shown above subject to $150,000 aggregate sublimit $1,000,000 aggregate ORM - :Kn,irlft� YI, Premium reflects Self Employed , Full Time 1,aura A. Rossini A.5istant City [Attorney Policy Forms & Endorsements(Please see attached list for a general description of many common policy forms and endorsements.) G- 121500 -D G- 121503 -0 GSL15564 GSL15565 GSL3908 GSL19904 G- 121501 -C1 G- 145184 -A GSL17101 GSL13424 G- 147292 -A GSL15563 G- 123846 -D04 GSL3886 Keep this document in a safe place. It and proof of payment are your proof coverage. There is no coverage in force unless the premium is paid in full. In order Chairman of the Board Secretary to activate your coverage, please remit emium in full b the effective date of V Y this Certificate of Insurance. Master Policy # 188711433 G- 141241 -B (03/2010) Coverage Change Date: Endorsement Change Date: ACORD CERTIFICATE OF LIABILITY INSURANCE TM. DATOSO92o 4vvY) PRODUCER Phone: (714) 9013494 Fax: (714) 901 -3495 BEACHVIEW INSURANCE BROKERAGE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 5011 ARGOSY AVENUE #15 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR HUNTINGTON BEACH CA 92649 POLICY NUMBER INSURERS AFFORDING COVERAGE NAIC # /V o I y" 0 S Agency Laid OG47892 GENERAL LIABILITY INSURED INSURERA: General Casualty Insurance 06104115 FORENSIC NURSE SPECIALIST, INC. INSURER 8: DAMAGE TO RENTED PREMISES Ea occursrce 3373 Cerritos Avenue Los Alamitos, CA 90720 INSURER C: INSURER D: INSURER E: MED. EXP (Any one person) $ 10,000 COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD' INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDI POLICY EXPIRATION DATE MMIDDIW LIMITS GENERAL LIABILITY CFB1058360 06/04/14 06104115 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES Ea occursrce $ 300,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR MED. EXP (Any one person) $ 10,000 PERSONAL B ADV INJURY $ 2,000,000 A GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMPADPAGG. $ 4,000,000 PRO- POLICY JECT LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per person) $ BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANYAUTO AUTO ONLY: AGO $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR 11 CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY we TORY srnro- OTHER LIMITS C.L. EACH ACCIDENT $ %ECUTIVE ANYCERTMEMBER E. L. DISEASE -EA EMPLOYEE $ XCLUDEE oFPlcewmemaere ExcwpeDT If PROVISIONS mmw E.L. DISEASE - POLICY LIMIT $ OTHER: DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Certificate holder is named as an additional insured per the attached 154875 endorsement. Waiver of sub also applies in favorAf�Certificate holder per attached form SP 0497 0 - . -o rA 6k!�� (J `= ry� CERTIFICATE HOLDER CANCELLATION City of Santa Ana 60 Civic Center Plaza SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. Santa Ana, CA 92701 Attention: AUTHORIZED REPRESENTATIVE yl]'c- -,°��� `-' Doi_ non M.CCyyphers ACORD 25 (2001108) Certificate # 9884 © ACORD CORPORATION 1988 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s) (Additional Insured): Location(s) of Covered Operations: All persons or organizations as required by written contract with insured. A. SECTION II - WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" casued, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: Additional Insured Contractual Liability "Bodily injury" or "property damage" for which the additional insured(s) are obligated to pay damages by reason of the assumption of liability in a contract or agreement. Finished Operations or Work "Bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization. Negligence of Additional Insured "Bodily injury" or "property damage" arising directly or indirectly out of the negligence of the additional insured(s). ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U156 -0310 Includes copyrighted material of ISO Properties, Inc., Page 1 of 1 with its permission. Insured OA Z) CYT ��- 1 BUSINESSOWNERS BP 70 84 11 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - WHEN REQUIRED BY WRITTEN AGREEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM Paragraph C. Who is an insured in Section II — Liability A. Is amended to include as an additional insured any person or organization when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional in- sured only with respect to liability for "bodily injury", "property damage" or "personal and advertising in- jury' caused, in whole or in part, by your acts or omissions or the acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing opera- tions; or 2. In connection with your premises owned or rented to you. B. The limits of insurance applicable to the additional Insured are those specified in the Declarations of this Policy or in the written contract, whichever is lower. These limits of insurance are inclusive of and not in addition to the limits of insurance shown in the Declarations. C. Any coverage provided hereunder shall be ex- cess over any other valid and collectible insur- ance available to the additional insured whether that insurance is primary, excess, contingent or on any other basis, unless you and the additional insure have specifically agreed in a written con- tract or written agreement that this insurance be primary. When coverage is provided on a primary basis we will not seek contribution from any other insur- ance available to the additional insured if a written contract or written agreement requires that this insurance be noncontributory. D. All other terms and conditions of this policy re- main unchanged. Includes copyrighted material of Insurance Services Office, Inc., BP 70 84 11 09 with its permission. 01JID Page 1 of 1 FlexBiz® BUSINESSOWNERS BP 04 97 01 06 IIf:1F� 1261* -W lI: 4►`1d10UlI[c]11`.E Us] 4L�]'A1 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Name Of Person Or Or anization: Blanket as per written contract Information required to complete this Schedule, if not shown above,will be shown inthe Declarations. Paragraph K, Transfer Of Rights Of Recovery Against Others To Us in Section II — Common Policy Conditions is amended by the addition of the following: We waive any right of recovery we may have 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 "your work" done under a contract with that person or organization and included inthe "products- completed operations hazard ". This waiver applies only to the person or organization shown in the Schedule above. BP 04 97 01 06 © ISO Properties, Inc., 2004 CV) -Vu Page 1 of 1