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HomeMy WebLinkAboutCARE AMBULANCE SERVICES INC. (2012-196-02)MAYOR jTVVEpe h Miguel . PUlido MAYOR PRO TEM Vicente Sarmiento COUNCILMEMBERS Angelica Amezcua P. David Benavides Michele Martinez Roman Reyna Sal Tinalero INSURANCE l)N FILL WORK MAY PROCEED UNTIL INSURANCE EXPIRE:, DATE�W'A4 August 11, 2016 CITY OF SANTA ANA FINANCE AND MANAGEMENT SERVICES AGENCY 20 Civic Center Plaza M-17 . P.O. Box 1988 Santa Ana, California 92702 714.647.5420 www santa-ana oro Troy Hagen, Chief Executive Officer CARE Ambulance Service, Inc. 1517 W. Braden Court Orange, CA 92868 A-2012-196-02 Re: Agreement A-2012-196, Agreement for EMS Emergency Transportation Services — 2nd Extension Dear Mr. Hagen, Pursuant to Agreement A-2012-196 ("Agreement'), entered into between CARE Ambulance Service, Inc. ("Contractor") and the City of Santa Ana ("City"), dated September 17, 2012, Section 5 "Term", the time period of said Agreement is hereby extended for one (1) additional year. In accordance with the provisions of Seotion 5 (c) of the Agreement the City's decision to grant an extension has been made with the concurrence of the Orange County Fire Authority. The term of this extension shall begin 12 a,m. on September 20, 2016 and end on 12 a.m. September 20, 2017. The insurance certificates required pursuant Section 8 of the Agreement shall be required to be extended and/or renewed to cover this extension. All other terms and conditions of said Agreement remain unchanged and in full force and effect. If you have any questions regarding this matter, please contact Willard Holt, Treasury and Customer Services Manager in the Finance and Management Services Agency at 714-647-5456. Sincerely, Francisco Gutierrez Executive Director Finance & Management Services APPROVED AS TO FORM: Sonia R. Carvalho City Attorney ty: Laura Rossini Senior Assistant City Attorney c: Clerk of the Council 2L - CIT SAN A ANA David Cavazos City Manager ATTEST: i. Marta D. Huizar Clerk of the Council CAREAM CE SERVICE, INC. By: �-- Name: T06y Hagen Title: Chief Executive Officer SANTA ANA CITY COUNCIL Miguel A. Pulido Vicente Sarmiento Michele Marl Angelica Am zona P. David eenavidee Roman Reyna Sal rnajero Mayor Mayor Pro Tem, Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 mnulid0�saola-a0a.oftl VSafnelt0®saotfl-Bna.or(1 nmarl nY.Z/GiSaola-ana oftl aameicuar(eaaow-aftlzcm naV tlesf�Santa-arte nr9 rceyna(7O9anla-and 0!U eCn2 UeiOlSanta-dO0 W4 FALCUSA•01 CHOUDHARIAV elC'C>/T[7 CERTIFICATE OF LIABILITY INSURANCE ("-'� -� DATE 121'121DDn Yn 1 211 212 01 6 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 INSURERB), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy los) 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 Willis Of Seale Inc. C/0 26 CantUy lVd P.O. Box 30581 Nashville, TN 37230.6191 CONTACT Willis Certificate Center .7876 FAAICX No): 688) 467.2378 Rcwlllis.com INSURORIBI AFFORDING COVERAGE NgIC N INSURER A: COVOrYS Specialty Insurance Company INBUREO ___15686 INSURER B:GreenwichInsurance Company 22322 INSURER C: Steadfast Insurance Company 26387 Care Ambulance Services, Inc. INSURERO:XL Insurance America Inc. 24664 1517 West Braden Court Orange, CA 92868 INSURER E: INSURER F: X COVERAGES CERTIFICATE NUMBER! REVISION NIIMRER- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUEDTO THE INSURED NAMEDABOVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOROTHER DOCUMENTWITH RESPECTTO WHICHTHIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL TFIETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE AD4 WVD DR POLICY NUMBER MMIDOIVYPW MMil"olm LIMITS A X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS -MADE ® OCCUR X 5.10013 1010112015 10/01/2016 _ERETO R6FflE�� EPId SES,LEkq._Yenca 5 10p,000 X Products -Claims Made MED EXP (Any one person $ 6,000 PER_SON_AL&ADV INJURY $ Included _ GEN'L AGGREGATE LIM IT APPLIES PER: X POLICY ❑ JECT ❑ LOC GENERAL AGGREGATE 5 2,000,000 PRODUCTS - COMP/OP AGO $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT G nt $ 1,000,000 BODILY INJURY In., person) S B X ANY AUTO X RAD5000476 10/0112016 10101/2016 AUTOS SCHEDULED NON -OWNED HIREDAUTOS AUTOS BODILY INJURY (Par accident) 'T $UT PROPERTY DAMAGE (ear accident)_ S — UMBRELLA LIAR Xj OCCUR EACH OCCURRENCE $ 15,000,000 AGGREGATE % 16,000,000 C X EXCESS LIAR CAMS -MAGE X UMB 6414770.02 10/01/2016 10/01/2016 DED RETENTION$ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY VIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFIOERIMEMBER EXCLUDE09 (Mandatary In NH) NIA RWD3000956 10101/2015 10/01/2016 X PER T - TATUTE _ ER_ EL. EACH ACCIDENT S 1,000,000 E, L. DISEASE - EA EMPLOYEE $ 1,000,000 Ifyyes describe under 1) SdRIPTION OF OPERATIONS below I I I E.L. DISEASE -POLICY LIMIT 3 1,000,000 _ A Mise Medical Prof. 510013 10101/2015 10/01/2018 See Attached DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may W reached if more apace Is requital) THIS VOIDS AND REPLACES PREVIOUSLY ISSUED CERTIFICATE DATED 1112412015 UmbrolialExcess Follows Form. The City of Santa Ana and OCFA, and their respective officers, officials, employees, representative and volunteers are Included as Additional Insureds per Contract or Agreements with the City of Santa Ana in accordance with the policy provisions of the General Liability, Automobile Liability, and UmbrolialExcess Liability policies. The Policies evidanced herein are Primary and Non -Contributory to other insurance available to Additional Insureds, but only in accordance with the policy's provisions. Excess coverage of $15,000,000 applies as Excess coverage over Commercial General Liability, Products; Medical Professional Liability and Automobile Liability coverage. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE /A Pw? r THE EXPIRATION THE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. i "5 AUTHORIZED REPRESENTATIVE The City of Santa Ana and OC FA l�.P[ �'%�I f/ 655 E. Memory Lane I / �`'fl ,I (,t,�L,� Sonata Age - CA 92702 I // 6 ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD ADDITIONAL COVERAGE SCHEDULE COVERAGE LIMITS POLICY TYPE: Mise Medical Professional Liability Claims Made CARRIER: Coverys Specialty Insurance Company $1,000,000 Per Claim POLICY TERM: 10101/2016 —110101/2016 $2,000,000 Aggregate POLICY NUMBER: 5.10013 $1,000,000 Abuse & Molestation APPROVED COVER,Y e INSURANCE COMPANY AMENDMENT TO THE DEFINITION OF INSURED Attached fo and Porming part of policy Number: First Named Insured: Policy Period: 5 10013 I Feick USA, Inc.; Care Ambulance Services 10/1/2015 —10/1/016 policy Number: First Named Insured: Policy Perlod: Effective Date of Change: 5-1 tl013 Falck USA, Inc.; Care Ambulance Services 10/1/2015-10/1/016 I—_10/1/2016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: ,orn,mefcial Qderal;L"_tabllltyefage Par(, SQceuTrence Gove,'rag 6F 61 SCHEDULE Name of Person or Party to (If Retroactive Date Activities Organization applicable) (It applicable) The City of Santa Ana and n/a n/a Ambulance service as described in contract OCFA; its officers, employees, agents, volunteers and representatives Subject to all other terms and conditions of the POLICY, it Is agreed and understood that Section Il. Definition of Insured is amended to include as an INSURED the Person(s) or Organization(s) shown in the Schedule above, but only with respect to the activities indicated above. This additional insured shall share In the Limits of Liability of the FIRST NAMED INSURED, and this extension of coverage shall not increase OUR Limit of Liability. We agree to notify the Named Person or Organization in writing at least thirty (30) days in advance of cancellation of this policy. Nothing in this endorsement shall vary, alter, waive or extend any of the terms and conditions of the POLICY, other than as expressly stated above. Sam Mezzich Richard G. Hayes President Treasurer APPROVED POLICY NUMBER: RAD5000476 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured; FALCK USA, INC. Endorsement Effective Date; October 1, 2015 SCHEDULE Name Of Person(s) Or Organization(s): Where required by written contract executed prior to loss, Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.I. of Section II — Covered will be shown in Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section 1 — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 1013 C Insurance Services Office, Inc., 2011 AP ROVE LIJ 11 Page 1 of 1