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HomeMy WebLinkAboutCALIFORNIA FORENSIC PHLEBOTOMY-2017INSURANCE NOT ON FILE A-2017-337 WORK MAY NOT PROCEED CLERK OF COUNCIL DATE: JAN Q S 2019 AGREEMENT TO PROVIDE BLOOD DRAWING s A?P CO AND EVIDENCE CUSTODIAN SERVICES Lt � rMa.r�idluei9. THIS AGREEMENT is made and entered into this 21st day of November, 2017 by and between, California Forensic Phlebotomy ("CFP" or "Contractor"), 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 C City"}. RECITALS A. The City desires to retain a Contractor having special skill and knowledge hi the field of drawing blood on a routine and continual basis for the Santa Ana Police Department. CFP is the Sole Source blood draw and evidence custodian for all law enforcement agencies in the County of Orange, B. Contractor represents that Contractor is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Contractor represents that it is knowledgeable in its field and that any services performed by Contractor 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 patties agree as follows: SCOPE OF SERVICES Contractor shall perform during the term of this Agreement, the tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately complete the drawing of blood on a routine and continual basis and evidence custodian for the Santa Ana Police Department as set forth in Exhibit A, attached hereto raid. incorporated herein by reference. 2. COMPENSATION a. The total amount to be expended under this Agreement shall not exceed $84,000. 'fbe City agrees to pay, and Contractor agrees to accept a. rate of $107 per draw. b. Payment by City shall be made within 45 days (forty-five) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work which fails to mect the standards of performance set forth in the Recitals which may reasonably be expected by City. Page I of 9 3. TERM This Agreement shall commence on the date first written above and continue for a one year period until November 20, 2018, unless terminated earlier in accordance with Section 16, below. 4. PREVAILING WAGES Contractor is aware of the requirements of California Labor Code Section 1720, et seq., and 1770, et seq., as well as California Code of Regulations, Title 8, Section 16000, et seq., ("Prevailing Wage Laws'), which require the payment of prevailing wage rates and the performance of other requirements on "public works" and "maintenance" projects. If the services being performed are part of an applicable "public works" or "maintenance" project, as defined by the Prevailing Wage Laws, and the total compensation is $1,000 or more, Contractor agrees to fully comply with such Prevailing Wage Laws. Contractor shall defend, indemnify and hold the City, its elected officials, officers, employees and agents free and harmless from any claim or liability arising out of any failure or alleged failure to comply with the Prevailing Wage Laws. 5. INDEPENDENT CONTRACTOR Contractor shall, during the entire term of this Agreement, be construed to be ail 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 Contractor performs the services which are the subject matter of this Agreement; however, the services to be provided by Contractor shall be provided in a manner consistent with all applicable standards and regulations governing such services. Contractor 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. 6. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy, use, modify, reuse, or sublicense any and all copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible mediurn of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Contractor under this Agreement ("Documents & Data"). Contractor shall require all subcontractors to agree in writing that City is granted a non-exclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Contractor represents and warrants that Contractor has the legal right to license any and all Documents & Data. Contractor makes no such representation and warranty in regard to Documents & Data which were provided to Contractor by the City. City shall not be limited in any way in its use of the Documents and Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. Page 2 of 9 7. INSURANCE Prior to undertaking performance of work under this Agreement, Contractor 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, with $2,000,000 in the aggregate. Such insurance shall (a) name the City, its officers, employees, agents, and representatives as additional insured(s); (b) be primary and not contributory with respect to insurance or self-insurance programs maintained by the City; and (c) contain standard separation of insureds provisions. b. Business automobile liability insurance, or equivalent form, with a combined single limit of not less than $1,000,000 per occurrence. Such insurance shall include coverage for owned, hired and non -owned automobiles. C. Worker's Compensation Insurance. In accordance with the provisions of Section 3700 of the Labor Code, Contractor, if Contractor 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, Contractor agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. d. If Contractor is or employs a licensed professional such as an architect or engineer: Professional liability (errors and omissions) insurance, with a combined single limit of not less than $1,000,000 per claim with $2,000,000 in the aggregate, e. The following requirements apply to the insurance to be provided by Contractor pursuant to this section: i. Contractor 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 by the City. 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. iv. Contractor shall supply City with a fully executed additional insured endorsement. f. If Contractor 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 Page 3 of 9 election, to forthwith terminate this Agreement. Such termination shall not affect Contractor's right to be paid for its time and materials expended prior to notification of termination. Contractor waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 8. INDEMNIFICATION Contractor agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, contractors, 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 death, and claims for property damage, which may arise from the negligent operations of the Contractor, its subcontractors, agents, employees, or other persons acting on its 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. The Contractor 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. Notwithstanding the foregoing, to the extent Contractor's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Contractor. 9. INTELLECTUAI. PROPERTY INDEMNIFICATION Contractor shall defend and indemnify the City, its officers, agents, representatives, and employees against any and all liability, including costs, for infringement of any United States' letters patent, trademark, or copyright infringement, including costs, contained in the work product or documents provided by Contractor to the City pursuant to this Agreement. 10. RECORDS Contractor shall keep records and invoices in connection with the work to be performed under this Agreement. Contractor shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three (3) years, or for any longer period required by law, from the date of final payment to Contractor under this Agreement. All such records and invoices shall be clearly identifiable. Contractor shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours. Contractor shall allow inspection of all Page 4 of 9 work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Contractor under this Agreement. 11. CONFIDENTIALITY If Contractor receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Contractor 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 infonnation that (a) has been disclosed in publicly available sources; (b) is, through no fault of the Contractor disclosed in a publicly available source; (c) is in rightful possession of the Contractor without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Contractor without reference to information disclosed by the City. 12. CONFLICT OF INTEREST CLAUSE Contractor 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. 13. DISCRIMINATION Contractor 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. Contractor affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 14. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Contractor, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terns 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 Contractor. 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 Contractor or 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 is not embodied herein. Page 5 of 9 15. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Contractor, Contractor 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 Contractors retained by City. 16. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Contractor shall be entitled to receive and the City shall pay Contractor compensation for all services performed by Contractor 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 Contractor to deliver to the City all work product(s) completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Contractor 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. 17. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 18. 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. 19. PROFESSIONAL LICENSES Contractor 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. Contractor shall notify the City immediately and Page 6 of 9 in writing of its inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 20. MISCELLANEOUS PROVISIONS a. Each undersigned represents acid warrants that its signature herein below 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. 21. 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 fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Cleric 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: Chief of Police Sonia R. Carvalho City of Santa Ana City Attorney 20 Civic Center Plaza (M-xx) City of Santa Ana P.O. Box 1988 20 Civic Center Plaza (1\4-29) Santa Ana, California 92702 P.O. Box 1988 Fax: Santa Ana, California 92702 Fax: 714- 647-6515 To Contractor: Califoinia Forensics Phlebotomy 27762 Antonio Parkway Suite 9L1-647 Ladera Ranch, CA 92694 Attn: Russ Liedholm Page 7 of 9 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 fax, 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. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: l qntp Mara i. Huzar Cleric of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney W�� By: Tamara Bogosian Assistant City Attorney RECOMMENDED FOR APPROVAL: aA-VM ALENTIN Acting Chief of Police CITY OF SANTA ANA Raul Godine City Manager CALIFORNIA FORENSICS PHLEBOTOMY, INC.: Russ Liedholm Presiden a IL 1' Tax ID# Page 8 of 9 EXHIBIT A SCOPE OF SERVICES California Forensic Phlebotomy, Inc. www,californ laforensicphl ebotomy.com SCOPE OF WORK 27762 Antonio Parkway, Suite L1-647 Ladera Ranch, CA 92694 24 Hour Technician Response (714) 529-0515 Administration (949) 309-2459 Fax (949) 203-2133 cvc23158@aol.com Contractor to provide employees who shall remain available on an on -call basis at all times, seven (7) days per week, twenty-four (24) hours per day, three hundred sixty five (365) a year, and agree to said employees to conduct tests identified in the City agreement, as requested. Locations for taking of blood samples shall include, but not limited to: Santa Ana Police Department, local hospitals, Orange County Jail field locations in and around the City of Santa Ana. Contractor to provide related employees to appear and conduct requested tests within forty-five (45) minutes of such request. Contractor to provide twenty-four (24) access to a supervisor to remedy any problems or questions that may arise. Contractor to provide medical supplies and equipment necessary to conduct tests at no cost to the City. Contractor to provide transportation for employees at no cost to the City. Contractor's employees, upon request of the City and/or the Orange County District Attorney, shall appear in court or any other designated location, at no additional cost, for the purpose of discussion or testimony concerning collecting of samples, Contractor's said employees agree to appear in court at the time designated by the City and/or the Orange County District Attorney. The City and/or the District Attorney will provide at least two (2) hours' notice to such appearance. In addition to applicable laws, all blood sample collection and subsequent handling shall be conducted in accordance with direction and procedures prescribed by the Orange County Sheriff Department Forensic Sciences Services Division. Only employees of the Contractor, deemed acceptable by the City, hereunder shall perform services; the City will refuse to permit blood samples to be collected by any employee of Contractor considered, by the City in its sole discretion, to be unacceptable. All blood samples shall be refrigerated immediately and deposited by the Contractor at the County of Orange's refrigerated blood locker within (6) hours of withdrawal. Contractor to provide at Contractor's expense, supplies necessary to ensure that blood samples are properly refrigerated as directed by the Orange, County Sheriff Department Forensic Science Services Division. CALIFOR-01 RROYC (MMID,a►coRU' DA12111/2 Y017 21117 CERTIFICATE OF LIABILITY INSURANCE 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 have ADDITIONAL INSURED provisions or 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 endorsements . PRODUCER License # 0596796 CONTACT NAME Fullerton Insurance Service, Inc. P.O. BOX 4054 Fullerton, CA 92834-4054 A- Z.o (, - 33 7 PHONE FAX AIc, No, El): (714) 577-5800 A/C, No : 714 447-0011 E-MAIL , rec@fullertoninsurance.com INSURERS AFFORDING COVERAGE NAIC IF INSURER A, Evanston Insurance Co. 35378 INSURED INSURER B:Midwest Employers Casual Co. 2 612 INSURER C: California Forensic Phlebotomy Inc. INSURER D 27762 Antonio Pkwy, Ste Li-647 Ladera Ranch, CA 92694 INSURER E INSURER F: rnVPRAr:F1R CERTIFICATE IdHMRFR• RFVISION NUMRER- 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X I COMMERCIAL GENERAL LIABILMY CLAIMS -MADE �X OCCUR Prof Liab- Claims Me X SM922977 11/1712017 11117/2018 EACH OCCURRENCE 2,000,000 DR AGETOEMISESERENTEonOQ.ur 90,000 X MED EXP (my onePerson) 5,()00 PERSONAL &ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 0 PRC LOG OTHER: GENERAL AGGREGATE 3,000,000 PRODUCTS - COMP/OP AGG 1,000,000 PROF LIAB AGG 3,000,000 A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTEO�S ONLYNAUTOS Ep X AUTOS ONLY WPM SM922977 11/17/2017 1111712018 COMBINED SINGLE LIMIT (Ea accident)$ 1,0 =0 0 BODILY INJURY PerPerson) $ BODILY INJURY Per accident $ PerOacc Eant AMAGE $ ++- UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS.MADE EACH OCCURRENCE $ AGGREGATE DED RETENTIONS B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY V� QAQN�V PROPRIETOR/ EXCLUDED? plandatory 1. NN) EXCLUDED? WH es,de%dbe Under D CR PT N ERATIONS below NIA BNUWC0138098 10/01/2017 10101/2018 X I PERTUT I I ETRH- E.L. EACH ACCIDENT 11000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DIS E-POL CV LIMIT 11000,000 DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be allached If more space is required) City of Santa Ana, its officers, employees, agents, volunteers and representatives are Included as additional insureds. Coverage is primary and n contributory. y Santa Ana Police Department I Chiefs Office Leo Martinez M-97 60 Civic Center Plaza Santa Ana, CA 92702 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 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD III POLICY NUMBER: SM922977 MA (EL EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT - GENERAL LIABILITY REQUIRE BY CONTRACT This endorsement modifies insurance provided under the following: SPECIFIED MEDICAL PROFESSIONS GENERAL LIABILITY INSURANCE COVERAGE PART In consideration of the premium paid, it is hereby understood and agreed that the policy is amended as follows: 1. Section The Insured is amended by the addition of the following: Whenever used in this Coverage Part, the unqualified word Insured shall also mean Additional Insured. 2. Additional Insured means, whenever used in this endorsement, the following: Any organization that the Insured is required to include under the policy as an Additional Insured by a written contract or written agreement in effect during this policy period and executed prior to the 'occurrence ofthe'bodily injury' or'property damage.' 3. Coverage provided to any Additional Insured as defined herein shall apply solely to an Occurrence or offense involving the products, goods, operations or premises covered by this Coverage Part. 4. No coverage shall be afforded to the above Additional Insured for Bodily Injury, Property Damage, Personal Injury or Advertising Injury to any Employee or to any obligation of the Additional Insured to indemnify another because Damages arising out of such injury. 5. In the event that the Limits of Insurance provided by this policy exceed the Limits of Insurance required by the written contract orwritten agreement, the insurance provide by this endorsement shall be limited to the Limits of Insurance required by the written contract or written agreement. This endorsement shall not increase the Limits of Insurance shown in the Declarations pertaining to the coverage provided herein. 5. Where no coverage shall apply herein for the Named Insured, no coverage or defense shall be afforded to the above Additional Insured. 6. The person or organization is only an additional insured with respect to liability arising out of'yourwork' or'your product.' 7. In accordance with the terms and conditions of the policy and as more fully explained in the policy, as soon as practicable, each additional insured must give the Company prompt notice of any act, error or omission which may result in a claim, forward all legal papers to the Company, cooperate in the defense of any actions, and otherwise comply with all the policy's terms and conditions. Failure to comply with this provision may, at the Company's option, result in the claim or suit being denied All other terms and conditions remain unchanged. Manuscript-1 Page 1 of 2 8. The Additional Insured and the Named Insured shall be represented by the same lawyer unless such mutual representation is prohibited by law or bay any applicable professional code of conduct. 9. This insurance shall be primary and non-contributory insurance. All other terms and conditions remain unchanged. Manuscript-1 Page 2of2 SUPPLEMENTAL INSURANCE CHECKLIST TO: CLERK OF THE COUNCIL OFFICE31 r FROM: CONTRACT ADMINISTRATOR: cm�(. Cra- t EXT.: 30 NAME OF CONSULTANT/ PARTY: Ca I&or6iA 47:�fmslc, PhlebotDm AGREEMENT NUMBER (IF APPLICABLE): A-2.0 14-337 Please review the insurance section of the agreement to ensure all necessary certificates of insurance are submitted to the Clerk's Office. Please provide ALL documents listed to fully execute the agreement and avoid payment delay to the vendor. Please check all boxes below that apply to your agreement. BUSINESS AUTOMOBILE LIABILITY NON -OWNED ❑ HIRED 0 ❑ 0 OWNED ❑ GENERAL LIABILITY ❑ PROFESSIONAL LIABILITY ❑ WORKER'S COMPENSATION[] ❑ REVISED: 9/19/2018 CALIFOR-01 LARRO ACORD DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 10/01/2018 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 have ADDITIONAL INSURED provisions or 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 License # 0596796 CONTACT NAME: Fullerton Insurance Service, Inc. PHONE FAX P.O. Box 4054 (AIC, No, Ext): (714) 577-5800 (A/C, No):(714) 447-0011 Fullerton, CA 92834-4054 E-MAIL, �. rec(a�futlertoninsurance.com INSURED California Forensic Phlebotomy Inc. 27762 Antonio Pkwy, Ste L1-647 Ladera Ranch, CA 92694 StarN Insurance COVERAGES CFRTIFICATF NI IMRFR• owicrnu u1 1■.—r,- - - - -- F-VY IVIM 1NU1V10Crt. 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 ER TYPE OF INSURANCE ADDL SUM POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MMIDDNYYYI (MM/DDNYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I A I OCCUR Prof Liab- Claims Ma X SM922977 11/17/2017 11/17/2018 EACH OCCURRENCE $ 2,000,000 PRAEMISEs eaoccu ante $ 50,000 X MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECOT- El LOC GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OP AGG $ 1,000,000 A OTHER: AUTOMOBILE LIABILITY PROF LIAB AGG COMBINED SINGLE LIMIT Ea accident $ 3,000,000 1,000,000 $ BODILY INJURY Perperson) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X AUTOS ONLY X AUOTOS ONLY SM922977 11/17/2017 11/17/2018 BODILY INJURY Per accident $ P O.PE dentDAMAGE $ UMBRELLA LIAB HAGGREGATE OCCUR EACH OCCURRENCE $ $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below _ X STATUTE ERH $ B N/A BNUWC0138098 10/01/2018 10/01/2019 EI_FACHACCIDENT $ 1000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of Santa Ana, its officers, employees, agents, volunteers and representatives are included as additional insureds. Coverage is primary and non contributory. � pp�'' ,,, i ��!/!J M) lia 11,0 /':3�r 4r Santa Ana Police Department / Chiefs Office Leo Martinez M-97 60 Civic Center Plaza Santa Ana, CA 92702 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 FIVVRV LA ILu loruol U 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD IIIPOLICY NUMBER: SM922977 EVANSTON INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT - GENERAL LIABILITY REQUIRE BY CONTRACT This endorsement modifies insurance provided under the following: SPECIFIED MEDICAL PROFESSIONS GENERAL LIABILITY INSURANCE COVERAGE PART In consideration of the premium paid, it is hereby understood and agreed that the policy is amended as follows: 1. Section The Insured is amended by the addition of the following: Whenever used in this Coverage Part, the unqualified word Insured shall also mean Additional Insured. 2. Additional Insured means, whenever used in this endorsement, the following: Any organization thatthe Insured is required to include under the policy as an Additional Insured by a written contract or written agreement in effect during this policy period and executed prior to the 'occurrence of the'bodily injury' or'property damage.' 3. Coverage provided to any Additional Insured as defined herein shall apply solely to an Occurrence or offense involving the products, goods, operations or premises covered by this Coverage Part. 4. No coverage shall be afforded to the above Additional Insured for Bodily Injury, Property Damage, Personal Injury or Advertising Injury to any Employee or to any obligation of the Additional Insured to indemnify another because Damages arising out of such injury. 5. In the event that the Limits of Insurance provided by this policy exceed the Limits of Insurance required by the written contractor written agreement, the insurance provide by this endorsement shall be limited to the Limits of insurance required by the written contract or written agreement. This endorsement shall not increase the Limits of Insurance shown in the Declarations pertaining to the coverage provided herein. 5. Where no coverage shall apply herein for the Named Insured, no coverage or defense shall be afforded to the above Additional Insured. 6. The person or organization is only an additional insured with respect to liability arising out of'yourwork' or 'your product.' 7. In accordance with the terms and conditions of the policy and as more fully explained in the policy, as soon as practicable, each additional insured must give the Company prompt notice of any act, error or omission which may result in a claim, forward all legal papers to the Company, cooperate in the defense of any actions, and otherwise comply with all the policy's terms and conditions. Failure to comply with this provision may, at the Company's option, result in the claim or suit being denied All other terms and conditions remain unchanged. Manuscript-1 Page 1 of 2 8. The Additional Insured and the Named Insured shall be represented by the same lawyer unless such mutual representation is prohibited by law or bay any applicable professional code of conduct. 9. This insurance shall be primary and non-contributory insurance. All other terms and conditions remain unchanged. Manuscript-1 Page 2 of 2 CALIFOR-02 LAURAARROYO CERTIFICATE OF LIABILITY INSURANCE DATE(MWODNYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLD8"5/ER.ITHIS 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 pOIICy(ies) must have ADDITIONAL INSURED provisions or be endorsed. f 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 endorsements . ODUCERRIMIACT P Propert & Casualty Services, Inc. 1551 North l astin Avenue Suite 500 Santa Ana, CA 92705 PNONE ac No, E.e : (714 5055550 AIC, Ne:(714) 975-8966 E- INSURERS AFFORDING COVERAGE NAICB INSURED California Forensic Phlebotomy 5753 E. Santa Ana Cyn Rd. Suite G-553 Anaheim Hills, CA 92807 INSURER A: Evanston Insurance COm all INSURERB:StarNet Insurance Com an 35378 40045 INSURER C: INSURER D: INSURER E: COVERAGES NSURER F: - -- � rr.amocn: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED REVISION NUMBER: BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IS SUBJECT TO ALL THE TERMS, INSR ADDL SUBR TR TYPE OF INSURANCE I SD POLICY NUMBER POLICY EFF POLICYEXP A X COMMERCIAL GENERAL LIABILITY lM9RS CLAIMS -MADE OCCUR EACH OCCURRENCE $ 2,000,000 X M928506 11/17/2D18 11117/2019 X Prof Liab- Claims Ma DAMAGETORENTED E 50000 MEDEXP An one rson $ 5,D00 GENLAGGRE ATE LIMIT APPLIES PER' PERSONAL&ADV INJURY $ 2,000,000 X POLICY � P� LOC GENERAL AGGR GATE E 3,000,000 OTHER: PRODUCTS-COMP/OPAGG E Included A PROF LIAB AGG $ 3,000,000 AUTOMOBILE LIABILITY COMBIN�SINGLE LIMB t,000,Q00 ANY AUTO SM928506 11/17/2018 11/17/2019 OWNED SCHEDULED $ BODILY INJURY Per sown AUpT�O�S ONLY AUppTOSWWNNEEDp X AUTOS ONLY X N N TiY BODILY INJURY Peraaitlerd PROPERdY DAMAGE Pe acti em g UMBRELLA LIAB OCCUR $ EXCESS LIAB CLAIMS -MADE EACH OCCURRENCE DED RETENTION$ AGGREGATE $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY X PER OTH- T ANYPROPRIETORIPARTNEWEXECUTIVE YIN OFa��R YI BER EXCLUDEDI ❑ NIA BNUWC0147463 4/1212019 4112/2020 E.L EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE 11000,000 If yes, describe untler DESCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT $ 1,000,006 DESCRIPTIONOFOPERATIONS/LOCATIONSIVEHICLES (ACORDIGI,AUCIUonal Remarks Schedule, maybeatMehe Vmorespacelsrequlnd) The City of Santa Ana, its officers, employees, agents & representatives are named as additional Insureds as respects to the General Liability policy endorsement Included in the policy. Coverage is Primary and Non -Contributory, as required by written contract. limits per _CERTIFICATE HOLDER City of Santa Ana Attn: Risk Management D 20 Civic Center Plaza, 4th Santa Ana, CA 92702 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 22 1o�Jn THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN J ACCORDANCE WITH THE POLICY PROVISIONS. M. LAMBERt AU IJORD:ED REPRESENTATIVE ACORD 25 (2016/03) _"-- - ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD (ClUJID August 16, 2019 City of Santa Ana CALIFORNIA FORENSIC PHLEBOTOMY Attn: Risk Management Division 20 Civic Center Plaza, 4th Floor Santa Ana, CA 92702 Dear Sirs/Madams, 5753 E. Santa Ana Cyn Rd, Suite G-553 Anaheim Hills, CA 92807 e-mail Nega@californiaforensicphlebotomy.00m 24 Hour Technician Response 714.529.0515 Administration 949.309,2459 Fax 949.203,2133 This letter is to confirm that California Forensic Phlebotomy, Incorporated does not have any company -owned vehicles. The automobile liability policy includes coverage for non - owned autos and hired autos, as the employees use their own vehicles when driving on company business. If you should have any questions, please feel free to contact me. I can be reached at the number below. Sincerely, f> Robert J. Vega' 11 President & Owner California Forensic Phlebotomy, Incorporated (949) 309-2459 x. 4 D & APPROVED INAC{EMENT DIVISION 2019 LAMBERT