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Home My WebLink AboutWELLDYNERXINSURANCE ON FILE WORK MAY PROCEED -- UNTIL IINNS--UI ANC _ XPIRES CLERK Qr- 0 C i 2098-� � �J DATE dUf 201 FOL9jrH AMU,NDMENT TO AGREEMT H NVE LkkY_NERx FOR PROFESSIONAL SERVICES ("SHARPS PROGRAM") THIS FOURn-1 AMENDMENT to the above -referenced agreement is entered into on May 15, 2018 by and between WollDyneRx ("Consultant'), and the City of Santa Ana, a charter city and municipal corporation organized and existing tinder the Constitution and laws of the State of California RECITALS A, The parties entered into Agreement No. A-2007.278, dated December 3, 2007, by which Consultant has provided services to onsure that used medical needles are collected from City residents and disposed of in a safe and sanitary manner, The original term of the Agreenent was front January 1, 2008 tuttil December 31, 2008. B, In the original Agreement, Consultant was known as WellDyneft West but has since been rebranded as WellDyneRx. C. On December 31, 2008, the parties entered into First Amendment to Agreement No, A- 2097-278-01, to extend the team of the Agreement until June 30, 2010. D, On Site 30, 2010, the patties entered into Second Amendment to Agreement No, A-2007- 278-02, to farther adjust the compensation and extend the term of the Agreement. E, On May 4, 2016, the parties entered into Third Amendment to Agroernent No. A-2016.104 to again adjust tlto co upenaatiort and extend the terns of the Agrecsuent The Agreement retnaitas in efect dnrough June 30, 2018, F. The parties now wish to extend the Agreement throvigh Funo 30, 2020, subject to a one- year extension, The Parties therefore agree: 1. Section 3, 'Terns, is amonded to extend the term of the Agreement for an additional two (2) year period through Suite 30, 2020, The tam cony be further extended for one (1) year upon mutual agreement by the parties, 2. Except as nnodified by this Fourth Amendment, and all prior amendments, all terms and conditions of the Agreement shall remain in full fcree and effect. [signature page to follow] IN WITNLSS WHEREOF, the parties hereto have executed this Fourth Amendment to the Agreement on the data and year first written above. ATTEST P=17AR ClCrIC Of the COL11161 APPROVED AS TO FORM SONIA R. CARVA 1,110, City Attomey By: 11K� — ---T —X— r JN Jol-i Assistant City Attorney R 1,"COMAI ENDED OR APPROVAL: Edwin "William" Cii)VU P I- Acting Executive Director Public Works Agency, CITY 0l,SANTA ANA RAL City Manager WELLDYNERx ray: 'ritie; v/., R CERTIFICATE OF LIABILITY INSURANCE DATE YI le. �' 2/16/2018 2/9/2018 18 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(les) 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 endorsament(s). PRODUCER LOCkton Com PameB 8110 E� Union Avenue Sulte 700 DenverCO80237 NEA T FAX "el; ac�rlo, eS.n: --- ---_ E.rn IL AMR'65: _ (303)414-6000 INSUBERISIAFFORDN COVE INSURER A: Arch Specialty Insurance Comeany 21199 INSURED WellDynER%'i LLC. 1424829 500 Eagles Landing Drive Lakeland, Lakeland, FL 33810 INSURER B: Zurich American Insurance Company 16535 INSURER C: Lexineton Insurance Company 19437 INSURER D: Lloyds of London iNsunER F Berkley Insurance Company 32603 t ERE: COVERAGES CFRTIFICATFNIIMRFR- 1451AOR9 eclnelnu Eu larovo. vv v v v vv 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, 1'HE 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. ILSR Y TYPE OF INSURANCE ALM INSD SUER MD POLICY NUMBER POLICY EFF 2/16/2018 POLICY EXP 2/16/2019 LIMITS A x COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR N N FLP006017701 EACH OCCURRENCE _ 1,000,000 DAM,AGE RENTED PRE ISE EeoccurreD.QI 100,000 MED EXP (Amyno ereon $ 000 PERSONAL BAOV INJURY $]000000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY] JECT LOG GENERAL AGGREGATE $3000000 PRODUCTS - COMPIOPAGG $ 3,000,000 OTHER: A AUTOMOBILE LIABILITY NI N Ff,P006017701 2/16/2018 2/16/2019 COMBINED MBIN DSINGLE-LIMIT $ ] 000 000 P ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per Person) $ xxxxxxx BODILY INJURY(Per aFddent $ XXXXXXX AUTOS ONLY X AUUTOSONLY Pe�accc ^DAMAGE $ xxxxxxx $xxxxxxx A X UMBRELLA LIAR X OCCUR N N FLP006017701 2/16/2018 2/16/2019 EACH OCCURRENCE $ 10,000,000 EXCESS LIAR ICLAIMS -MADE AGGREGATE $ 10,000,000 DED RETENTIONS s xxxxxxx B ON ANWORKERS OYERS'LA LIABILITY YIN ANY PROPR ITFORIPARTNERIEXECLIC 1 OFFICEWMEMDER EXCLWEP N Ieen,deory In Nu a . n.'s" 'den DESCRIPTION OF OPERATIONS below NIA N WC014390901 2/16/2018 2/7/2019 X einmTE DEH- E L. EACH ACCIDENT $ 1000000 E.L. DISEASE - EA EMPLOYEE 1,000,000 ELDBEASE-POLICY LIMIT a 1000000 A C D E Phmmac9 Prof. l.ieb PBME9,OLiah, Cyber Cclme N N PLP006017701 012110742 NIPLI84736417 BCCR4500242320 2/16/2018 2/16/2019 2/16/2017 10/21/2016 2/16/2019 2/16/2019 2I1 G/201R 2/]6/2018 SIMIS3M Limil:$8M/RDtS25I( Limil:$5M Le, Clan,45M Aug LimiC S2M per OcC, DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addillmal Remarks Schedule, may be sttachad 11 more space is required) 14516082 Cityy of Santa Ana AT N: Christy Kindig 20 Civic Center Plaza, M-21 Santa Ana, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, ai)f The ACORD name and logo are registered marks of ACORD rinhbb roc. nmA ,aco�zo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 2/16/2020 1 2/15/2019 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 Lockton Companies 8110 E Union Avenue ' Suite 700 Denver CO 80237 CONTACT PH NE FAX AIC No Ext : A/C, No): E-MAIL ADDRESS: (303) 414-6000 INSURERS AFFORDING COVERAGE NAIC # INSURER A; Arch Specialty Insurance Company 21 199 INSURED WellDyneRX, LLC. 1424829 500 Eagles Landing Drive Lakeland, FL 33810 INSURER B : Zurich American Insurance Company 16535 INSURERC: Lexington Insurance Company 19437 INSURER D : Ll0 ds of London A-�v/`�C//((// INSURER E: Berkley Insurance Company 32603 INSURER F : //�007 COVERAGES CERTIFICATE NUMBER: 14516082 REVISION NUMBER• XXXXXXX THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR NVD POLICY NUMBER POLICY EFF IMMIDDNYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR N N FLP006017702 2/16/2019 2/16/2020 EACH OCCURRENCE 1,000,000 PREMISES (Ea occurrrence) $ 100,000 MED EXP (Any oneperson) 5,000 PERSONAL & ADV INJURY $ 1 OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER. PRO - POLICY❑ PRO- ❑ LOC GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OP AGG $ 3,000,000 OTHER: A AUTOMOBILE LIABILITY N N FLP006017702 2/16/2019 2/16/2020 Ee eBINEDtSINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ XXXXXXX ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident $ XXXXXX AT ED OS ONLY AUTOS NON -OWNED X PROPERTY Prr accident) $ XXXXXXX $XXXXXXX • X UMBRELLA LIAB X OCCUR N N FLP006017702 2/16/2019 2/16/2020 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ XXXXXXX B WORKERS COMPENSATION AND EMPLO ERS' L ABILI Y Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Mandatory in NH) IMf yes, tlescribe untlnd er DESCRIPTION OF OPERATIONS below N / A N WC014390902 2/16/2019 2/16/2020 X STATUTE VTR E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE- EA EMPLOYEE 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 A C D E Pli acyProf. Liab. PBM E&O Liab. Cyber Cruse N N FLP006017702 011741917 MPLI84736419 BCCR4500242322 2/16/2019 2/16/2019 2/16/2019 2/16/2019 2/16/2020 2/16/2020 2/16/2020 2/16/2020 VIV1/$3M Limit: $8M/Ret $250K Limit: $1OM Ea. Claim/$IOM Agg Limit: $2M per Oce. DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) -I" rk ANI.tLLA I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 14516082 AUTHORIZED REPRESENTATIVE City of Santa Ana ATTN: Christy Kindig 20 Civic Center Plaza, M-21 Santa Ana, CA 92701 ACORD 25 (2016/03) @1 988-20A ACOR6 CORP RATION_ All rinhtc roc-cl The ACORD name and logo are registered marks of ACORD Digitally signed Ac"Mor CERTIFICATE OF LIABILA W E DATE (MMIDDIYYYY) �.,.,,� /l4 3 n 11Q2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS WRIGHTS UPON TF c -FxRTIFICATE H LDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGF AF,Qex*tQPOLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A ZITRACT BETWEEN THE ' UING Ii:`zURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy es) A DI D provisions c: be en orsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may rer,uire an en(yeP q,,:4tten�tt7► �J 7.lJo.`} �J lJ D this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).CONTACT PRODUCER Lockton Companies _ NAME, PHONE FAX A/C No): 8110 E Union Avenue Suite 100 Denver CO 80237 E-MAIL ADDRESS: (303) 414-6000 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Arch Specialty Insurance Company 21199 INSURED WellDyneRX, LLC 1477414 500 Eagles Landing Drive INSURER B : Zurich American Insurance Company 16535 INSURER C : ACE American Insurance Company 22667 INSURER D : Berkley Insurance Company 32603 Lakeland, FL 33810 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 14516082 REVISION NUMBER: XXXxxS x THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY N N FLP006017705 2/16/2022 2/16/2023 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 1XI OCCUR DAMAGE T PREM SESOEa occurrDence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY n PRO - POLICY F-1 LOC PRODUCTS - COMP/OP AGG $ 3,000,000 $ OTHER: A AUTOMOBILE LIABILITY N N FLP006017705 2/16/2022 2/16/2023 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ XXX)CS XX ANY AUTO OWNED SCHEDULED AUTOS ONLYNAUTOS BODILY INJURY (Per accident) $ XXX�CSCSCS� Xr PROPERTY DAMAGE Per accident $XXXXXXX HIRED NON -OWNED AUTOS ONLYAUTOS ONLY $ XXXyCS xx A X UMBRELLA LIAB X OCCUR N N FLP006017705 2/16/2022 2/16/2023 EACH OCCURRENCE $ 10,000,000 A EXCESS LIAB CLAIMS -MADE Prof. Liab. RetroDate: 2/16/20 X AGGREGATE $ 10,000,000 DED RETENTION $ $ XXXXX� B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A N WC014390905 2/16/2022 2/16/2023 EROTH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Pharmacy Prof. Liab. N 2/16/2022 2/16/2023 $1M/$3M Retro Date: 2/16/2020 C PBM E&O Liab. =FLPOR046017705 2508130002 2/16/2022 2/16/2023 Limit: $3M/Ret $250K D Crime 500242325 2/16/2022 2/16/2023 Limit: $2M per Occ. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Per Agreement Master Agreement A-2007-278 and current agreement A-20180-131-01 with the City of Santa Ana, Proof of Worlcers' Compensation Coverage. 14516082 City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92701 ACORD 25 (2016103) 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,— Risk M8118gement DMskrn +� �m REVIEWED & APPROVED BY: @ 1 s88-2o ACo The ACORD name and logo are registered marks of ACORD r Risk Management Specialist off IN Miscellaneous Attachment: M577149 Master ID: 1477414, Certificate ID: 14516082 Excess Liability Schedule Carrier Policy Number Limit Lloyd's of London MCFAL1000459 $25,000,000 Lloyd's of London B0180PC2209645 $30,000,000 m Risk Management DlMsian REVIEWED & APPROVED BY: r Risk Management Specialist