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HomeMy WebLinkAboutSTERLING HEALTH SERVICESINSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES 101!WL4 l 70 —Z J - CLERK OF COUNCIL - TE'. N-2019-252 0: W11tvT (Airy'', a hune,r dr AGREEMENT BETWEEN THE CITY OF SANTA ANA AND STERLING HEALTH SERVICES FOR AFFORABLE CARE ACT COMPLIANCE THIS AGREEMENT is hereby made and entered into this 12th day of November, 2019, by and between the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California ("City"), and Sterling Health Services, a California Corporation ("Consultant"). RECITALS A. The City desires to retain Consultant to assist City in maintaining compliance with the Patient Protection and Affordable Care Act ("ACA") (42 U.S.C. Sections 18001 etse9.) B. 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 fine in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terns and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES A. Consultant shall provide services necessary to assist City in maintaining compliance with the ACA, including but not limited to, capturing all employees including full time, part time, variable hour employees, and multi -employer and/or union employees, generation of 1094 and 1095 forms on behalf of the City including the potential for printing and mailing the forms on behalf of the City, IRS fulfillment status, aid in resolving 226-J letter/fine issues that may develop, and the ability to talk with an ACA compliance specialist during normal business hours. B. City shall provide information necessary to prepare 1094 and 1095 forms on behalf of City no later than January 8`h of every year. Consultant will then distribute ACA forms to City for distribution or at City's election, mail forms to City employees no later than January 31 ". Consultant will e-file 1094 and/or 1095 forms on behalf of the City with the IRS, no later than March 3 I ". 2. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services a flat yearly fee of $5,400 for the first year and $4,000 for each renewal year. The total sum authorized under this Agreement shall not exceed twenty-five thousand dollars ($25,000) for the entire term of this Agreement. This amount includes the flat service fee total of $21,500 over the term of the Agreement and a contingency of $3,500 to be used at the City's sole discretion for the optional services of printing and mailing IRS forms 1094 and 1095 at a cost of $3.75 per mailing. t# 14325v2 b. Consultant will invoice City on a quarterly basis. Payment will be made within forty- five (45) days of the date of the invoice. 3. TERM The tern of this Agreement shall commence on the date first written above and terminate on October 31, 2022, with two optional one-year extensions exercisable by the City with the agreement of Consultant unless terminated earlier in accordance with Section 13, 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 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 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 its 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-Czeneral Liability -.Insurance ...Consultant shall maintain commercial general liability insurance, which 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 Consultant's negligent 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 and $2,000,000 in the aggregate. Such insurance shall (a) name the City, its officers, employees, agents, volunteers 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 insured 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 California State law, 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 414325v2 the work under this Agreement, Consultant agrees to obtain and maintain any employer's liability insurance with limits not less than S 1,000,000 per accident. d. If Consultant 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 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. (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) Consultant shall supply City with fully executed additional insured endorsement. f 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 terminate this Agreement. Such termination shall not affect 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 defend, and shall indemnify and hold hanmless 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 Consultant, its subcontractors, agents, employees, or other persons acting on its behalf which relates to the services described in section l 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 Consultant 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 914325v2 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 Consultant'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 Consultant. 7. RECORDS Consultant shall keep records and invoices in connection with the work to be perfonned under this Agreement. Consultant 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 Consultant under this Agreement. All such records and invoices shall be clearly identifiable. Consultant 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. Consultant shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Consultant under this Agreement. 8. CONFIDENTIALITY Due to the nature of the services provided pursuant to this Agreement, Consultant will be provided information by City that is confidential, including identifying information for City employees. Consultant will maintain strict confidentiality as required by all applicable laws. "Confidential Information" shall include all nonpublic infonnation. 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 and disclosed 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. In the event of a data breach, Consultant will advise City of the breach as soon as practicable but in not event more than 48 hours after Consultant learns of any data breach involving any information provided to Consultant pursuant to this Agreement. Consultant will comply with all applicable laws regarding notice to any person whose information was provided pursuant to this Agreement whose data has been subject to any breach. #14325v2 CONFLICT OF INTEREST CLAUSE Consultant covenants that it presently has no interest and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 10. 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, sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: To City: City of Santa Ana City Clerk (M-30) 20 Civic Center Plaza P.O. Box 1988 Santa Ana, California 92702 With copy to: Executive Director of Human Resources City of Santa Ana 20 Civic Center Plaza (M-24) P.O. Box 1988 Santa Ana, California 92702 Fax (714) 647-6930 And: 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: Ms. Cora Tetlez Sterling Health Services 1932 Cortereal Avenue Oakland, California 94612 Fax: (877) 517-4729 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 snail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by facsimile, communication shall be effective or deemed to 414325v2 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. It. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant regarding the subject matter herein, 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 and will serve to fully supersede existing Agreement. 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, that terms or 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 parties, which are not embodied herein. 12. 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 that are the subject to this Agreement performed by City personnel or by other Consultants retained by City. 13. TERMINATION This Agreement may be terminated by the City with thirty (30) days written notice of termination to the Consultant. a. As a condition of such payment, the City may require Consultant to deliver to the City all the work product completed, as of such date, and in such case, such work product shall be the property of the City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes, as the City deems appropriate. b. Payment need not be made for work that fails to meet the standard of performance specified in the Recitals of this Agreement. 15. NON-DISCRIMINATION Consultant shall not discriminate because of race, color, creed, relation, sex, marital status, sexual orientation, gender identity, 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 or any activities under this Agreement. #14325v2 Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 16. JURISDICTION - VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation, perfonnance, 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. 17. PROFESSIONAL LICENSES Consultant 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 Sates, 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. 18. COMPLIANCE WITH ALL LAWS Consultant agrees to comply with all applicable federal, state and local laws and regulations including but not limited to, the California Consumer Privacy Act (California Business and Professions Code Section 1798.100 et seq.) 19. MISCELLANEOUS PROVISIONS a. Each undersigned represents and 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. 414325v2 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: DAISY GOMEZ Clerk of the Council APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney I �2( = By: LAURA A. ROSSINI Senior Assistant City Attorney STEVEN V Executive E #14325v2 ED FOR APPROVAL: of Human Resources CITY OF SANTA ANA ISTINE IDG City Manager STERLING HEALTH SERVICES By: Sarah Soman (Name) Director of Operationgitle) m a n y N A IyG 0 V Obi N W N O V N W N V •^ 2 'bJ 6 = `J ] J n A N 9 fpt N g d < A ry q ^ r W_ p 'bJ S y� O (a'1 S o N da• a d N M a.P '". m� �a n a 4 d o• a a T� J � c 49 W] P C F m " ew CBS „a a gn ; Gr e C n�0 a:?a o c 8 g S�,�E� �g ad`8.d �'"'Rx g 2 1 vo �n �� 4 c " Y.ro��EB ap gO ¢ A a�SF C d NN FN d ? Q gg E. ga 2 gc F na� .E -_� n a_ g `n 'm EtSod �o ao d3 may 'g 3 9 ORL 6 P C O J W 9 N q N O '3 d a O O 3 d a 0 m F lA m 2 n 6 O d N O ) {�} \}� ` \ ( ! ! ; « & 0 ! ! }{f{ /\ _ \ƒ/]!;! __ )§ (§![ r(\`[ \� _ ƒ)\ 0� ��\\ s � \ 0\ ` �/ \} k} ED k ) | W Iq k§} _ _ - }{ - - z 7o A� CERTIFICATE OF LIABILITY INSURANCE DAM 12/3/2019312019 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 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 Agency Insurance Lea /Car enter/Kem s A P P P 9 Y 3187 Collins Dr. Merced CA 95348 CONTACT NAME: Chris Bdllen 2r — 9 - �- PHONE FAX ",EX0�209-386-5046 Lac nPL709-385-6117 —' EMAILP4PRESS_ sballenger@Ickinsurance.com INSURER(S) AFFORDING COVERAGE NAIC0 INSURER A: Travelers Cas Ins CO Of Amer INSURED STERL-2 Sterling Health Services, Inc. P.O. Box 71107 INSURER B: AXIS Insurance Company INSURER D: Oak River Insurance Co. 34630 _ INSURER D: Oakland CA 94612-7207 INSURER_E: ---—.. .-- INSURER F; COVERAGES CERTIFICATE NUMBER' 7747n9363 plc flelnhl AN luccm. 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 TR TYPE OFINSURISNCE AOOL U R POLICY EFF P0LICYEXP POLICY NUMBER WOOD"" A DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY UNCO03OW sl4y2019 ' 5I142O20 LEACH OCCURRENCE lS2000000 CLAIMS.MADE ; %� OCCUR , Ox0haY6RENTE0 PREMISES( Cdgarerlcel �SOW_000 ___ MED EXP(Any we person) SS0ol --_-----_-_._--_ _ PERSONAL& ADV INJURY S200000o GEN'L AGGREGATE LIMIT APPLIES PER XPOLICY L— ECT � Jn PRO- �.� LOC ' 54000000 CT PRODUS GENERALAGGCOMPOP AG� $4000000. OTHER i$ A AUTOMOBILE UABNTY 88o9C8038% &14WI9 5114R020 --�ANY SCHEDULED ALL AUTO i — AUTOS SCHEDULED X IIIREDAUT05 X AUr05 - AUTOS 1 COMBINED SINGLE LIMIT $ LaacadanlL_ BODILY INJURY (Per person :BODILY INJURY (Per academy S PROPERTY DaM CF Le m.. I 3 UMBRELLA UAB OCCUR EACH OCCURRENCE S AGGREGATE 5 IEXCESS LIAB CWM$-MADE; ❑ED RETENTIONS C AND EMPLOYERS'UABILOITY YINI RTWO034098 'A NY PROPRIETORIPARTNERIEXECUTIVE A andaRry In N REXCLUDEDT ❑INIA IN FICE ME SER If yCS, call under DESCRIPTION OF OPERATIONS below 51142019 5I14r1020 I I X SiATIfTE IERH. EL EACH ACCIDENT 51 CCXI' EL. DISEASE -EA EMPLOYE4 ...__ 51,000000 E.L. DISEASE -POLICY LIMIT I 51.OfM1.000 9 Pmleswonal LlabBty P00100012245401 1 &142019 5!14=20 S2,000DDO S25.00o Rat DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AndlUonal Remarks schedule, maybe attached If mom space Is required) City of Santa Ana is named as additional insured per attached CGD105 0494 form by mitten contract, Primary & Non -Contributory wording included under the policy endorsement CGT1OO 0219 attached MIMI) & APPROVED City of Santa Ana Risk Management Div 20 Civic Center Plaza, Santa Ana CA 92701 AGUHU Z5 (24114I01) 20 SHOULD ANY OF EXPIRATIONHABOVE DESCRIBED POLICIES CA NCELLED BEFORE DELIIVERED THEIN ACCORDANCE WITH THE POLICY PROVISIONS. M. LAMBERT 1 AUTHORIZED REPRESENTATIVE y7). 1988-2014 ACORD The ACORD name and logo are registered marks of ACORD reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC990410C (Ed.01-19) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named In the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) The additional premium for this endorsement shall be calculated by applying a factor of 2% to the total manual premium, with a minimum Initial charge of $350. then applying all other pricing factors for the policy to this calculated charge to derive the final cost of this endorsement. This agreement shall nut operate directly or indirectly to benefit anyone not named in the Schedule. Schedule Blanket Waiver Person/Organization Blanket Waiver — Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. Job Description Waiver Premium (priorto adjustments) All CA Operations 497.00 This endorsement changes the policy to which it Is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement Is issued subsequent to preparation of the policy.) Endorsement Effective: 05/1412019 Policy No.: STWC034096 Endorsement No.: Insured: Insurance Company: Oak River Insurance Company WC 99 0410 C (Ed. 01-19) Premium $ Ccuntersigned by COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS: 1. WHO IS AN INSURED (SECTION Iq is amended in a written contract for this insurance to to include as an insured any person or organiza- apply on a primary or contributory basis. tion (celled hereafter "additional insured') whom 3. This insurance does not apply: you have agreed in a written contract, executed prior to loss, to name as additional insured, but a. on any basis to any person or organization only with respect to liability arising out of "your for whom you have purchased an Owners work' or your ongoing operations for that addl- and Contractors Protective policy. tianal insured performed by you or for you. b. to "'bodily injury," "property damage," "per- t. With respect to the Insurance afforded to Addi- sonal injury," or "advertising injury" arising tlonal Insureds the following conditions apply: out of the rendering of or the failure to render any professional services by or for you, in - a. Limits of Insurance — The following limits of cluding: liability apply: 1. The preparing, approving or failing to 1: The limits which you agreed to provide; prepare or approve maps, drawings, or opinions, reports, surveys, change or-. _ --- 2. The ilmits shown on the declarations, ders, designs or specifications; and Whichever is less. 2. Supervisory, Inspection or engineering b. This insurance is excess over any valid and services. collectible insurance unless you have agreed s 8 CG 0105 04 94 Copyright, The Travelers Indemnity Company, 1994. Page 1 of 1 Includes Copyrighted Material from Insurance Services Office, Inc. COMMERCIAL GENERAL LIABILITY c. Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. Required By Written Contract If you specifically agree in a written contract or agreement that the insurance afforded to an insured under this Coverage Part must apply on a primary basis, or a primary and non- contributory basis, this insurance is primary to other insurance that is available to such insured which covers such insured as a named insured. and we will not share with that other insurance, provided that (1) The "bodily injury' or "property damage" for which coverage is sought occurs: and (2) The "personal and advertising injury' for which coverage is sought is caused by an offense that is committed: subsequent to the signing of that contract or agreement by you. S. Premium Audit a. We will compute all premiums for this Coverage Part in accordance with our rules and rates. b. Premium shown in this Coverage Part as advance premium is a deposit premium only. At the close of each audit period we will compute the earned premium for that period and send notice to the first Named Insured. The due date for audit and retrospective premiums is the date shown as the due date on the bill. If the sum of the advance and audit premiums paid for the policy period is greater than the earned premium, we will return the excess to the first Named Insured. a. The statements in the Declarations are accurate and complete; b. Those statements are based upon representations you made to us; and c. We have issued this policy in reliance upon your representations. The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in issuing this policy will not prejudice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations. 7. Separation Of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this Coverage Part to the first Named Insured, this insurance applies: a. As if each Named Insured were the only Named Insured; and b. Separately to each insured against whom claim is made or "suit" is brought. 8. Transfer Of Rights Of Recovery Against Others To Us If the insured has rights to recover all or part of any payment we have made under this Coverage Part. those rights are transferred to us. The insured must do nothing after loss to impair them. At our request. the insured will bring "suit" or transfer those rights to us and help us enforce them. 9. When We Do Not Renew If we decide not to renew this Coverage Part, we will mail or deliver to the first Named Insured shown in the Declarations written notice of the nonrenewal not less than 30 days before the expiration date. If notice is mailed, proof of mailing will be sufficient proof of notice. SECTION V — DEFINITIONS "Advertisement" means a notice that is broadcast or published to the general public or specific market segments about your goods, products or services for the purpose of attracting customers - or supporters. For the purposes of this definition: c. The first Named Insured must keep records of a. Notices that are published include material the information we need for premium placed on the Internet or on similar electronic computation, and send us copies at such times means of communication: and as we may request. b. Regarding websites, only that part of a website 6. Representations that is about your goods, products or services for the purposes of attracting customers or By accepting this policy, you ee: supporters is considered an advertisement. Page 16 of 21 ® 2017 The avel rrndemnity Company. All rights reserved. CG T1 00 02 19 Includes copyrighted material of Insurance Services office, Inc. with rts permission. oniic; Nambe- 6607964B71605 Namer. insuredd Singh, A J. DSA Sign-A-Rarr.a CG2015 11 88 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - VENDORS This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART. PRODUCTSICOMPLETED OPERATION LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization (Vendor): City of Santa Ana, its officers, agents, and employees 20 Civic Center Plaza Santa Ana, CA 92701 (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) 5 Ara tNSURED (Section {i) is amendec V_ reC= .!-..-... �:mal ccnla,n=r ',dude as an insured any persun ui Piyanizatio e. A ,,:h inapedia�. 'relerrnd !u abc-.e as vendor) sham, in the adjusir ,ervicing as the Schedule but oniy with respect to "bodily injury- cr vendor iialke or normal:y *none damage" arising out of your products' undem i'.. � . qte usual course If inmv, ut -he `;Gledoie. which are distributed or hu�, I• �, c.rh !hr distribution <cIC. m riu, regular course of the vendors business. o, I - .Arj?.t to the followng additional exclusions f. f r=". _,. „en -. _.,,:y or re, ., - ;:apt sup• -rations 1. The insurance afforded the vendor does not pertL, '.. _ ..:X'S pr¢.!r'-."S ul apply to, conne,,r, .. . de of the product a. ' Bcdily injury- or 'property damage' for g. Produ c r. ,tistnbution or sale by v:!t, 1, the vendor is obligated to pay you, hare rr-- ! or re-fabiated or user. iamages by reason of the assumption of as a container Ingredient o! any other hahility in a contract or agreement. This thing or substi, or for the ve,d,,r ?xClusion does not apply to tiabilily tot images that the vendor would have in !hie 2. This Insurance duer riot apply to a-:o insured. _..sence •tf the contract or agreement; Person or ergam; air•,r toin whore you nave b. „r^-. ex.ur;-ss .varranty unaethorized by you acquired StI orod,x1s, or any nc reJenf. port c. Any physical nr chemical change in the or container. emeni ; in!::. accompar I,q cr products made intentionally by the vendor. containing such products d. Repackaging. unless unpacked solely for the purpose of inspection. demonstration, !e5bcn, y the substitution of pans under nc'p,.rtIcnc from the manufacturer, and then ..... -.. ;r 1. Insurance seances Office. ha 19E. +=88 STERLING v-A11f1191S1'RAIIDY- November 26, 2019 City of Santa Ana Risk Management Division C/O: Samantha M. Lambert, Risk Management Supervisor 20 Civic Center Plaza, 4th floor Santa Ana, CA 92701 cc: Carrie Hanes Hello Samantha, Please accept this letter as confirmation that Sterling does not own vehicles. Therefore, the 'All Owned Vehicle' box will not be checked on the Automobile Liability section of the Acord 25 Certificate. Regards, Sarah Soman, Director of Operations Sterling Health Services, Inc. 1000 Broadway, Suite 250 Oakland, CA 94607 800-617-4729 EXT.217 Sarah.soman(cDsterlineadministration.com 1212/19 Date EREWE�nMOsoDBnN LAMBERT %cooRUr CERTIFICATE OF LIABILITY INSURANCE I DAM (MMIDDY" 05/18/2 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. INI [AN I: IT the cermicate holder is an AUUI I IUNAL INSUKhU, me POIICy(teS) must have AUUI I IUNAL IN5UKEU 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 CONTACT Wendy Benitez. CIC, CISR NAME: Winton Ireland Strom & Green PHONE (209) 667-0995 Ax (209) 667-7142 AIC, No License# 0596517 -Mall wbenitez@%visg.com ADOREaS. P.O. Box 3277 INSURERS AFFORDING COVERAGE NAIL a Turlock CA 95381 INSURERA: Travelers Casualty Insurance Company of America 19046 INSURED / INSURERS: Sterling H.S.A., Inc., DBA: Sterling Health Services, Inc. y INSURER C: PO Box 71107 .....ewe ,, . I Oaktand CA 94612 1 INSURER F: COVFRAGFR CFRTIFICATF NIIMFi CL205846749 DM¢Iryu mIUDFR• 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. LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDD/YYYY LIMITS x COMMERCIAL GENERALUABILnY CLAIMS -MADE ® OCCUR EACH OCCURRENCE E 2,000,000 PREMISES occurrence)$ 300,000 MEDEXP An one on $ 5.000 PERSONAL$ADV INJURY $ 2,000,000 A Y 6809C803856 05/14/2020 05/14/2021 GENLAGGREGATE LIMITAPPUES PER: POLICY ❑ PRO- JECT LOC GENERALAGGREGATE $ 4,000,000 PRODUCTS-COMPIOPAGG E 4,000,000 1 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea Accident) $ BODILY INJURY Per person) $ AWAUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per acckenU E HIRED NON�OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Per acc,clentl $ E UMBRELLA LAB OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAR CLUNS-MADE DED I I RETENTION $ VIORKERS COMPENSATION I PER OTH- ANDEMPLOYERS'LIABILITY YIN E.L. EACH ACCIDENT E ANY PROPRIETORIPARTNERIFJ(ECUT VE OFFICER/MENIBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE I $ (Mandatory In NH) Nyes,descdbeunder E.L. DISEASE -POLICY LIMIT s DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 11001,EAAd'"diitionalalfRemarksSchedule. may be attached If more space M regolrad) `(ACORD Cert?Irate holder is included as Additional Insfir ,14ry,It 16DI&nIi Ip4l9r11"fQrkl included in regards to General Liability per forms CGD105 0494 attached. ✓ By RISK MANAGEMENT DIVISION 6 2020 City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Fir 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. AUTHORISED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ACOR& CERTIFICATE OF LIABILITY INSURANCE pA05 az0220 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 endorsement(s). PRODUCER NONE T Wendy Benitez Winton Ireland Strom & Green PHONE (209) 667-0995 /209) 667-7142 A/c. Nor Lkernsei10596517 nODRE55: wbenitez@wisg.com INSURERS AFFORDING COVERAGE NAIC K P.O. Box 3277 Turlock CA 95381 INSURERA: Travelers Casualty Insurance Company of America 1904c INSURED / INSURER B: Oak River Insurance Company 3463C INSURER c: AXIS Insurance Company 37273. Sterling H.S.A., Inc., DBA: Sterling Health Services, Inc. ✓ INSURER o: Evanston Insurance Company PO Box 71107 NSUSURERERE: INR,: Oakland CA 94612 COVERAGES CERTIFICATE NUMBER: 2020 GL/E80/CyberlWC 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. LTR TYPE OF INSURANCE POLICY NUMBER tPOLICYIEFF Mtwo DrynnY MMIDOIYYYY I LIMITS COMMERCIAL GENERALLWBILITY EACH OCCURRENCE 111 2,000,000 CWMS-MADE ® OCCUR PREMISES (Ea cocurraccal 300•000 MED ExP (my one raon $ 5,000 PERSONAL &ADV INJURY $ 2,000,000 A 6809C803856 05/141220020 05/14/2021 GENL AGGREGATE LIMITAPPLIES PER GENERALAGGREGATE $ 4,000.000 ❑JECT PRODUCTS - COMPIOPAGG $ 4,000.000 POLICY LOD $ OTHER: AUTOMOBILE LIABILITY COMIMNED SINGLE LIMIT (Ea accickent) $ Included in GL ANYAUTO BODILYINJURY(Perperson) S A OWNED SCHEDULED 8809CK3856 05114/2020 05114/2021 BODILY INJURY (Per acclderin $ AUTOSONLY AUTOS MIRED NON-0WNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per wident S UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIMB CLAIMS -MADE DIED I I RETENTION WORKERS COMPENSATION >< PER OTH­ AND EMPLOYERS' LIABILITY YIN E.L. EACH ACCIDENT 1,000,000, B NY APROPRIETORIPARTNERIFJ(ECUTIVE OFFICERIMEMBER EXCLUDED? ❑ NIA STWC140324 05/14/2020 05/14/2021 E.L.OISEASE-EAEMPLOYEE $ 1,000,000 (Mandatory In NH) / ✓ ✓ 1,000,000 de$Qi1 antler Dyea, DESCRIPTIONN OF OPERATIONS delta E.L. DISEASE -POLICY LIMIT $ E&O Limit: $2.000.000 C: Professional E80 Liability L// GD D: Cyber Liability! Data Breach P0020001224.14` 02 05/1412020 061 4/2021 E&O Retention $25,000 MKLV5PDB000030 05/14/2020 05/14/2021 Cyber Limit/ Deductible 1 $1,000,000/$2.500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD fill, Additional Remarks Schedule, may W attached Nmore space Is required) REVIEWED & APPROVED By Risk MANAGEMENT DIVISION Y 6 2029 ANGIE ACEVEdc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Insured's Purposes ACCORDANCE WITH THE POLICY PROVISIONS. —Proof of Insurance only... AUTHORIZED REPRESENTATIVE 1QRR_9n15 Ar.rg; n rnRPr1RATIr1N All rinhtc rnccrund ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Digitally signed ACOROF CERTIFICATE OF LIABILITY INs4kwye by n IM/DD/YYYY) 05/25/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHW UPON THE CERTIF /.TE , CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWE IIiG �c IZ�c.P22.OJ.2 FTFIIIR'Z� 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 CONTACT Priscilla Ramirez NAME: Winton Ireland Strom & Green FAX A/CNNo Ext : (209) 667-0995 (AIC No): (209) 667-7142 License# 0596517 E-MAIL pramirez wis com ADDRESS: @ g' INSURER(S) AFFORDING COVERAGE NAIC # P.O. BOX 3277 INSURERA: Travelers Casualty Insurance Company ofAmerica 19046 Turlock CA 95381 INSURED INSURER B : Oak River Insurance Company 34630 Sterling H.S.A., Inc., DBA: Sterling Health Services, Inc. INSURERC: PO Box 71107 INSURER D : INSURER E : Oakland CA 94612 INSURER F : COVERAGES CERTIFICATE NUMBER: CL2152552891 REVISION NUMBER: THIS IS TO CERTIFYTHAT 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL UBR EFF O ICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER M� DD YYYYMLICY DD YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 � DAMAGE ence 300,000 OCCUR PREM SESORENTEEa occur $ _7CLAIMS-MADE MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 A Y 680OR423616 05/14/2021 05/14/2022 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 4,000,000 ❑ PRO ❑ 4,000,000 POLICY JECT LOC PRODUCTS - COMP/OPAGG $ Employee Benefits $ 2,000,000 OTHER: AUTOMOBILE LIABILITY CC?MMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANYAUTO OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED I I RETENTION $ $ WORKERS COMPENSATION X AND EMPLOYERS' LIABILITY Y / N STATUTE EORH E.L. EACH ACCIDENT 1,000,000 $ B ANY PROPRIETOR/PARTNER/EXECUTIVE NIA STWC246755 05/14/2021 05/14/2022 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE- EA EMPLOYEE $ If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Santa Ana, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Contractor including materials, parts, or equipment furnished in connection with such work or operations per attached CGD1050494, Primary & Non -Contributory wording applies (Form to Follow) City of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Flr 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. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Risk Mwwgernenf Dhb1an tt REVIEWED & APPROVED BY: ai -- Risk Management Specialist COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS: 1. WHO IS AN INSURED (SECTION II) is amended in a written contract for this insurance to to include as an insured any person or organiza- apply on a primary or contributory basis. tion (called hereafter "additional insured") whom 3. This insurance does not apply: you have agreed in a written contract, executed prior to loss, to name as additional insured, but a. on any basis to any person or organization only with respect to liability arising out of "your for whom you have purchased an Owners work" or your ongoing operations for that addi- tional insured performed by you or for you. b. to "bodily injury," "property damage," "per- t. With respect to the insurance afforded to Addi- sonal injury," or "advertising injury" arising tional Insureds the following conditions apply: out of the rendering of or the failure to render any professional services by or for you, in - a. Limits of Insurance — The following limits of cluding: liability apply: 1. The preparing, approving or failing to 1. The limits which you agreed to provide; prepare or approve maps, drawings, or opinions, reports, surveys, change or- 2. The limits shown on the declarations, ders, designs or specifications; and whichever is less. 2. Supervisory, inspection or engineering b. This insurance is excess over any valid and services. collectible insurance unless you have agreed CG D1 05 04 94 Copyright, The Travelers Indemnity xAMumiganeniMbIm Company, 1994. REVIEWED&APPROVED BY. tll Includes Copyrighted Material from Insurance Services Office, Inc — — Risk Risk Management Specialist 1000 Broadway, Suite 250 Oakland, CA 94607 1-800-617-4729 www.sterlinghsa.com 20 Civic Center Plaza Santa Ana, CA 92702 Re: Auto Insurance Requirement Dear City of Santa Ana Risk Management Division: Sterling Administration has intent to enter into an agreement with the City of Santa Ana. Throughout the course of this agreement, Sterling Administration attests to the following: Sterling Administration, will not use/drive any vehicle during the course and scope of the services provided in the agreement/contract. Sterling Administration will not use any owned/rented/leased vehicles during the course and scope of the services provided in the agreement/contract. 3. Sterling Administration consultants/independent contractors/employees utilize their personal vehicles/non-company owned, borrowed, or rented/leased vehicles for transportation to and from work and if applicable carry their own automobile insurance. By signing below, 1, attest that I possess the legal authority to enter into an agreement with the City of Santa Ana as well as the legal authority to attest to the statements above. If at any time it is found that Sterling Administration is not adhering to any/all statements in this document and has not provided the minimum Auto liability insurance coverage of $1 million per occurrence, the contract will be considered null and void and the company will be held fully liable for any and all damages. l! s"rdent & COO Sterling Administration 1-800-617-4729 Duarte.Batista@sterlingadministration.com �N tt xAMumpnenttii blan REVIEWED & APPROVED BY. -- Risk Management Specialist • Digitally - A� CERTIFICATE YY) I I I URANC os/2o/2022 g IQ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONOMS NO RIGHTS UPON " H,' 64VI C CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAG : AF,ED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTI TE A CONTRACT BETWEEN TH IS .DING h ) I REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOL]� IMPORTANT: If the certificate holder is an ADDITIONAL INSURE is s m e ITI , L I � pt� G' 7b etlabr/t o�01 If SUBROGATION IS WAIVED, subject to the terms and conditions oft a po Icy, certain pollcles :na, require an ry�� l� this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Priscilla Ramirez NAME: Winton Ireland Strom & Green (209) 667-0995 a/c, (209) 667-7142 ACNE. Ext : No): License# 0596517 E-MAIL pramirez@wisg.com com ADDRESS: P.O. Box 3277 INSURER(S) AFFORDING COVERAGE NAIC # Turlock CA 95381 INSURERA: Travelers Casualty Ins Co of America 19046 INSURED INSURER B : Allied World Surplus Lines Insurance Company 24319 Sterling H.S.A., Inc. INSURER C : DBA: Sterling Health Services, Inc. INSURER D : PO Box 71107 INSURER E : Oakland CA 94612 INSURER F : COVERAGES CERTIFICATE NUMBER: 2022 GL/E&O/Cyber/Auto/ REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW FIAVE 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 MAYBE 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 INSURANCEAUULbUbil INSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE DAMAGE TO RENTED PREMISES $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 2,000,000 A Y 680OR423616 05/14/2022 05/14/2023 AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 4,000,000 OLICY ❑ PRO ❑ LOC JECT: ITHER PRODUCTS-COMP/OP AGG $ 4'000'000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ Included in GL BODILY INJURY (Per person) $ ANYAUTO A OWNED SCHEDULED AUTOS ONLY AUTOS 680OR423616 05/14/2022 05/14/2023 BODILY INJURY (Pe r accide nt) $ PROPERTY DAMAGE Per accident $ X HIRED �/ NON -OWNED AUTOS ONLY X AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ PDICESS AGGREGATE $ LAB CLAIMS -MADE D RETENTION $ $ AOFFICER/MEMBER WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE EXCLUDED? (Mandatory in NH) N /A STWC352048 O5/14/2022 O5/14/2023 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 1000000 $ ,, B: Professional E&O Liability C: Cyber Liability / Data Breach P00100012245403 05/14/2022 05/14/2023 C yber Limit: E&O Limit: $1,000,000 $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The City of Santa Ana, its officers, officials, employees, and volunteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Contractor including materials, parts, or equipment furnished in connection with such work or operations per attached CGD1050494, Primary & Non -Contributory wording applies (Form to Follow) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana Risk Management Division ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza, 4th Flr AUTHORIZED REPRESENTATIVE Santa Ana CA 92701 E Risk Muagment DiMsian REVIEWED & APPROVEDBY: © 1988-2015 ACOF °( '. e Aeevaa ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ir_ Risk Management specialist COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS: 1. WHO IS AN INSURED (SECTION II) is amended in a written contract for this insurance to to include as an insured any person or organiza- apply on a primary or contributory basis. tion (called hereafter "additional insured") whom 3. This insurance does not apply: you have agreed in a written contract, executed prior to loss, to name as additional insured, but a. on any basis to any person or organization only with respect to liability arising out of "your for whom you have purchased an Owners work" or your ongoing operations for that addi- tional insured performed by you or for you. b. to "bodily injury," "property damage," "per- 2. With respect to the insurance afforded to Addi- sonal injury," or "advertising injury" arising tional Insureds the following conditions apply: out of the rendering of or the failure to render any professional services by or for you, in - a. Limits of Insurance — The following limits of cluding: liability apply: 1. The preparing, approving or failing to 1. The limits which you agreed to provide; prepare or approve maps, drawings, or opinions, reports, surveys, change or- 2. The limits shown on the declarations, ders, designs or specifications; and whichever is less. 2. Supervisory, inspection or engineering b. This insurance is excess over any valid and services. collectible insurance unless you have agreed Ririe Division CG 13105 04 94 Copyright, The Travelers Indemnity Company, 1994. ;i n E o REVIEWED & APPROVED BY. - Includes Copyrighted Material from Insurance Services Office, Inc 4+e Aavd4 '�--'Risk Management Specialist