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Home My WebLink AboutWELLDYNERX (3)0 N N INSURANCE ON FILE r` WORK MAY PROCEED N UNTIL INSURANCE EXPIRES J i1Z/l 69/20 CLERK OF COUNC11 DATE FIFTH AMENDMENT TO AGREEMENT WITH WELLDYNERx p, tJA (2�C1 hY $\� FOR PROFESSIONAL SERVICES ("SHARPS PROGRAM") A-2020-106 THIS FIFTH AMENDMENT to the above -referenced agreement is entered into on May 19, 2020 by and between WellDyneRx- "Consultant'), 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 ("City"). RECITALS A. The parties entered into Agreement No. A-2007-278; dated December 3, 2007, by which Consultant has provided services to ensure that used medical needles are collected from City residents and disposed of in a safe and sanitary manner. The -original term of the Agreement -was from January 1 2008 until December31, 2008. B. In the original Agreement, Consultant was known as- WellDynelRx West but has since been rebranded as WellDyneRx___,_. C. On December 31, 2008, the parties entered into First Amendment to Agreement No. -A- 2007-278-01, to extend the term of the Agreement until June 30, 201:0. D. On June 30, 2010, the parties entered into Seeond Amendment to Agreement No: A-2007- 278-02, to further adjust the compensation and extend the term of the Agreement. E. On May 4, 2016, the parties entered into Third Amendment to Agreement No. A-20.16404 to again adjust the compensation and extend the term of the Agreement. F. On May 15, 2018, the parties entered into Fourth Amendment to AgreementNo.-A-2018- 131 to further extend the term of the Agreement. The Agreement remains in effect through June 30, 2021. G. The parties now wish to extend the Agreement through June 30;-2-022. The Parties therefore agree: 1. Section 3, Term, is amended to extend the term of the Agreement for an additional one (1) year period through June 30, 2022. 2. Except as modified by this Fifth Amendment, and all prior amendments, all terms and conditions of the Agreement shall remain in full force and effect. [signature page to follow] Page 1 of 2 A-2020-106 IN WITNESS WHEREOF, the parties hereto have executed this Fifth Amendment to the Agreement on the date and year first written above. ATTEST ?Daisy -•�� APPROVED AS TO FORM Sonia R. Carvalho, City Attorney John W Funk Assistant City Attorney RECOMMENDED FOR APPROVAL U f^—�-, ) G v� R "� � ° � Nabil Saba Executive Director Public Works Agency Page 2 of 2 CITY OF SANTA ANA Kristine Ridge City Manager WELLDYNERx t2 hee t Stzph n Saft(Apr 28, 220) By: Stephen Saft Title: Chief Financial Officer CERTIFICATE OF LIABILITY INSURANCE o2/13/2020 zn THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ERTIF HOLDER. T 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 WANED, 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 CONTACT 8110 E Union Avenue NAME: PHONE FAX Suite 700 E t' No: Denver CO 80237 ADDRESS: (303)414-6000 INSURER$ AFFORDING COVERAGE me# INSURER A: ATCh S eC"I Insurance Company an 21199 INSURED WellDyneRX, LLC. 1424829 INSURER B: Zurich American Insurance Company 16535 500 Eagles Landing Drive INSURER c :National UnionFire Ins Co Pitts. PA 19445 Lakeland, FL 33810 INSURER D: Berkley Insurance Company 32603 INSURER E : COVFRA(:FR reurrnrnrc un.....-.,. NSURER F: NC:VI6IUIN NUMBER: XX)DCXXX 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 AD S BR LTR TYPEOFINSURANCE VIV POLICY NUMBER MMADWYYYY MM(DDIIYYYY LIMITS A )( COMMERCIAL GENERAL LIABILITY CLAIMS -MADE W OCCUR N N FLP006017703 2/162020 2/16/2021 EACH OCCURRENCE $ 1000 000000 PREMI-ORWSES oc yErrence $ 100,000 MED EXP (Any one emn) $ 5,000 PERSONAL a ADV INJURY S 1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ jEC LOC OTHER: GENERAL AGGREGATE s 3,000,000 PRODUCTS-COMP/OPAGG s 3000000 S A AUTOMOBILE X LIABILITY ANY AUTO OWNECHED AUTOS? UTOS ONLY F:jAUTOSULEO NON_U NEBODILY HIRED ONLY X AUTOS ONLP N N FLP006017703 2/162020 2/I62021 COMBINED SINGLE OMIT Eeaccidei s 1000000 BODILY INJURY(Perperson) $ XXXX)M INJURY(Per accident $ X)OC XXX PROPERTY DAMAGE er accla 1 $ XXXXXX S X 5555ff A B X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MACE N NIA N N FLP006017703 WC0143909D3 2/162020 2/162020 i(i6 021 2/16/2021 EACH OCCURRENCE $ 10,000A0 AGGREGATE $ 10 000 000 OEO RETENTION$ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORMARTNER/EXECU T W E OFFICERIMEMSER EXCLUDED? ENE (Mandatory In NH) ayes, describe uMer X ASTUTE ORH $ XXXXJ{){)C EL EACH ACCIDENT $ 1000000 E.1- DISEASE - EA EMPLOYE $ 1000 000 A C D DESCRIPTION OF OPERATIONS below Pharmacy Prof,Liab. PBM E&O Liab• Crime N N FLP006017703 039869656 BCCR4500242323 7J162020 2/I62020 2/162020 216/2021 2/16/2021 2/162021 EA.OISFASE- POLICYUMn $ 1000000 $IM/$3M Limit: $SM/Ret $250K Limit: $2M per Oce. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be aaacbed R more space Is required) ByVttiEWiskMD & APPRpOVEITD rconnrnrc unr nco _ r, __..___ 16191579 City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Risk Management Division THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza, M-28 ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 1988 REPRESENTATIVE AUTHORIZED REPRESE Santa Ana, CA 92702 \�f � �„ ✓,.. � /�f`�/s,�J.+ reserved. ,------- 1 111w ..,mu ,mitre anu logo are registered marks of ACORD �itsi 2Cc;a9Yet ab Ttta A +A mme odlcysgsraMrateOd, wft of ACM Francine R. Digitally signed by Francine R. Villareal Villareal Date �Wl MneiF�i U-mv ACORO° CERTIFICATE OF LIABILITY INSURANCE 1 DATE (MMIDDIYWY) 2/16/2022 2/15/2021 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 CONT NAMEACT 9110 E Union Avenue PHONE FAX Suite 100 Ext : A/C, Na E-MAIL Denver CO 80237 ADDRESS: (303) 414-6000 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Arch Specialty Insurance Company 21 199 INSURED WellDyneRX, LLC 1477414 INSURER B : Zurich American Insurance Company 16535 500 Eagles Landing Drive INSURER C : ACE American Insurance Company 22667 Lakeland, FL 33810 INSURER D : Berkley Insurance Company 32603 INSURER E : INSURER F : 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 WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY N N FLP006017704 2/16/2021 2/16/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 IVIED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY ❑JECT PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 3,000,000 $ OTHER: A AUTOMOBILE LIABILITY N N FLP006017704 2/16/2021 2/16/2022 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ XXXXXXX ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ XXXXXXX X PROPERTY DAMAGE Per accident $ XXXXXXX HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY $XXXXXXX A X UMBRELLA LIAB OCCUR N N FLP006017704 2/16/2021 2/16/2022 EACH OCCURRENCE $ 10,000,000 A EXCESS LIAB CLAIMS -MADE Retro Date: 2/16/2020 X AGGREGATE $ 10,000,000 DED RETENTION $ 1 $ XXXXXXX 1 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N I A N WC014390904 2/16/2021 2/16/2022 PER OTH- X STATUTE I I ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $ 1,000,000 $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Pharmacy Prof. Liab. N N FLP006017704 2/16/2021 2/16/2022 $1M/$3M Retro Date: 2/16/2020 C PBM E&O Liab. MSPG72508130001 2/16/2021 2/16/2022 Limit: $5M/Ret $250K D Crime BCCR4500242324 2/16/2021 2/16/2022 Limit: $2M per Occ. DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be 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 Workers Compensation Coverage. 14516082 City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92701 ACORD 25 (2016/03) 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 ]Z181l Mwagmerit; DR isiun • z REVIEWED & APPROVED BY. - Cc, 1988-20'.d The ACORD name and logo are registered marks of ACORD ` Risk Management Analyst Miscellaneous Attachment: M577149 Master ID: 1477414, Certificate ID: 14516082 Excess Liability Schedule Carrier Policy Number Limit Lloyd's of London MC1000459 $25,000,000 Lloyd's of London B018OPC2109645 $30,000,000 �oRaN Risk MwaganadDMsiun REVIEWED & APPROVED BY. - Risk Management Analyst 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