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HomeMy WebLinkAboutKAISER FOUNDATION HEALTH PLANINSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES 1 • ► • ZO &- CLERK OF COUNCIL DATE: N-2022-182 JVA 3 0 2022 CONSULTANT AGREEMENT BETWEEN THE CITY OF SANTA ANA AND KAISER FOUNDATION HEALTH PLAN, INC. FOR KAISER 0: HI,(KtA (GeAA)1 PERMANENTE MOBILE HEALTH VEHICLE THIS AGREEMENT is made and entered into on this 23`d day of June, 2022, by and between Kaiser Foundation Health Plan (`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 City desires to retain a consultant having special skill and knowledge in the field of providing mobile health vehicles services for biometric screenings (blood pressure, BMI, glucose and cholesterol). B. Consultant represents that Consultant is able and willing to provide such services to the City. C. 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 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 parties agree as follows: 1. SCOPE OF SERVICES Consultant 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 services described and set forth in Exhibit A attached hereto as and incorporated herein by reference. 2. COMPENSATION a. As outlined in Exhibit A, Consultant will be covering the cost in full for the Scope of Services on the condition that the City is able to produce at a minimum 6 participants per hour and at least 32 participants in total for biometric screenings at each event. If the City is unable to meet the minimum participant requirement, the City agrees to pay, and Consultant agrees to accept as total payment for its services a sum not to exceed One Thousand Two Hundred Forty Eight Dollars ($1,248). b. Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. 3. TERM This Agreement shall commence on the date first written above and continue until the services in Exhibit A are fully performed on July 12 and 19, 2022, unless terminated earlier in accordance with the Cancelation Policy for All Event Types outlined in Exhibit A. 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 employees and shall be responsible for all applicable withholding taxes. 5. 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 medium 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 Consultant under this Agreement ("Documents & Data"). Consultant 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. Consultant represents and warrants that Consultant has the legal right to license any and all Documents & Data. Consultant makes no such representation and warranty in regard to Documents & Data which were provided to Consultant 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. 6. INSURANCE Consultant shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder by the Consultant, its agents, representatives, employees or subcontractors. a. MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall beat least as broad as: 1. Commercial General Liability (CGL): Insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury 2 with limits no less than $1,000,000 per occurrence. If general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall be twice the required occurrence limit. 2. Automobile Liability: ISO Form Number CA 00 01 covering any auto (Code 1), or if Contractor has no owned autos, hired, (Code 8) and non -owned autos (Code 9), with limit no less than $1,000,000 per accident for bodily injury and property damage. 3. Workers' Compensation: as required by the State of California, with Statutory Limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident for bodily injury or disease. 4. If the Consultant maintains broader coverage and/or higher limits than the minimums shown above, the City requires and shall be entitled to the broader coverage and/or the higher limits maintained by the Consultant. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City. b. Other Insurance Provisions — The insurance policies are to contain, or be endorsed to contain, the following provisions: 1. Additional Insured Status: The City, 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 Consultant including materials, parts, or equipment furnished in connection with such work or operations. General liability coverage can be provided in the form of an endorsement to the Consultant's insurance (at least as broad as ISO Form CG 20 10 11 85 or both CG 20 10, CG 20 26, CG 20 33, or CG 20 38; and CG 20 37 forms if a later revisions used). 2. Primary Coverage: For any claims related to this contract, the Consultant's insurance coverage shall be primary coverage at least as broad as ISO CG 20 01 04 13 as respects the City, its officers, officials, employees, and volunteers. Any insurance or self-insurance maintained by the City, its officers, officials, employees, or volunteers shall be excess of the Consultant's insurance and shall not contribute with it. 3. Notice of Cancellation: Each insurance policy required above shall provide that coverage shall not be canceled, except with notice to the City. 4. Waiver of'Subrogation: Consultant hereby grants to City a waiver of any right to subrogation which any insurer of said Consultant may acquire against the City by virtue of the payment of any loss under such insurance. Consultant agrees to obtain any endorsement that may be necessary to affect this waiver of subrogation, but this provision applies regardless of whether or not the City has received a waiver of subrogation endorsement from the insurer. 5. Self -Insured Retentions: Self -insured retentions must be declared to and approved by the City. The City may require the Consultant to purchase coverage with a lower retention or provide proof of ability to pay losses and related investigations; claim administration, and defense expenses within the retention. The policy language shall provide, or be endorsed to provide, that the self - insured retention may be satisfied by either the named insured or City. 6. Acceptability of Insurers: Insurance is to be placed with insurers authorized to conduct business in the state with a current A.M. Best's rating of no less than A:VII, unless otherwise acceptable to the City. 7. Claims Made Policies: If any of'the required policies provide coverage on a claims -made basis: 1. The Retroactive Date must be shown and must be before the date of the contract or the beginning of contract work. 2. Insurance must be maintained and evidence of insurance must be provided for at least five (5) years after completion of the contract of work. 3. If coverage is canceled or non -renewed, and not replaced with another claims -made policy form with a Retroactive Date prior to the contract effective date, the Consultant must purchase "extended reporting" coverage for a minimum of five (5) years after completion of contract work. 8. Verification of Coverage: Consultant shall furnish the City with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage required by this clause) and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements to City before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive the Consultant's obligation to provide them. City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. 9. Special Risks or Circumstances: City reserves the right to modify these requirements, including limits, based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. INDEMNIFICATION Consultant 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 Consultant, its subcontractors, agents, employees, or other persons acting on its behalf which relates to the services described in section I 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 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. 8. INTELLECTUAL PROPERTY INDEMNIFICATION Consultant 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 Consultant to the City pursuant to this Agreement. 9. RECORDS Consultant shall keep records and invoices in connection with the work to be performed 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. 10. CONFIDENTIALITY If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Consultant 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 information that (a) has beendisclosedin 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 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. It. CONFLICT OF INTEREST CLAUSE Consultant 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. 12. NON-DISCRIMINATION Consultant 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. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 13. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant, 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. 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, the terms and conditions hereof, shall not bind or obligate Consultant 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. 14. 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 which are the subject to this Agreement performed by City personnel or by other consultants retained by City. 15. 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. 16. 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. 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 States, the State of California, the City of Santa Ana and all other governmental agencies. Consultant shall notify the City immediately and 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. 18. 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: Clerk 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: City of Santa Ana 20 Civic Center Plaza (M-25) P.O. Box 1988 Santa Ana, California 92702-1988 Facsimile (714) 647-6549 To Consultant: Kaiser Foundation Health Plan, Inc. Sunny Smith, Territory Manager Address: 3100 Thornton Ave, 3rd floor, Burbank, CA 91504 Phone: 818-319-0467 Email: Sunny.Smith@kp.org 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. 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. [signatures on following page) IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: Daisy Gome Clerk of the ouncil APPROVED AS TO FORM: SONIA R. CARVALHO City Attorney M. Jose Montoya Assistant City Attorney RECOMMENDED FOR APPROVAL: ✓e Director Resources Department CITY OF SANTA ANA Kristine Ridge City Manager CONSULTANT Sunny Smith Kaiser Permanente Territory Manager EXHIBIT A m KAISER PERMANEME- Date: 5/26/22 Mobile Health Vehicle Services for City of Santa Ana Group wishes to engage Kaiser Foundation Health Plan, Inc. ("KP") to arrange for the Kaiser Permanente Mobile Health Vehicle (MHV) to provide the services described below at Group's worksite (the "Services"), and KP wishes to provide such Services: ®Biometric Screenings ❑Limited Screenings ❑Care Gap Closure to members of KP ❑Community Event ❑Primary Care services to members of KP fully -insured health plans TERMS & CONDITIONS FOR KAISER PERMANENTE WORKSITE SERVICES FEES: Biometric Screenings (blood pressure BMI glucose and cholesterol) • Biometric screenings are charged at $39 per participant for both KP members and non- members. Limited Screenings (blood pressure BMI and glucose) • Limited screenings are at no cost to the employer. No fees apply. Care Gap Closures to members of KP • Care Gap Closures are at no cost to the employer. Standard member copayments may apply if a non -preventive service is delivered on the mobile health vehicle. Primary Care to members of KP fully -insured health plans ■ Primary Care services are at no cost to the employer. Standard member copayments and deductibles apply and will be collected either at the time of service or via mailed invoice. PARTICIPATION GUIDELINES: Biometric Screenings • Minimum 6 participants per hour and at least 32 participants in total for biometric screenings, or $1,248 will be assessed. Limited Screenings • Minimum of 6 participants per hour for limited screenings. Care Gap Closures • Minimum 2 participants per hour for Care Gap services. Service includes a review of the member's medical record to check if the member is up to date with recommended care, to close any gaps in care and to provide limited biometric screenings. Primary Care • Minimum 2 participants per hour for primary care services. (LOA07032019) 94 KAISER PERMANENTE® CANCELLATION POLICY FOR ALL EVENT TYPES: • Cancellations received by the MHV Product Manager at least 30 calendar days prior to the event are allowed and will not be assessed a penalty. • Cancellations fewer than 30 calendar days prior to the event date but greater than 14 calendar days can be rescheduled for an alternate location and for the same services on a different date. If the event is not able to be rescheduled a cancelation fee of $2,600 will be assessed. ■ Cancellations within 14 calendar days will be assessed a cancellation fee of $2,600. • Cancellations due to circumstances beyond the control of either party (natural disaster, fire, etc.) will not be assessed a penalty. • If the MHV is inoperable, alternative options will be offered. Alternatives could include but are not limited to providing the service in a conference room or setting up a standalone station using pop-up tents. • Note: Cancellation notice is not effective until it is received by the Mobile Health Vehicle Product Manager or a similar role. Date(s) on which Services will be provided: July 121h (City Yard) & July 19'h (Police Department) Estimated number of participants receiving Services: 120 total: 50 at public works & 70 at police department Location where Services will be provided: Address for the City Yard is: 215 S. Center Street, Santa Ana, CA 92703 Address: 60 Civic Center Plaza, Santa Ana, CA 92701 Funding source if applicable: Keenan to fund a MAX of $2,807.02 & Kaiser Permanente will fund the remaining balance. NO COST TO THE CITY FOR THESE SERVICES on the above dates. (LOA07032019) P I KAISER PERMANENTE; Date: 5/26/22 Mobile Health Vehicle Services for City of Santa Ana Group wishes to engage Kaiser Foundation Health Plan, Inc. ("KP") to arrange for the Kaiser Permanente Mobile Health Vehicle (MHV) to provide the services described below at Group's worksite (the "Services'), and KP wishes to provide such Services: XBiometric Screenings []Limited Screenings ❑Care Gap Closure to members of KP FEES: ❑Community Event ❑Primary Care services to members of KP fully -insured health plans TERMS & CONDITIONS FOR KAISER PERMANENTE WORKSITE SERVICES Biometric Screenings (blood pressure BMI, glucose and cholesterol) Biometric screenings are charged at $39 per participant for both KP members and non- members. Limited Screenings (blood pressure, BMI and glucose) • Limited screenings are at no cost to the employer. No fees apply. Care Gap Closures to members of KP ■ Care Gap Closures are at no cost to the employer. Standard member copayments may apply if a non -preventive service is delivered on the mobile health vehicle. Primary Care to members of KP fully -insured health plans • Primary Care services are at no cost to the employer. Standard member copayments and deductibles apply and will be collected either at the time of service or via mailed invoice. PARTICIPATION GUIDELINES: Biometric Screenings • Minimum 6 participants per hour and at least 32 participants in total for biometric screenings, or $1,248 will be assessed. Limited Screenings • Minimum of 6 participants per hour for limited screenings. Care Gap Closures Minimum 2 participants per hour for Care Gap services. Service includes a review of the member's medical record to check if the member is up to date with recommended care, to close any gaps in care and to provide limited biometric screenings. Primary Care • Minimum 2 participants per hour for primary care services. (LOA07032019) CANCELLATION POLICY FOR ALL EVENT TYPES: • Cancellations received by the MHV Product Manager at least 30 calendar days prior to the event are allowed and will not be assessed a penalty. ■ Cancellations fewer than 30 calendar days prior to the event date but greater than 14 calendar days can be rescheduled for an alternate location and for the same services on a different date. If the event is not able to be rescheduled a cancelation fee of $2,600 will be assessed. • Cancellations within 14 calendar days will be assessed a cancellation fee of $2,600. • Cancellations due to circumstances beyond the control of either party (natural disaster, fire, etc.) will not be assessed a penalty. • If the MHV is inoperable, alternative options will be offered. Alternatives could include but are not limited to providing the service in a conference room or setting up a standalone station using pop-up tents. • Note: Cancellation notice is not effective until it is received by the Mobile Health Vehicle Product Manager or a similar role. Date(s) on which Services will be provided: July 121h (City Yard) & July 191h (Police Department) Estimated number of participants receiving Services: 120 total: 50 at public works & 70 at police department Location where Services will be provided: Address for the City Yard is: 215 S. Center Street, Santa Ana, CA 92703 Address: 60 Civic Center Plaza, Santa Ana, CA 92701 Funding source if applicable: Keenan to fund a MAX of $2,807.02 & Kaiser Permanente will fund the remaining balance. NO COST TO THE CITY FOR THESE SERVICES on the above dates. By signing below the parties agree to the terms and conditions. authorized signatory Lori Schnaider Printed Name Signature KP's authorized signatory Kirsten Howell Printed Name Signature (LOA07032019) Francine R. Digitally rigned by Francine R. Villareal Villareal Dace: 2022.011609:a4:17 EVIDENCE OF COVERAGE ISSUE DATE (MMIDDIYY) -0800 01/19/2022 SPONSOR THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Kaiser Foundation Health Plan, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Attention: Corporate Risk Management ALTER THE COVERAGE ARRANGEMENTS SET FORTH BELOW, One Kaiser Plaza, 25'h FI. Oakland, CA 94612 COVERAGE AFFORDED COVERED ENTITIES LETTER A Kaiser Foundation Health Plan, Inc. Self -insured Kaiser Foundation Hospitals COVERAGES CO TYPE OF COVERAGE DESCRIPTION EFFECTIVE DATE EXPIRATION LIMITS LTR MMIDDIYY DATE MMIDDIYY A Hospital/Physician/Professional Self -Insured 1/1/2022 1/1/2023 Each Occurrence: $ 5,000,000 Liability Annual Aggregate: None S.Y.r DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS This certificate provides evidence of professional liability coverage for the above -named entities in accordance with a written contract or agreement. Kaiser Mobile Health Vehicle - coming onsite to hold biometric City of Santa Ana screenings & flu shots 20 Civic Center Plaza Santa Ana CA 92701 [RC006161] CERTIFICATE HOLDER CANCELLATION City of Santa Ana NOT APPLICABLE 20 Civic Center Plaza, AUTHORIZED REPRESENTATIVE Santa Ana, CA 92701 Mario Espindola Martin King, VP KPCRMEOC 21 (2021 0628) Walt Mnugmwnt Divisimt n CREVIEWED&APPR.C,VtEDBr': ® Risk Management Malys[ ACRE) CERTIFICATE OF LIABILITY INSURANCE DATE IYYYY avzs122022 Dzz 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 MARSH RISK & INSURANCE SERVICES CONTACT PHONE FAX AX xo: FOUR EMBARCADERO CENTER, SUITE 1100 CALIFORNIA LICENSE NO. D437153 SAN FRANCISCO, CA 94111 EJAgIL ADDRESS INSURERS AFFORDING COVERAGE NAIC# CN101403686-SCAL-CAS-22-23 GLALW CA INSURER A: Safety Nalional Casualty Corp. 15105 INSURED KAISER FOUNDATION HEALTH PLAN, INC, INSURER B INSURER C KAISER FOUNDATION HOSPITALS 393 EAST WALNUT STREET PASADENA, CA 91188 INSURER D INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: SEA-003811693-02 REVISION NUMBER: 2 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 INSURANCEINSID AIJIJ1 SUER POLICY NUMBER MMIDDYEFF MMIDD/YYXYY LIMITS A X COMMERCIAL GENERAL LIABILITY CI -AIMS -MADE OCCUR GL4048017 01/012022 01/012023 EACH OCCURRENCE S 5,000,000 ERENTED PREMISESS ( Ea occurrence) S 5,000,000 MED EXP (Any one person) S 10,000 PERSONAL &ADV INJURY S 5,000,000 AGGREGATE LIMIT APPLIES PER: POLICY PET TOO GENERALAGGREGATE S 5,000,000 GEN'L X PRODUCTS-COMPIOPAGG S 5,000,000 $ OTHER: A A AUTOMOBILE X LIABILITY ANY AUTO CA6675880 $5,000,000 SIR 01/0112022 01/01/2023 COMBINED SINGLE -LIMIT Me accident $ 4,000000 BODILY INJURY (Per person) S OWNED BCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Peracciden0 S HIRED NON -OWNED AUTOS ONLY HAUTOS ONLY PROPERTY DAMAGE Per accident s Is UMBRELLA LNB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LU18 CLAIMS -MADE DED I I RETENTIONS S A WORKERS COMPENSATION EMPLOYERS' LIABILITY YIN ANYPROPRIETOWPARTNEWEXECUTIVE OFFICERIMEMBEREXCWDEDT N/A SP4066154 SIR. $5,000,000 01/0112023 X PER OH_ STATUTE ER E.L. EACH ACCIDENT $ 5,000,000 E.L. DISEASE -EA EMPLOYEE $ 5,000,000 (Mandatory In NH) If yes, describe under E.L. DISEASE- POLICY LIMIT $ 5,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) REQUEST 9RC006161 THE CITY OF SANTA ANA, ITS OFFICERS, OFFICIALS, EMPLOYEES AND VOLUNTEERS ARE INCLUDED AS ADDITIONAL INSURED AS RESPECTS GENERAL LIABILITY TO THE EXTENT REQUIRED BY WRITTEN CONTRACT. THE GENERAL LIABILITY POLICY IS PRIMARY AND NON-CONTRIBUTORY WHERE REQUIRED BY WRITTEN CONTRACT. POLICIES INCLUDE A WAIVER OF SUBROGATION WHERE REQUIRED BY WRITTEN CONTRACT AND ALLOWED BYLAW. CITY OF IC SANTA ANA20 I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE SANTA ANA, CA 92701 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN SANTA ANA, CA 92701 ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE Risk Mu agnrla,t D wipD r REVIEWED&APPROVED By. ©1988-2016 ACORD CACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD '' Risk Management Anarylt POLICY NUMBER: GL 4048017 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED- DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance prodded under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name OfAdditional Insured Person(s) Or Organ!zation(s): As required by written contract or agreement when such written contract or agreement is executed prior to an occurrence, offense or loss to which this endorsement applies, but only for the limits agreed to in such contract or the Limits of Liability provided by this policy, whichever is less. Any individually scheduled additional insureds shall net be construed to override nor negate this blanket additional insured. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect toliability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf. 1. In the performance ofyeur ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies tothe extent permitted by law; and 2. if coverage prodded tothe additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage prodded to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contractor agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 0413 © Insurance Services Office, Inc., 2012 rrIAentn�im b RwEwED 6 APPROVED BY., `✓ R6k Management Analpt POLICY NUMBER: GL 4048017 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) As required by written contract or agreement when such written contract or agreement is executed prior to an occurrence, offense or loss to which this endorsement applies, but only for the limits agreed to in such contract or the Limits of Liability provided by this policy, whichever is less. Any individually scheduled additional insureds shall not be construed to override nor negate this blanket additional insured. A. Section II — Who is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies tothe extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to prowde for such additional insured. 1 locations of Insured's Operations B. With respect to the insurance afforded to these additional insureds, the fdlowing is added to Section III —Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount ofinsurance: 1. Required by the contract or agreement; or 2. Aveilable under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 © Insurance Services Office, Inc., 2012 .+ REVIEWED& APPROVED 13Y. 1 MLiYNi1 R. V�V.Ni(FC �� Ri k Managenxnt Analys t �. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT OR AGREEMENT - PRIMARY BASIS This endorsement modifies insurance provided under the following Coverage Form: COMMERCIAL GENERAL LIABILITY PRODUCTS/COMPLETED OPERATIONS LIABILITY LIQUOR LIABILITY POLLUTION LIABILITY This endorsement changes the policy effective on the inception date of the policy unless another endorsement effective date is indicated below. SCHEDULE Name of Additional Insured Persons or O anization s : As required by written contract or agreement when such written contract or agreement is executed prior to an occurrence, offense or loss to which this endorsement applies, but only for the limits agreed to in such contract or the Limits of Liability provided by this policy, whichever is less. Any individually scheduled additional insureds shall not be construed to override nor negate this blanket additional insured. Designated Project, Location, or Work of Covered Operations: As per written contract or agreement with the above described person(s) or organization(s). CHANGES SECTION II - WHO IS AN INSURED is amended to include: 4. The person(s) or organization(s) shown in the Schedule above with whom you have agreed in a written contract to provide insurance such as is afforded under this Coverage Form, is included as an Additional Insured subject to the below: a. Insurance for such Additional Insured(s) scheduled above shall be afforded only to the extent that such Additional Insured is liable for 'bodily injury", "property damage" or 'personal and advertising injury' caused by your acts or omissions while actively engaged in the performance of your ongoing operations involving the project(s), locations(s), or work designated in the Schedule and as specified in the contract between you and the above scheduled Additional Insured(s). b. The insurance afforded under this Coverage Form to such Additional Insured(s) applies only: (1) If the 'occurrence' or offense takes place subsequent to the execution and effective date of such written contract and, (2) While such written contract is in force, or until the and of the policy period, which ever occurs first. c. How Limits Apply to Additional Insured(s) The most we will pay on behalf of the Additional Insured(s) scheduled above is the lesser of. (1) The limits of insurance specified in the written contract or written agreement; or, (2) The Limits of Insurance provided by the Coverage Form. SNGL 023 1209 Safety National Casualty Corporation RiskMntagementDKUM REmIhl ho&pDAPPRmm By. f4 , V�(RMLf.0 .0 Risk Management Analyst`' The amount we will pay on behalf of such Additional Insured(s) shall be a part of, and not in addition to, the Limits of Insurance shown in the Coverage Form Declarations and described in this section. Such amount will thus not increase the Limits of Insurance shown for the Coverage Form. d. Obligations at the Additional Insured's Own Cost No Additional Insured will, except at their own cost, voluntarily make a payment, assume any obligation, or incur any expense, other than for first aid, without our consent. SECTION IV — CONDITIONS is amended by deleting item a. Primary Insurance under 4. Other Insurance and replacing such item by the following, only with respect to insurance provided to the Additional Insured(s) shown in the above Schedule: a. Primary Insurance and/or Primary and Non -Contributory Insurance This insurance is primary if you have agreed in a written contract that this insurance is to be primary. If you have agreed in a written contract that this insurance is primary and non-contributory with the Additional Insured(s) own insurance, this insurance is primary and we will not seek contribution from that other insurance. The Additional Insured(s) scheduled above shall be subject to all other conditions set forth in the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. 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 01/01/2020 Policy No. cL 4048M Endorsement No. Named Insured KAISER FOUNDATION HEALTH PLAN, INC. Premium $ Included Insurance Company Safety National Casualty Corporation Countersigned By Page 2 of 2 Safety National Casualty Corporation RiskMnuganadDlAsian Rine & APPRovm By., F4acr. ,: W Z WLIWAl U Rtsk Management Analyst THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL AUTOMOBILE COVERAGE PART SCHEDULE Name Of Person Or Organization: Person(s) or Organization(s) as required by written contract when such written contract is executed prior to an accident to which this endorsement applies. Any individually scheduled Waivers shall not be construed to override nor negate this blanket Waiver. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CHANGE We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for "bodily injury" or "property damage" to which this insurance applies, caused by an "accident" and resulting from the ownership, maintenance or use of a covered "auto". This waiver applies only to the person or organization shown in the Schedule above_ 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 01/01/2022 Policy No. CA 6675880 Endorsement No. Named Insured KAISER FOUNDATION HEALTH PLAN, INC_. Premium $ Included Insurance Company Safety National Casualty Corporation Countersigned By RorkhimagmentDMsion •moo iR1 Ewm &nAppH m By: NaKn-N[ R. V+44�14iL SNCA0271013 Safety National Casualty Corporation RukWn.gen,entAnatpt POLICY NUMBER: GL 4048017 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLEI'ED OPERATONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Person(s) or Organization(s) as required by written contract when such written contract is executed prior to an occurrence, offense or loss to which this endorsement applies. Any individually scheduled Waivers shall not be construed to override nor negate this blanket Waiver. Information required to complete this Schedule if not shown above will be shown in the Declarations. The following is added to Paragraph 9. Transfer Of Rights Of Recovery Against Others To Us of Se cti on IV— Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products-compl eted operations hazard". This waiver applies only to the person or organization sham in the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 =�-�3 �R,•� DhWm AmEwm RaRavm By.22�. F4M«ez� R. V&Ai [ ® Risk Managemen[Matyst 0456 00 0113 (XWC) ENDORSEMENT BLANKET WAIVER OF SUBROGATION Effective 12:01 A.M., Local Time, January 01, 2022 In consideration of the payment of premium and adherence by both parties to the terms of this Agreement, it is hereby understood and agreed that the Recovery From Others section of this Agreement is amended to include the following additional language: The CORPORATION has the right to pursue subrogation recoveries from anyone liable for an injury covered by this Agreement_ The CORPORATION will not enforce its right against any person or organization for whom the EMPLOYER performs work under a written contract that requires the EMPLOYER to obtain this agreement from the CORPORATION. All other terms, conditions, agreements and stipulations remain unchanged. Attached to and forming a part of Excess Workers' Compensation and Employers' Liability Insurance Agreement No. SP 4066154, issued by SAFETY NATIONAL CASUALTY CORPORATION of St. Louis, Missouri to KAISER FOUNDATION HEALTH PLAN, INC_, ET AL, dated January 01, 2022. Endorsement No. 0456 00 0113 (XWC) SAFETY NATIONAL CASUALTY CORPORATION .a..s'n�Jtcc�_ d+f�dJ/JSecretary Risk MawgemadDW[bo t RE Ewm & APPRav® BY: faa� R. VLU.cWt �' R6k Management Malpt