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Home My WebLink AboutCONCENTRA MEDICAL CENTER dba OCCUPATIONAL HEALTH CENTERS OF CALIFORNIA (3)INSURANCE ON FILE WORK NIAY PROCEED UNTIL INSURANCE EXPIRES 9-i-2o23 CLERK OFv fAgMIL DATE: Valerie Amezcua MAYOR PRO TEM Jessie Lopez COUNCILMEMBERS Phil Bacerra Johnathan Ryan Hernandez David Penaloza Thai Viet Phan Benjamin Vazquez 0', H12 0166 S)(5A� ( J AN 2 4 2020 January 5, 2023 r. I411SIR HUMAN RESOURCES 20 Civic Center Plaza a P.O. Box 1988 Santa Ana, California 92702 W W W.santa-ana.ora Occupational Health Centers of California, a Medical Corporation 5080 Spectrum Drive, Suite 120OW Addison, TX 75001 Attn: Jeffrey Wainstein, MD, President and Treasurer A-2019-006-02 CITY MANAGER Kristine Ridge CITY ATTORNEY Sonia R. Carvalho ACTING CLERK OF THE COUNCIL Norma Orozco Re: Second Extension of Agreement to Provide Medical Services Review, No. A-2019-006 Pursuant to Section 3 ("Term") of the above -referenced Agreement, entered into by Concentra Medical Center dba Occupational Health Centers of California, a Medical Corporation, and the City of Santa Ana, dated January 15, 2019, the time period of the Agreement is hereby further extended for an additional one- year period, from January 31, 2023 through January 30, 2024. Any insurance certificates are required to be extended and/or renewed to cover this extension. All other terms and conditions of the Agreement remain unchanged and in full force and effect. Sincerely, Jason on Mo sick 0 Executive Director Human Resources Department CITY OF SANTA ANA Kristine Ridge City Manager APPROVED AS TO FORM ATTEST 7 Norma Orozco Acting Clerk of the Coun OCCUPATIONAL HEALTH CENTERS OF CALIFORNIA, A MEDICAL CORPORATION Kathy Le, MD Kathy La,h MD Ilan 13, 2Q231a14 PST) 'frandon Salvatierra Name: Kathy T. Le, MD, MPH Deputy City Attorney Title: President and Treasurer SANTA ANA CITY COUNCIL Valerie Aral Jessie Lopez Thai Viet Phan Benjamin Vazquez Phil Bacena Johri Ryan Hemandez D.vid Penal.. Mayor Mayor Pro Tem. Ward] Wind Word Ward Ward5 Ward6 vannotwaaame-ana am sielooeassanla-ana.oro tohanlAsantaanaora byamuez@saraii am abvoomeAaante-ana.am imhemantlezaient.h. am daanalozainssola-a�a om Ho, Josephine From: City of Santa Ana <certificate-request@ctraxjdidata.com> Sent: Tuesday, January 10, 2023 10:01 AM To: Concentra_unit@grahamco.com; Ho, Josephine; Nguyen, Danvi; info@grahamco.com; Murray, James; Schnaider, Lori Subject: Internal Notice of Compliance NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL Contractor Occupational Health Centers of California, A Medical Corporation Name: Project A-2019-006-01 Number: Project Extension of Agreement to Provide Medical Services Review, No. A-2019- Name: 006 The Certificate of Insurance (COI) submitted indicates that the coverages are in compliance with the insurance requirements. No further action is required at this time. The compliant coverage(s) are: TYPE OF INSURANCE GENERAL LIABILITY PROFESSIONAL LIABILITY WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Thank you, POLICY EXPIRATION COI DATE NUMBER DATE HAZ40322445817 01/01/2024 01/04/2023 HAZ40322445817 WA763D510199352 1 01/01/2024 01/05/2023 04/01/2023 03/30/2022 FILE NAME CITY-OF-SANTA- ANA_Occupational- He 1-1-23-1-I-20 1- 4- 2023_1091828540.pdf. CITY-OF-SANTA- ANA_Occupational- He 1-1-23-1-1-20 1- _ 4 2023_1091828540.pdf Occupational Health Center of CA DBA Concentra COI Exp 4- ' 1-23 RMD04042022.pdf NOTICE OF COMPLIANCE CITY STAFF: PRINT THIS PAGE AND INCLUDE WITH AGREEMENT TO THE CLERK OF THE COUNCIL Contractor Occupational Health Centers of California, A Medical Corporation Name: Project A-2019-006-02 Number: Project A-2019-006-02 Name: The Certificate of Insurance (COI) submitted indicates that the coverages are in compliance with the insurance requirements. No further action is required at this time. The compliant coverage(s) are: EXPIRATION TYPE OF INSURANCE POLICY NUMBER COI DATE FILE NAME DATE GENERAL LIABILITY HAZ40322445817 01/01/2024 03/27/2023 CERT-1309430899.pdf CITY-OF-SANTA- ANA_Occupational- PROFESSIONAL LIABILITY HAZ40322445817 01/01/2024 01/05/2023 He_1-1-23-1-1-20_1- 4- 2023_1091828540.pdf WORKERS COMPENSATION WA763D510199353WC2631510199263 04/01/2024 03/27/2023 CERT-1309430899.pdf AND EMPLOYERS' LIABILITY Thank you, City of Santa Ana Risk Management Division in partnership with CTrax Plus Services Team 5/16/2023 6:21 PM