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HomeMy WebLinkAboutCORRECTIONAL MANAGED CARE 2~~~ AGREEMENT TERMINATION j<<; ^• '~ Please complete this form when the attached agreement is no longer in effect. ;'. Return form to the Sr. Deputy Clerk of the Council (M-30). Call ~64'~-5238 if you have any questions. ----------------------------------------------------------------- I he agreement with l~U{r~ll,~4~Of~ I~krr1ao~.~ CQhe ~'LQpU1:~CK t/At-Q, No. /~ `OwVT-02,3 was completed on ~ ~ ~'~~ ,and final payment has been made. Department: ~ I I Signature: ~ ~'~, 1 Date: ~ ~' ~~ -~ City of Santa Ana Revised 8-7-03 Clerk of the Council iNSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES CLERK OF COUNCIL DATE: IL-iS-o4 ~,; PD ~5~' AGREEMENT FOR THE PROVISION OF INMATE MEDICAL SERVICES BETWEEN CITY OF SANTA ANA AND CORRECTIONAL MANAGED CARE MEDICAL CORPORATION A-2004-231 THIS AGREEMENT is made and entered into this j~~day of, 2004 by and between CORRECTIONAL MANAGED CARE MEDICAL CORPORATION, a California corporation (hereinafter "Contractor"), 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 (hereinafter "City"). RECITALS A. The City desires to retain a Contractor having special skill and knowledge in the field of providing inmate medical services. B. Contractor represents that Contractor is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Contractor represents that it is knowledgeable in its field and that any services performed by Contractor under this Agreement will be performed in compliance with such standazds as may reasonably be expected from a professional 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: TERM This Agreement shall commence on September 1, 2004 and terminate on August 31, 2005, unless terminated eazlier in accordance with Section 15, below. The term may be renewed for two additional one-yeaz periods. 2. SCOPE OF SERVICES Contractor shall provide medical services to inmates at the Santa Ana Jail, as set forth in Exhibit A to this Agreement. 3. COMPENSATION a. The Total Annual Sum to be expended under this Agreement for staffing, pharmaceuticals, supplies and other, shall not exceed $857,784.00, during Period One - September 1, 2004 through August 31, 2005, as set forth in Exhibit A attached hereto and incorporated by this reference. An additional amount up to $110,000.00, for Additional / Chargeback Services as listed in Exhibit C, may be expended during Period One. The total sum to be expended under this Agreement shall not exceed $967,784.00 during Period One. b. During Period Two, September 1, 2005 through August 31, 2006, the Total Annual Sum to be expended under this Agreement for staffing, pharmaceuticals, supplies and other, shall not exceed $926,406.00, as set forth in Exhibit A. An additional amount up to $110,000.00 for Additional / Chargeback Services, as listed in Exhibit C, may be expended during Period Two. The total sum to be expended under this Agreement shall not exceed $1,036,406.00, during Period Two. c. During Period Three, September 1, 2006 through August 31, 2007, the Total Annual Sum to be expended for staffing, pharmaceuticals, supplies and other, shall not exceed $1,000,518.00, as set forth in Exhibit A. An additional amount up to $110,000.00 for Additional / Chargeback Services, as listed in Exhibit C, may be expended during Period Three. The total sum to be expended under this Agreement shall not exceed $1,110,518.00, during Period Three. d. One-twelfth of the Total Annual Sum shall be paid monthly by the 30s' day of each month, after receipt of a complete invoice. Payment for Additional / Chargeback Services shall be made within thirty (30) 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. e. City shall not reimburse Contractor for services provided beyond the expiration and/or termination of this Agreement, except as may otherwise be provided under this Agreement, or specifically agreed upon in a subsequent Agreement. 4. INDEPENDENT CONTRACTOR Contractor is, and shall at all times be deemed to be, an independent contractor, wholly responsible for the manner in which it performs the services hereunder. Contractor is entirely responsible for compensating staff and consultants employed by Contractor. This Agreement shall not be construed as creating the relationship of employer and employee, or principal and agent, between City and Contractor or any of Contractor's agents, employees or subcontractors. Contractor assumes exclusive responsibility for acts of its employees, agents or subcontractors as they relate to the services provided during the course and scope of their employment. Contractor's employees, agents or subcontractors shall not be entitled to any rights or privileges of City employees, nor be considered in any manner to be City employees. 5. EXPENDITURE AND REVENUE REPORT No later than sixty (60) days following Period One, Period Two and Period Three of this Agreement, Contractor shall submit to City for informational purposes only, an Expenditure and Revenue Report for that period. Such report shall be prepared in accordance with the format that is provided by City. 6. FACILITIES PAYMENTS AND SERVICES City shall compensate Contractor and Contractor agrees to provide the services, staffing any equipment and supplies, and reports in accordance with Exhibit A to this Agreement. Contractor shall operate continuously throughout the teen of this Agreement with at least the required number and type of staff which meet applicable City, State and Federal requirements, and which aze necessazy for the provision of services hereunder. INSPECTIONS AND AUDITS A. City, any authorized representative of City, any authorized representative of the State of California, the Secretary of the United States Department of Health and Human Services, the Comptroller General of the United States, or any of their authorized representatives, shall have access to any books, documents and records, including but not limited to medical and client records of Contractor which such person deem pertinent to this Agreement, for the purpose of conducting an audit, evaluation, examination or making transcripts during the periods of retention set forth in the Records section of Exhibit A to this Agreement. Such persons may at all reasonable times inspect or otherwise evaluate the services provided pursuant to this Agreement, and the premises in which they aze provided. B. Contractor shall actively participate and cooperate with any person specified in subparagraph A above in any evaluation or monitoring of the services provided pursuant to this Agreement, and shall provide the above-mentioned persons adequate office space to conduct such evaluation or monitoring. C. Following an audit report, in the event ofnon-compliance with applicable laws and regulations governing funds provided through this Agreement, City may terminate this Agreement as provided for in the Termination paragraph or direct Contractor to immediately implement appropriate corrective action. A plan of correction shall be submitted to City in writing within thirty (30) days after receiving notice from City. D. Within fourteen (14) days of receipt by Contractor, Contractor shall forward to City a copy of any audit report. Such audit shall include, but not be limited to, management, financial, programmatic or any other type of audit of Contractor's operations, whether or not the cost of such operation or audit is reimbursed, in whole or in part, through this Agreement. 8. INSURANCE Prior to undertaking performance of work under this Agreement, Contractor shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Comprehensive General Liability Insurance. Contractor shall maintain comprehensive general liability insurance naming the City, its officers, employees, agents, volunteers and representatives as additional insureds) and shall include, but not be limited to protection against claims azising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Contractor's 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 $2,000,000 per occun•ence. Contractor shall supply City with a fully executed additional insured endorsement in substantially the form attached hereto as Exhibit E upon execution of this Agreement and shall be approved in form by the City Attorney. b. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the Labor Code, Contractor, if Contractor 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 the work under this Agreement, Contractor agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. c. Any person providing Physician Services pursuant to this Agreement shall maintain Professional liability (errors and omissions) insurance against medical malpractice with a combined single limit of not less than $1,000,000 per claim and $3,000,000, in the aggregate, per year. d. The following requirements apply to the insurance to be provided by Contractor pursuant to this section: (i) Contractor 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 Attorney. (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. e. If Contractor 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 forthwith terminate this Agreement. Such termination shall not effect Contractor's right to be paid for its time and materials expended prior to notification of termination. Contractor waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 9. INDEMNIFICATION Contractor agrees to and shall indemnify and hold harmless the City, its officers, agents, employees, Contractors, special counsel, and representatives from any liability for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including health, and claims for property damage, which may arise from the direct or indirect operations of the Contractor or its subcontractors, agents, employees, or other persons acting on their behalf which relates to the services described in section 1 of this Agreement. The Contractor 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 asserting that personal injury, damages, just compensation, restitution, judicial or equitable relief due to personal or property rights azises by reason of the direct or indirect operations of Contractor. City may make all reasonable decisions with respect to its representation in any legal proceeding. 10. CONFIDENTIALITY a. Contractor shall maintain the confidentiality of all records, including billings and any audio and/or video recordings, in accordance with all applicable State and Federal codes and regulations, as they now exist or may hereafter be amended or changed. b. Prior to providing any services pursuant to this Agreement, all employees, subcontractors, and volunteer staff or interns of Contractor shall agree, in writing, with Contractor to maintain the confidentiality of any and all information and records which may be obtained in the course of providing such services. The agreement shall specify that it is effective irrespective of all subsequent terminations of Contractor's employees, subcontractors, volunteers or interns. c. All confidential information furnished by Contractor to City hereunder will be kept confidential by City and shall not, without the prior written consent of Contractor, be disclosed by City, or by its representatives, contractors, or employees in any manner whatsoever, in whole or in part, and shall not be used by City or its representatives, contractors or employees who need to know the Confidential information. 11. CONFLICT OF INTEREST CLAUSE Contractor 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. NOTICE a. 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 telefacsimile 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 telefacsimile (714) 647-6956 With courtesy copies to: City of Santa Ana Santa Ana Jail 60 Civic Center Plaza Santa Ana, California 92702 telefacsimile (714) 245-8116 and City Attorney City of Santa Ana 20 Civic Center Plaza (M-29) P.O. Box 1988 Santa Ana, California 92702 telefacsimile (714) 647-6515 To Contractor: Correctional Managed Caze Medical Corporation 2040 S. Santa Cruz Street, Suite 100 Anaheim, California 92805 Attn: Rhoberta Paz A party may change its address by giving notice in writing to the other party. Thereafter, any notice, tender, demand, delivery, or other communication shall be addressed and transmitted to the new address. If sent by mail, any notice, tender, demand, delivery, or other 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 telefacsimile, any notice, tender, demand, delivery, or other 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. b. NOTIFICATION OF DEATH -Upon becoming awaze of the death of any person receiving services hereunder, Contractor shall immediately, in person or by telephone, notify the on-premises Jail Administrator or his designee, the Orange County Coroner, and the Orange County District Attorney. In addition, Contractor shall, within sixteen (16) hours after such death, deliver in person or by facsimile machine, a Written Notification of Death to the above persons. The telephone report and Written Notification of Death shall contain the name of the deceased, the date and time of death, the nature and circumstances of death, and the name(s) of Contractor's officers or employees with knowledge of this matter. Upon request, and to the extent allowable by law, Contractor shall provide the Coroner, District Attorney, Jail Administrator or his designee with a complete copy of the deceased patient's medical record. c. NOTIFICATION OF SPECIAL INCIDENTS -Immediately upon becoming aware of any occurrence of a serious nature which may expose either party to liability or disrupt the services hereunder, Contractor shall verbally notify the on-premises Jail Administrator or his designee. Such occurrences may include but are not limited to accidents, injuries or acts of negligence, or any incident or circumstance which adversely impacts the capacity of Contractor to provide the services hereunder. Such verbal notification shall be followed within twenty-four (24) hours, by written notification to City and the Jail Administrator or his designee. 13. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Contractor, 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 Contractor. 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 Contractor 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 party, which aze not embodied herein. 14. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Contractor, Contractor may not assign, transfer or delegate any interest herein and any such assignment, transfer or delegation shall be considered null and void. However, obligations undertaken by Contractor pursuant to this Agreement may be carried out by subcontracts, provided such subcontracts are approved in writing by City, meet the requirements of this Agreement as they relate to the service or activity under subcontract, and include any provisions that City may reasonably require. No subcontract shall terminate or alter the responsibilities of Contractor to City pursuant to this Agreement. 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 Contractors retained by City. 15. TERMINATION a. This Agreement may be terminated by either party without cause, by giving ninety (90) days written notice of termination. b. After receiving any Notice of Termination, Contractor shall continue to provide services and cooperate with City staff un61 the date of termination in a manner which is consistent with recognized standazds of quality patient caze and prudent business practice, and obtain immediate clarification from City of any unsettled issues of contract performance during the remaining contract term. c. The right and remedies of City provided in this Termination paragraph shall not be exclusive, and are in addition to any other rights and remedies provided by law or this Agreement. d. City may terminate this Agreement immediately, upon written notice, on the occurrence of any of the following events: 1. The loss by Contractor of legal capacity. 2. Cessation of services 3. Delegation or assignment of Contractor's services operation without written approval by City Of Santa Ana 4. Neglect by any physician or licensed person employed by Contractor of any duty required pursuant to this Agreement 5. The loss of accreditation or any license required by the Licenses and Law paragraph of this Agreement 6. The continued incapacity of any physician or licensed person to perform duties required pursuant to this Agreement 7. Unethical conduct or malpractice by any physician or licensed person providing services pursuant to this Agreement; provided, however, City may waive this option if Contractor removes such physician or licensed person from serving anyone pursuant to this Agreement. 16. NONDISCRIMINATION A. Employment. Contractor shall not discriminate because of race, color, creed, religion, sex, mazital 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. Contractor affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. B. Services, Benefits and Facilities. Contractor shall not discriminate in the provision of services, the allocation of benefits or the accommodation in facilities on the basis of ethnic group identification, race, color, religion, ancestry, creed, sex, national origin, mazital status, age, sexual preference, medical condition or physical or mental disability. For the purpose of this subpazagraph B, "discrimination" means denying a client or potential client any service, benefit or accommodation that would be provided to another and includes, but is not limited to, the following: 1. Denying a client any service or benefit or availability of a facility. 2. Providing any service or benefit to a client which is different or is provided in a different manner or a different time from that provided to other clients. 3. Restricting a client in any way in the enjoyment of any advantage or privilege enjoyed by others receiving any service or benefit. 4. Treating a client differently from another in satisfying any admission requirement or condition or eligibility requirement or condition, which individuals must meet in order to be provided any service or benefit. 5. Assignment of terms or places for the provision of services on the basis of ethnic group identification, race, religion, ancestry, color, creed, sex, marital status, national origin, age, sexual preference, medical condition or physical or mental disability of the clients to be served. C. Persons with Disabilities -Contractor agrees to comply with the provisions of Section 504 of the Rehabilitation Act of 1973 (29 U.S.C. 794 et seq., as implemented in Title 45 CFR, Section 84.1 et seq.) pertaining to the prohibition of discrimination against qualified persons with disabilities in all programs or activities, and the Americans with Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) as they exist now or may be hereafter amended together with succeeding legislation. D. Retaliation -Neither Contractor nor its employees or agents shall intimidate, coerce or take adverse action against any person for the purpose of interfering with rights secured by Federal or State laws, or because such person has filed a complaint, certified, assisted or otherwise participated in an investigation, proceeding, hearing or any other activity undertaken to enforce rights secured by Federal or State law. 17. JURISDICTION -VENUE This Agreement and all questions relating to its validity, interpretation, performance, and enforcement shall be governed and construed in accordance with the laws of the State of California. 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 fiirther 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. 18. PROFESSIONAL LICENSES a. Contractor and all of its employees and subcontractors providing services pursuant to this Agreement shall, throughout the term of this Agreement, maintain all necessazy 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. Contractor 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. b. Contractor warrants that all Contractor physicians providing services under this Agreement aze and will continue to be as long as this Agreement remains in effect, the holders of currently valid unrestricted licenses to practice medicine in the State of California. 19 MISCELLANEOUS PROVISIONS a. Neither party intends that this Agreement shall create rights hereunder in third parties, including but not limited to any subcontractors or any clients provided services hereunder. b. Each undersigned represents and warrants that its signature hereinbelow 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. c. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: CITY OF SANTA ANA ,~~ ~ PATRICIA E. HEALY DAVID N. REAM Clerk of the Council City Manager APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney By: ~CP~ La Sheedy Assistant City Attorney CONTRACTOR ,ci 6 OBERTA PAZ Director of Operations Tax ID# ,~~-o ~SoZ S~ to EXHIBIT A TO INMATE MEDICAL SERVICES AGREEMENT DEFINITIONS, SERVICES AND ADDITIONAL REQUIREMENTS I. PAYMENTS A. Inmate Medical Services, City shall pay Contractor one-twelfth (1/12) of Total Annual Sum for medical services, upon receipt of Contractor's invoice on a form approved or supplied by City, provided, however, that the total of all payments for each one-year term, commencing September 1, 2004 and continuing through August 31, 2007, shall not exceed the City's Total Annual Cost for Medical Services for that annual period. 1. Payments will be made by City within Thirty (30) days of receipt of a correctly filled out and complete invoice form. 2. City shall not reimburse Contractor for services provided beyond the expiration or termination of this Agreement, except as may otherwise be provided under this Agreement, or specifically agreed upon in a subsequent Agreement. B. Additional Services. The total amount City will be obligated to pay for Chazgeback Services and Psychiatric Crisis Intervention and Evaluation shall not exceed $110,000.00, during each one-yeaz term, commencing September 1, 2004 and continuing through August 31, 2007. II. The parties agree to the following terms and definitions, and to those terms and definitions, which for convenience, aze set forth elsewhere in this Agreement. 1. "Health Authority" means Correctional Managed Caze Medical Corporation's Medical Director. 2. "Responsible Physician and Health Care Professional" means any physician, nurse, or other person or class of persons designated by Contractor to perform treatment authorization functions specified in this Agreement. 3. "Custodial Patient" means any of the following: a) A City of Santa Ana Jail inmate referred to Contractor for treatment by the Santa Ana Jail Sick-Call Protocol. b) A person brought to Contractor for treatment by the City of Santa Ana Jail on behalf of outside "Owning Agencies", i.e. U.S. Marshall Service, INS, etc. c) A minor, brought to Contractor for treatment, who is under the caze and custody of the City of Santa Ana Jail. d) Emergency health care needs will be provided by Contractor until City contracted pazamedics azrive. Emergency treatment for facility personnel 11 who are injured or become ill while on the job and emergency first medical care will be provided to any visitor or the Jail Facility. 4. "Emergency" means the sudden and unexpected onset of a symptom, illness or injury which, in the judgment of a physician, requires immediate diagnosis and/or treatment in order to alleviate or attempt to prevent severe pain, permanent disability, serious medical complications or loss of life. 5. "Emergency psychiatric crisis intervention and evaluation" means all of the following: a) The provision of 24 hour, 7 day a week, mobile response to the Santa Ana Jail with a 30-45 minute estimated time of arrival to the Santa Ana Jail. Such Gaze shall include a team of specialists who will provide crisis intervention and evaluation of inmates in psychiatric distress, i.e. sever depression (suicidal ideation) and psychotic disorders (schizophrenia). Upon completion of the evaluation, team staff member will provide findings and suggested disposition for safe caze of the inmate. 6. "Fiscal Year" means the period from July 1 through the following June 30`h, and may be abbreviated "FY". 7. "Health Caze Services" means any treatment, or referral for supportive services, including Physician Services, which are determined by Contractor to be medically necessary to protect life or prevent significant disability, and to treat diseases, illnesses or injuries in order to prevent a serious deterioration of health. 8. "Inpatient" means a Custodial Patient referred by Contractor, for admission for the purpose of receiving Health Caze Services, with the expectation of remaining hospitalized at least overnight and will be the responsibility of the City of Santa Ana or the outside "Owning Agencies". 9. "Physician Services" means Health Caze Services provided by the responsible physician, acting within the scope of his/her license. 10. "Usual and Customazy Charge" or "Charge" means the amount which Contractor normally or usually chazges the majority of its patients for a specified type of service, including the types of Health Care Services provided hereunder. Contractor's Usual and Customazy Charges shall be subject to review by City to determine that they conform to Usual and Customary Chazges made by other providers. III. SERVICES A. At the Santa Ana City Jail, Contractor shall provide Health Caze Services including Physician Services requested or required for Custodial Patients by City or any other person authorized in accordance with this Agreement. Baseline services to be provided by Contractor shall include the following: 1. Physician services, nursing, dental clinics, psychiatric clinics, laboratory services, sick call, intake triage and on-site emergency. 2. Medical Service Hours. Medical staff shall be present 24 hours daily, every day of the year. Minimum staff requirements aze as follows: • Physician -One (1) on call 24 hours daily. 12 • NP -One (1); Four (4) hours per day, five (5) days per week. • RN -One (1); Twelve (12) hours per day, seven (7) days per week. • LVN -Two (2); Twenty-Four hours per day (one each shift), seven (7) days per week. • DDS -Four (4) hours per week. • Dental Assistant -Four (4) hours per week, if necessary. • Psychiatrist -Eight (8) hours per month. • Medical Records Clerk -One (1); Forty (40) per week, five (5) days per week. 3. Laboratorv Services -Contractor will partner with a Medical Services Laboratory to provide all lab services, including pickup. The contracted Lab will deliver "STAY" results within two (2) hours via FAX or telephone with FAX follow-up. Lab will provide a Phlebotomist on an as needed basis. 4. Fourteen (14) Dav Physicals -Contractor will perform full physicals on inmates with a length of stay 14 days and greater, including TB skin testing after a four (4) day stay. 5. Pharmaceuticals -Contractor shall provide routine over-the counter pharmaceutical and routine prescription care for all inmates. Contractor will identify and maintain appropriate levels ofover-the-counter medications for inmate minor medical needs. Long-term medication for chronic care, including HIV and psychotropic medications, shall be the responsibility of the inmate's contracting agency. 6. First Aid Kits -Contractor will provide First Aid Kits to all of the booking units as well as the exam rooms and kitchen areas. Contractor will be responsible for inventory and re-stocking of all First Aid Kits. 7. Dental Clinics -Contractor will be responsible to perform dental clinics once a week. Dentist and dental assistant will perform this service on-site. 8. Psychiatry Clinics -Contractor will be responsible to perform psychiatry clinics twice a month. Said psychiatry clinics will be offered three times a month for three months each year. Psychiatrist will perform this service on-site. 9. City Responsible Medical Services- City will be responsible for all medical services that are rendered outside the Jail. This includes but is not limited to Hospital in-patient services, Hospital emergency services, Hospital out-patient services, Specialty physician out- patient consultations and treatments, ancillary and diagnostic testing. 13 10. Chazeed Back Medical Services -Contractor will be responsible to arrange and pay for on-site mobile x-ray, Ophthalmology, OB/Gyn and dental repair services. Contractor will invoice City monthly, at the rates and charges set forth in Exhibit C, for services rendered in that month. 11. On-site Psvchiatric Intervention and Evaluation. Contractor shall provide on-site intervention and evaluation of inmates' psychiatric distress and psychotic disorders on a 24 hour, 7 day a week period, with an estimated response time of 30-45 minutes to the Santa Ana Jail. Contractor will invoice City monthly, at the rates and chazges set forth in Exhibit C, for services rendered in that month. 12. Billin¢ Services for Off-Site Emergency Caze. Contractor shall provide billing services for all off-site emergency care of Santa Ana Jail inmates obtained at Western Medical Center- Santa Ana and any other off-site medical location without contracts with the City. Such billing services shall include a complete accounting of all services performed in addition to a detailed report of the cost of such service. Such billing service shall be performed in accordance with Exhibit D, attached hereto. 13. TB Testine -CONTRACTOR will perform TB testing on all Police Department and Jail Staff on an annual basis. B. Contractor shall recruit, screen, qualify, orient, provide, manage, compensate and evaluate all physicians required to provide any Health Caze Services which may be requested and authorized pursuant to this Agreement. Physicians shall write legibly in patient charts, orders, etc. C. Contractor shall provide staff located within the Santa Ana Jail whose duties include, but are not limited to, the following in accordance with Section III. A. 2 above: 1. Appointments based on sick-call activity 2. Receiving and routing of treatment authorizations 3. Establishing, providing and maintaining medical records 4. Receiving and forwazding telephonic and written communications between physician and medical staff and Jail personnel 5. Requesting lab services ordered by Responsible physician, and routing results to appropriate medical staff. D. Contractor shall pay parking for all administrative and medical staff. E. Contractor shall provide appropriate medical equipment and furniture, where needed, for two (2) exam rooms, as specified in Exhibit B. F. Contractor shall assist the City in negotiating Hospital and Emergency Department Contracts for inmate medical care, which contracts will reduce the cost of Emergency Room and In-patient services. to IV. ADDITIONAL REQUIREMENTS A. Contractor shall provide those medical reports required by City for Custodial Patients provided services pursuant to this Agreement. At a minimum, Contractor shall provide a written Medical Service Activity Report for services provided hereunder. The report shall include, but not be limited to, date of service, booking number, name of inmate, attending nurse or physician, brief description of problem, brief description of disposition and amount billed to the City of Santa Ana. Medical Service Activity Report will be submitted to City daily. B. Utilization Review / Ouality Assurance. 1. Contractor shall develop and maintain a Utilization Review (U.R.) program and a Quality Assurance (Q.A.) program for the review of all services provided pursuant to this Agreement. Subject to all confidentiality laws, and upon request, Contractor shall provide City with a written copy of its Q.A. and U.R. procedures together with such periodic statistical reports, encounter data and other information which may result from Q.A. and U.R. activities for Custodial Patients. The extent and format of such information shall be determined, in writing, by City. Such programs shall meet the requirements of all appropriate Federal and State laws and regulations. 2. "Responsible Physician", means the physician who provides on-site medical services to Custodial Patients at the Santa Ana Jail. Contractor's U.R. personnel shall perform concurrent U.R. in conjunction with the Responsible Physician and provide periodic reports to Contractor's Health Authority. 3. Contractor's Health Authority will assume responsibility for review, approval and implementation of medical policies and procedures. The Health Authority and Contractor's Director of Operations will work with City to insure appropriateness and adequacy of imnate health care. 4. When City and Contractor disagree regazding the level, appropriateness or quality of caze, including the need for Inpatient or Outpatient Care, the Contractor's Responsible Physician ,Nurse Practitioner, Director of Operations and the City's Jail Administrator will meet and attempt to resolve the disagreement. If the disagreement is not thereby resolve within thirty (30) days, then the Contractor's Responsible Physician and the City's Jail Administrator shall meet with the Contractor's Health Authority and attempt to obtain agreement. If agreement is not obtained within thirty (30) days after such meeting, such dispute shall be submitted to binding azbitration, conducted according to the rules of the American Arbitration Association, but not necessazily by said Association. The arbitrator shall be a person mutually agreed upon by the parties. If the parties cannot agree upon an azbitrator, then either party may bring an action in the appropriate court to have the dispute resolved. If an azbitrator is agreed upon by the parties, all parties shall contribute equally to the arbitrator's fees and other costs of the proceedings, and shall beaz their own attorney's fees. Said azbitration shall be the sole remedy for disputes arising from disputes under this subparagraph, provided, however, if the arbitrator fails to render a decision within thirty (30) days after the IS matter is submitted to him/her, then either party hereto may bring an action de novo in the appropriate court to have the dispute resolved. C. Contractor shall provide City access to any medical records of Custodial Patients in accordance with all applicable laws and regulations as they now exist or may hereafter be changed. D. Contractor's Responsible Physician and Director of Operations shall be available to meet on a regular basis with the representative of the Santa Ana Jail. Such persons, acting for their respective parties, shall have the authority to resolve U.R., Q.A. or other issues related to the treatment of Custodial Patients. E. Contractor shall provide City with the name, specialty, board status, professional license number, DEA number and office phone number of each physician providing services hereunder. F. Contractor's off-site Administrative and/or Medical staff and visitors shall follow procedures established by the Santa Ana Jail regarding security and access to the Jail. V. COMPENSATION Total Annual Sum for inmate medical services -Period 1 Staffing cost $676,220.00 Pharmaceutical cost $ 42,000.00 Supply cost $ 21,390.00 Other $118,174.00 Total Annual Sum for Inmate Medical Services -Period 2 Staffing cost $710,031.00 Pharmaceutical cost $ 45.000.00 Supply cost $ 23,529.00 Other $147,846.00 Total Annual Sum for Inmate Medical Services -Period 3 Staffing cost $762,800.00 Pharmaceutical cost $ 47,000.00 Supply cost $ 28,529.00 Other $162,189.00 16 $857,784.00 $926.406.00 $1,000,518.00 EXHIBIT B INMATE MEDICAL SERVICES AGREEMENT EQUIPMENT REQUIREMENTS I. EQUIPMENT Contractor shall provide necessary and appropriate medical equipment for two exam rooms as follows: • Two (2) Examination Tables • Two (2) Table-Mayo • Two (2) Swivel Head Examining Lamps • Two (2) Physician's Scale • Four (4) Tyco's Pocket Aneroid • Two (2) Revolving Stools • Five (5) Emergency Resuscitators -Mouth to Mask • Five (5) Anaphylaxis Kits • Five (5) First Aid Kits #50 • Three (3) Kappa 100 Otoscope / Ophthalmoscope Sets • Four (4) Thermometer -Two (2) Filac F - 1500 Electronic and Two (2) First Temp Genius • Four (4) Adscope 655 • Three (3) Instrument Trays with Covers • Two (2) sets of Sundry Jars • Three (3) Step-on Cans 17 EXHIBIT C INMATE MEDICAL SERVICES AGREEMENT COST SCHEDULE FOR CHARGEBACK SERVICES Contractor shall provide the following services, as needed, as set forth in Exhibit A, Section III. A. 10 and A.11: Per unit repair cost for Dentures, Plates & Partials $200.00 Per study cost for mobile x-ray service $85.00 (Including Radiologist interpretation, transcription and delivery) Cost per patient visit for OB/GYN $150.00 Cost per patient visit for Ophthalmology $150.00 Cost per visit for Emergency Psychiatric Crisis $50.00 Intervention & Evaluation Monthly administrative fee for billing service $400.00 18 EXHIBIT D INMATE MEDICAL SERVICES AGREEMENT OFF-SITE BILLING SERVICES Contractor shall follow these procedures in processing claims for off-site emergency medical services. A. All claims shall be reviewed by Santa Ana Jail administration for appropriateness and approval B. All approved claims will be given to Contractor for processing C. Contractor will process claims as they are received but will close claims once a month. D. Contractor will generate a claims run that will identify the claims by patient, date of service, provided and amount billed. E. Contractor will generate a monthly invoice billing to the City of Santa Ana for claims processed in the prior month. F. The claims run will be included with the invoice as well as copies of each claim. G. Contractor will bill the City an administrative fee that will be identified on each invoice. H. The City of Santa Ana will pay Contractor for services rendered and Contractor will reimburse the physicians and hospitals for their services. 19 EXHIBIT E ADDITIONAL INSURED ENDORSEMENT FOR COMMERCIAL GENERAL LIABILITY POLICY Insurance Company This endorsement modifies such insurance as is afforded by the provisions of Policy # relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ("additional insureds") with regazd to liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. 2. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with any other insurance carried by or for the benefit of the additional insureds. 3. This insurance applies sepazately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability. The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. 4. With respect to the additional insureds, this insurance shall not be cancelled, or materially reduced in coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective Policy # Issued to this endorsement form as a part of Named Insured Countersigned by Authorized Representative 20 FROM CORRECTIONRL MANAGED CARE MEDICRL CORP. (TUE)NOV 30 2004 9:36~ST. 9:36~NO.6358an9R9R P ~ COR CERTIFICATE OF LIABILITY INSURANCE a" io Yos oa _ c PROPUCEA H C IFI IS 1 ED AS A M TTE OF 1 ORMA N7 ONLY AND CONFERS NO RK#ITS UPON THE CERTIFICATE EIGi Zasuraaca 8arricas HOLDER. THI$ CERTIFICATE DOE$ NOT AMEND EXTEND OR 23241 Bout3 Pointe Drive , ALTER 7HE COVERAGE AFFORDED BY THE POLICIES BEL Laguna Hills G 92653 Phoaa:969-460-8730 Paz:9a9-460-8733 INSURERSAFFORdNC:COVERAGE NAIL/ asuReD NsugEaA st. Plax Eiq i wne. xd.. w ~~ ~7YC~3.~K Cpra N&1RER B: '141a BtatQ r11~ I~dLOai ~ N9lMERC ...,_. .... ._.....__ ~j ~r~y si G 92$05 _ 1 N81YIEfI O' _.. . NaEIEa E: L6TED BELOW H1NE 1 A A 06/01/04 ~O THE lJBURED NAMED ABOVE FOR THE POIq OTHER DOCUMENT W RH RESPECT TO W HICK REED HEREN I$ SUBJECT TO ALL THE TERMIS, BV PAQ CIABIS. MEacw. GENERAI. LMBIIIY I HR01772007 cinMa NADE XQ occua AurosoNLB u.NUrr ANTAUm ALL owNFtAUros scNa:ouLlD Aaros X HIRED AUTO! Y NDN-0WNEC AURb Lac WS UABWTT ANT Aura Essarsglw Lurm accua ~ cwES a"DE DEnuCIe:E YYORYEp CDYPENBATIDN AYD H laPLOTlp' WELRT OFF E~RMEMIER EXC~LWED9¢CU:NE 8X01772007 8X01772007 06/01/04 06/01/Oa EACHaccuaaEHCE s 1000 06/OS/D5 Par,AE~ ~.m s 1000 viD EJn ullerall. P..an: MsooD PEasoN"LEAavwuev E 1000000 aEraRALAOCN:ecnre S 2000000 Paoauols-CDIIWIOYAGG E 2000000 (FeC rider ISNN.E LYIf ~ ~ESium` 06/01/05 aoo~rNAIaT 06/01/05 ~°f°0d°YSl PRaPFR1VDAM~aE ~r~cclENlp oTEJenuN EAACC µ:fpaMlr, AOG EAa, occwAENce AaaaEw~E 1a9oa53-oa ~ 07/o1/Da ~ 07/D1/os ~e~eAC~IACCnENr :zooooo0 ~- s 7 0 s s s s s s as~s~-E.. t dBEABE-POLICVUNR : *10 Daya Notate of Canoallation for Hon-PayaaaL of Praoi~. Csrti.fioatJs Holder is aafad as an additional anavrad par the term anfl conditions of the policy (azcluding the ltorkors Ccopensatioa Policy), City of Banta Ana Banta Ana City Jail ]Lttn:Chria Laugaoaur,Contraots 62 Civic Canter Pla:a Banta Ana CA 927D2 BT.aHX00 aYAgnANraPTIeABOVeDIacq.ao-aursaBCAYOaL®Eenge7YEexwunp WTE TYlgBOP, TH! aNIMD ulEUglR asJ, lYOUVOR +o auL 3G wTS agIYTEY YOIICE'1'O TIE CER7INC"iE MOI.OEq WYla TO7N! LIFT, WT P"IWq! TD DO EO EMALL IsFaaelo DY{AAIYIY oR LuuYUn OP AYT Rao uroN THE aEYgEq, m ADEYre oq FRAM CORRECTIONAL MHNRGED CARE MEDICAL CORP. (TUE)DEC 7 2004 13;46/ST.13:46/N0,6366309836 P 2 LEXINGTON INSURANCE COMPANY WILMINGTON, pELAWARE ADMINISTRATIVE OFFICES: 100 SUMMER STREET, BOSTON, MA 02110.2103 IA Capital Stock Insurance Company! HEALTHCARE PROFESSIONAL LIABILITY • CLAIMS MADE AND HEALTHCARE GENERAL LIABIWTY -CLAIMS MADE bECLARATIONS Various proNslons In the Osnerd Policy Provisions end Conditlons and Coversgs Parts restrict coverage. Thsro may bs both owurrence coverages end claims made cowregee in this Poacy. Claims made towrope la limited to Ilabllhy for claims flrot made agdnat an Insured during the policy period or any extended roporting period, If appNcabk. Plsasa read all General Policy Provsions and Conditlona and Covsrsge Parts carefully to determine rights, du6sa, and what Is end whet b not covered. A complete Policy includes the Declarations, General Policy Provisions and Conditions, and the applicable Covsroge Pans, POLICY NUMBER: 0314761 RENEWAL OF NUMBER: 0314781 Item 1. FIRST NAMED INSURED: CORRECTIONAL MANAGED CARE MEDICAL CORP. Item 2. ADDRESS; 2040 S. SANTA CRUZ STREET, rT 100 ANAHEIM, CA 92805 Item 3. lal RETROACTIVE GATE: HEALTHCARE PROFESSIONAL LIABILITY COVERAGE PART: 03/01/1998 HEALTHCARE GENERAL LIABILITY CLAIMS MADE COVERAGE PART: 08!0112002 Ib1 POLICY PERIOD: From; August 1, 2004 To: August 1, 2006 et 12:01 a.m. Standard Time at your mailing address shown above. ICI OPTIONAL EXTENDED REPORTING PERIOD: TBD years for Tep% of the annual premium Item a, DESCRIPTION OF OPERATIONS: OUTSOURCE MEDICAL SERVICE PROVIDER Item 5. LIMITS OF lal Heehhcare Professional Uability Aggregate Limit 83,000,000 Each Medical Incident 81,000,000 Deductible 026,000 Deductible Aggregate None Ibl Heehhcare General Uabilky Aggregate Limk 83,000,000 Each Occurrence Limit 81,000,000 Products/Completed Operations Umk 81,000,000 Personal/Advertising Injury Limit 91,000,000 Fire Damage Limit 850,000 Medical Expense limit 85,000 Deductible 825,000 Oaductible Aggregate None item 8. PREMIUM: item 7. FORMS AND ENDORSEMENTS: Attached at Inception Each Fira Each InJured Person d~~ 2 Item 8. PRODUCER NAME AND ADDRESS: LEMAC & ASSOCIATES, INC. 800 CITY PARKWAY WEST, SUITE 410 ' ORANGE, CA 92888 By Countersignature pn States Where Applicable) 79223110!03) HC0357 Authorised INSUREO'S COPY FROM CORRECTIONRL MRNAGED CARE MEDICAL CORP C. Medical Expenses (TUE)DEC 7 2004 13:46/ST.13;45/N0.6356309836 P 3 We will pay medical expenses as described below for bodily Injury caused by an occurrence: 1. On premises you own or rent; 2. On ways next to premises you own or rent; or 3. Because of your operations; Provided that: t. The occurrence takes place in the coverage territory and after the retroactive date but before the end Of the policy period; 2. The expenses are incurred. and reported to us wittun one year of the date of the occurrence; and 3. The injured person submits t0 examination, at our expense, by physicians of our Choioe as often as we reasonably require, We will make these payments regardless of fault. The amount we will pay for damages is limited aS described in Section IV., Limits Of Insurance. We will pay reasonable expenses for: 1. First aid administered at the time of an oocurtence; 2. Necessary medical, surgical, x-ray and dental services, including prosthetic devices; and 3. Necessary embulartce, hospital, processional nursing and funeral services. ~ ll. WHO IS AN INSURED ~ The following are Insureds under this Coverage Part: A. You. B. An individual and the individual's spouse are Insureds, but only with respect to the conduct of your business named In the Declarations of which such individual is the sole owner. C. A partnership or joint venture is an Insured, but only ff the partnership or joint venture is SpeCifi• tally listed as a Named Insured. 1'he partnership's partners or joint venture's members and their spouses are also Insureds, but ally with respect to the conduct of your business. No person or organization is an Insured with respect to the conduct of any current or past part- nership a' joint venture that is not shown as a Named Insured in the Declarations. D. A limited liability company is an Insured, but onlyrf the limited IiabitAy company is spedfically listed as a Named Insured. The limited liability company's members are also Insureds, but only with respect to the conduct of your business. Your managers are Insureds but only with respect to their dunes as your managers. E. If you are designated in the Declarations as other than partnership, joint venture or limked liability company, the organization so designated and any executive officer, director or stockholder thereof while acting within the scope of his duties for you, F. Your employees, other than your execudve officers ('rf you are an organization other than a partnership, joint venture or limited liability company) or your managers ('rf you are a limited liability company, are Insureds, but only for acts within the scope o} their employment by you or while performing duties related to the conduct of your business . 1 79228 (7/03) HC0272 HGL-2 INSURER'S COPY FROM CORRECTIONAL MRNAGED CRRE MEDICAL CORP. (TUE)DEC 7 2004 13:47/ST.13:45/N0,6356309836 P 4 No employee, however, is an Insured for: 1. Bodily Injury, personal and adverdsing injury: a. To you, to your partners or members ('d you are a partnership or joint venture), tiD your members (it you are a limited liability company), or to a co-empbyse while in the course of his or her employment or while performing duties related to the conduct of your business; b. 7o the spouse, child, parent, grandparent, brother, dr sister of that co-empbye9 as a con- sequence of paragraph t.a. above; c. For which there is an obligation to share damages with or repay another who must pay damages due to an injury described in 1.a o- t.b. above• or d. Arising out of his or her providing or failing to provide professanal healthcare services. 2. Property Damage to property: a. Owned, occupied, or used by, or b. Fientad to, in the care of, custody or contrd of, or over which physical control is being exercised for any purpose by, - you, any of your employees, any partner or member Qf you are a partnership or a joint van- ' , lure), or any member (if you are a limited liability company). G. Any student enrolled in a training program in connection with your professional services, but only when acting within the scope of his or her duties and at you- direction. H. Any o} your authorized volunteer workers, other than a healthcare provider, but only while acting within the scope of their duties as such and at your direction, ' I. Your legal representative if you die, but only with respect to his w her duties es a legal represen- tative. J. Your superintendents, adminlstl'ators, dtrectors, department heads and heads of the medical staff, but only in their capacity as such. K. Members of your boards and committees, but only for rAnduot azising out of their drtGes as board or committee members and those who execute orders from your boards or committees, but only while in the course and scope of executing those orders. = L. Your trustees and governprs, but only for the conduct of your business within the course and scope of their employment or (heir duties as trustees or governors. M, Any person (other than your empbyee) or any organization while acting as your real-estate manager. ' N, Any person or organization having proper temporary custody of your property ff you die, but only: 1, With respect to liability azising out of the maintenance or use Of that property; and 2. Until your leget representative has been appointed. .' 0. With respect to mobile equipment registered in your Wane under any rcator vehicle registration law, arty person is an Insured while driving such equipment along a public highway with your permission. Any other person or organization responsible for the conduct of such person is also an 79228 (7/03) WGL - 3 WC0272 INSURED'S COPY /~ FROM CORRECTIONRL MRNRGED CRRE MEDICRL CORP. (TUE)DEC 7 2004 13:47/ST.13:45/N0.6356309836 P 5 general access to the policy and necessary books, documents and records to verify the cost of the policy, to the extent required by law. Access will also be allowed to subcontract between the Company and any affiliated organization of the Company and to itR books, documents and records. Such access will be provided up to four years after tits services furnished under mis policy end. S. Tales Of Paragraphs Titles of paragraphs are inserted solely for convenience of reference and shall not be deemed ro limit, expand or otherwise affect the provisions to which they relate. T. Service Of Suit In the evem of our failure to pay any amount claimed to be due hereunder, we, at your request, will submit to me jurisdiction of a court of competent jurisdiction within the United States. Nothing in this condition constitutes or should be understood to constitute a waiver of our rights to comments an action in any court of competent jurisdiction in the United States to remove an action ro a United States District Court or ro seek a transfer of a case ro another court as permitted by the laws of the United States or of any state in the United Statos. It is further agreed that service of process in such suit may be made upon Counsel, Legal Department, Lexington Insurance Company, t 00 Summer Street, Boston, Massachusetts 02110.2f 03 or his or her representative, and that in arty suit instituted against us upon this Policy, we will abide by the final decision of such court or of any appellate court in me event of any appeal. Further, pursuant to any statute of -any slate, territory, or district Of the United States which makes provision therefor, we hereby designate the Superintendent, Commissaner or Director of Insurance, or other officer specified for that purpose in the statute, or his or her successors in office, as our true and lawful attorney upon whom may be served any lawful process in any action, suit, or proceeding instituted by you or on your behaH or any beneficiary hereunder arising out Of this PdiCy of insurance, and hereby designates me above named Counsel as the person to whom the said officer is authorized ro mail such process or a true copy thereof. IV. CANCEI.LA~'ION/NON-IQENEWAL A. When We Do Not Renew If we decide not to renew this Policy, we will mail or deliver to the Flrst Named Insursd at the address designated in the Declarations written notice of the non-renewal not less than mirly (30) days before the expiration date. M such notice is mailed, proof of mailing will be sufficient proof of notice. K wa mal or deliver the notice less man thirty (30) days before the expiration, we will extend the policy period so that the expiration date will be thirty (30) days after we mail or deliver the notice. You will be charged a pro rata additional premium for such extension. Such extension shall ba subject to the remaining Limits of Insurance of this Policy and mere shall not be a reinstatement of the Aggregate Limits. Vou Can ter- minate the extension at any time, but not retroactively. , B, Cancellation This Policy may be canceled by the First Named Insured by surrendering it to us or any o} our aumor- ized representatives or by mailirg to us written notice stating when mereatter the cancellation shall be effective. We may cancel mis Policy by mailing or delivering a written notio9 of Cancellation to the Flrst Named Insured at the address shown in mis Policy stating when, not less man 30 days mereafter, Cancellation will be effective. However, if we cancel this Policy because the Flrst Named Insured has failed to pay a premium when due, this Policy may be canceled by us by mailing or delivering a written notice of cancellation to me Flrst Named Insured at the address shown in mis Policy stating when, not less man 10 days thereafter, such cancellation will be effective. The mailing of notice as aforosaid shall be suf- ficient proof of notice. Q.~-~ 78229 (7/03) t2 /z~ `~`~ ~~ HC0271 INSURED'S COPY FROM CORRECTIONRL MRNRGED CARE MEDICRL CORP. (TUE)DEC 7 2004 13;4~/ST.13:45/N0.6356309836 P 6 The time of the surrender or the effective date and hour of cancellation stated in the notice shall become the end of the policy period. Delivery of such written notice either by the Firet Named Insured or by us shall be the equivalent to mailing. If the Fist Named Insured Cancel9, the unearned premium shall be computed in accordance with the customary short rate table and procedure. fl we cancel, unearned premium shall be computed pro rata. Premium adjustment may be made either at the Gme cancellation is effected or as soon as practicable otter cancellation becomes effective, but payment or tender of unearned premium is not a condition of cancellation. _ ~ . ~~ SECRETARY 13 ~~~~ 79229 (7/03) HCA271 PRESIDENT INSUpED'S COPY FROM CORRECTIONAL MRNRGED CRRE MEDICAL CORP, (TUE)DEC 7 2004 13:48/ST,13;45/N0.6356309836 P 7 ENDORSEMENT NO. 5 This endorsement, effective 12:01 AM: August 1, 2004 Forms a part of policy no.: 0314761 Issued to: CORRECTIONAL MANAGED CARE MEDICAL CORP. BY~ LEXINGTON INSURANCE COMPANY SCHEDULE OF LOCATIONS ENDORSEMENT The Poky is amended as fellows: 'fhe insurance provided by Coverage Part(s): ® HEALTHCARE GENERAL LIABILITY COVERAGE PART ® HFJILTHCARE PROFESSIONAL LIABILITY COVERAGE PART shall be limited to the following location(s), unless otherwise provided For within the Policy: ADDRESS 001 2040 S. SANTA CRUZ STREET, X100 ANAHEIM, CA 92805 002 MADERA COUNTY JAIL (CLINIC ONLY) 14791 ROAD 28 MADERA, CA 93638 003 MADERA COUNTY JWENILE FACILITIES (CLINIC ONLY) 28261 AVENUE 14 MADERA, CA 93638 004 SANTA ANA CITY JAIL (CLINIC ONLY) 62 CIVIC CENTER SANTA ANA, CA 92702 005 WESTERN MED CENTER (CLINIC ONLY) 1025 S. ANAHEIM 80ULEVARD ANAHEIM, CA 92805 All other terms, conditions, and exclusions of the Policy remain unchanged. ~... Authorized RepresenlatNe ' g or countersignature (where required by law) ,Y~s ~/~ 74780 (12/99) H00097 INSURED'S COPY Page 1 Of t FR0~1 CORRECTIONRL MRNRGED CRRE MEDICRL CORP. (TUE)DEC 7 2004 13:48/ST.13:45/N0.6356309836 P 8 ENDORSEMENT NO. 6 This endorsement, effectlve 12:01 AM: August 1, 2004 Forms a part of ppllcy no.: 0314761 Issued to: CORRECTIONAL MANAGED CARE MEDICAL CORP. By: Lexington Insurance Company ADDITIONAL INSUREDS ENDORSEMENT The Policy is amended as follows: Section II. WWO IS AN INSURED of the HEALTHGARE PROFESSIONAL LIABILITY COVERAGE PART is amended by adding the following: * NONE but only as respects liability arising out of the conduct of your business, Section II. WHO IS AN INSURED Of the HEALTHGARE GENERAL LIABILITY COVERAGE PART is amended by adding the following; • SANTA ANA CITY JAIL 82 CMC CENTER PLAZA SANTA ANA, CA 92702 COUNTY OF MADERA 14191 ROAD 28 MADERA, CA 83638 ~~ ~~" but only as respects liability arising out of the conduct of your business. All other terms, condfions and exclusions of the policy remain unchanged. 79523(5/02) HC0310 Authorized Representative or countersignature (where required by law) INSURED'S COPY 08/02/2005 09:20 19493056166 COLONIAL PRA PAGE 01/02 .9~.Oe4N CERTIFICATE OF LIABILITY INSURANCE °"'~'M~°°"Y"" os/ol/zoos PaowDrn (94g);OS-6161 FAX (949) 305-6166 THIS CERTIFICATE IS 133UED AS A MATTER OF INFORMATION Colani al Nestern Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 26691 Plaza Drive, Suite 220 HOLDER.THISCERTIFICATEDOESNOTAMEND,EXTENDOR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ~ Mission Viejo, CA 9[691 INSURERS AFFORDING COVERAGE NAIC M i w3uREB Correct ono Managed Care Me xa arpordtion INBURZR A: Lexington Insurance C an 4211 E. La Palllcel Ave. INSURER B: St. Paul Travelers Ins. Co. Anaheim, CA 92807 INSUR~RC: INBUa$a DI INSVRER E: 1 ne wu uuc, ur IrvauNArvct usTED BE LOW NAVE BEEN ISSUED TD THE I NSURED NAMED A BOVE FOR THE PO LICY PERIOD INDICATED. NOTWITHSTANDING A NY R EgUIREMENT, TERM OR CONDITIO N OF ANY CONTRACTOR OTHER DOCUMENT WITH R ESPECT Tq WHIC H THIS CERTIFICATE MAY BE ISSUED OR M AY P ERTAIN, THE INSURANCE AFFORDE D SYTHE FOLIGIES DESCRIBED HEREIN IS SUBJEC T TO PLL THE TER MS ExCLUSION3 ANO CONDITIONS OP SUCH P OUCI 63. AGGREGATE LIMBS SWOWN M AY HAVE BEEN REDUCED BY PAID GlAIM3. , INSR TYPE Of INSURANCE PoLM:Y NUMBER POLICYE FICTIVE PQLM:Y F]IPIRAl10N UMR9 GENBRAL LUUBUIY D114761 D8/Dl/2005 D$/Ol/20D EACH OCCURRENCE f 10001000 X COMMCnCIAL CENEn/IL IIaMLRV DAMAQP, TQ RF.'PJ'IEP E S~ DO F1AIyF?•{ka•ONWM X CLAIMS MADE n OCCUR MEP EJ(P IAaY one Person) E 5 , 00 A PER80NALQADVIWURY E 1 000 00 , , l ENERAL AGOREOaTE 5 3 000 000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPIOP AGO , S 1 000 OD POLICY JECT LOC AUTOMOBILE LIABIDTY RX02071644 D2/D4/2D05 D2/D4/2006 arvr auto COMBINE091NGLE LIMB ~1 eEtl°°nll _ S 1000 000 411. OWNFn 411T(i5 g SCHEDULEP AUTOS DM~r ll.v iwunv I P°'°'1 E X HIRED AUTOS -' )( rnurv•uwneu au lua SOFTLY INJURY (pw acddnnll f PROPERTY DAMAGE E __ (PxeCCIUeMI GARAGE lM181LRY AUlOONLY-EA ACCIDENT S ANV AUTO OTHER THAN EAACC S AUTO ONLY: AGG f E%CEB&UMBRELLA LLIBIUTY EACH OCCURRENCE E OCCUR ~CUIMB NAOE A17 ~JRQ'~7 ~1~ ~~S 1(~ j'~lZ~ AGGREGATE P E OEOUCTIBLE ~` RETENTION f - - ~__.. - 8 WORNERB COMPEN8A710NAND ,H Ca - 1 ~- ' we arnTlF OTrv ELIPLOYEIIS' LIABR.ITY . TORV.LIMttB. ~ , Sti15 NUI Lily hli~: nJt ANY PROPRIE-fOfiIPARSNER1OfECUTIVE OFFICEg EL. EACH ACCICE'NT S MIEMBER E%CLUDEV! Il yee Ee9CllbeuMK EL OISEASE•EA EMPLO S SPECIAL PROVISIONS EebW E.L. OISEASE•POLICV UMR S ro"~essionai Liability 0314761 08/01/2005 08/01/2006 ProF Liability: Slmil/f3mi1 A anaged Care EdA Liab . 0314761 D8/0 1 / 2 005 08/01/2006 Managad tarn E81D: 41M17/13Bri1 ~ gp $ L p[ 9 pE C 1 pL MiON1810Ne 10f Gays notice o~`ca^cellal7~Wllf or n0~„ pavRlCnt o~E `~' ' pf e mi plll ertificate Holder is an Additional insured for general liability and professional liability per indorsem t N14 d en attache . City of Santa Ana Santa Ana City ]ail Attention: Chris Laugedaur, Contracts 62 Civic Center Plaza Santa Ana, CA 92702 BNOULB ANY OF THE ABOVE OESCRIBEO POLw1E9 Bfi CANCELLED BEFORE THE E%PIRATNNi GATE THEREOF, THE 169UINO INSURER WILL BNOEAV00. TO MAIL b3~ DAIBWWITRN NOTICE TO THE GF.BTIFlCBR NOI-lR NaMlDN THE OBIT, BUT FAR.VRE TO MAIL SUCH NOTICE SHALL IMP08E NOOBUOATNIN OR LUIBILRY ACORD 45 (4007!08) \~ f t ~ ~ Z ~ S _ _ ~j ~ ~ f ®ACORD CORPORATION 1988 OroYldu COYeTM}fIP ~,.•••••o -- 08/02/2005 09:20 19493056166 AUG-01-05 01:41PIi FROM-Lemaa~Aesoclstae COLONIAL PRA 7147044709 &~IDORS~~' ND,14 Thla ~~~~~~ eftecdve 12427 AM: August 1, 2oD5 ~ ~ pO~Y ~„ Q914T61 Fpntte a pe Issued tip: OORRF_C'nON1~ MANAGED CARE rylEDiOAL CpitP. gy; )~NQTQN IN9AlRANGE COMPANY P .,see•, eunaRSEMEN7 PAGE 02/02 T~71B P.O10Po10 F-819 The Policy 1s amended as follows: sxtian Ii. WHO IS AN 1NSURED of the HEALTHCARE PROFEssloNeu LIAB1l.f[Y CGVEFIAGE PAKT is amended by adding tits faUo+~^g` SANTA AtdA CITY JAIL 62 CIVIC CEMXER ~~' SANTA Ah1A. CA g27oz GouIVTY of nnADEi1a 1eF19 ROAD 28 MADE-RA. GA 53638 CavoreOe provided under'f}'is policy is limttad to Medical tncidenela) while Providing proieaslonal services at the medical clinic yr whUo In tronAP~ only. This PaAcY dogs clot provide coverage arising out of acts which occur beyond the scope of business of ~ medical clinic. Seodon Il. YJHO l$ AN INSURED of tfie H1ALTHCARE GENERAL LIA131U1Y COVERAGE PART is amended by adding the fppowing: SANTA ANA CITY JAIL 52 GIV1C CENTER PLAZA SAN7 A AtdA~ CA ®2702 COUNTY QF MADERA 1419 ROAD 28 MADERA. GA laS6i~ Coverage Provided under this policy is Iimhed profeaelonat eervieen at the ryledloal clinic or while ih transport only. Thi6 poRoy does not provide coverage any eodOY b'Vurl- and/or Property Demogs arteaing nut of acts which occur beyond the sCOpe of buSlltRS>! of the medbal cGnio. ~PPR©V1D AS TC7 F~1tNi ', ~__ =-- ldurz Stitt Si~eedy AN oltter terms. conditions and exeiuswns of ttte policy remain unchanged. n~~i~aan~ city Atror~~~~ ~ ~ SP C CERTHOLDER COPV STATE P.O BOX $07, SAN FRANCISCO,CA 94142-0807 COMPENSATION INSURANCE FUND CERTIFICATE OF WORKERS° COMPENSATION_ INSURANCE ISSUE DATE: 07-01-2005 GROUP: POLICY NUMBER: 1480453-2005 CERTIFICATE ID: 7 CERTIFICATE EXPIRES: 07-07-2008 07-01-2005/07-01-2008 CITY OF SANTA ANA, SANTA ANA CITY JAIL ATTN CHRIS LAUGENAUR 62 CIVICS CENTER'PLA2A SANTA ANA CA 92702 This is to certify that we have issued a valid Workers' Compensation insurance policy in a farm approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 10 days' advance written notice to the employer. We will also give you 10 .days' advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amehd,extend or alter the coverage'. afforded by the policies listed herein. NOtwithstandingany requirement, term, or condition of any contract or other document with respect 'to which this certificate of insurance may tie issued or may pertain; the insurance afforded py khe policies described herein is subject to all the terms, exclusions and conditions of such policies. ~~ ~ c . AUTHORIZED REPRESENTATIVE PRESIDENT EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000_00 PER OCCURRENCE. ~PPROV~U ~~ l f3 E'`Ji~:.= ~r ,~ ~ 3~ _ _ L'+trt Stitt SLecdy ' Aasitta rtt l`ity !I 'r ~'-` EMPLOYER ,...LEGAL NAME CORRECTCONAL MANAGED CARE.. coRRECTiONAL MANAGED. CARE MEDICAL CORP. MEDICAL CORP 4211 E LA PALMA AVE ANAHEIM CA 92807 laev.3-oat PRINTED: 06/17/2005 Pnann