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Home My WebLink AboutU.S. HEALTHWORKS 2B - 2005 # -. 1""'UR'\r\ii'L ",'I., ,','I I': ,) .",,1 --"- ~ ~ ,r ~ '-,_. AUK;(. ;v:,\'( PKG~;Lr_,-: U!'lTiL Uf-;URANCE. !~XP;Rt~~ </-1 - () L~.________ CLUj; GF-COUN':i; OA1E' 3-1-:;><' A-2005-143 ;",' F~ (&1 .......' ~ .../ Cf;-.~fc) THIRD AMENDMENT TO CONSULTANT AGREEMENT THIS THIRD AMENDMENT TO AGREEMENT #A-2002-l57, is entered into on the 20th day ofJlme, 2005 by and between U. S. Healthworks, a California corporation ("Consultant") and the City of Santa Ana, a charter city and municipal corporation of the State of California ("City') Recitals: A The parties entered into Agreement #A-2002-157, dated August 19, 2002, (hereinafter "said Agreement") by which Consultant has provided comprehensive physical examinations for the Fire and Police Departments. B. In accordance with the terms and conditions of said Agreement, the parties wish to extend the term of said Agreement and increase the compensation to pay for services during the extended term. Wherefore, in consideration of the covenants contained in said Agreement, and subject to all the terms and conditions of said Agreement, except those amended in this Third Amendment to Consultant Agreement, the parties agree as follows: L Section 2 a., COMPENSATION, shall be amended to read as follows: "City agrees to pay, and Consultant agrees to accept as total payment for its services, the rates and charges identified in Exhibit A. The compensation to be paid under this Agreement shall not exceed $52,000.00, during the 2005-2006 fiscal year." 2. Section 3, TERM, shall be amended to read as follows: 'This Agreement shall commence on August 19,2002 and terminate on June 30, 2006, unless terminated earlier in accordance with Section 12, below. The term of this Agreement may be extended upon a writing executed by the Fire Chief and the City Attorney." 3. Except as amended hereinabove, all terms and conditions of said Agreement shall remain in full force and effect. II II - .' IN WITNESS WHEREOF, the parties hereto have executed this Third Amendment to Consultant Agreement on the date and year first written above. ATTEST: CITY OF SANTA ANA ~e DAVID N. REAM City Manager PATRICIAE. HEALY Clerk of the Council APPROVED AS TO FORM: JOSEPH W. FLETCHER City Attorney ,. ,;1 By:A< iA4....J!p4U?..k~ 1 i ..-" Laura Sheedy / Assistant City Attorney CONSULTANT MI E LE HARRISON Industrial Accounts Coordinator , ACORD~ CERTIFICATE OF LIABILITY INSURANCE I DATE (MMlDDNYVY) 813112005 PRODUCER 50 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur J. Gallagher & Co. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE License #0726293 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 505 North Brand Blvd, Suite 600 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Glendale, CA 91203-3944 Phone: 818~539-2300 Fax: 818.539-2301 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Hartford Casualty Insurance Company 29424 U.S. HealthWorks, Inc. INSURER B: Hartford Fire Insurance Company 19682 3655 North Point Parkway, Suite 150 INSURERC: Hartford Insurance Company ofthe Midwest 37478 Alpharetta, GA 30005 INSURER D: INSURER E: COVERAGES 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 iHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I~~ r.!:D' ~DD nD POLICY NUMBER POUCYEFFECTlVE POt.ICYEXPIRATJON UMITS A f.E!NERAL UABIUTY 72UENUM8309 09/01/05 09/01106 EACH OCCURRENCE , 1.000.000 X COMMERCIAL GENERAL LIABILITY ~~~~~~S YEa occ ranee $ 3OQ.OOQ I CLAIMS MADE 0 OCCUR MED EXP (Anyone ""'rson) $ 10,000 e--- PERSONAL & ADV INJURY $ 1.000.000 e--- GENERAL AGGREGATE $ 3,000,000 n'L AGG:Er~E LIMIT APFilIPER: PRODUCTS -COMP/OP AGG $ 3,000,000 POLICY 1~J"'p,: X LOG B ~TOMOBILE LIABILITY 72UENUM8309 09/01/05 09/01/06 COMBINED SINGLE LIMIT {Eaaccident} $ 1.000.000 e--- ANY AUTO e--- ALL OWNED AUTOS 60DIL Y INJURY $ 0- SCHEDULED AUTOS (Per parson) :!. HIRED AUTOS BODILY INJURY $ :!. NON-OWNED AUTOS {Peracciden,> PROPERTY DAMAGE $ (Per accident) ~~GEUABIUTY AUTO ONLY. EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A ~~SSlUMBRELlA LIABILITY 72XHUTQ5969 09/01/05 09/01106 EACH OCCURRENCE $ 10.000,000 X OCCUR D CLAIMS MADE AGGREGATE $ 10,000,000 $ ~ ~EDUCTIBLE $ X RETENTION $10000 $ C WORKERSCOMPENSATlON AND 72WNMG3070 09/01/05 09101/06 X!T~:;;~J~IIt~ J IO;-,!;!- EMPLOYERS' UABILITY 1.000.000 ANY t" ROPRiETOR/PARTt.lER/iOXCCUTIVE: E.l. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA f;MPLOYEE $ 1,000,000 ~P~~~~~~~~bNS below E.l. DISEASE - POLICY LIMIT $ 1.000.000 OTHER DESCRIPTION OF OPERATlONS I LOCATlONS I VEHICLES J EXCLUSIONS ADDED BY ENDORSEMENT f SPECIAl.. PROVISIONS "Except 10 days notice for non-payment of premium. RE: 1530 EAST EDINGER, SANTA ANA, CA 92705 -'--/-<>/1' . ~ / "'~ ,~' .J- /-_".~I-:~~_/ 11< /' ' . #'/ : CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION OATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL ~ DAYS WRITlEN City of Santa Ana NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO so SHALL IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 20 Civic Center Plaza REPRESENTATIVES. Santa A~a, CA 92701 AUTHORIZED REPRESENTATIVE ~cR- '-- ACORD 25 (2001108) @ACORDCORPORATION19~ ACORD,. CERTIFICATE OF LIABILITY INSURANCE I DATE{MMlDDIYYYY) 101712004 PRODUCER (800) 733-4474 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION GALLAGHER HEAL THCARE INSURANCE SERVICES, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ONE BRIAR LAKE PLAZA, SUITE 2000 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 2000 WEST SAM HOUSTON PARKWAY SOUTH ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. HOUSTON, TX 77042 INSURERS AFFORDING COVERAGE NAlC # INSURED INSURER A: THE DOCTORS COMPANY 1BOB3 U.S. HEAL THWORKS, INC. INSURER B: 3655 NORTH POINT PARKWAY, SUITE 150 INSURER C: ALPHARETTA, GA 30005 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOlWITHSTAN01NG 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I~i'~ ~~~L p~;~y ~:~~~E POLICY EXPIRATION LIMITS TYPE OF INSURANCE POLICY NUMBER DATE MM/DDNY ~NERAL LIABILITY EACH OCCURRENCE NIA COMMERCIAl. GENERAL L1ABLITY ~~~~~~~E~E~~~~RENCE'" N/A - =.J CLAIMS MADE DOCCUR MED EXP (Anyone pElrwn) NIA PERSONAL & AOV INJURY N/A GENERAL AGGREGATE N/A ~N~L AGGREA ~~': APp~r PER: PRQDUCTS _ COMP/OP AGG N/A POLICY JECT LOC ~TOMOBilE LIABilITY COMBINED SINGLE LIMIT N/A (EaaOOdent) - ANY AUTO - ALL OWNED AUTOS BOOIL Y INJURY N/A (Per person) - SCHEDULED AUTOS - HIRED AUTOS BODILY INJURY N/A (Peracddent) - NON.OWNED AUTOS PROPERTY DAMAGE N/A (Peracddent) ~AGE UAS,un AUTO ONLY _ EA ACCIDENT NIA ANY AUTO OTHER THAN EAACC N/A AUTO ONLY: AGG N/A EXCESS/UMBRELLA LJABJ1.JTY EACH OCCURRENCE N/A =::J OCCUR 0 CLAIMS MADE AGGREGATE N/A N/A =i:DUCT"" N/A ETENTlON NIA WORKERS COMPENSATION MID I WCSTATU., I <\ OTH. EMPLOYERS'LIABJLJTY )( TDRY LIMiTS X ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT NIA OFFICER/MEMBER EXCLUDED? N/A ~ yes, describe under EL DISEASE: _ EA EMPLOYEE: SPECIAL PROVISIONS below E,L. DISEASE - POLICY LIMIT N/A OTHER 1,000.000 PER CLAIM A MEDICAL PROFESSIONAL 69727 05101105 05101106 3,000,000 ANNUAL AGGREGATE LIABILITY - CLAIMS MADE DEDUCTIBLE $100.000 PER CLAIM DESCRIPTION OF OPERATlONSILOCATIONSIVEHICLES/EXCLUSIONS ADDEO BY ENDORSEMENT/SPECIAL PROVISIONS MEDICAL PROFESSIONAL RETROACTIVE DATE: 1010111995 w ^ - ,{-/ It 1/ ", ^", 'p.Jt \';t' { 11 '-'-. ,,;,. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE;: ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF SANTA ANA DATE THEREOF, THE ISSUIK13 IKSURER WILL ENDEAVOR TO MAIL .....H.. DAYS WRITTEN NOTICE 20 CIVIC CENTER PLAZA TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO SANTA ANA, CA 92701 OBLIGATION OR LIABILITY 0' AN' KINO UPON THE INSURER:, ,,. AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE <':"7 /52. r~ -;) ''''- ~------------ ,~L ,~~,-._-,~- -"--' ACORD 25 (2001/OB) @ACORD CORPORATION 19BB ADDITIONAL INSURED ENDORSEMENT I C Hartford Casualty Insurance Co.; Hartford Fire Insurance Co. nsurance ompany This endorsement modifies such insurance as is afforded by the provisions of Policy # 72UENUM8309 relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92702; its officers, employees, agents and volunteers are named as additional insureds ("additional insureds") with regard 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 separately 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 canceled, 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 92702. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective September 1,2005 , this endorsement form as a part of Policy # 72UENUM8309 Issued to u.s. HealthWorks, Inc. Countersigned by resentative "./ ~/ ~,.), 0., /, )j, 0/(.__ ~I.::,-,_~'i:(fl_.</__':~__' . ~/ ACQBJ:t CERTIFICATE OF LIABILITY INSURANCE I i i DATI' {MM,POIY)''(Y) 10/19!2006 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, PRODUCER Arthur J, Gallagher & Co. License #0726293 505 North Brand Blvd, Suite 600 Gler;t:Jale, CA 91203.3944 Phone_ 818,539-2300 rme 818,.539-230, INSURERS AFFORDING COVERAGE NAIC# IN$'JRED U.S. HealthWorks, Inc. 3655 North Point Parkway, Suite 150 A!pharetta, GA 30005 INSUREr< A _,!j~~~?_~i:!,!:iE:.,l0.~~E~0,~,~_S~9!':"P~ ny INSUR,,;:'l a Hartford IP,SJRER D IN$JRFRf COVERAGES THE POLICiES O~ iNSURANCE LISTED BELO'N H/IVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERiOD INDIC,\TED NOTVi!THSTANDING ANY REQUIREMENT, TERM OR CONDITiON Or: ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE r.,'AY BE ISSUED OR MAY PERTAIN, THE !NSURANCE- AFFORDED BY THE POLJCIES DESCRI8ED HEREIN JS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLlCES, AGGREC',ATE LIMITS SHOWN r.1AY HAVE BEEN REDUCED BY PAID CLAJMS. ^ " 72UENUM8309 LIMITS 09/01106 09/01/07 _,~i:~gg;::!,~H~,I\PVI~.JURY q?t_~:")~LA:q<:;!'lS(;ATC 300,00G 10,000 '1,000,000 3,000,000 3.:;)00,'060 CCCUR I'~/(r ,;"'p:d~S "iiiK A POliCY 09/01107 1 ,000.000 ANY AUTO A.LlCWVNE~AJT()..,> BODilY IN...'URY lPeqxvUJI! X SC!,EOU",PCAUTOS X X H)I~f.:; AUTOS BO(}ll Y IN.;;JRY li'tHaccid(l1)1; I\ON.owr;;:[;AUros GII.:RAGE LIABILITY AuTOO....L Y .f:.AACClQEN1 ANY Al!f(, OTHER'rH^," AiJTOONLY G ,_ €XCESS!iJMBREL ~~1~6IL1T Y 09/0'1/06 09101;07 X OCCUR : 0_AIM$ MADE ~~~~::;;;:~,!E D~DUCT-i>:~E X R[TF'H'O'1 S 10000 ^ WORl{ERS COMPENSATION ANO EMPLOYERS' LlABIUTY 72WNi',.1G3070 09(0 1 1lJ6 09;01/07 X ~,::L^, ~t:Cl1 ACCIDeNt is ~" YSEASE. ;'OUCY!.i'tiT 1,000,000 1,000,000 OTHER - .----.- .-- DESCRIPTION Of' OPERA nO~lS.' LOCATIONS i VEHICLES! EXCLUSIONS AOoeo &V ENDORSEMENT I SPECIAL PROVISIONS 'Except ~o days notice for r,on-poyrr)l;ml of premium The City 01 Santa Ana. 20 Civic Center Plaza, Santa J\na, California 92;'0'1. its officers, employees. agents volunteers and represontatives are named as additior,QI insureds with regard to liability ar:d defense of suits arising from the operations and uses performed by or on behalf of the namBd ifl$!Jred. CERTIFICATE HOLDER CANCELLATION 20 OAc Center Pklza S.an:",1 Ana. C/\ 92701 SHOULD ANY OF THE ABOVE OESCRlIlEO POLICIES 6f CANCELLED BEFORE THE EXPlRA TlON OATe THEREOF, THE ISSUING INSUReR WILL XXXXXXl<.XXXXMAlt. ,,,;?St,, DAYS WR:rrTEN ~~:pfi Tp THE CERTifICATE HOLOER NAMEO TO THE lEFT, XXXXYJ0lXXx.xXXXXXXXXXXXX l.iJ...!:xiidXyy'XXJ(xXXXXXX:XXXXXXXXxYJOC';XXXXXXXXXXXXXXXXXXXXX;<.XXXXXXXXXxxxx.>: XXYJ;XXXXMXXXXX AUTHORIZEO REPRESEtHATlVE City of Santa An;) City of Santa An~l Fire DepiOrtmeh! A:!ll'lltb'VtH::I AS '1'0 ~ ACORD 25 (2001108) @ ACORD CORPORATION 1988 L. c, ADDITIONAL INSURED ENDORSEMENT Insurance Company Hartford Fire Insurance Company This endorsement modifies such insurance as is afforded by the provisions of Policy # 72UENUM8309 relating to the following: 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92702; its officers, employees, agents and volunteers are named as additional insureds ("additional insureds") with regard 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 separately 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 canceled, 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 92702. (Completion of the following, including countersignature, is required to make this endorsement effective.) Effective 911106 - 911107 Policy # 72UENUM8309 Issued to u.s. Healthworks, Inc. , this endorsement form as a part of Named Insured Countersigned by ~- Authorized Representative ['0 ]i'01~M ~~/ ,_ ~'ll L. L Urii Stitt Sheedy \<,I~li';H