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Home My WebLink AboutCORRECTIONAL MANAGED CARE MEDICAL CORP. 2Bu AGREEMENT TERMINATION Please complete this form when the attached agreement is no longer in cQ'~ _ ~ ~1 c~; ~~ Return form to the Sr. Deputy Clerk of the Council (M-30). Call 647-~8'if you have an '! :~. ~a,,,~, questions. R The agreement with ~Y1(`6y~Q ~~~~Q(~ ~,Qlh~, ~ No ~_a ~p~ - a 1'7 was completed on ,and final payment has been made. Department: _ ~D Signature: ti ~e.'k',d Date: ~f ~S~ C?~ Revised 8-7-03 City of Santa Ana Clerk of the Council City of Santa Ana ~, Clerk of the Council AGREEMENT TERMINATION Please complete this form when the attached agreement is no longer in effect. ~~ _ ~ t~ ` Return form to the Clerk of the Council Office (M-30). Call 647-6520 if you have any questions. C~~Y ~ • ~a ~~~ ___________________________________ ' CLER;' ~t ~~~~~~~JL r -' The agreement with ~~; ~~ ~ - f.- ,,..: , . _ /r ~' ,~ , ,~ , ~ ~ ~ ~ .: x, _ ~r , ~ ~ ~,. ; No. - yam' ~ ~, ~ ~ ~ ~ ~ ` ~~ was completed on ~~~ ~ ~~ ~ ~ ~ ~~> and final payment has been made. ~-~ , . ~ I Department: ~~ I -~ ~~ ~/ j~ ~ .1 Phone/Ext.: ,~~ / ` /_ Signature: Date: t'~> ~ , ~ _ ~a Revised 12-07-07 - A-2006-217 g -( -07 1;;)- </-010 SECOND AMENDMENT TO AGREEMENT FOR THE PROVISION OF INMATE MEDICAL SERVICES BETWEEN CITY OF SANTA ANA AND CORRECTIONAL MANAGED CARE MEDICAL CORPORATION 0: fo Pt'SUJ.t THIS SECOND AMENDMENT TO AGREEMENT, is entered into this 21" day of August, 2006, by and between 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"), and Correctional Managed Care Medical Corporation ("Contractor") RECITALS: A. City and Contractor entered into Agreement #A-2004-231, dated October 18,2004, for the Provision ofInmate Medical Services, hereinafter referred to as "said Agreement". B. The Parties desire to renew the term of said Agreement and approve the maximum obligation to be expended for services. NOW, THEREFORE, in consideration of the mutual and respective promises, and subject to all the terms and conditions of said Agreement, and Amendments to Agreement, except as herein modified, the parties agree as follows: I. Section I, TERM, shall be extended to August 31, 2007. 2. The Maximum Baseline Obligation shall be increased to $1,110,518.00, as set forth in Section 3.b. COMPENSATION, of said Agreement. 3. Except as hereinabove modified, all terms and conditions of said Agreement shall remain in full force and effect. II II II II II IN WITNESS WHEREOF, the parties hereto have executed this Amendment to Agreement the day and year fust above written, ATTEST: / bA PATRlCIAE. HEALY Clerk ofthe Council APPROVED AS TO FORM: JOSEPH W. FLETCHER City Attorney BY:'~P~ Lama eeay . Assistant City Attorney CITY OF SANTA ANA .. ~~j~~ y.DAVIDN.RE. \ City Manager CORRECTIONAL MANAGED CARE MEDICAL CORPORATION /J (N.ame) /L t.<.r~/ ?~;.6~d (Title) . . '..;7 c/ 08/82/2005 10:01 T \ I 19493055155 e COLONIAL PRA e PAGE 01/02 ~~ CERTIFICATE OF LIABILITY INSURANCE \ DATE IMll1/DDNYYY) 0&/01/2006 roRODUCIliA (949)30S-6161 FAX (949)~05-61~~ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Colonial W@stern Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTlflGA r1: HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 26691 Plaza Drive, Suite Z20 AL fER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Aission Viejo, CA 92691 INSURERS AFFORDING COVERAGE NAlC# INSURED Correctional Managed Care Medica1' Corporation Lexington Insurance Company - INSURER A: 4211 E. La Palma Ave. fl. ~oS -.)d.J INSURER B: St. Pau~ Travel ers Ins. co. Anaheim, CA 92807 INSURER c: Everest Insurance Company A-;xo{p-~1 INSURI:R D' IN$URI:R E: ES THe POliCieS OF INSURANce L.ISTeO 6F:::LUVII HAVt:o t$EEN ISSUI;O TO THE IN~UR!O NAMeD ABOVE FOR THE F>OL.ICY peRIOD INDICATEC. NOTWITI-IST^NOING ANY REQUIREMENT, Te~M OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THis CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HI;RE1N IS SUBJECT TO ALL THE TERMS. EXCI.USIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATEI.IMITS SHOWN MAY HAVe SEEN REDUCED BY PAlO CLAIMS. '!'l$~ ~~~! .",.. . POLICV EFFECTIVE P~~!fJ EXPlRATIO,.. lYPE Of IN$URANCE POLICY NUMBER LIMITS GENERAL UABlLITY 0314761 08/01/2006 08/01/2007 EACH OCC~~eNCI: S 1,000,000 X COMM~RCIAL GENERAL LIABILITY DAMAGE TO RE~m,.o $ _ _ ~_<1,~ - ~ CLAIMS MADe 0 OCCUR t'i':'I"'IU'T.'I"r!JIl) MED EXP (Any one ~91"lon) $ S,OOO A - l,OOO,OO(] PeRSONAl. Il AOV INJURY $ - OENI:RALAGGREGATE $ l,Onn,Ooo - GeN'L AGGREGATE LIMIT APPLIES peR; I"~OCUCTS . COMPIOP AQO S 1. 000,000 n .nI"RO. n POLICY JeeT lOC AUTOMOBILE LIABILITY 6809447H706 02/04/2006 02/04/2007 cOMelNEO SINGll: LIMIT f-- S ANY AUTO (Ea QCCId<lnl) 1,000,000 - - ALL OWNED ""UTOS aODlL Y INJUfl.Y S SCHEiDULJ;O AUTOS 1I'"6r"",r~cn) B X -"" u_ ., HIRED AUTOS OOOll Y INJURY X $ ~IO~I-()1J11NJ;i:I 41 .Tn<: (1"Ar"""lde~l) r--- n..... '-- PROPE~rY DAMAGE S (Per acclde~t) GARAGE LIAalLrlV ^UTO ON.. Y - ~ ACCIDENT a ==J ANY ",I,JTO ~ OTHER THAN E'IACC ~ .- F . AUTO ONLY: AGG $ EXCESalUMBRELLA LIABILITY r J /Le~--ct -/ /Ic eACH OCCURRENCE $ ~ OCCUR D C~AIMS MAOE I AGGReGATE; $ $ R DeCUCTIBlE $ RI:TI:NTION $ $ WUfCI\I:.K:J r,;OM,.eNl;lATlQN AND C^200109!iS061 07/01/2.006 07/01/2007 X-L WCSTAlU-ic=TITH. EMI'l.OVeRS' UABIUTY m _ _TOB:r_UMIL$. l:~, 1'.-- C ANY pROPRleTOR/PARTNERlEXECUTIVE e.~. i:ACI-I ACCIDENT $ 1,000.000 OFFICEMo1eMBER J:XCLUDE07 E;L OISEASE. EA,EMPLOYEF. $ 1,000,000 It ,,/00, c:r""Qflbo und'af SPECIAL PROviSIONS bolo.v e;.L. OII;1E;AsE. f'ULIL;Y L1MII $ I. 000. OOC ~;~~essional Liability 0314761 08/01/2006 08/01/2007 Prof liability: $lmi11$ 3rllil A ~a"ag~d Car~ E&o Liab. 0314761 08/01/2006 08/01/2007 Managed Care E&O: $lnril/$3mil DEaC~IPTION OF OP~^TION5f LOCA110~ ~\I~r~LJ;lIl ?tCLUSIONS AoDtoll ay J;NDORleMENT I SpECIAL PROVISIONS lO Day~ not ~~ 0 cance at,on or non-payment 0 premnum. ertjticate Holder is an Additional Insured for general 1 iabi' ity <'1m.! p~'ores5';ol1al 1 iabil i1:y pel" ndorsement #14 attached. ION SHOULD ANY OF THE ABOVE OESCRIBED POLICIES BE CANCELLED aEiFO~E. THE EXPIRATION DATE TI-ltoREOF, THE ISSUING INSUReR WI.... ~NDEAVOR TO MAIL _:J~L DAYS WRITTEN NOTIce TO THE; CERTlFICA TE HOLDER NAMeD TO tHE LEFT, UT FAlI.URJO TO Il/lAll eUCH NOTICI! SHALL IMPOSE: NO OaUGATION OR LIABILITY NY KIND UPON THE INSURER, IfS AGENTS OR REPRESENTATIVes. ~ REPRES A TIVE City of Santa Ana Sant:a Ana City Jail Attention: Chris Laugenaur, Contracts 62 Civic Center Plaza Santa Ana. CA 92702 ACORD 25 (2001108) ol~S-'BI(l.o @ACORDCORPORATION1988 ',~i4 19493055155 e rROvrLE~C ~ ~SSOC\~iE~ COLONIAL PRA PAGE 02/02 ~i.4TT P.010/Ol, f-T25 08/@2/2005 10:01 , 07~~7-mE I 1 ENDOASEMENT NO.14 Thts Rndorsementj ~ffectlve 12~01 AMl Auguat 1. 2006 F01~ A part tit polle" no.~ O~147S1 .,sued to: COARECnONAL MANAGSD CARE MeDICAL CORP. By: LEXINGTON INSURANCE CqMPANY ADompNAL IftSURED E:NDOflSEMENT The Po)lp,y 1s amended as tollows: SGctlon II. WHO IS AN INSURED Qfthe HEAlTHCAFl.c PROFESSIONAL LlABll.ITY COVERAGE PART i~ amended by llIdding tha folfowil1g: SANTA ANA cITY JAIL 62 CIVIC CENTER PLAZA SANTA ~A1 CA 9270.2 coUNTY OF MA05RA 1419 ROAD 28 MAD~RA, CA 93639 Coventj;JEl provided Lloder this policy is limned to Medlcm In\:ldel'lthd whila providing prQfessiQt\fl1 sel ViCB6 at the metilcal clinic tlf while in lranspO" onlY, Thl~ policy does not Pfr:lvldr;l Qoverage arislns o\.lt of acts whlcn Qceut beyond th~ Icope of bl.llill'\8~ of tn. madlcal clinic. ' Section II. WHO IS AN INSURED of the HEAI.THCARE GENERAlllABILlTY COVEflAGf: PART Is em~nded wedding the folTowinSl SANTA ANA CITY JAIL e2 CIVIC CENTliR PLAZA SANTA ANA. CA 92102 COUNTI OF MADERA 1419 ROAD 28 MADERA. CA 9363B Cowrag& proVided unde!' thl~ pollClY is IimEtad profljl~>>ion~r ~Grvio9t 31: tho meclioal olinlc Qr wfllll>' io tnmapDrt (lnly. This pOIll:Y does ml'l: ]:Irovide ooverage ilny aodl/Y injury and/or Prop"rtv Qamsse erlsing out of acts which 1;IaCUr beyond the scope of busIness at the medical ellnlc. AU ather tarms. conditions ancl excluslcns Of the pOlicY remain unchanged. ( I ) 7,r ~/7<O/L r~~ntgtlvl;l f1ture (where requIred by Jaw) , CERTHOLDER COpy e STATE COMPENSATION INSURANCE FUND e P.O. BOX 420807, SAN FRANCISCO,CA 94142-0807 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 07-01-2006 GROUP: 000834 POLICY NUMBER: 0000870-2006 CERTIFICATE ID: 3 CERTIFICATE EXPIRES: 07-01-2007 07-01-2006/07-01-2007 CITY OF SANTA ANA, SANTA ANA CITY JAIL SP ATTN CHRIS LAUGENAUR 62 CIVICS CENTER PLAZA SANTA ANA CA 92702 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form 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 amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. a:::- REPAl'SENT ATI EMPLOYER1S LIABILITY LIMIT INCLUDING DEFENSE COSTS: ~ PRESIDENT $1,000,000 PER OCCURRENCE. EMPLOYER ~ ' ~r, ~'~ CORRECTIONAL MANAGED CARE 4211 E LA PALMA AVE ANAHEIM CA 92807 SP (REV.2-05) PRINTED 06-19-2006 SP M0408 " ACORq CERTIFICATE OF LIABILITY INSURANCE I DATE IMMlDDIVYYY) 08/07/2007 PRODUCER (949)305-6161 FAX (949)305-6166 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Colonial Western Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 26691 Plaza Drive, Suite 220 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Mission Viejo, CA 92691 INSURERS AFFORDING COVERAGE NAIC tI INSURED Correct i ona I Managed Care Med i ca I Corporat i on INSURER A: Lexinqton Insurance Company 4211 E, La Pa I ma Ave, A 02.00 " _ Jt { '7 INSURER B: Travelers Insurance Company Anaheim, CA 92807 4 INSURER C: Everest Insurance Company A - ,2(Xn-' 9'3 INSURER D: INSURER E: C THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOlWlTHST ANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VV1TH RESPECT TO \MilCH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE 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. Ir;~ ~1l12:! TYPE OP INSURANCE POLICY NUMBER POLICY EFFECTIVE POUCY EXPIRAnON UMITS ~NERAL UABILITY 0314761 08/01/2007 08/01/2008 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,OQC ~ txJ CLAIMS MADE 0 OCCUR MED EXP (Anyone pemln) $ s,ooe A PERSONAL & ADV INJURY $ 1,000,000 f- 3,000,OOC GENERAL AGGREGATE $ f- 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ nPOLlCyn~~ nLOC . ~TOMOBlLE UABIUlY 6809447H706 02/04/2007 02/04/2008 COMBINED SINGLE LIMIT (Ea accident) $ 1,ooO,OOe f-- ANY AUTO ALL OWNED AUTOS BODILY INJURY $ c-- (Par person) SCHEDULED AUTOS B - ~ HIRED AUTOS BODILY INJURY $ X NON.QWNED AUTOS (Per accident) I-- f- PROPERTY DAMAGE $ (Per accident) RAABE UABlLITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EAACC $ AUTO ONLY: AGG $ OESSlUMBRELLA UABIUTY EACH OCCURRENCE $ OCCUR 0 CLAIMS MADE AGGREGATE $ $ R DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND CA2001 0955061 07/01/2007 07/01/2008 X'- we STATU- IO~ EMPlOYERS' UABIUlY E.L. EACH ACCIDENT $ 1,000,000 C ANY PROPRIETORlPARTNERlEXECUTIVE E.L. DISEASE. EA EMPLOYEE $ 1,000,000 OFFICERlMEMBER EXCLUDED? ~~~~Iir=~mrNS baIow E.L. DISEASE - POLICY LIMIT $ 1,000,000 p01~~essional Liability 0314761 08/0112007 08/01/2008 Prof Liabi I ity: $1mi 1/$3mi I A Managed Care E&O Liab. 0314761 08/01/2007 08/01/2008 Managed Care E&O: $1mi 1/$3mi I DESCRIPTION Of OPERAnONli( LOCATION' I VeHl\lLES I EXClUSIONS ADDED BY ENDO~EMENT J l!PEClAl PROVISIONS 10 Days notice 0 cance latlon for non-payment 0 premIum. professional I iabi I ity per ertificate Holder is an Additional Insured for general. I iabi I ity and ndorsement #14 attached. ACORD 25 (2001/08) Don PRIETARY CORi~!. '.~TiONAL MANAC.t:D CARE , @ACORDCORPORATION1988 (/]('7' / / c City of Santa Ana Santa Ana City Jai I Attention: Chris Laugenaur, Contracts 62 Civic Center Plaza Santa Ana, CA 92702 ) ) ENDORSEMENT NO. 14 This endorsement, effective 12:01 AM: August 1, 2007 Forms a pan of policy no.: 0314761 I8sued to: CORRECTIONAL MANAGED CARE MEDICAL CORP. By: LEXINGTON INSURANCE COMPANY ADDmONAL INSUREDS ENDORSEMENT- PRIMARY AND NON-CONTRIBUTORY &. WAIVER OF SUBROGATION It is agreed that the HEALTHCARE GENERAL LIABILITY COVERAGE PART is amended by adding the fotlowing as Additional Insured but only with respect to any claim or suit arising out of the conduct of your business. The City of Santa Ana. 20 Civic Center Plaza, Santa Ana, California 92701 Its Officers, Employees, Agents. Volunteers and Representatives Subject to the foregoing, it is also agreed that the insurance afforded by this poficy for the benefit of the Additionellnsured shaH be primary insurance and any Insurance maintained by the Additional Insured shall be non-contributory. In the event of payment under the HEALTHCARE GENERAL LIABILITY COVERAGE PART of this policy, we waive our right of subrogation against any person or organization listed above where the insured has waived liability of such person or organization as part of a written contractual agreement between the insured and such person or organization entered into prior to the occurrence or offense. .., .. ~~ -~;f5?/~- 1/- " . . .:;.~;;J.: ..~ :,~ ., other terms, conditions and exclusions of the policy ,emain unchanged. ,.' 6~ ..~. 8CPT (09/07) ::-,.f.....a=== reqUlNd by law) ) ) 1. Claims or suits arising from the same occurrence, offense or medical Incident; or 2. Persons or organizations covered in those policies that are jointly and severalty liable. In such a case, we shall not be liable under this Policy for an amount greater than the proportion of the loss that this Policy s applicable Limit of Insurance bears to the total applicable Limits of insurance under atl such policies. In addition, the total amount payable under all such policies is the highest, single applicable Limit of Insurance among all such policies. flj)J. Separation of Insureds Except with respect to the Limits of Insurance and deductible, and except with respect to any rights or duties specifically assigned in this Policy to the Named Insured, this insurance applies: 1. As if each Insured were the only Insured; and 2. Separately to each Insured against whom a claim is made or suit is brought. K. Bankruptcyllnsolvency Yout bankruptcy or insolvency will not relieve US of our obtigations under this Policy. L. Representations By accepting this Policy, the First Named Insured agrees that: 1. The statements in the Declarations andlor Applications are accurate and complete; 2. Those statements are based upon representations made to us by you; and 3. We have issued this Policy in reliance upon your representations. M. Subrogation If an Insured has rights to recover aU or part of any payment we have made under this Policy, those rights are transferred to us. An Insured shall do nothing to impair these rights after a loss. At. our request, an Insured wUl bring suit or transfer those rights to U8 and fully cooperate with us with respect to enforcing them. Any recoveries wm be applied in accordance with the following priorities: 1. Any person or organization, including the Insured, that have paid an amount in excess of our pay- ment under this policy will be reimbursed first; 2. We then will be reimbursed up to the amount we have paid; and 3. Lastly, any interests, including the Insured, over which our insurance is excess, are entitled to the residual. N. Conformance To Statute To the extent that this Po&cy conflicts with any law, statute, or regulation applicable to this policy, this Policy shall conform to the minimum requirements of that Jaw, statute, or regulation. O. Transfer of Your Rights and Duties 79229 (01/05) HC0271 10 . . ENDORSEMENT NO. 14 PROPRIETARY CORRECTIONAL MANAGED CARE This endorsement, enectlve 12:01 AM: August 1,2007 Forms a part of policy no.: 0314761 Issued to; CORRECTlONAL MANAGED CARE MEDICAL CORP. By: LEXINGTON INSURANCE COMPANY ADDITIONAL INSURED ENDORSEMENT The Policy is amended as follows: Section 1I. WHO IS AN INSURED of the HEAL THCARE PROFESSIONAL LIABILITY COVERAGE PART is amended by adding the following: SANTA ANA CITY JAIL 62 CIVIC CENTER PLAZA SANT A ANA. CA 92702 Coverllge provided under this policy is limited to Medicallncldent(sl while providing professional services at the medical clinic or while in transport only, This policy does not provide coverage arising out of acts which OCCllr beyond the scope of business of the medical clinic. Section II. WHO IS AN INSURED of the HEALTHCARE GENERAL LIABILITY COVERAGE PART is amended by adding the following: SANTA ANA CITY JAIL 62 CIVIC CENTER PLAZA SANTA ANA. CA 92702 Coverage provided un,der this policy is limited professional services at the medical clinic or while in transport only. This policy does not provide coverage any Bodily Injury and/or. Property DlImage arising out of acts which occur beyond the scope of business of the medical clinic. All other terms, conditions and exclusions of the policy remain unchanged. MNSCPT (08106) Authorized Representative or countersignature (where required by law)