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HomeMy WebLinkAboutAMPHIBIOUS MEDICS (INDUSTRIAL MEDICAL SUPPORT, INC.) INSURAiVC�ON FILE WORK MAY PROCEED N-2025-099 UNTIL INSURANCE EXPIRL�S CIT CLERK DAl LAPR 2 9 206N-CALL AGREEMENT WITH INDUSTRIAL MEDICAL SUPPORT, INC.,DBA AMPHIBIOUS MEDICS FOR STANDBY EMERGENCY MEDICAL SERVICES AT CITY EVENTS THIS AGREEMENT is made and entered into on this 18th day of March, 2025 by and between Industrial Medical Support, Inc., a Nevada corporation dba Amphibious Medics ("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("City"). RECITALS A. The City desires to retain a contractor having special skill and knowledge in the field of standby emergency medical services at various City events. 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 standards as may reasonably be expected from a professional consulting firm in the field. NOW THEREFORE, in consideration of the mutual and respective promises, and subject to the terms and conditions hereinafter set forth, the parties agree as follows: 1. SCOPE OF SERVICES a. On an on-call basis, and at the City's sole discretion, Contractor shall perform, during the term of this Agreement, all tasks and obligations including all labor, materials, tools, equipment, and incidental customary work required to fully and adequately complete standby emergency medical services as further described and set forth in Exhibit A, attached hereto and incorporated by reference. b. All Emergency Medical Technicians assigned to provide services pursuant to this Agreement shall be certified and registered with the appropriate authorities to practice pre- hospital emergency medical care in the State of California. C. Contractor shall provide all medical supplies. d. Contractor shall provide a safety plan to the City's Parks, Recreation and Community Services Department within forty-eight(48)hours of an event where Contractor's services are requested. 2. COMPENSATION a. City does not warrant any minimum compensation to Contractor under this Agreement. Contractor shall be paid only for actual services performed under this Agreement at the rates and charges identified in Exhibit A. The total compensation for these standby emergency Page 1 of 9 medical services provided by Contractor under this Agreement shall not exceed Forty Thousand Dollars and Zero Cents ($40,000.00). b. Payment by City shall be made within forty-five (45) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures, City and Contractor agree that all payments due and owing under this Agreement shall be made through Automated Clearing House (ACH) transfers. Contractor agrees to execute the City's standard ACH Vendor Payment Authorization and provide required documentation. Upon verification of the data provided, the City will be authorized to deposit payments directly into Contractor's account(s) with financial institutions. c. Payment need not be made for work that fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. 3. TERM This Agreement shall commence on April 1, 2025 and terminate on March 31, 2028, unless terminated earlier in accordance with Section 15, below. 4. INDEPENDENT CONTRACTOR Contractor shall, during the entire term of this Agreement, be construed to be an independent Contractor and not an employee of the City. This Agreement is not intended nor shall it be construed to create an employer-employee relationship, a joint venture relationship, or to allow the City to exercise discretion or control over the professional manner in which Contractor performs the services which are the subject matter of this Agreement; however, the services to be provided by Contractor shall be provided in a manner consistent with all applicable standards and regulations governing such services. Contractor shall pay all salaries and wages, employer's social security taxes, unemployment insurance and similar taxes relating to employees and shall be responsible for all applicable withholding taxes. 5. OWNERSHIP OF MATERIALS This Agreement creates a non-exclusive and perpetual license for City to copy,use,modify,reuse, or sublicense any and all. copyrights, designs, and other intellectual property embodied in plans, specifications, studies, drawings, estimates, and other documents or works of authorship fixed in any tangible medium of expression, including but not limited to, physical drawings or data magnetically or otherwise recorded on computer diskettes, which are prepared or caused to be prepared by Contractor under this Agreement ("Documents & Data"). Contractor shall require all subcontractors to agree in writing that City is granted a non-exclusive and perpetual license for any Documents & Data the subcontractor prepares under this Agreement. Contractor represents and warrants that Contractor has the legal right to license any and all Documents & Data. Contractor makes no such representation and warranty in regard to Documents & Data which were provided to Contractor by the City. City shall not be limited in any way in its use of the Documents and Data at any time, provided that any such use not within the purposes intended by this Agreement shall be at City's sole risk. Page 2 of 9 6. INSURANCE Contractor shall procure and maintain for the duration of the agreement, the following insurance coverages: Minimum Scope and limit of Insurance. Contractor shall maintain limits of insurance coverage in the following minimum amounts and shall be at least as broad as: • Commercial General Liability (CGL): Insurance Services Office Form CG 00 01 covering CGL on an "occurrence" basis, including products and completed operations, property damage, bodily injury and personal & advertising injury with limits no less than $1,000,000 per occurrence and $2,000,000 aggregate. • Automobile Liability (AL): Insurance Services Office Form CA 00 01 covering Code 1 (any auto), with combined single limits of$1,000,000. In the event Contractor does not maintain commercial automobile liability insurance, City will accept evidence of personal automobile insurance with existing limits, which can be lower than$1,000,000. • Workers' Compensation (WIC): as required by the State of California, with statutory limits, and Employer's Liability Insurance with limit of no less than $1,000,000 per accident, per employee, per policy for bodily injury or disease. This requirement can be waived if Vendor has no employees. • If Contractor maintains broader coverage and/or higher limits than the minimums shown above, City requires and shall be entitled to the broader coverage and/or the higher limits maintained by Contractor. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to City. Other Insurance Provisions. The insurance policies are to contain, or be endorsed to contain, the following provisions: • CGL and AL policies: City of Santa Ana, its City Council, its officers, officials, employees, agents, and volunteers are to be covered as additional insureds with respect to liability arising out of work or operations performed by or on behalf of the Permittee including materials,parts, equipment, and personnel furnished in connection with such work or operations. • All required insurance policies: Insurance company(ies) agrees to waive all rights of subrogation against City, its City Council, its officers, officials, employees, agents, and volunteers for losses paid under the terms of any policy which arise from work performed by Permittee for City. • All required insurance policies: For any claims related to this contract, Permittee's insurance coverage shall be primary and any insurance maintained by City, its City Council, its officers, officials, employees, agents, or volunteers shall not contribute with it. • All required insurance policies: A severability of interest provision must apply for all the additional insureds, ensuring that Permittee's insurance shall apply separately to each insured against: whom a claim is made or suit is brought, except with respect to the insurer's limits of liability. Page 3 of 9 • Each insurance policy required herein shall provide that coverage shall not be canceled, suspended, voided, reduced in coverage or in limits, non-renewed by the carrier, or materially changed except after thirty(30) days prior written notice has been given to City. Ten(10)days prior written notice shall be provided to City for policy cancellation or non-renewal due to non-payment. • Certificate Holder on. each Evidence of Insurance certificate shall be; City of Santa Ana, Attention: (Name of Department Staff Responsible for Agreement), Address of Department Responsible for Agreement, M-XX, Santa Ana, CA 92701. The name and location of event should be included in the Description of Operations section of each certificate. Self-Insured Retentions. Self-insured retentions must be declared to and approved by the City. City may require Contractor to purchase coverage with a lower retention or provide proof of ability to pay losses and related investigations, claim administration, and defense expenses within the retention. Acceptability of Insurers. Insurance is to be placed with insurers authorized to conduct business in the state of California with a current A.M. Best rating of no less than A:VII,unless otherwise acceptable to City. Verification of Coverage. Permittee shall furnish City with original Certificates of Insurance including all required amendatory endorsements (or copies of the applicable policy language effecting coverage required by this clause)and a copy of the Declarations and Endorsement Page of the CGL policy listing all policy endorsements to Entity before work begins. However, failure to obtain the required documents prior to the work beginning shall not waive Permittee's obligation to provide them. City reserves the right to require complete, certified copies of all required insurance policies, including endorsements required by these specifications, at any time. Claims Made Policies. If any of the required policies provide coverage on a claims-made basis: • The retroactive date must be shown and must be before the date of the contract or the beginning of work. • Insurance must be maintained and evidence of insurance must be provided for at least three(3) years after completion of work. • If coverage is canceled or non-renewed, and not replaced with another claims-made policy form with a retroactive date prior to the contract effective date, Company must purchase "extended reporting" coverage for a minimum of three (3) years after completion of work. Subcontractors. Contractor shall require and verify that all sub-contractors maintain insurance meeting all the requirements stated herein, and Contractor shall ensure that City is an additional insured on insurance required from sub-contractors. Special Risks or Circumstances. City reserves the right to modify these requirements, including limits,based on the nature of the risk, prior experience, insurer, coverage, or other special circumstances. Page 4 of 9 7. INDEMNIFICATION Contractor agrees to defend, and shall indemnify and hold harmless the City, its officers, agents, employees, contractors, special counsel, and representatives from liability: (1) for personal injury, damages, just compensation, restitution, judicial or equitable relief arising out of claims for personal injury, including death, and claims for property damage, which may arise from the negligent operations of the Contractor,its subcontractors, agents, employees, or other persons acting on its behalf which relates to the services described in section 1 of this Agreement; and (2) from any claim that personal injury, damages, just compensation, restitution, judicial or equitable relief is due by reason of the terms of or effects arising from this Agreement. This indemnity and hold harmless agreement applies to all claims for damages, just compensation, restitution, judicial or equitable relief suffered, or alleged to have been suffered,by reason of the events referred to in this Section or by reason of the terms of, or effects, arising from this Agreement. The 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 challenging the validity of this Agreement, or asserting that personal injury, damages,just compensation,restitution,judicial or equitable relief due to personal orproperty rights arises by reason of the terms of, or effects arising from this Agreement. City may make all reasonable decisions with respect to its representation in any legal proceeding. Notwithstanding the foregoing, to the extent Contractor's services are subject to Civil Code Section 2782.8, the above indemnity shall be limited, to the extent required by Civil Code Section 2782.8, to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Contractor. 8. INTELLECTUAL PROPERTY INDEMNIFICATION Contractor shall defend and indemnify the City,its officers,agents,representatives, and employees against :any and all liability, including costs, for infringement of any United States' letters patent, trademark, or copyright infringement, including costs, contained in the work product or documents provided by Contractor to the City pursuant to this Agreement. 9. RECORDS Contractor shall keep records and invoices in connection with the work to be performed under this Agreement. Contractor shall maintain complete and accurate records with respect to the costs incurred under this Agreement and any services, expenditures, and disbursements charged to the City for a minimum period of three(3)years,or for any longer period required by law,from the date of final payment to Contractor under this Agreement. All such retards and invoices shall be clearly identifiable, Contractor shall allow a representative of the City to examine, audit, and make transcripts or copies of such records and any other documents created pursuant to this Agreement during regular business hours. Contractor shall allow inspection of all work, data, documents, proceedings, and activities related to this Agreement for a period of three (3) years from the date of final payment to Contractor under this Agreement. 10. CONFIDENTIALITY If Contractor receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Contractor agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the Page 5 of 9 same degree of care it uses to protect its own information of like importance, but in no event less than reasonable care. "Confidential Information" shall include all nonpublic information. Confidential information includes not only written information, but also information transferred orally, visually, electronically, or by other means. Confidential information disclosed to either party by any subsidiary and/or agent of the other party is covered by this Agreement. The foregoing obligations of non-use and nondisclosure shall not apply to any information that(a)has been disclosed in publicly available sources; (b) is, through no fault of the Contractor disclosed in a publicly available source; (c) is in rightful possession of the Contractor without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Contractor without reference to information disclosed by the City. 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. NON-DISCRIMINATION Contractor shall not discriminate because of race, color, creed,religion, sex, marital status, sexual orientation, gender identity, gender expression, gender, medical conditions, genetic information, or military and veteran status, age, national origin, ancestry, or disability, as defined and prohibited by applicable law,in the recruitment,selection,teaching,training,utilization,promotion,termination or other employment related activities or any services provided under this Agreement. Contractor affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 13. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and 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 or the City. Each party to this Agreement acknowledges that no representations, inducements,promises or agreements, orally or otherwise,have been made by any party, or anyone acting on behalf of any party, which is not embodied herein. 14. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Contractor, Contractor may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services that are the subject to this Agreement performed by City personnel or by other Contractors retained by City. Page 6 of 9 15. TERMINATION This Agreement may be terminated by the City upon thirty(30) days written notice of termination. In such event, Contractor shall be entitled to receive and the City shall pay Contractor compensation for all services performed by Contractor prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Executive Director may require Contractor to deliver to the City all work product(s) completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Contractor consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work that fails to meet the standard of performance specified in the Recitals of this Agreement, 16. WAIVER No waiver of breach, failure of any condition, or any right or remedy contained in or granted by the provisions of this Agreement shall be effective unless it is in writing and signed by the party waiving the breach, failure, right or remedy. No waiver of any breach, failure or right, or remedy shall be deemed a waiver of any other breach, failure, right or remedy, whether or not similar, nor shall any waiver constitute a continuing waiver unless the writing so specifies. 17. JURISDICTION-VENUE This Agreement has been executed and delivered in the State of California and the validity, interpretation,performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement, 18. PROFESSIONAL LICENSES Contractor shall, throughout the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Santa Ana and all other governmental agencies. 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. 19. NOTICE Any notice, tender,demand,delivery, or other communication pursuant to this Agreement shall be in writing and shall be deemed to be properly given if delivered in person or mailed by first class or certified mail,postage prepaid, or sent by fax or other telegraphic communication in the manner provided in this Section, to the following persons: Page 7 of 9 To City: City Clerk City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 Fax: 714- 647-6956 Executive Director of Parks, Recreation and Community Services City of Santa Ana 20 Civic Center Plaza (M-23) P.O. Box 1988 Santa Ana, California 92702 Fax (714) 571-4211 To Contractor: Industrial Medical Support, Inc., dba Amphibious Medics Attn: Shanna Ickler, Assistant Director 3320 E. Airport Way Long Beach, CA 90806 A party may change its address by giving notice in writing to the other party. Thereafter, any communication shall be addressed and transmitted to the new address. If sent by mail, communication shall be effective or deemed to have been given three (3) days after it has been deposited in the United States mail, duly registered or certified, with postage prepaid, and addressed as set forth above. If sent by fax, communication shall be effective or deemed to have been given twenty-four(24)hours after the time set forth on the transmission report issued by the transmitting facsimile machine, addressed as set forth above, For purposes of calculating these time frames, weekends, federal, state, County or City holidays shall be excluded. 20. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. [signatures appear on following page] Page 8 of 9 SIGNATURE PAGE TO ON-CALL AGREEMENT WITH INDUSTRIAL MEDICAL SUPPORT, INC., DBA AMPHIBIOUS MEDICS FOR STANDBY EMERGENCY MEDICAL SERVICES AT CITY EVENTS IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTEST: CITY O NTA ANA ennifer L. all °� lvaro Nunez r City Manager APPROVED AS TO FORM: SONIA R. CARVALHO CONTRACTOR: City Attorney By: S anna Ickler(Mar 18,2025 17:41 EDT) Jonathan T. Martin Shanna Ickler Assistant City Attorney Assistant Director RECOMMENDED FOR APPROVAL: Hawk Scott Executive Director, Parks, Recreation and Community Service Page 9 of 9 EXHIBIT A Industrial Medical Support, Inc. PROJECT PROPOSAL Prepared exclusively for City of Santa Ana Proposal for Service Overview This proposal is submitted by Industrial Medical Support, Inc.to the City of Santa Ana for services to provide onsite medics to provide basic first aid support during their yearly events. It is our objective to partner with The City of Santa Ana to address their specific needs to ensure successful and safe events. Company Profile Industrial Medical Support, Inc. is a nationwide, multi-discipline emergency, occupational health, and wellness services firm.Our scope of practice is basic first aid. Industrial Medical Support, Inc. Service Description and Pricing Medic Services EMT(s)will be available with specialized training, responsibility,and authority for safety compliance and enforcement responsibility during the event to address injuries should they arise. COST:$68 per hour per medic *8-hour minimum per medic **OT after 8-hours$78 per hour per medic ***DOT after 12-hours$88 per hour per medic BLS Jump Bad Each of our EMTs arrive on site with a fully stocked BLS jump bag to be able to administer basic first aid if the need arises. Bag fee is all inclusive, no single item charged and is charged per medic per day, bag does stay with EMT when they leave at the completions of the event. COST:$50 per medic per day Payment Payment due upon receipt of invoice after the conclusion of event Industrial Medical Support, Inc. Client _.- Authorized Representative Signature Authorized Representative Signature � upervisor Authorized Representative Print Name Authorized Representative Print Name Date Date AC" OR ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) llh � 3/15/2026 3/20/2025 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Lockton Companies,LLC CONTACT DBA Lockton Insurance Brokers,LLC in CA PHONE FAX A/C No t• AIC,No): CA license#OF15767 E-MAIL 1185 Avenue of the Americas,Ste.2010 ADDRESS__ New York NY 10036 INSURER(S)AFFORDING COVERAGE NAIC# (646)572-7300 _ _ INSURER A:National Fire and Marine Insurance Co 20079 INSURED Industrial Medical Support,Inc. _ INSURER B 1527640 5639 Hansel Ave INSURER C: Edgewood, FL 32809 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 20395522 REVISION NUMBER: XX}Q{XXx THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDD/YYYY LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1000 000 Y Y HN033337 3/15/2025 3/15/2026 DAMAGE-TO-RENTED CLAIMS-MADE a OCCUR PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) $ 5,000 _ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000 000 POLICY❑JECOT- L X 1 LOG PRODUCTS-COMPlOPAGG $ 3,000,000 OTHER: S AUTOMOBILE LIABILITY NOT APPLICABLE COMBINED SINGLE LIMIT $ Ea accident XXXXXXX ANY AUTO BODILY INJURY(Per person) $ XXXXXXX OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS XXXXXXX HIRED AUTOS ONLY AUTOS ONLDY Pe a c den DAMAGE $ XXXXXXX sXXXXXXX A UMBRELLA LIAB OCCUR N N EN033337 1/15/2021 3/11/2026 EACH OCCURRENCE 5 5,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 7— DECT RETENT Is XXX'XXxx WORKERS COMPENSATION NOT APPLICABLE AND EMPLOYERS'LIABILITY PER OTH- YIN ( STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ xxxxxxx OFFICERIMEMBER EXCLUDED? NIA XXXXXXX (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ XXXXXXX A Healthcare Professional N N HN033337 3/Li/2025 3/15/2026 Per Event:S1,000,000 Liability Aggregate:$3,000,000 I. Retro Date:3/31/2014 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THIS CERTIFICATE SUPERSEDES ALL PREVIOUSLY ISSUED CERTIFICATES FOR THIS BOLDER.APPLICABLE TO THE CARRIERS LISTED AND THE POLICY TER.NI(S)REFERENCED. City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers are included as Additional Insured on the General Liability as required by written contract.A waiver of subrogation applies per written contract. Tu Tran Digitally signed 6y Tu Tfan Nguyen APPROVED Dare:2025.04.23 Nguyen DZ48:47.DTOD' 8y Tu Tran Nguyen at 7:47 am,Apr 23, 2025 CERTIFICATE HOLDER CANCELLATION See Attachment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 20395522 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Parks, Recreation,and AUTHORIZED REPRF.:;,.IA11VE (" Community Services Agency 20 Civic Center Plaza Santa Ana,CA 92702 �t ©1988.2015 ACORD COI RPORATION. 7A I rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD DATE(MMroD1YYYV) ACRE) 03127l2025 1i CERTIFICATE OF LIABILITY INSURANCE ACCt#:3036240 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: LOCKTON AFFINITY,LLC LOCKTON AFFINITY, LLC PHONE FAX P.O. BOX 879610 (AIC,No.i (AIC,1913 552-7599 KANSAS CITY, MO 64187-9610 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Arch Insurance Company 11150 INSURED INSURER B Industrial Medical Support,Inc. 5639 Hansel Avenue INSURER C: Edgewood,FL 32809 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSO WVD POLICY NUMBER (MMIDDM'YY) (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS- OCCUR PREMISES E n $ MED EXP(Any oneperson) $ PERSONAL 6 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY QPRO- ❑LOC I I IF:(.T PRODUCTS-COMP/OP AGG $ THE,: A AUTOMOBILE LIABILITY X X LAAUT0066801 01/0112025 01/01/2026 I LE IMI $1,000,000 Ea ac ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY X AUTOS ( ) HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (For nor,dentl UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER A NY P ROPR IETORIPA RTN ER/EXECU TI V E OFFICERIMEMBER EXCLUDED? N 1 A E.L.EACH ACCIDENT $ (Mandatory In Ni If yes,describe under E.L.DISEASE-EAEMPLOYEE DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)GPBR: POLICY PROVIDES PROTECTION FOR ANY AND ALL OPERATIONSIJOBS PERFORMED BY THE NAMED INSURED WHERE REQUIRED BY WRITTEN CONTRACT.CERTIFICATE HOLDER IS AN ADDITIONAL INSURED WHERE REQUIRED BY WRITTEN CONTRACT.WAIVER OF SUBROGATION INCLUDED BY WRITTEN CONTRACT.INSURANCE IS PRIMARY AND NON-CONTRIBUTORY. City of Santa Ana,its City Council,officers,officials,employees,agents,and volunteers are included as Additional Insured.A waiver of subrogation applies per written contract. APPROVED By Tu Tran Nguyen at 7:48 am,Apr 23,2025 CERTIFICATE HOLDER CANCELLATION City of Santa Ana SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Attn: Parks,Recreation,and Community Services Agency BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Civic Center Plaza ACCORDANCE WITH THE POLICY PROVISIONS. Santa Ana,CA 92702 AUTHORIZED REPRESENTATIVE ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD DATE ,acoRO� CERTIFICATE OF LIABILITY INSURANCE 03/20/202YYY) 03/20/20Z5 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Colleen DeWitt SUNZ Insurance Solutions, LLC ID : (Vensure HR) NAME: FAX c/o Vensure HR Inc PHONE (800) 409-89S8 A/C No: E-MAIL cents@vensure.com 1475 S. Price Road, ADDRESS: Chandler, AZ 85286 INSURERS AFFORDING COVERAGE NAIC# INSURERA: SUNZ Insurance Company 34762 INSURED INSURER B: Vensure HR Inc L/C/F Industrial Medical Support Inc INSURERC: DBA Amphibious Medics INSURERD: 1475 S. Price Road INSURERE: Chandler AZ 85286 INSURER F COVERAGES CERTIFICATE NUMBER: 10220168 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDC)= MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE1-1 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO ❑ JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AJTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTYOAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACHOCCURRENCE $ EXCESS LAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION ✓ . PER ORH AND EMPLOYERS'LIABILITY YIN WC071-00125-025 01/01/2025 01/01/2026 STATUTE E ANYPROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1 00,000 CFFICERIMEMBEREXCLUOED? FN—] NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Coverage provided for all leased employees but not subcontractors of: Industrial Medical Support Inc DBA Amphibious Medics. Client Effective: 08/01/2023. Waiver Of Subrogation in favor of certificate holder, as per written contract, while work is performed at or in: CA - California. APPROVED By Tu Tran Nguyen a�7:418 =23,2025 CERTIFICATE HOLDER CANCELLATION CA - California SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Santa Ana, Attention THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Parks, Recreation, and Community Services Agency ACCORDANCE WITH THE POLICY PROVISIONS. 20 Civic Center Plaza Santa Ana CA 92701 AUTHORIZED REPRESENTATIVE Rick Leonard - ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 10220168 I VensureHRInc MCP (CA) WC0710012502S I Karina Rodriguez 1 03/20/2025 12:37:37 PM -05 1 Page 1 of 2 Policy Number: LAAUT0066801 COMMERCIAL AUTO CA 04 43 1120 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) - AUTOMATIC WHEN REQUIRED BY WRITTEN CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to any person(s) or organization(s) for whom you are required to waive subrogation with respect to the coverage provided under this Coverage Form, but only to the extent that subrogation is waived: A. Under a written contact or agreement with such person(s)or organization(s); and B. Prior to the "accident'or the"loss." CA 04 4311 20 0 Insurance Services Office, Inc., 2019 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE PART Schedule Person(s)or Organization(s): Any person(s)or organization(s)as required by written contract or agreement. 1. SECTION II — COVERED AUTOS LIABILITY COVERAGE, A. Coverage, Paragraph 1. Who Is An Insured is amended to include the person(s) or organization(s) designated in the Schedule above but only for damages: a. Which are covered by this insurance; and b. Which you have agreed to provide in a written contract. 2. The limits of insurance afforded to such person(s)or organization(s)will be: a. The minimum limits of insurance which you agreed to provide; or b. The limits of insurance of this policy; whichever is less. All other terms and conditions of this Policy remain unchanged. Endorsement Number: This endorsement is effective on the inception date of this policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy Number: LAAUT0066801 Named Insured: Industrial Medical Support, Inc. Endorsement Effective Date: 01/01/2025 00 CA0228 00 02 23 Includes copyrighted material of Page 1 of 1 Insurance Services Office, Inc.,with its permission. 0 2023 Arch Insurance Group Inc. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 03 13 - _ (Ed 7-09) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy.We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be$ 100 Schedule Person or Organization Job Description City of Santa Ana, Attention Coverage provided for all leased employees but not Parks, Recreation, and Community Services Agency subcontractors of: Industrial Medical Support Inc DBA 20 Civic Center Plaza Amphibious Medics. Client Effective, 08101/2023, Waiver of Santa Ana CA 92701 Subrogation in favor of certificate holder, as per written contract, while work is performed at or in: CA - California. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated, (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 0J/01/2025 Policy No.: WC071-00 125-02 5 Endorsement No.: 10220168 insured: Vensure HR Inc L/C/F Industrial Medical support Inc DBA Amphibious Insurance Company: Countersigned by SUNZ Insurance company WC 99 03 13 (Ed. 7-09) 10220168 I VensureHRInc MCP (CA) WC07100125025 I Karina Rodriguez 03l2012025 12:37:37 PM -05 I Page 2 of 2 Issuing Company: 1® MedPro Group National Fire & Marine Insurance Company It,k:6iml6dhmrernmren, Omaha, Nebraska THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULL Y. Endorsement No.: 12 Forming Part of Policy No.: HN033337 Issued to: Industrial Medical Support, Inc Effective Date of Endorsement: 03/15/2025 at 12:01 a.m. at the address of the First Named Insured stated herein. BLANKET WAIVER OF SUBROGATION ENDORSEMENT (GENERAL LIABILITY) In consideration of the payment of the additional premium due, if any, and in reliance upon the representations of all insureds, the company and the insureds agree to amend the policy as follows: Only with respect to coverage provided under the General Liability Coverage Part, the following condition is added to the Conditions section of the Common Policy Provisions and Conditions: WAIVER OF SUBROGATION The company shall waive any right of recovery the company may have against a person or organization to the extent that the insured has agreed in writing prior to the date of loss to waive the insured's rights of recovery against that person or organization. All other terms and conditions of the policy remain unchanged. 1512-PGX-00-1215 Page 1 of 1 © 2015 MedPro Group. All rights reserved. Issuing Company: MedPro Group National Fire & Marine Insurance Company 1 n X&Jdn lGuh,ni...... Omaha, Nebraska THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULL Y. Endorsement No.: 11 Forming Part of Policy No.: HN033337 Issued to: Industrial Medical Support, Inc Effective Date of Endorsement: 03/15/2025 at 12:01 a.m. at the address of the First Named Insured stated herein. BLANKET ADDITIONAL INSURED — PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT (GENERAL LIABILITY) Only with respect to coverage provided under this endorsement and under the General Liability Coverage Part, and in consideration of the payment of the additional premium due, if any,and in reliance upon the representations of all insureds, the company and the insureds agree to amend the policy as follows: The definition of additional insured in the Definitions section of the Common Policy Provisions and Conditions is deleted and replaced with the following: Additional insured means any person or organization with which the insured has entered into a written contract or agreement prior to the event or offense agreeing: 1. to add the person or organization as an additional insured; or 2. to hold harmless or indemnify such person or organization. However, such person or organization is not an additional insured with respect to events or offenses arising from, or in connection with, any acts or omissions alleged to have been committed by that additional insured. The following subparagraph is added to the Other Insurance condition of the Conditions section of the Common Policy Provisions and Conditions: Only if required by written contract or agreement with the insured, coverage for any additional insured shall be primary and non-contributory as respects any other insurance policy issued to such additional insured. The following subparagraph is added to all Insuring Clauses of the General Liability Coverage Part policy: The company's duty to defend and pay losses or claims expense on behalf of any insured shall extend to any additional insured meeting the terms and conditions of this policy, but only with respect to any loss or claims expense payable as the result of the additional insured's vicarious liability for the acts or omissions of an insured otherwise covered under this Coverage Part. However, the coverage provided to an additional insured shall not be broader than that which an insured is required by written contract or agreement to provide to that additional insured and is subject to all other conditions, definitions, exclusions and terms applicable to the insured. Additionally, coverage shall not apply to structural alterations, new construction or demolition operations performed by or on behalf of an additional insured. 1507-PGX-00-0121 Page 1 of 2 © 2021 MedPro Group. All rights reserved. The following provision is added to the Limits of Liability section of the General Liability Coverage Part; ADDITIONAL INSUREDS Additional insureds share the Limits of Liability of the insured for which the additional insured is alleged to be vicariously liable for the acts or omissions of the insured otherwise covered under this Coverage Part. All other terms and conditions of the policy remain unchanged, 1507-PGX-00-0121 Page 2 of 2 ©2021 MedPro Group. All rights reserved. DATE(MM/DD/YYYY) A�" CERTIFICATE OF LIABILITY INSURANCE 5/27/2026 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Marsh &McLennan (CLW) PHONE FAX 101 N Starcrest Dr A/C No Ext: 727 447-6481 vc,Noy 727-449-1267 E-MClearwater FL 33765 ADDRESS: cicerts@marshmma.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: National Fire&Marine Insurance 20079 INSURED INDUSSUPP01 INSURERB: Hartford Fire Insurance Co. 19682 Industrial Medical Support Inc 5639 Hansel Avenue INSURERC: Edgewood FL 32809 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1998527338 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY Y Y HN033337 3/15/2026 3/15/2027 EACH OCCURRENCE $1,000,000 CLAIMS-MADE OCCUR PREMISES DAMAGE TO PREMISES Ea occurrence) ccurrence $50,000 X 5,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $3,000,000 POLICY JECT PRO � LOC PRODUCTS-COMP/OP AGG $3,000,000 OTHER: Policy Aggregate $6,000,000 A AUTOMOBILE LIABILITY Y Y HN033337 3/15/2026 3/15/2027 COMBINED SINGLE LIMIT $1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED X NON-OWNED FIR ERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident A UMBRELLALIAB X OCCUR Y Y EN033337 3/15/2026 3/15/2027 EACH OCCURRENCE $5,000,000 X EXCESS LAB CLAIMS-MADE AGGREGATE $5,000,000 DED RETENTION$ $ B WORKERS COMPENSATION Y 21WECBZ4NMH 2/18/2026 2/18/2027 X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICE R/M EMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Professional Liability HN033337 3/15/2026 3/15/2027 Per Event 1,000,000 Aggregate 3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Policy Aggregate Limit of$6,000,000 applies to General&Professional Liability subject to the terms,conditions and limits as specified in the policy. Professional Liability& Excess Professional Liability are written on a claims-made basis subject to the terms,conditions and limits as specified in the policy. Certificate Holder is Additional Insured as respects to General Liability, Hired& Non-Owned Auto Liability,and Excess Liability only if required by written contract,and subject to the terms,conditions and limits as specified in the policy. Waiver of subrogation applies in favor of certificate holder as respects to General Liability, Hired& Non-Owned Auto Liability, Excess Liability and Workers Compensation only if required by written contract,and subject to the terms,conditions and limits as specified in the policy. General Liability, Hired& Non-Owned Auto Liability,and Excess Liability are written on a primary and non-contributory basis when required by written contract, agreement or permit and subject to the provisions and limitations of the policy. See Attached... APPROVED CERTIFICATE HOLDER CANCELLATION By Tu Tran Nguyen at 3:45 pm,Jun 17,2026 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Santa Ana* ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Parks, Recreation, and Community Services Agengy AUTHORIZED REPRESENTATIVE 20 Civic Center Plaza Santa Ana CA 92702 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: INDUSSUPP01 LOC#: ,a`oRo ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Marsh&McLennan(CL" Industrial Medical Support Inc 5639 Hansel Avenue POLICY NUMBER Edgewood FL 32809 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Excess Liability applies on a follow-form basis with respect to General Liability, Professional Liability, Hired&Non-Owned Auto Liability,and Employers Liability, subject to the provisions and limitations of the policy. 'Complete Certificate Holder Name:City of Santa Ana,it's City Council,officers,officials,employees,agents,and volunteers ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Issuing Company: '�+ MedPro Group National Fire & Marine Insurance Company aBerlvhimHa2hamaycompny Omaha, Nebraska THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULL Y, Endorsement No.: 9 Forming Part of Policy No.: HN033337 Issued to: Industrial Medical Support, Inc Effective Date of Endorsement: 03/15/2026 at 12:01 a.m. at the address of the First Named Insured stated herein. BLANKET PER LOCATION LIMITS OF LIABILITY ENDORSEMENT (PROFESSIONAL LIABILITY) In consideration of the payment of the additional premium due, if any, and in reliance upon the representations of all insureds, the company and the insureds agree to amend the policy as follows: The following provision is added to the Limits of Liability section of the Professional Liability Coverage Part: PER LOCATION LIMITS OF LIABILITY The Limits of Liability shown on the Declarations will apply for health care events that took place at, or arose out of the operations of, each location. All other terms and conditions of the policy remain unchanged. 1357-PPX-00-0121 Page 1 of 1 © 2021 MedPro Group. All rights reserved. Issuing Company: '�+ MedPro Group National Fire & Marine Insurance Company aBerlvhimHa2hamaycompny Omaha, Nebraska THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULL Y, Endorsement No.: 11 Forming Part of Policy No.: HN033337 Issued to: Industrial Medical Support, Inc Effective Date of Endorsement: 03/15/2026 at 12:01 a.m. at the address of the First Named Insured stated herein. BLANKET ADDITIONAL INSURED — PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT (GENERAL LIABILITY) Only with respect to coverage provided under this endorsement and under the General Liability Coverage Part, and in consideration of the payment of the additional premium due, if any, and in reliance upon the representations of all insureds, the company and the insureds agree to amend the policy as follows: The definition of additional insured in the Definitions section of the Common Policy Provisions and Conditions is deleted and replaced with the following: Additional insured means any person or organization with which the insured has entered into a written contract or agreement prior to the event or offense agreeing: 1. to add the person or organization as an additional insured; or 2. to hold harmless or indemnify such person or organization. However, such person or organization is not an additional insured with respect to events or offenses arising from, or in connection with, any acts or omissions alleged to have been committed by that additional insured. The following subparagraph is added to the Other Insurance condition of the Conditions section of the Common Policy Provisions and Conditions: Only if required by written contract or agreement with the insured, coverage for any additional insured shall be primary and non-contributory as respects any other insurance policy issued to such additional insured. The following subparagraph is added to all Insuring Clauses of the General Liability Coverage Part policy: The company's duty to defend and pay losses or claims expense on behalf of any insured shall extend to any additional insured meeting the terms and conditions of this policy, but only with respect to any loss or claims expense payable as the result of the additional insured's vicarious liability for the acts or omissions of an insured otherwise covered under this Coverage Part. However,the coverage provided to an additional insured shall not be broader than that which an insured is required by written contract or agreement to provide to that additional insured and is subject to all other conditions, definitions, exclusions and terms applicable to the insured. Additionally, coverage shall not apply to structural alterations, new construction or demolition operations performed by or on behalf of an additional insured. 1507-PGX-00-0121 Page 1 of 2 © 2021 MedPro Group. All rights reserved. The following provision is added to the Limits of Liability section of the General Liability Coverage Part: ADDITIONAL INSUREDS Additional insureds share the Limits of Liability of the insured for which the additional insured is alleged to be vicariously liable for the acts or omissions of the insured otherwise covered under this Coverage Part. All other terms and conditions of the policy remain unchanged. 1507-PGX-00-0121 Page 2 of 2 © 2021 MedPro Group. All rights reserved. Issuing Company: '�+ MedPro Group National Fire & Marine Insurance Company aBerlvhimHa2hamaycompny Omaha, Nebraska THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULL Y, Endorsement No.: 12 Forming Part of Policy No.: HN033337 Issued to: Industrial Medical Support, Inc Effective Date of Endorsement: 03/15/2026 at 12:01 a.m. at the address of the First Named Insured stated herein. BLANKET WAIVER OF SUBROGATION ENDORSEMENT (GENERAL LIABILITY) In consideration of the payment of the additional premium due, if any, and in reliance upon the representations of all insureds, the company and the insureds agree to amend the policy as follows: Only with respect to coverage provided under the General Liability Coverage Part, the following condition is added to the Conditions section of the Common Policy Provisions and Conditions: WAIVER OF SUBROGATION The company shall waive any right of recovery the company may have against a person or organization to the extent that the insured has agreed in writing prior to the date of loss to waive the insured's rights of recovery against that person or organization. All other terms and conditions of the policy remain unchanged. 1512-PGX-00-1215 Page 1 of 1 © 2015 MedPro Group. All rights reserved. Issuing Company: '�+ MedPro Group National Fire & Marine Insurance Company aBerlvhimHa2hamaycompny Omaha, Nebraska THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULL Y, Endorsement No.: 15 Forming Part of Policy No.: HN033337 Issued to: Industrial Medical Support, Inc Effective Date of Endorsement: 03/15/2026 at 12:01 a.m. at the address of the First Named Insured stated herein. BLANKET PER LOCATION LIMITS OF LIABILITY ENDORSEMENT (GENERAL LIABILITY) In consideration of the payment of the additional premium due, if any, and in reliance upon the representations of all insureds, the company and the insureds agree to amend the policy as follows: The following provision is added to the Limits of Liability section of the General Liability Coverage Part: PER LOCATION LIMITS OF LIABILITY The Limits of Liability shown on the Declarations will apply for events and offenses that took place at, or arose out of the operations of, each location. All other terms and conditions of the policy remain unchanged. 1557-PGX-00-0121 Page 1 of 1 © 2021 MedPro Group. All rights reserved. ® Issuing Company: 1■ MedPro Group National Fire & Marine Insurance Company a Berkshire Haiha ycompany Omaha, Nebraska Forming Part of Policy No.: HN033337 Issued to: Industrial Medical Support, Inc Policy Period: From 03/15/2026 to 03/15/2027 at 12:01 a.m. at the address of the First Named Insured stated herein. SCHEDULE OF FORMS AND ENDORSEMENTS Forms and Endorsements attached to this Policy: ENDORSEMENT FORM NAME FORM NUMBER NUMBER Healthcare Liability Policy Declarations 0001-PXX-00-0121 Schedule of Forms and Endorsements 0002-PXX-00-1215 Schedule of Named Insureds - Professional Liability 0006-PPX-00-1215 Schedule of Named Insureds -General Liability 0007-PGX-00-0717 Schedule of Named Insureds -Cyber Liability and Breach Response 0008-PCX-00-0121 Schedule of Trade, Fictitious and/or Business Names 0009-PXX-00-1215 Healthcare Liability Policy Common Policy Provisions and Conditions 0010-PXX-00-0121 Healthcare Liability Policy- Professional Liability Coverage Part 0011-PPF-00-0121 Healthcare Liability Policy-General Liability Coverage Part 0012-PGX-00-0121 Healthcare Liability Policy-Cyber Liability and Breach Response Coverage Part 0013-PCX-00-0121 Schedule of Additional Insureds Endorsement 1120-PXX-00-0121 1 Schedule of Additional Insureds- Primary and Non-Contributory with Notice of 1123-PXX-00-0121 2 Cancellation Endorsement Schedule of Waiver of Subrogation Endorsement 1128-PXX-00-1215 3 Amended Definition of Employee Endorsement 1136-PXX-00-0121 4 Policy Aggregate Limit Endorsement(Professional Liability&General Liability) 1173-PXX-00-0121 5 Disciplinary, Licensing and Credentialing Actions Endorsement(Professional 1303-PPX-00-0121 6 Liability) Intentional Acts Exclusion with Sublimits for Innocent Insureds Endorsement 1318-PPF-00-0121 7 (Professional Liability) Blanket Restricted Practice - Covered Practice Endorsement(Professional 1338-PPX-00-0121 8 Liability) Blanket Per Location Limits of Liability Endorsement(Professional Liability) 1357-PPX-00-0121 9 Employee Benefits Liability Endorsement(General Liability) (Claims-Made and 1504-PGX-00-0121 10 Reported Coverage) Blanket Additional Insured - Primary and Non-Contributory Endorsement 1507-PGX-00-0121 11 (General Liability) Blanket Waiver of Subrogation Endorsement(General Liability) 1512-PGX-00-1215 12 0002-PXX-00-1215 Page 1 of 2 © 2015 MedPro Group. All rights reserved. SCHEDULE OF FORMS AND ENDORSEMENTS Forms and Endorsements attached to this Policy: ENDORSEMENT FORM NAME FORM NUMBER NUMBER Cap on Losses from Certified Acts of Terrorism Endorsement(General Liability) 1536-PGX-00-0520 13 Blanket Hired and Non-Owned Auto Liability Limited Coverage with Sublimits 1545-PGX-00-0121 14 Endorsement(General Liability) Blanket Per Location Limits of Liability Endorsement(General Liability) 1557-PGX-00-0121 15 Evacuation, Disinfection and Public Relations Expenses Endorsement(General 1563-PGX-00-0121 16 Liability) 0002-PXX-00-1215 Page 2 of 2 © 2015 MedPro Group. All rights reserved. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT Policy Number: 21 WEC BZ4NMH Endorsement Number: Effective Date: 02/18/26 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: Industrial Medical Support Inc 3320 E AIRPORT WAY LONG BEACH CA 90806 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. SCHEDULE Any person or organization for whom you are required by contract or agreement to obtain this waiver from us. Endorsement is not applicable in KY, NH, NJ or for any MO construction risk Countersigned by Authorized Representative Form WC 00 03 13 Printed in U.S.A. Process Date: 02/18/26 Policy Expiration Date: 02/18/27 kThe Hartford THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 21 WEC BZ4NMH Endorsement Number: Effective Date: 02/18/26 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: Industrial Medical Support Inc 3320 E AIRPORT WAY LONG BEACH CA 90806 We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2 % of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE Person or Organization Job Description Any person or organization for whom you are required by written contract or agreement to obtain this waiver of rights from us Countersigned by Authorized Representative Form WC 04 03 06 (1) Printed in U.S.A. Process Date: 02/18/26 Policy Expiration Date: 02/18/27