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WELLDYNE/RX WEST INC. 1A-2008
1NSURANC90N R1LE WORK MAY PROCEED UNTIL I ? URAN CES CLERK OUN ? Wore l -Zj M tJ THIS FIRST A-2007-278-01 FIRST AMENDMENT TO AGREEMENT AMENDMENT TO AGREEMENT is entered into on December 31, 2008, by and between, WeliDyne/RxWest ("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 parties entered into Agreement A-2007-278, dated December 3, 2007, (hereinafter "said Agreement") by which Contractor has provided services necessary to ensure used medical needles ("sharps") are collected and disposed of in safe and sanitary manner. B. In accordance with the terms and conditions of said Agreement, the parties wish to extend the term of said Agreement to continue to provide medical sharps disposal services. 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 First Amendment to Agreement, the parties agree as follows: 1. Section 3, TERM, shall be amended to extend the termination date to June 30, 2010. 2. Except as hereinabove amended, all terms and conditions of said Agreement shall remain in full force and effect. IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to Agreement on the date and year first written above. ATTEST: PATRICIA E. HEALY Clerk of the Council APPROVED AS TO FORM: JOSEPH W.FLETCHER City Attorney By: X l6, . ?`?C6 Laura Sheedy Assistant City Attorney Director, Public Works Agency DATE (MhWDNY) CERTIFICATE. 01' LIABILI AC TY INSURANCE _ DfinSrzoas THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PRODUSerial # A17446 T ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE AON RVICES, INC. OF FLORIDA P.JSK HOLDER. THIS E OOVER?AfiE AFFORDED BY THE POLwME$ BELOW. 100LL BAY DRIVE, SUITE #1100 CO INPANIES AFFORDING COVERAGE MIA31-4937 PHONE: 500.743-0130 FAX: 800-622-7614 COMPANY NEW HAMPSHIRE INSURANCE COMPANY A COMPANY nn n INSURED _- ADP TOTALSOURCE, INC 10200 SUNSET DRIVE cppAHy MIAMI. FL 33173 C 'ALTERNATE EMPLOYER: WELL DYNE, INC. CDAVANr D THIS IS TO CERTIFY TNA7 THE POLICIES OF INSURANCE LISTED BELOW NAYS BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD Y CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF AN IS SUBJECT TO ALL THE TERMS, ED EDUCE CERTIFICATE BE ISSUED OR MAY PERTAIN. THE LIMITS SF INSURANCE AFFORD REDUCED BY PAID Y HBEEN C F AND POUCYEPPECTM POLICYIMPLAMON LIMITS CO TYPE OF INSURANCE POLICY NUMBER CAYEIMMmDrjY) DATE(MMMWM LTR GENERAL AGGREGATE f GENERAL LIABILITY COWJOPAGG PRODI - f CDM AERAL LIABILITY , - PERSWALAAOVIHJURY f CL CLAIMS N.6 MADE ?GCWR EACH OCCURRENCE f OVMERSSCONTRACTOR'B PPOT FIRE DAMAGE Wry w4P) MEDEAP (Any" PE ) f AU TOMOBILE UAimm"TY COM&NEDSNGtEUWT I ANYAUTO ALL OWNED AUTOS r P:w„ y 9=y f SCHEDULED AUTOS HIRED AUTOS epD9wKw RV f?PPR:?MtCM?11 f NON-OWNEDALITOS PROPERTY DAMAGE II AUTOONLY-EAACCIDENT f GA RAGE WBBJTY OTHER THANAWOONLY' ANY AUTO EACH ACCIDENT AGGREGATE s FACHOCCURRENCE f EXCESS LIABILITY wGGREGATE f UMBRELLA FORM f OTHER THAN UMBRELLA FORM X T?ruR?s SATM AND WC 5081064 CO 07101/2008 OW0112009 000 1 000 r f WORKEn COMPON , , EL EACH A?1oM+ EMPLOYE DUTY A EL WEAM-POLICY LMT f 1,000,000 WE r cu Twitu INa WE PARRERAFJtfCUTMi EL dSEASE•EA EMPLOYEE f 1,000,000 piPCFA9 ARE: EXCL OTHER I ITEMS IDNOF L FOR THE ABOVE NAMED CLIENT COMPANY, PAID UNDER ADP TOTAL SOURCE INC'S PAYROLL. WILL BE COVERED UNDER LL EM ALL A EMPLOYEES WORKING Y 'THE ABOVE NAMED CLIENT IS AN ALTERNATE EMPLOYER UNDER THIS POLICY THE ABOVE STATED POLIC 77... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE UPIRATIOM DATE 11HUNIOP, THE ISSUING COMPANY WILL ENDEAVOR TO MAL WELL DYNE, INC 30 GAYS L'IMREN NOTICE TO THE EIRTRICATE HOLDER NAMED TO THE LEFT' 7472 S TUSCON WAY PAn11ME 70 MML SI/CII Np71CESNALLSIPODE MOOBMOAtIDN QL LMBLIIY BUT ENGLEWOOD, CO 80112 ar ANY lino UPON 7xe COMPANY. ITS AGENTS OR REINEWNTA10466, T AON RISK SERVICES, INC. OF FLORIDA j 2 7 E:D ATE (MN1D0lYY) 06!16!09 A,CORD CERTIFICATE OF LIABILITY INSURANCE e rtificate( D: 94783 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND PRODUCER CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE Aon Risk Services, Inc. of FL DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 1001 Bricked Bay Drive, Suite #1100 POLICIES BELOW. NAIL #? Miami, FL 33131-4937 INSURERS AFFORDING COVERAGE 23841 INSURER A: New Hampshire Ins Co INSURED ADP TotalSource MI XXX, I- INSURER R 10200 Sunset Drive INSURER C: Miami, FL 33173 INSURER D: ALTERNATE EMPLOYER Well Dyne, Inc. INSURER E: 7472 S Tuscon Way MED EXP (Any one perso - PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER ? POLICY ? PROJECT ? LOC PRODUCTS - COMPIOP AGG $ $ COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY (Ea accident) 13 ANY AUTO ? ALL OWNED AUTOS BODILY INJURY $ ? SCHEDULED AUTOS (Per person) CI HRED AUTOS BODILY INJURY $ ? NON OWNED AUTOS (per accident) PROPERTY DAMAGE $ (Per accident) AUTO ONLY - EA ACCIDENT $ ? GARAGE LIABILITY EA $ ? ANY AUTO OTHER THAN ACC AUTO ONLY: AGG $ EACH OCCURRENCE $ EXCESS 1 UMBRELLA LIABILITY AGGREGATE $ O OCCUR ? CLAIMS MADE $ ?OEDUCTIBLE $ $ ? RETENTION WORKERS' COMPENSATION AND WC 060167003 CO 07/01109 07101/10 g WC TORY LIMITS STATu- TS [3 OTHER A EMPLOYERS' LIABILITY Y I N E.L. EACH ACCIDENT $ $2,000,000 ANY PROPRIETOR 1 PARTNER I EXECUTIVE OFFICERJMEMER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ $2,000,000 tMuMatury in NH) E.L. DISEASE - POLICY LIMIT $ $2,000,000 If Yea. dmaibe under SPECIAL PROVISIONS below OTHER En !;wood, CO 80112 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, CERTIFICATE NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EXCLUS AN HEREIN IS TO ALL TER CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SOHOW N MAY HAVE BEEN RED CEID BY PAID CLAIMSBJECL1Mi't'S SF OWN ARL^AS RFQUFSj[OFDS AND MAY BE ISSUED OR MAY PERTAIN. THE ISURANCE BY THE POLICIES POLICY EFFECTIVE POLICY EXPIRATION LIMITS INSR AOD'L TYPE OF INSURANCE POLICY NUMBER DATE (MMtOOIYYYY) DATE (MMIDDIYYYY) LTR INSRD EACH OCCURRENCE $ GENERAL LIABILITY DAMAGE TO RENTED $ O COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurrence) - ? CLAIMS MADE ? OCCUR -- n) $ ENT DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES I EXCLUSIOnNdSeA OP DT?TALSOURCEMINC s payroll,Aare cRoveISIOunder the above stated policy. The above All worksite employees working for the above named client company, paid named client is an alternate employer under this policy. GERT{F{CATE',HOLDER CA1+tCELL ATION WELL DYNE, INC. ?Fl QULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE F p f?ip?aREDF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 7472 S TUSCON WAY NOTICE TO THE 7472 S TUSCO CO 60112 CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION APPROVED AS TO ENGLEWOOD, OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE of on ovj.§A ifetvic" q". of to ,i Laur Stitt Sheedy p1fli3$-2009 ACORU Co kpoRATION,' All rights reserved: ACORD 25 (2009101) ASsistant City AttoTIey The ACORD name and logo are registered marks of ACORD '' CERTIFfCATE OF LIABILITY INSURANCE DATEiA1M1YDr11YYYYI 7/6lzola PRODUCER (303)534-"2325 FAX: (303) 623-7325 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Peak 360, Inc. www.coak360.com ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1600 Emerson St, ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Denver CO 80218 INSURERS AFFORDING COVERAGE NAIC,t} oosia rsLRERA The Hartford WELLDYNE, INC. 7477 S. TUCSON 1?4'AY rsLREr:_ a•a?ur?Er ?_. CENTENNIAL CO 60112 rs DER _ 4,rVYCTCAUCJ THE POLICIES O!" INSURANCE LjS?'EC BE; C.'N HAVC UrN';S',-IJEt? T;? 'NE INSURES? NAMED ABOVE FAR THE P?rLIC'Y' PERIOD INaICATECJ 1407o'JrT iSrAN CANG, ANY RFLN)tREMENT, T=RPA OR COND T16N OF ANY CONTRACT OR OTHER Q(Y IJMLN;` 4.01H REC.,PFCT TO VJNICH THIS CERTIFICATE IA KY BE I SSUEO OR lf,AY PERTAIN THE INSI,FtANCE: AFFORDED EY D-E POLICIES DESCRIBED HEREIN IS SUBJErJT TL ALL THE TERNIS. E,XI LL151C1NS ANf: CONDI'r]ONS i)F SI,iGH PC)LICIES. AOGPEGATE _INIiTS SIICM KCAy IV, VE BEEN Rr-cwCEi'? Hy PAO CLAIMS PIRA..,?r, _ nwT?a .....__. ....._... vE POLICY EXIRA.T'1pN .. POI ICY NUM1A2 FR POLICY EE -14 INSHG TYPE OF INSIJRANf.F f '?[1P1 u I f85rI L § ..-?•.'r .t-;,4 ? IN,?r F '?? tl'41,;: I,I I?-('::;11r •:_iCi 3 .i AIFTJMOC3LL8 LIABILITY __._ GNtY A,T-'J (E<+d4l.nprrt} A.I '-?t?JFi" L C7ti S C?.F Dv E v .ct I' Gil; 17'9' 3:DDILY 1 XH' S D ` GARAGE LIA131UTY •.. ,.: ` ?,? ll r•, A01-0Ir r :_•',. „E"r §. .... ?:C b EXCESS LlMeRELLA LIABILITY t1.7,1 .•, t ?""^,:L_,_, F'"':Ii ...,.F f',.F ..,- § y ' G I I,;,• '-'JI.GN i A WS?HrtER*,COMPEFtSATTON A*. ,_?.. .--__,,;.? - ._.....,_..._..,. AND EMFLOYERS' LIA816,tTY Y7 N ._ `_-4R' -001i v pct IF Pn T E L1--.:.T r H i 1"000,000 IMandatnry In 4HI -- :34WE-Jr3045 6/'1/201..0 6/1/2011 J _- MF__ _? 1,000 000 , -- --------- ._ .. .............. . ---.,._? GQUCY _AMI- 1,000 000 OTHER GENERAL LIA:BILYTY t,Mx. •a..iE _., DESCFCPTION OF OPERATIONS; LO--ATTONS ? VEWCLES 1 EXCLUSIONS AUpED 13Y ENOORSEUEHT, SPECIAL PROVISIONS k., C:M I IlrIL !A I t MULUt:K CANCELLATION SHOULD ANY OF THEABOVE OUCR18ED POLICIES BE CANCELLED BEFORE THE, EXPIRATION WELL DYNE , INC. GATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 19..._ DAYS WRfTTEN NOTICE TO THE C,ERTIFICA tS HOLOER NA MFID TO THE LEFT, BUT FAILURE TO DO 50 SHALL IMPOSE NO OBLnATION OR LIAB7IJTY OP ANY KIND OPON THE INSURER. 17S AGENTS OR ACORD 25 (2009101) ALlIkOR12ED REPRESENTATIVE 3 .' L 'n r? r ?, F'i ,?%--?17P?'?.° 1988-2009 ACORD CORPORATION. All rinhtn reaarvnri IN5025 r r, Q,,,; The ACORD name and logo are registered marks of ACORD W. J AI`c,aOR°® CERTIFICATE OF LIABILITY INSURANCE 6DATE /6/2011rr) PRODUCER (303) 534-7325 FAX: (303) 623-7325 Peak 360, Inc. 1600 Emerson St. 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. Denver CO 80218 _ INSURERS AFFORDING COVERAGE NAIC # INSURED - INSURER&Columbia Casualty (CNA) WellDyne, Inc.; WellDyneRX INSURER B: Continental Insurance (CNA) 7472 S. Tucson Way INSURER C: The Hartford 00914 INSURER D: Centennial CO 80112 SURER 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 THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR DD' INSR -TYPE F INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE IMMIDD/YYYY) POLICY EXPIRATION DATE MWDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE T RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 50,000 A X CLAIMS MADE OCCUR HHA 4016059333 - 0 12/7/2010 12/7/2011 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $ 3,000,000 X POLICY PRO LOC AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 B ALL OWNED AUTOS 4026985883 12/7/2010 12/7/2011 BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO EA ACC OTHER THAN $ AUTO ONLY: AGG $ EXCESS/ UMBRELLA LIABILITY EACH OCCURRENCE $ 2,000,000 F7 OCCUR CLAIMS MADE AGGREGATE $ 2,000,000 A DEDUCTIBLE - 4016059333 - 0 12/7/2010 12/7/2011 $ X RETENTION $ 10,00 EXCESS OVER CNA ONLY $ C WORKERS COMPENSATION W C STATU- OTH- AND EMPLOYERS' LIABILITY Y T Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE ? OFFICER/MEMBER EX E.L. EACH ACCIDENT $ 1,000,000 CLUDED? (Mandatory in NH) 34WEJ13046 6/1/2011 6/1/2012 E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 OTHERTHIRD PARTY ADMIN. EACH OCCURRENCE $ 1,000,000 C ERRORS & OMISSIONS PG0257328 12/7/2010 12/7/2011 ANNUAL AGGREGATE $ 1,000,000 LIABILITY DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS - ' _._ -- 13 U Pl ?t l . i C S i"O (l y `?.??:lStftill ekindig@santa-ana.org CITY OF SANTA ANA CHRISTY KINDIG 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Gary Friedman/GARY a'? A%,VMU co (Lwy/lJT) I NS025 (200901) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/01) NS025 (200901 POLICY NUMBER: 6303193N600TIL 11 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME" OF PERSON(S) OR ORGANIZATION(S): As per Certificate Holder Name on the attached Certificate of Insurance. PROJECT/LOCATION OF COVERED OPERATIONS: As per project description on the attached Certificate of Insurance. 1. WHO IS AN INSURED - (Section II) is amended b) The insurance provided to the additional in- to include the person or organization shown in the sured does not apply to "bodily injury", "prop- Schedule above, but, erty damage" or "personal injury" arising out a) Only with respect to liability for "bodily injury", of the rendering of, or failure to render, any "property damage" or "personal injury"; and professional architectural, engineering or sur- y ng services, including: b) If, and only to the extent that, the injury or i. The preparing, approving, or failing to damage is caused by acts or omissions of prepare or approve, maps, shop draw- you or your subcontractor In the performance " " ings, opinions, reports, surveys, field or- on or for the project, or at the your work of ders or change orders, or the preparing, location, shown in the Schedule. The person or organization does not qualify as an addi- approving, or failing to prepare or ap- tional insured with respect to the independent prove, drawings and specifications; and acts or omissions of such person or organiza- Ill. Supervisory, inspection, architectural or tion. engineering activities. 2. The insurance provided to the additional insured c) The insurance provided to the additional in- by this endorsement is limited as follows: sured does not apply to "bodily injury" or a) In the event that the Limits of Insurance of "property damage" caused by "your work" " this Coverage Part shown in the Declarations products-completed op- and included in the " " exceed the limits of liability required by a written contract unless a erations hazard " "written contract requiring insurance" for that specifically requires you requiring Insurance additional insured, the insurance provided to to provide such coverage for that additional the additional insured shall be limited to the insured, and then the insurance provided to limits of liability required by that "written con- the additional insured applies only to such " " " " tract requiring insurance". This endorsement that oc- or property damage bodily injury shall not increase the limits of insurance de- curs before the end of the period of time for scribed in Section III - Limits Of Insurance. which the "written contract requiring insur- ance" requires you to provide such coverage CG D2 47 08 05 0 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if a "written contract requiring insurance" for that ad- ditional insured specifically requires that this in- surance apply on a primary basis or a primary and non-contributory basis, this insurance is pri- mary to 'other insurance" available to the addi- tional insured which covers that person or organi- zation as a named insured for such loss, and we will not share with that 'other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible "other insurance", whether pri- mary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional in- sured under such "other insurance". 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible, such notice should include: 1. How, when and where the "occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and ill. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a claim is made or "suit" is brought against the additional insured, the additional insured must: 1. Immediately record the specifics of the claim or "suit" and the date received; and fl. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. - DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 ® 2005 The St. Paul Travelers Companies, Inc. CG Q2 47 08 05 COMMERCIAL GENERAL LIABILITY The Damage To Premises Rented To You Limit will be the higher of: a. $300,000; or b. The amount shown on the Declarations for Damage To Premises Rented To You Limit. 4. Under DEFINITIONS (Section V), Paragraph a. of the definition of "insured contract" is amended so that it does not include that por- tion of the contract for a lease of premises that indemnifies any person or organization for damage to premises while rented to you, or temporarily occupied by you with permis- sion of the owner, caused by: a. Fire; b. Explosion; c. Lightning; d. Smoke resulting from such fire, explosion, or lightning; or e. Water. 5. This Provision D. does not apply if coverage for Damage To Premises Rented To You of COVERAGE A. BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section I - Coverages) is excluded by endorsement. E. BLANKET WAIVER OF SUBROGATION We waive any right of recovery we may have against any person or organization because of payments we make for injury or damage arising out of premises owned or occupied by or rented or loaned to you; ongoing operations performed by you or on your behalf, done under a contract with that person or organization; "your work"; or "your products". We waive this right where you have agreed to do so as part of a written contract, executed by you prior to loss. F. BLANKET ADDITIONAL INSURED - MANAG- ERS OR LESSORS OF PREMISES WHO IS AN INSURED (Section II) is amended to include as an insured any person or organization (referred to below as "additional insured") with whom you have agreed in a written contract, exe- cuted prior to loss, to name as an additional in- sured, but only with respect to liability arising out of the ownership, maintenance or use of that part of any premises leased to you, subject to the fol- lowing provisions: 1. Limits of Insurance. The limits of insurance afforded to the additional insured shall be the limits which you agreed to provide, or the lim- its shown on the Declarations, whichever is less. 2. The insurance afforded to the additional in- sured does not apply to: a. Any "occurrence" that takes place after you cease to be a tenant in that premises; b. Any premises for which coverage is ex- cluded by endorsement; or c. Structural alterations, new construction or demolition operations performed by or on behalf of such additional insured. 3. The insurance afforded to the additional in- sured is excess over any valid and collectible insurance available to such additional in- sured, unless you have agreed in a written contract for this insurance to apply on a pri- mary or contributory basis. G. BLANKET ADDITIONAL INSURED - LESSOR OF LEASED EQUIPMENT WHO IS AN INSURED (Section II) is amended to include as an insured any person or organization (referred to below as "additional insured") with whom you have agreed in a written contract, exe- cuted prior to loss, to name as an additional in- sured, but only with respect to their liability arising out of the maintenance, operation or use by you of equipment leased to you by such additional in- sured, subject to the following provisions: 1. Limits of Insurance. The limits of insurance afforded to the additional insured shall be the limits which you agreed to provide, or the lim- its shown on the Declarations, whichever is less. 2. The insurance afforded to the additional in- sured does not apply to: a. Any "occurrence" that takes place after the equipment lease expires; or b. "Bodily injury" or "property damage" aris- ing out of the sole negligence of such ad- ditional insured. 3. The Insurance afforded to the additional in- sured is excess over any valid and collectible insurance available to such additional in- sured, unless you have agreed in a written contract for this insurance to apply on a pri- mary or contributory basis. H. INCIDENTAL MEDICAL MALPRACTICE 1. The definition of "bodily injury" in DEFINI- TIONS (Section V) is amended to include "In- cidental Medical Malpractice Injury". Page 4 of 7 Copyright, The Travelers Indemnity Company, 2003 CG D1 8711 03 ACORO CERTIFICATE QF LIABILITY INSURANCE ?? DATE (MM/DD/YYYY) 12/8/2011 PRODUCER (303) 534-7325 FAX: (303) 623-7325 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Perak 360, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1600 E S HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR merson t. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Danvar CO 80218 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: HOmaland Insurance CO Of NY We1lDyna, Inc_ Wa1lDynaRX INSURER B,Continantal Insurance (CNA) 7472 S . Tucson Way wsuRER cTha Hartford oo91a Suite 100-A and $111 t0 100-B INSURER D: Cantann a1 CO 80112 - e2. INSURER E' vvcKACats 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 OFSUCH POLICIES- AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR DD' N R TYPE FIN C POLICY NUMBER POLICY EFFECTIVE DA MM/ POLICY EXPIRATION ATE MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 OOO 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 300 000 A CLAIMS MA ?X ' ` DE OCCUR L-0925-11 12/7/ 2011 12/7/201 1 MED EXP (Any one person) $ $ 000 PERSONAL 8 ADV INJURY $ 1 OOO OOO GENERAL AGGREGATE $ 3 000 OOO GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS -COMP/OP AGG $ 3 000 000 X POLICY PRO LOC AUT OMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accitlent) $ 1 , 000 , OOO B ALL OWIJED AUTOS 4026985883 12/7/2011 12/7/2012 BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS C F RM ?y ?j L ?? ?`, ?O ?v BODILY INJURY $ X NON-OWNED AUTOS ? AF T` l (par accitleni) // / Z PROPERTY DAMAGE P ic $ ( er acc enl) GA RAGE LIABILITY .a.IITa. edY ) AUTO ONLY - EA ACCIDENT $ ANY AUTO _ Agy1SC9.RL ?l AtY OT11 (' OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ 2 OOO 000 X OCCUR ? CLAIMS MADE AGGREGATE $ 2 OOO 000 A DEDUCTIBLE -0251-11 12/7/2011 12/7/2012 $ X RETENTION $ 10,00 EXCESS OVER CLiA ONLY $ C WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ? OFFICER/MEM BER EXCLUDEDi E.L. EACH ACCIDENT $ 1 OOO OOO (mandatory In NH) 34wEJZ3046 6/1/2011 6/1/2012 E.L. DISEASE-EA EMPLOYE $ 1 000 OOO If yes, describe antler SPECIAL PROVISIONS below E.L. DISEASE -POLICY LIMIT $ 1 000 000 OTHER EACB OCCURRENCE $ 1 , OOO , OOO A PROFESSIONAL -0925-11 12/7/2011 12/7/2012 ANNDaL Ac,GREC,xxE $ 3,000,000 LIABILITY DESCRIPTION OF OPERATONS/ LOCATIONS /VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS IiGR I lrl V/'11 G 1"IVLUCR VAry(i CL.L/>\ I ILJry ckindig@santa-erne. org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF SANTA ANA DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3O DAYS WRITTEN CHRI STY K2NDIG NOTCE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATNES. AUTHORIZED REPRESENTATIVE / l ?__ _ Gary Friedman/GARY ! - - {? °? AGUKU l5 (L009/07) ©1988-2009 ACORD CORPORATION. All rights reserved. ? INS025 (zooso'I) The ACORD name and logo are registered marks of ACORD j . f IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it afFrmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. 1 N6UZ6 (20090'1) 2012 JAt1 -9 Pt 12= 49 C LE ,?:i?i??C1L r AC40R" ` ,? CERTIFICATE OF LIABILITY INSURANCE DATE 6/20/2M/DDI012 6/20 12 PRODUCER (303) 534-7325 FAX: (303) 623-7325 Peak 360, Inc. 1600 Emerson St. ,n . THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER T I$$,,,,,,??RTIFICATE DOES NOT AMEND, EXTEND OR ,^AL ECOII RAGE AFFORDED BY THE POLICIES BELOW. Denver CO 80218 INSURERS AFFQRpING COVERAGE NAIC # INSURED C , t INSURER A: Ho*14 5d Insurance Co of NY Wel lDyne , Inc.; WellDyneRX; CF Pharmacy Svc)5' , INSURER B: CC)nti? i 'ntal Insurance (CNA) 7472 S. Tucson Way The Hartford INSURER C: 00914 ©? a-731 INSURER D: Centennl al CO 80112 INSURER E: I1(11'1G D A (_G C THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REQUIREMENT , MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ADD' NSR TYPE OF INSURANCE POLICY NUMBER POLICYM EFFECTIVE DATE MIDD/YYYY POLICY EXPIRATION DATE MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 A CLAIMS MADE [A] OCCUR L-0925-11 12/7/2011 12/7/2012 MED EXP (Any one person) $ 5,000 ! PERSONAL & ADV INJURY $ 1,000,000 i GENERAL AGGREGATE $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: / PRODUCTS - COMP/OP AGG $ 3,000,000 77 PRO- X POLICY ! LOC AUT OMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANY AUTO B ALL OWNED AUTOS 4026985883 12/7/2011 12/7/2012 BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) -e-? PROPERTY DAMAGE 3 (Per accident) $ - GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO 1 / OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ 2,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 2,000,000 $ A DEDUCTIBLE MFX-0251-11 12/7/2011 12/7/2012 $ X RETENTION $ 10,00 EXCESS OVER CNA ONLY $ C WORKERS COMPENSATION WRYTATU- OT H- AND EMPLOYERS' LIABILITY R Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 ? OFFICER/MEMBER EXCLUDED? (Mandatory in NH) 34WEJI3046 6/1/2012 6/1/2013 E.L. DISEASE - EA EMPLOYE $ 1 000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A OTHER PROF LIABILITY L-0925-11 12/7/2011 12/7/2012 EACH OCCURRENCE $ 1,000,000 ANNUAL AGGREGATE $ 3,000,000 C TPA E&O LIABILITY iPG0257328 12/7/2011 12/7/2012 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES/ EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION ckindig@santa-ana.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CITY OF SANTA ANA DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN CHRI STY KIND IG NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE _ G F i d /GARY ary r e man ACORD 25 (2009/01) © 1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200901) The ACORD name and logo are registered marks of ACORD IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009101) INS025 (200901) ACORO CERTIFICATE OF LIABILITY INSURANCE 29/2013DATE (MMIOD/YYYY) 1/ 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 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 NAMTACT Gary Friedman, CPCD, MSIS, RPLU, ARM, AAI Peak 360, Inc. PHONE (303)534-7325 rFAXN .(303)623-7325 1600 Emerson St. EMAIL s: gfriedman@peak360.com INSURERS AFFORDING COVERAGE NAIC 0 Denver CO 80218 INSURERAArch Specialty Insurance Co. INSURED INSURERS :Continental Insurance WellDyne, Inc.; WellDyneRX; CF Pharmacy Svcs. INSURER C Hartford 7472 S. Tucson Way 1 INSURERD: 19,20,9 7)-77191 INSURER E: Centennial CO 80112 INSURER F: COVERAGES CERTIFICATE NUMBER'l.iability 2012 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 LTR TYPE OF INSURANCE A L B POLICY NUMBER POLICY EFF (MMIDDNYYYI POLICY EXP IMMIDDNYYY) LIMITS A GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL ABILITY P0052 651-00 2/7/2012 2/7/2013 DARMAI R E n $ 100,000 CLAIMS-MADE Fx7OCCUR MED EXP(My one person) $ 5,000 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEWL AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP AGG $ 3,000,000 X POLICY PF'Q.T F7 LOC $ B ILE LIABILITY OMO COMBINED SINGLE LIMIT Eaa id n 000 000 A ANY AUTO BODILY IWURV(Per person) $ P ALLOWNED AUTOS X SCHEDULED AUTOS 026985883 2/7/2012 2/7/2013 BODILY INJURY Per accident) $ HIRED AUTOS X NON-OWNED AUTOS PROPERTY DAMAGE Per cciden $ X UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 2,000,000 EXCESS UAB CLAIMS-MADE P0052 651-00 2/7/12 2/7/13 AGGREGATE $ 2,000,000 DED X RETENTION 10,00 $ $ WORKERS COMPENSATION X WC STATU- OTH- ANDEMPLOYERS'UABILIry YIN ANY PROPRIETOWPARTNEWEXECUTIVE OFFICEWMEMBER EXCLUDED? NIA E.L. EACH ACCIDENT $ 1,000,000 (Mandatory in NH) If i 4wSJ13046 6/1/2012 6/1/2013 E.L. DISEASE - EA EMPLOYE $ 1,000,000 yes, descr be under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1-10-00,000 A PROFESSIONAL LIABILITY P0052 651-00 2/7/2012 2/7/2013 OCCURRENCE/AGGREGATE $1M / $3 C TPA E60 LIABILITY 0 PG 0257328 2/7/2012 2/7/2013 OCCURRENCE/AGGREGATE $1M / $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 0 more space is required) Certificate Holder is an additional insured under the General Liability policy in accordance with all the terms, conditions, and limitations of the policy and then only for liability caused by the negligent acts of the named insuradr_MbV2bonly, IIIr}pterest may appear by way of written contract. ckindig@santa-ana.org CITY OF SANTA ANA CHRISTY KINDIG 20 CIVIC CENTER PLAZA SANTA ANA, CA 92701 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Gary Friedman/GARY n1oRR_7n1n ArnonrnoonoATlnM AIIA-h.-.-.,..,nd INS025 nn rr,%m Th. Arnon name and Innn a_ .a oicta.n _,,4 of arnRn THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COVERAGE CHANGE ENDORSEMENT (PROFESSIONAL PLUS) This endorsement modifies insurance provided under the following designated coverage forms: Healthcare Professional Liability Coverage Form; or Healthcare Professional Liability Coverage Form- Occurrence; Healthcare General Liability Coverage Form; or Healthcare General Liability Coverage Form- Claims Made; whichever applies. A. Changes Applicable to All Coverage Forms The following is added to the Who Is An Insured section of your policy. Good Samaritan. Your "employees" are insureds for any "occurrence" or "medical incident" arising out of their rendering emergency first aid outside of their duties as your "employees" as long as the emergency first aid is rendered without the receipt or expectation of remuneration. For the purpose of this Good Samaritan provision only, "medical incident" means any act or omission in the providing or failure to provide "health care professional services". We will consider a series of related acts or omissions in the providing or failure to provide "health care professional services" to be one "medical incident". Medical Director. Your Medical Directors are covered for "medical professional injury" that results from acts or omissions in the providing of or failure to provide "health care professional services" that are performed as part of their employment duties for you. Blanket Additional Protected Persons. Other individuals or organizations when required to be covered by written contract, agreement, or permit, provided the written contract, agreement or permit is executed prior to the "claim" being made or the "suit" being brought. Coverage is provided for them only forthe work you performed or should have performed on their behalf. They will share in your limit of liability for any covered "claim" or "suit". Damages paid on their behalf will reduce and may exhaust your limit of liability under this policy. B. CHANGES APPLICABLE TO ALL COMMON POLICY CONDTIONS The following paragraph is added to item 15. Transfer of Rights Of Recovery Against Others To Us We waive the right of recovery we may have against persons or organizations because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a written contract with that person or organization and included in the "products-completed operations hazard". This waiver applies only when required by written contract and when such contract was executed prior to any loss. C. Changes Applicable to Healthcare Professional Liability Coverage Form and Healthcare Professional Liability Coverage Form - Occurrence, whichever applies. The following is added to the Coverage section. 00 ML0207 00 11 03 Page 1 of 6 DAMAGE TO PATIENT'S PROPERTY The Coverage section • 2. Additional Payments Is amended to add g. We will pay up to $500 for loss that is due to "property damage" to your patient's tangible property if resulting directly from the These payments will not exceed $5,000 for all such losses resulting from all "healthcare professional services", regardless of the number of patients whose tangible property is injured. For the purposes of this Additional Payment, the following changes are made: 1. The Deductibles section does not apply; 2. The Definitions section is amended to add: "Occurrence" means an accident, including continuous or repeated exposure to substantially the same general harmful conditions. "Property damage" means: a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; or b. Loss of use of tangible property of others that is not physically injured. All such loss of use shall be deemed to occur at the time of the accident, Including continuous or repeated exposure to substantially the same general harmful conditions that caused it. For the purposes of this insurance, electronic data is not tangible property. As used in this definition, electronic data means information, facts or programs stored as or on, created or used on, or transmitted to or from computer software, including systems and applications software, hard or floppy disks, CD-ROMS, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. MEDICAL BOARD LICENSING HEARING COST REIMBURSEMENT COVERAGE h. We will reimburse the named insured for "hearing costs" which arise out of "hearings" involving physicians named in the Named Individual Or Organization Endorsement- Employed Individuals (Shared Limit) provided such "hearings" result from "medical incidents" covered by this coverage form. We have no right or duty to defend any physician in any "hearing". For the purposes of Medical Board Licensing Hearing Cost Reimbursement Coverage the following paragraphs are added to the Limits Of Insurance section. 4. Subject to the aggregate limit described in 3. above, the medical board licensing hearing cost per physician aggregate limit shown below is the most we will reimburse for all "hearing costs" covered by this endorsement regarding any one physician. Medical Board Licensing Hearing Cost Per Physician Aggregate Limit:$20,000 5. Subject to the medical board licensing hearing cost per physician aggregate limit shown above, the per hearing per physician limit shown below is the most we will reimburse for costs associated with any one "hearing" covered by this endorsement regarding any one physician. Per Hearing Per Physician Limit: $10,000 For the purposes of Medical Board Licensing Hearing Cost Reimbursement Coverage only, the following exclusions are added to the Exclusions section. 00 ML0207 00 11 03 Page 2 of 6 Medical Staff Privileges This insurance does not apply to any "hearing" arising out of or resulting from the appointment or reappointment to medical staff or the revocation or restriction of medical staff privileges by any health care facility or managed care organization. Completion Or Alteration Of Medical Records This insurance does not apply to any "hearing" arising out of or resulting from disputes over timely completion or alteration of medical records. Fraud, Abuse, Or Non-Compliance This insurance does not apply to any "hearing" arising out of or resulting from fraud, abuse or willful non-compliance with the rules and regulations of Medicaid or Medicare or any other program of a local, state or federal agency. Substance Abuse This insurance does not apply to any "hearing" arising out of or resulting from allegations of substance abuse by the physician. Improper Prescriptions This insurance does not apply to any "hearing" arising out of or resulting from allegations of improper prescription of any medication. This includes prescriptions provided without an appropriate history or physical. For the purposes of Medical Board Licensing Hearing Cost Reimbursement Coverage only, the following changes are made: 1. Deductibles section does not apply; 2. Definitions section is changed to add the following "Hearings" means investigations conducted, or administrative proceedings or actions brought, by state medical licensing boards. "Hearing costs" means reasonable and necessary fees and expenses of legal counsel and expert consultants, including, without limitation, investigation, travel, costs of transcripts, and court fling fees, incurred in the defense of an administrative proceeding or action. "Hearing costs" associated with appeals are considered part of those incurred during the original proceeding. "Hearing costs" do not include salary, charges or incidental expenses of your "employees", "administrators" or agents, or any sanctions, penalties, fines or other monetary penalties imposed by a medical licensing board. COVERAGE TERRITORY CHANGE (Worldwide) The following is added to the "Coverage Territory" definition: c. For any "claims" or "suits" not addressed by paragraphs a. orb. above, we will only reimburse the named insured for: (1) Reasonable expenses incurred by your investigation and defense. (2) Damages for liability incurred or settlement(s) made that are otherwise covered by this policy. Any reimbursement made under paragraph c. for "claims" or "suits", shown below and the deductibles shown in the declarations page. You must notify us of all such "claims" or "suits" as soon as practicable. Aggregate Limit: $1,000,000 Each Medical Incident Limit: $1,000,000 The above limits are part of, and not in addition to, the each medical incident limit specified in the declarations. Notwithstanding the above, the coverage territory does not include any country or jurisdiction which is subject to trade or other economic sanction or embargo by the United States of America. 00 ML0207 00 11 03 Page 3 of 6 D. Changes applicable to Healthcare General Liability Coverage Form and Healthcare General Liability Coverage Form - Claims-Made, whichever applies EVACUATION EXPENSE COVERAGE The following is added to Supplementary Payments - Coverages A and B, : h. We will reimburse the insured for "evacuation expenses" actually incurred in connection with an "evacuation" which first takes place during the Policy Period and which is reported in accordance with the Duties in the Event an Evacuation Occurs section of this endorsement, subject to the sublimit shown below. Evacuation Sublimit of Insurance Annual Aggregate Evacuation Expense Limit: $25,000 Each "Claim" Evacuation Expense Limit: $25,000 The annual aggregate evacuation expense limit shown above is the maximum we will pay for all expenses in any way related to, in whole or in part, "evacuation expense". Subject to the annual aggregate evacuation expense limit, the each "claim" evacuation expense limit shown above is the maximum we will pay for expenses for any one "claim" in any way related to, in whole or in part, "evacuation expense". The above limits are part of, and not in addition to, the aggregate limit applicable to this coverage form. For the purposes of Evacuation Expense Coverage, no coverage will be available for "evacuation expenses" arising out of any : a. strike or bomb threat, unless the "evacuation" was ordered by a civil authority; b. false fire alarm or a planned evacuation drill; c. vacating of one or more residents because of their individual medical condition; d. nuclear reaction, radiation or any radioactive contamination, however caused; e. seizure or destruction of property by order of a governmental authority; provided that this Exclusion shall not apply to an order of evacuation by a governmental authority due to a condition described above; or f. war, including undeclared or civil war, warlike action by a military force, insurrection, rebellion or revolution. For the purposes of Evacuation Expense Coverage, the following definitions are added: "Evacuation" means the removal of all or the majority of residents from one or more of your locations or facilities in response to an actual or threatened, natural or man-made condition, that is unexpected and unforeseen and, causes the residents of such location or facility to be in imminent danger of loss 00 ML0207 00 11 03 Page 4 of 6 of life or physical harm. Such condition must be in the form of an emergency or sudden crisis requiring immediate action, and not the result of a latent or hidden condition at the location or facility. "Evacuation expenses" means reasonable costs and expenses actually incurred by you in connection with the "evacuation", including the costs associated with transporting and lodging residents who have been evacuated. "Evacuation expenses" shall not include any remuneration, salaries, overhead, fees or benefit expenses of the Named Insured or any Insured. Duties in the Event an Evacuation Occurs 1. Any "evacuation" shall be reported to us as soon as practicable, but in no event later than thirty (30) days after you first incur "evacuation expenses" for which coverage will be requested, or thirty (30) days after the expiration date of your policy, or whichever is earlier. 2. You are not required to obtain our prior written approval or consent before incurring any"evacuation expenses". E. Changes applicable to Healthcare Professional Liability Coverage Form; Healthcare Professional Liability Coverage Form - Occurrence; Healthcare General Liability Coverage Form; and Healthcare General Liability Coverage Form - Claims-Made, whichever applies The Abuse or Molestation exclusion is deleted from the Exclusions section of your policy. The following is added to Section I - Coverage, 1. Insuring Agreement of the Healthcare Professional Liability Coverage Form and Healthcare Professional Liability Coverage Form - Occurrence, Section I - Coverage, Coverage A Bodily Injury and Property Damage Liability, 1. Insuring Agreement of the Healthcare General Liability Coverage Form, and Section I - Coverages, Coverage A Bodily Injury and Property Damage Liability, 1. Insuring Agreement of the Healthcare General Liability Coverage Form- Claims-Made. We will defend any "claim" in any way related to, in whole or in part, "abuse or molestation", provided that no insured, other than the alleged perpetrator and/or victim, knew about or could have reasonably foreseen or discovered the event which gave rise to such "claim". We will also pay amounts that any insured becomes legally required to pay as damages. The defense provided and damages paid under this coverage are subject to the abuse or molestation limits of insurance shown below. Defense expenses and damages paid will reduce and may exhaust the limits of insurance as shown in the declarations . Annual Aggregate Abuse Or Molestation Limit: $1,000,000 Each "Claim" Abuse Or Molestation Limit: $1,000,000 The annual aggregate abuse or molestation limit shown above is the maximum we will pay for all "claims" in any way related to, in whole or in part, "abuse or molestation", including the defense expense related to such "claims". This limit is part of, and not in addition to, the aggregate limit or the general aggregate limit specified in the declarations, whichever applies. Subject to the annual aggregate abuse or molestation limit, the each "claim" abuse or molestation limit shown above is the maximum we will pay for any one "claim" in any way related to, in whole or in part, "abuse or molestation", including the defense expense related to such "claims". This limit is part of, and 00 ML0207 00 11 03 Page 5 of 6 not in addition to, the each medical incident limit or the each occurrence limit, whichever applies, specified in the declarations. All other terms and conditions of this Policy remain unchanged. Issued By: Arch Specialty Insurance Company Endorsement Number: 8 Policy Number: FLP0052651-00 Named Insured: WellDyne Inc Endorsement Effective Date: December 07, 2012 President 00 ML0207 00 11 03 Page 6 of 6