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Home My WebLink AboutWESTCLIFF MEDICAL LABORATORIES, INC 3City of Santa Ana 4r Clerk of the Council AGREEMENT TERMINATION Make sure to include all amendments if any. Please complete this form when the attached agreement is no longer in effect. V;91 -7 Z: j Return form to the Clerk of the Council Office (M-30)- Call 647-2520 if you have any questions. T The agreement with No- N-2009-096 was completed on 6(30 1-b I and final payment has been made. Department: Phone/Ext.: Signature: Date: Ll a, 11z— Revised 05-04-08 ' N-2009-096 INSURANCE ON FILE WORK MAY PROCEED UNTIL INSURANCE EXPIRES ia' ~~ - ~ 9 CONSULTANT AGREEMENT CLERK OF COUNCIL DATE: ~_ ~: F',r~C2~~~ THIS AGREEMENT, made and entered into this 10th day of July, 2009 by and between Westcliff 8.11 Wc~ov~ Medical Laboratories, Inc., a California corporation (hereinafter "Consultant"), and the City of Santa Ana, a charter city and municipal corporation organized and existing under the Constitution and laws of the State of California (hereinafter "City"). RECITALS A. The City desires to retain a consultant having special skill and knowledge in the field of phlebotomy, to draw and test blood samples as part of regular medical exams. B. Consultant represents that Consultant is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Consultant represents that it is knowledgeable in its field and that any services performed by Consultant 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 Consultant shall provide phlebotomy services including drawing and testing blood samples as part of regular medical exams for Police and Fire personnel, as set forth in Exhibit A to this Agreement. 2. COMPENSATION a. City agrees to pay, and Consultant agrees to accept as total payment for its services, the rates and charges identified in Exhibit A. The total sum to be expended under this Agreement shall not exceed $24,000.00, annually, during the term of this Agreement. b. Payment by City shall be made within thirty (30) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. 3. TERM This Agreement shall commence on the date first written above and terminate on June 30, 2010, unless terminated earlier in accordance with Section 12, below. The term of this Agreement may be extended upon a writing executed by the Fire Chief and the City Attorney. 4. INDEPENDENT CONTRACTOR Consultant 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 Consultant performs the services which are the subject matter of this Agreement; however, the services to be provided by Consultant shall be provided in a manner consistent with all applicable standards and regulations governing such services. Consultant 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. INSURANCE Prior to undertaking performance of work under this Agreement, Consultant shall maintain and shall require its subcontractors, if any, to obtain and maintain insurance as described below: a. Commercial General Liability Insurance. Consultant shall maintain commercial general liability insurance which shall include, but not be limited to protection against claims arising from bodily and personal injury, including death resulting therefrom and damage to property, resulting from any act or occurrence arising out of Consultant's operations in the performance of this Agreement, including, without limitation, acts involving vehicles. The amounts of insurance shall be not less than the following: single limit coverage applying to bodily and personal injury, including death resulting therefrom, and property damage, in the total amount of $1,000,000 per occurrence, $2,000,000 in the aggregate. Such insurance shall (a) name the City, its officers, employees, agents, volunteers and representatives as additional insured(s); (b) be primary with respect to insurance or self-insurance programs maintained by the City; and (c) contain standard separation of insureds provisions. b. Worker's Compensation Insurance. In accordance with the provisions of Section 3300 of the Labor Code, Consultant, if Consultant has any employees, is required to be insured against liability for worker's compensation or to undertake self-insurance. Prior to commencing the performance of the work under this Agreement, Consultant agrees to obtain and maintain any employer's liability insurance with limits not less than $1,000,000 per accident. c. Professional liability (errors and omissions) insurance, with a combined single limit of not less than $1,000,000 per claim. d. The following requirements apply to the insurance to be provided by Consultant pursuant to this section: (i) Consultant shall maintain all insurance required above in full force and effect for the entire period covered by this Agreement. (ii) Certificates of insurance shall be furnished to the City upon execution of this Agreement and shall be approved in form by the City Attorney. (iii) Certificates and policies shall state that the policies shall not be canceled or reduced in coverage or changed in any other material aspect without thirty (30) days prior written notice to the City. e. If Consultant fails or refuses to produce or maintain the insurance required by this section or fails or refuses to furnish the City with required proof that insurance has been procured and is in force and paid for, the City shall have the right, at the City's election, to forthwith terminate this Agreement. Such termination shall not effect Consultant's right to be paid for its time and materials expended prior to notification of termination. Consultant waives the right to receive compensation and agrees to indemnify the City for any work performed prior to approval of insurance by the City. 6. INDEMNIFICATION Consultant agrees to and shall indemnify and hold harmless the City, its officers, agents, employees, consultants, 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 health, and claims for property damage, which may arise from the direct or indirect operations of the Consultant or its contractors, subcontractors, agents, employees, or other persons acting on their 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 Consultant 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 or property 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. 7. CONFIDENTIALITY If Consultant receives from the City information which due to the nature of such information is reasonably understood to be confidential and/or proprietary, Consultant agrees that it shall not use or disclose such information except in the performance of this Agreement, and further agrees to exercise the 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 Consultant disclosed in a publicly available source; (c) is in rightful possession of the Consultant without an obligation of confidentiality; (d) is required to be disclosed by operation of law; or (e) is independently developed by the Consultant without reference to information disclosed by the City. 8. CONFLICT OF INTEREST CLAUSE Consultant 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. 9. 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 telefacsimile or other telegraphic communication in the manner provided in this Section, to the following persons: To City: Clerk of the City Council City of Santa Ana 20 Civic Center Plaza (M-30) P.O. Box 1988 Santa Ana, CA 92702-1988 telefacsimile (714) 647-6956 With courtesy copies to: Fire Chief City of Santa Ana 1439 S. Broadway (M-80) Santa Ana, California 92702 telefacsimile (714) 647-5779 and Chief of Police City of Santa Ana 60 Civic Center Plaza Santa Ana, California 92702 (714)245-8007 City Attorney City of Santa Ana 20 Civic Center Plaza (M-29) P.O. BOX 1988 Santa Ana, California 92702 telefacsimile (714) 647-6515 To Consultant: Westcliff Medical Laboratories, Inc. 1821 E. Dyer Road, # 100 Santa Ana, California 92705 Telefacsimile (949) 222-1809 Attn: Noel Laflin 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 telefacsimile, 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. 10. EXCLUSIVITY AND AMENDMENT This Agreement represents the complete and exclusive statement between the City and Consultant, 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 Consultant. 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 Consultant nor the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein. 11. ASSIGNMENT Inasmuch as this Agreement is intended to secure the specialized services of Consultant, Consultant 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 which are the subject to this Agreement performed by City personnel or by other consultants retained by City. 12. TERMINATION This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Consultant shall be entitled to receive and the City shall pay Consultant compensation for all services performed by Consultant 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 Consultant to deliver to the City all work product completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Consultant consents to the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 13. DISCRIMINATION Consultant shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Consultant affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 14. JURISDICTION -VENUE This Agreement and all questions relating to its validity, interpretation, performance, and enforcement shall be governed and construed in accordance with the laws of the State of California. This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties 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. 15. PROFESSIONAL LICENSES Consultant 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. Consultant shall notify the City immediately and in writing of her inability to obtain or maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 16. MISCELLANEOUS PROVISIONS a. Each undersigned represents and warrants that its signature hereinbelow has the power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify City fully, including reasonable costs and attorney's fees, for any injuries or damages to City in the event that such authority or power is not, in fact, held by the signatory or is withdrawn. b. All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. IN WITNESS WHEREOF, the parties hereto have executed this Agreement the date and year first above written. ATTES •~ " - -~ PATRICIA E. HEAL Clerk of the Council CITY OF SAIY~A ANA ~ ,,~ :~ ~~~`~ DAVID N. REAM City Manager APPROVED AS TO FORM: JOSEPH W. FLETCHER City Attorney Teresa Judd Deputy City Attorneys J RECOMMENDED FOR APPROVAL: WESTCLIFF MEDICAL LABORATORIES Y~~/, , W~ MARC MARTIN (NAME) Fire Chief (Title) ~ _ ~ r--- ~: ~: ~,~ ~ PAUL M. WALTERS Chief of Police T-,_..~_ C-o ~ ~~ C~~~r~ EXHIBIT A FEE SCHEDULE SERVICE COST TOTAL Chemistry Panel 2747 $25.00 each based on 230 individuals $5,750 Hepatitis C Screen $20.00 each based on 230 individuals $4,600 PSA Blood Screen $20.00 each based on 80 individuals $1,600 Subtotal Fire Department $11,950 Subtotal Police Department $12,050 Total $24,000 DATE (MM7DDIYYYY) ~! ' •~4~t~RD,. C_ER_TIFICATE OF 1-(ABILITY 1N_SUR_ANCE _ _ _ ~ 1210312008 _ _ TH15 CERT~ICATE IS ISSUED AS A MATTER ~ INFORMATION I PRODUCER • ONLY AND CONFERS NO RIGHTS NO SEND, EXTEND AOR I ~ Marsh Risk & Insurance Services HOLppZ- THIS CERTIFICATE DOES 4695 Macgrttlur Court, Suite 700 ALTER THE COVERAGE AFFORDED BY 'THE POLICIES ~L~• (949)399-5800 License 40437 t 53 Newport Beach, CA 92660 1607996-002-G~2-08-09 iNSUIt~ Wesicliff Medical Labs, Mc. At~1~ Rodney mown 18,3, ~. Dyer Road, Sure 100 Sarif~ Ana, CA 92705 V iNSURFJ2S AFFORDING COVERAGE I NAIC #1 ~74 ri ca tNSURER a Travelers Property Casualty Co. Of Ame INSURER s:11n8ed Stales Fire f nsurartce Co. ~ 21113 INSURER c: Nautilus Insurance Company 17370 -~ SJSURER D: - ~ I ~~_ ~ INSURER E: COVERAGES _ THE POLICIA~~ ANY REQUIREMENT, TERM OR CONDITION OF A~Mf C TONTRACT OR OTHER DOCUMENT~W TN RESPECT 70 WHICH TH~CER IFICATE I NOTWiTHS _ MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS CONDITIONS OF SUCH POLICIES. AC3GREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED~BYC~ p~Y ~~Tlort t,lM11Ts ~LRR ADD'L TYPE OF INSURANCE ~ POLS:Y NUMBER DATE (1MWDrYY1 DdLTE (MMIDDR'Y) t 1.004.000 NE g30 154p569A-TIL-08 I A I X ' COMMERCIAL GENERAL LIA9ILITY I ~ j ~i - f- CLAIMS MADE x.^ OUR ERAL AGGREGATE LIMIT APPLIES PE I PRO- --~ I ~ ~ -' POLICY ~ ~ JECT ~ LOC • J • AUTOMweILE uABlurr i X Arn Auro ~~ ALL OWNED AUTOS 'r SCHEDULED AUTOS HIRED AUTOS ~ ~ NOM-OWNEDAUTOS (B 10154 D589A-Tt L-08 1 N01 !08 10/01109 l I A.pPRO ED AS IO FORM ~ - Bid; ~ FpAMAt3E TO REIVTEU $ 100,000 ~REMISES(Ea occurence,~ MED EXP (Arty one oereoN $ ~ 5,400 `PERSONAL a ADV IN.RIRY ~a 1 ,000,OOq IOENERALAGGREGATE Is 2,000,00 ~ COMBINED SINGLE OMIT ~ 1,000,OOQ (Ea accidenQ 90[~XLY IN.IURY (Per persDn) s I i BOOILYIN.fURY i$ (Per exident) PROPERTY DAMAGE f Per accident) I`~ I i _J --' / CID ENT~$ AUTOONLY-EAAC J ~ I GARALiE LIA&UTY - - ~- EA ACC I~ rr I ~ ANY AUTO I OTHER7HAN AUTO ONLY' a AGG i •I EXCESSruMaREwuAeluTt' CUP 154D589A-TIL-08 10/01/08 EACH OCCURRENCE ~S 10/01/09 rF $ 2.000,000 400 00 2 A ~ AGG~cA ~ , , I OCCUR ~ CLAMAS MADEi I- ~ - ~ i ~ pEDUCTIBLE I J ~ RETENTIONS WORI~RS COMPENSATION AND WC STATU- OTH- X ITORV I arts _~EB_. ' £ACH ACCi~NT I r 1 ~~ ~ i EI~WYERS UAMLI7Y f 408696715-8 AM! pROPRIETpwPARTNEWEXECUTIVE ~ 12K11f08 .L. l 12101109 I L. DISEAb'E EA EMPLOYEE $ - 1,040,ooO - ~ OFFICERfWIEMeEREXCLUOEp~ ~ ~ -'~- L DISEASE -POLICY LNIAIT a 1,004,000 ~~ Myea deaclitle urdsr SPECIAL PR'w IBC N8 oe~ov. OTHER PFP1000006P2 C professional IOJ01108 10101!09 Each Claim I Aggregate Llntit 2,000,OOOy 4,000,000 I Liability I ` ~ Dedllctitible 5,40 Retro Date: 6!13!87 I DESCRIPTION OF OPERATIONSIIOCAT(ONSNBIICLES/E7~U ~D ~ E'~~~~IB~~ 0~ ~ and em are included as Additiona ifs officers, ages PbY~ of Santa Ana The Cil ium d P l Insured as y . rem 10 Day Notice of Cancellation for Non-Payment , I required by written contract. _ I~ L CERTIFICATE HOLDER 1 10101/08 ~ 10/01/09 LOS-00068441fr12 ~ City of Santa Ma 20 CIVIC Center Plaza (M-29) PO Sox 1988 I Santa Ana, CA 92702 cANCEU.ATtoN SHOULD ANY OF THE A90VE pESCRIBED POLIG~S BE CANCELLED BEFORE THE EXPIRILTION DATE THEREOF, THE ISSUINri INSURER Wltl ENDEAVOR TO 1A111L DAYS WRITTEN NOTICE TO TIIE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 90 SHALL N~POSE NO OBLKiAT10N OR UA9ILnY OF ANY qND .~_.. ....~ ,.,e,.em rte SITS OR REPRESENTATIVES. Jo}m Oraef _ I 1988 V ;. ~ s ~r - - - _- - -- - --- -- _ - --- -- - ` 03/18/2009~rrY) '~ ACORDTM CERTIFICATE OF LIABILITY INSURANCE - -'~` - _ - --- - - - - -- ---- ---- _ _ --_ - - PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF Marsh Risk & Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4695 MacArthur Court, Suite 700 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ' (949) 399-5800 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. License #0437153 Newport Beach, CA 92660 .607996-002-002-08-09 - - - - - INSURED Westcliff Medical Labs, Inc. Attn: Rodney Brown 1821 E. Dyer Road, Suite 100 Santa Ana, CA 92705 IH`If ~ ~ ~ 1' CITY 0% _ '~~~ A~ CLERK yr ,.,~J~1C! INSURERS AFFORDING COVERAGE _- - -- -_- - -_ .. ~uRER A Travelers Property Casualty Co. Of America - -- - ERB United States Fire Insurance Co. ~ - - - w RERC Nautilus Insurance Company INSURER D: INSURER E NAIC # 25674.,._ -- 21113 ,17370 _-- -~- - -- _ _ ---- - THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. COVERAGES NY RE UIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE NOTWITHSTANDING A Q 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. _ _ _- - --- -------__-- - ~- -- -- ~«~:-rivo enr Irv cvoio ennw INS quv y TYPE OF INSURANCE ' INSR POLICY NUMBER 'DATE (MMlDDlYY) DATE (MM/DDlYY) ~ "'~" ~ ~ I GENERAL LIABILITY ~ - 630 154D589A-TIL-08 q EACH OCCURRENCE -{ - - 10!01/08 10/01/09 ~ ~AnnACE ro RENrEO $ - 1.~000~Q~ - 00 100 I i X '', COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence , ' - i ~--- X - 1 MED EXPfAny one person) ~ -_ S,OOa _ _ --_J _ OCCUR CLAIMS ngp.DE '~ _ --- - ~ ' I PERSONAL & AD'v INJURY i$ I ,000,OOO - T _- ERAL AGGREGATE LIMIT APPLIES PER G E j PRODUCTSGCOMP/OP AG $ - - - -- ~ _ 2 OOO,OOO PRO- '. ~ POLICY i ~ JECT ~ LOCI ~ OMOBILE uABIUTY ' ,ALIT 810 154D589A-TIL-08 ~ 10!01/08 110/01/09 SwGLE LIMIT I D o O $ 00 1 000 A t i E cide a a , , X ', ANY AUTO ~ t _ ~ - - i ~ BODILY INJURY ~ $ ~ ~ ~I p I ~ H RED AUTOS UTOS !-~ C'~~i'~~lJ Y ~ll tea 1 it i ~~1V1 LY NJURY ---- ODI ~ ~ -- - _ ~~ -- -- - NON-OWNED AUTOS ~ ~ .. - ~ ~~~ /~ %~ (Per accident) ~'. PROPERTY DAMAGE ' $ , - . r_ (: ~ ~- ~~ ~ IPer accident) ~ i !, GARAGE UABILITV ~:ity F,t u~r~~ ~~ istant ~ !AUTO ONLY - EA ACCIDENT ~ - - - $ - - - -- ~'I ANY AUTO . ss OTHER THAN _EA ACC AUTO ONLY: $ - - $ -_ - -----~. ~i I AGG ~ EXCESS/UMBREUIILIABILITY !CUP 154D589A-TIL-OS I 10/01/08 EACH OCCURRENCE lO/O1/O9 $ 2,000,00 O OO 1 CLAIMS MADE k ] OCCUR ~ AGGREGATE $ , q 2 OO _ .. I DEDUCTIBLE _ '~$ - '~.. RETENTION $ WORKERS COMPENSATION AND ' X I WC STATU- OTH- ER- 'TOI3YlIMfr_s ~ - - EMPLOYERSUABIUTY B i ORlPARTNERlEXECUTIVE 408696715-8 !, 12/01/08 i 12/01!09 - L ,EACH ACCIDENT - I $ $ - -- 1 OOO,OOQi ANY PROPRIET OFFICER/MEMBER EXCLUDED? .DISEASE - EA EMPLOYE -. 1 OOO,OOQ - - If yes, describe under i ! L. DISEASE -POLICY LIMIT $ 1 ,000,00 SPECIAL PROVISIONS below I ~ ~I OTHER i ~ II C professional PFP1000006P2 ~ 10101!08 h Ciaim 10/U1/09 Eac 2 OOO,Ovu ' Aggregate Limit 4,00 ~ Liability ~ I i Deductible 5 000 , Retro Date: 8!31/09 DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLES/EXCUJSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 10 Day Notice of Cancellation for Non-Payment of Premium. The City of Santa Ana, it's officers, agents and employees are included as Addition al Insured as required by written contract. - - -- CERTIFICATE HOLDER LOS-000684416-15 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Santa Ana EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 Civic Center Plaza (M-29) 3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, PO Box 1988 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND oanw nna, vn acr vc iL ACORD 25 (2001 /08) O ACORD CORPORATION 1 S88 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 The Certificate of Insurance on the reverse side of this form 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 (2001108) Reverse of Pape 1 ACORD,~ CERTIFICATE OF LIA_BILIT_Y INSURANCE DATE(MM/DDlYYYY) 03/19/2009 aROOUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Marsh Risk 8 Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4695 MacArthur Court, Suite 700 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR (949) 399-5800 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. License #0437153 Newport Beach, CA 92660 607996-002-002-08-09 URERS AFFORDING COVERAGE INSURED Westcliff Medical Labs, Inc. Attn: Rodney Brown CITY Q~ , `~ T 1821 E. Dyer Road, Suite 100 t~ ~t Santa Ana, CA 92705 C~E[~T- ~JI t•~ ~,N INSURER A: I ravelers nuNCny liaauany ~.~...~ ~,~~~~~~.,u I I~~RERa: United States Fire Insurance Co. NAIC# _I 25674 i fa`~' u~ C: Nautilus Insurance Company 117370 I D: INSURER E: COVERAGES _ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. li NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE ..... __ ._-..._.. ,.., ...., r,~r,r~,.~ ruc ir.ic~ ronnrro econonFn av TNF cnl iclFS nFSCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND ' CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ _~ INSR' ADD'4 ',, TYPE OF INSURANCE POLICY NUMBER OLICY EFFECTIVE I POLICY EXPIRATIONI LIMITS DATE (MMlDDIYY) 'I DATE (MMlDD/YY) ' LTR i INSRq GENERAL LIABILITY ~~ it A ', __ 1630 154D589A-TIL-08 i EACH OCCURRENCE 1 OOO,OOO 10/01/08 i 10/01/09 DAMAGE ro RENrE~ 100, PREMISES Ea occurence COMMERCIAL GENERAL LIABILITY X ~ 0 ' -~-ll r II CLAIMS MADE C~ OCCUR i ~ ~ '~$ S,OO ~, MED EXP (Any one person) - - ~ PERSONAL 8 ADV INJURY ' $ 1 ,000,OOOI I ~ - _ '~, ~ GENERAL AGGREGATE $ 2,000,OOa _ GENERAL AGGREGATE LIMIT APPLIES PERK PRODUCTS -COMP/OP AGQ~ 2,000,000, ~I PRO- POLICY ' JECT ~-1 LOC , ~ it A I I~ AUTOMOBILE LIABILITY 1810 154D589A-TIL-O8 j 1 O/O1/O8 ~', 1 O/O1/O9 I' COMBINED SINGLE LIMIT ~ 1 ,000,00 (Ea accident) ii ~( ,ANY AUTO ~I '~ ALL OWNED AUTOS ~ 80DILY INJURY F Y I ~ I~ SCHEDULED AUTOS ~-i ~~U~~~~ AS {I r r~ T® ~~-.1+..a'+1 ~ ~(Perperson) - I 'HIRED AUTOS III--- ~ ~~ I~ i BODILY INJURY 'I$ (Per accident) ~ ~ ~ NON-OWNED AUTOS ~ ~ ~~ ~ ~ ~~ C. ~---~, / Ui~-..t -~-~-' -.~..,... ~-.•- ROPERTY DAMAGE ..~-/•-•-^-•-~ L,3LlIa. ~t1t'= 3~'IGC.i:~y (Per accident) ~ ~GARAGELIA&LITY ,F~SS1St8Tlt .~ ~' ~`~~`~'-iITiO~I AUTO ONLY-EAACCIDENT ~ ~ I ', OTHER THAN EA ACC '$ ANY AUTO ~ ~- AUTO ONLY: GG A EXCESSlUMBRELLALIABILITY CUP 154D589A-TIL-08 i 10/01/08 lO/O1/O9 EACH OCCURRENCE O OO 2 OO ~ ' A t ~I I CLAIMS MADE' ' ~ AGGREGATE ' $ 2,000,00 . ~ OCCUR , I ' ^~~ DEDUCTIBLE I~ RETENTION $ ,WORKERS COMPENSATION AND )( i WC STATU- ' OTH- ' '~, EMPLOYERS' LIABILITY j4O8696715-8 i 12/O1/OS 12/O1/09 .L. EACH ACCIDENT ~ 1,000,00 B V PROPRIETOR/PARTNERlEXECUTIVE OO 000 $ 1 I AN /MEMBER EXCLUDED? .L. DISEASE - EA EMPLOYE , , OFFICER If yes. describe under i ~.L. DISEASE -POLICY LIMIT ,,I $ 1,000,OOO t SPECIAL PROVISIONS below ~ I OTHER ~' , C I Professional PFP1000006P2 10/01/08 10/01/09 , Each Claim 2,000,000 Aggregate Limit 4,000,000 Liability I Deductible 5,000 I Retro Date: 8/31!06 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS 10 Day Notice of Cancellation for Non-Payment of Premium. The City of Santa Ana, it's officers, agents and employees are included as Additional Insured as ' required by written contract. I CERTIFICATE HOLDER LOS-000684416-17 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL City of Santa Ana 20 Civic Center Plaza (M-29) 3~ DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, ' PO BOX 1988 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND Santa Ana, CA 92702 i UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Aof MaRrsh RLskE& Insurarw:e SBrvices . ~~'s~~ John Graef ACORD 25 (2001!08) p ,acoRU cc~Krciri:pLnc~rv Tana