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HomeMy WebLinkAboutWELLDYNE/RX WEST INC. -2007INSI1RAi&L UN FILE WORK MAY PROCEED ' INTIL INSl1RANCE EXPIRES A-2007-278-o2 CLERK bF COUNCIL DATE JUL 302011(" SECOND AMENDMENT TO AGREEMENT THIS SECOND AMENDMENT TO AGREEMENT is entered into on June 30, 2010, by and between, WellDyne/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 amend the City reimbursement rates and 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 Second Amendment to Agreement, the parties agree as follows: 1. Section 3, TERM, shall be amended to extend the termination date to the date that allocated funds have been expended. 2. Section 4, COMPENSATION, shall be deleted in its entirety and replaced with the following: "CITY shall deliver to CONSULTANT, subject to CONSULTANT's submittal of the information required by Section 1, moneys calculated at the following rate: A. $21.16 for each of the first three Sharps containers obtained by each individual participant during a one year period. B. $10.58 for each additional (4 or more) Sharps container obtained by each individual participant during a one year period. CONSULTANT shall be compensated for its services pursuant to the agreement between CONSULTANT and Sharps Compliance, Inc. City will not be responsible for compensating CONSULTANT for its services. Total compensation to be paid for reimbursements under this Agreement shall not exceed $60,000, during the term of this Agreement." 3. Exhibit A shall be deleted in its entirety and replaced with Exhibit A-1, attached hereto and incorporated by this reference. 4. 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 Second Amendment to Agreement on the date and year first written above. ATTEST: �14 � MARIA D. HUIZAR r- Clerk of the Council �RECOMMENDED FOR APPROVAL: RAUL GODINEZ 11 Executive Director Public Works Agency APPROVED AS TO FORM: AEP LETCH City Attorney CITY OF SANTA ANA DAVID N. REAM City Manager WELLDYNE RX, WEST (NAME) CaY\ e Q.t VA (Title) Cro EXHIBIT A-1 HOW THE SYSTEM WORKS A City resident obtains his/her first three Sharps Disposal by Mail containers in a single year from a participating pharmacy at no cost to the resident. The resident will be required to pay $10.58, half the program costs, for each Sharps Disposal Container in excess of three during the one year period. • The Sharps Disposal by Mail Systemg includes a specially designed sharps container; a government approved exterior shipping box and instructions for use. • Used sharps are placed inside the container for safe storage. • When full, the container is closed, bagged and sealed inside its original packaging that includes a postage pre -paid mailing box. • Residents return the postage pre -paid box to their mail carrier or nearest post office. • The box is delivered to the processing center where both the sharps container and its packaging are destroyed. • The receipt and complete destruction of the container and its contents are documented. SYSTEM BENEFITS This system offers self -injectors convenience (available at their local pharmacy), confidentiality (protected by HIPPA Patient Privacy Act), and affordability. These benefits assure better compliance and diversion of used and contaminated syringes, making our communities safer. Consultant works with participating Pharmacies to account for the number of sharps containers acquired by Santa Ana residents. Consultant provides the report to the City, which will reimburse the pharmacy, through Consultant, for the cost of the sharps containers provided to Santa Ana residents. A`� b® CERTIFICATE OF LIABILITY INSURANCE MIDDAYM 7%6/20 PRODUCER (303) 534-7325 FAR: (303) 623-7325 Peak 360, Inc. TVNN. peak360.com 1600 Emerson St. Denver CO 80218 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. INSURERS AFFORDING COVERAGE NAIC # INSURED WELLDYNE, INC. 7472 S. TUCSON WAY CENTENN ) / CO 80112 INSURE0.A The Hartford 009M INSURER INSURER D. INSURER E: v 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. WSR O SURANCE POLICY NUMBER POLCYEFFECTIVE DATE IM POUCYEIOHRATION DATE IMMfDDFYrYY) UMTS GENERAL LIABILITY EACH OCCURRENCE $ PREMISES S COMMERCIAL GENERAL ABILITY MED EXP Airy are Person S CLAIMS MADE ❑ OCCUR PERSONAL & ADV INJURY S GENERAL AGGREGATE S GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO S POLICY PRO- LOC JFCT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea e¢i4 0 S BODILY INJURY ( Pe ) $ ALL OVMED AUTOS SCHEDULED AUTOS BODILY INJURY $ HIRED AUTOS NON-0 NED AUTOS PROPERTY DAMAGE (Per ersieanl) S -- GARAGE LIABILITY � -IQ FORR OYS AUTOONLY-EAACCIOENT S OTHER THAN EA ACC S ANY AUTO `` S I £ AUTO ONLY: AGG EXCESS I UMBRELLA LIABILTTY OCCUR F—ICLAIMS MADE dUTU :s 1;�( ASSJSIa D, c'JLy tih Attpd0 Cy EACH OCCURRENCE E AGGREGATE E E S DEDUCTIBLE $ RETENTION $ NCSTATUS OTH- A WOW(ERS COMPENSATION AND EMPLOYERS W BILITY Y 1 N ANY PRORUETORIPARTNER/FJ�CUTNE E.L. EACH ACCIDENT 4 1,000,000 EL pSEASE - EA EMPLOYE S 1 000 000 OMCERIMEMWR EXCLUDED! ❑ (MeIIEMory M NH) 41rEJ23046 6�1�2010 6�1�2011 E.L DISEASE -POLICY LIMIT E 1,000,000 If yes eeavi0e untleT SPECIAL PROVISIONS Oelee OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS WELLDYNE, INC. SHOULD ANY OF THE ABOVE DESCRBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAUL 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 Friedman/GARY (Df988-2009 INS025 pweDi) The ACORD name and logo are registered marks of ACORD reserved. A1Z"® CERTIFICATE OF LIABILITY INSURANCE 12/�/20113 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 ONE, Inc. dba Peak 360 1600 Emerson St. Deriver CO 80218 COMNICT Gary Friedman PHONE . (b,d303)534-7325 FAXfAIC Nob (303)623-7325 ADORIEs:gfriedman@peak360. com INSURERS AFFORDING COVERAGE NAIC # INSURERAArch Specialty Insurance INSURED WellDyne Holding Corporation 7472 S. Tucson Way ,^ �o l.� /� / �� I�� Centennial CO 80112 91 INSURERB:Continental Insurance INSURERC:CNA Insurance Company INSURER D:HartfOrd INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:CL1312701175 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. INBR R TYPE OF INSURANCE ADD BR POLICY NUMBER POLICY M DD EYY MMIDOD YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY I CIAIMS-MAOE ❑X OCCUR LP0052651-01 12/7/2013 12/7/2014 DAMAGE 10 PREMISES (Ea occurr' c $ 100,000 MILD EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 3,000,000 GEHL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $ 3,000,000 X POLICY PRO-LOCCOMINED $ AUTOMOBILE LIABILITY (Ea accdentSINGLE LIMIT 1,000,000 BODILY I NJURY(Per person) $ B x ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 4026985883 12/7/2013 12/7/2014 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 A EXCESS LIAB CLAIMS -MADE DEXETENTION 10,00 $ LP0052651-01 12/7/2013 12/7/2014 Q WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y1N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICEWMEMBER EXCLUDED? In NH) NIA C5093687712 6/1/2013 6/1/2014(Mantlatory X I TWO STATDCRY LIM - I OTH- ED E.L. EACH ACCIDENT $ 1,000,000 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 LP0052651-01 12/7/2013 12/7/2014 OCCURRENCE/AGGREGATE $IN / $3M D TPA E&O LIABILITY GOPGO257328 12/7/2013 12/7/2014 OCCURRENCE/AGGREGATE $IN / $1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if 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 insured �Iand ti`igr}pgly,�s ,,igi; �ijzyest may appear by way of written contract. GNltUlla Cl 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, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Gary Friedman/GARY i.._ _A ©1988-2010 ACORD CORPORATION. All rights reserved. INS625 (minom) m The ACr1Rn namn anH Inrin am ronieforeH me,kc of Ar.npn ��..., WeIIDyneRX A-2007-278-02 REVIEWED BY ` �1 ''f ,.__ EUNICE HEREDIA (PG 1 OF 1) ACC>RL'r CERTIFICATE OF LIABILITY INSURANCE17/23/2015D ATE /DD/Y 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 One, Inc. dba Peak 360 1600 Emerson St. Denver CO 80218 CONTACT Gary Friedman, CPCU MSIS RPLU ARM, AAINAME: PHONE (303)534-7325 FAX C Not: (303)623-7325 E-MAIL friedman@ eak360.com ADDRESS:g P INSURERS AFFORDING COVERAGE NAIC # INSURERAArch Specialty Insurance INSURED WellDyne Holding Corporation, WellDyne, Inc.; WellDyneRX, Inc.; Wellsystems 500 Eagles Landing Drive Lakeland FL 33810 INSURER B :Continental Insurance INSURERC:CNA Insurance Company INSURER D:Hartford INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER:CL14121001363 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 ADDL SUER POLICY NUMBER MMIDDY� POLICY DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 A CLAIMS -MADE a OCCUR X LP0052651-00 12/7/2014 12/7/2015 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/OP AGG $ 3,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 X BODILY INJURY (Per person) $ $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS 40269115883 12/7/2014 12/7/2015 NON -OWNED PROPERTY DAMAGE Per accident $ HIRED AUTOS AUTOS $ X I UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 A EXCESS LIAB CLAIMS -MADE DED X RETENTION 10,00C $ FLP0052651-00 12/7/2014 12/7/2015 C WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN E.L. EACH ACCIDENT - $ 1 000 000 , ANY PROPRIETOR/PARTNER/EXECUTIVE [NE]NIA-• OFFICER/MEMBER EXCLUDED? (Mandatory in NH) C5093687712 6/1/2015 6/1/2016 E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under r E.L. DISEASE - POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS below A PROFESSIONAL LIABILITY LP0052651-00 12/7/2014 12/7/2015 OCCURRENCE/AGGREGATE $lM / $3 D TPA E&O LIABILITY 0OPGO257328 12/7/2014 12/7/2015 OCCURRENCE/AGGREGATE $1M / $1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if 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 insured and then only as their interest 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 L;ANL;CLLA I IUN 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 .. "r cr; ACORD 25 (2010/05) INS025 mmnns) ni © 1988-2010 ACORD CORPORATION. All rights reserved. Tha Ar'.r1Rr1 nmmn nnrl Innn nra rnnicfnrarl mnrkc of Ar:rlpn Ac"Rbr CERTIFICATE OF LIABILITY INSURANCE 12/7/2016 DATEcMM/DD/YY(Y) 5/25/2016 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 8110 E. Union Avenue Suite 700 Denver CO 80237 ONTACT NAME: -— PHONE - — FAX - o Ext1: �— E-MAIL --- E-MAIL _ADDRESS: _ INSURER(S) AFFORDING COVERAGE NAIC # (303) 414_6000 INSURER A: Arch Specialty Insurance Con71Jal1Y 21199 INSURED WellDyne RX, Inc. 1405981 500 Eagles Landing Drive Lakeland, FL 33810 INSURER B : Transportation Insurance Colnparty 20494 _ _ INSURER C : Continental Casualty —I� Coin an. 20443 INSURER D : ACE American Insurance Company 22667 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 14149761 REVISION Nt]MRFR- YYYYV ru 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 ADDL INSD SUBR WVDI POLICY EFF POLICY NUMBER MM/DD/YYYY POLICY EXP MM/DD/YYYY " LIMITS A X COMMERCIAL GENERAL LIABILITY J CLAIMS -MADE �, OCCUR N N '7 FLPQ05�651-03 '.. 12/7/2015 2 1_/7/2016 EACH OCCURRENCE $ 1,000,1100 DAMAGE Tb RENTED PREMISES (Ea occurrence) _ $ 100 000 MED EXP (Any one person) _ $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY F. PRO- JECT LOC GENERAL AGGREGATE — $ 310001000 GEN'L PRODUCTS COMP/OP AGG ...... -- $ 3,000,000.... ---. OTHER: $ B AUTOMOBILE LIABILITY N N 5093294681 2/7/2016 2/7/2017 EOa aBcld DISINGLE LIMIT $ 1,000,000 Ix ANY AUTO OWNED SCHEDULED AUTOS ONLY X AUTOS BODILY INJURY (Per person) $ XXXXXXX BODILY INJURY (Per accident) - $ XXXXXXX HIRED AUTOS ONLY X.. AUTOS ONLY PROPERTY DAMAGE (Per accident) $ XXXXXXX $XXXXXXX A X UMBRELLA LIAB }{ OGGUR N N FLP00526.51-03 ' 12/7/2015 12/7/2016 EACH OCCURRENCE $ 3,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 3,00C,00Q DED I RETENTION $ $ XXXXXXX C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NI N / A N 6022940902 6/1/2016 6/1/2017 PER OTH- X STATUTE ER _. E.L. EACH ACCIDENT --- $ T,QQ0,000 E.L. DISEASE - EA EMPLOYEE ._— $ 1,000,000 (Mandatory in NH) If yes, describe under E.L DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below A D Pharmacy Prof. Liability PBM/TPA E&O Liability N N FLP0052651-03 12/7/2015 G25673529 2/7/2016 12/7/2016 2/7/2017 $1,000,000/$3,000.000 $1,000,000/$1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) *Please see attached list of Named Insureds* r' w I , 0 .. f Phi 14148761 City of Santa Ana ATTN: Christy Kindig 20 Civic Center Plaza, M-21 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 r • baf,`A5 l ©1988- 015 ACORD CORPO ATION. All rinhts rasprvort ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Digitally signed Ac"Mor CERTIFICATE OF LIABILA W E DATE (MMIDDIYYYY) �.,.,,� /l4 3 n 11Q2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS WRIGHTS UPON TF c -FxRTIFICATE H LDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGF AF,Qex*tQPOLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A ZITRACT BETWEEN THE ' UING Ii:`zURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy es) A DI D provisions c: be en orsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may rer,uire an en(yeP q,,:4tten�tt7► �J 7.lJo.`} �J lJ D this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).CONTACT PRODUCER Lockton Companies _ NAME, PHONE FAX A/C No): 8110 E Union Avenue Suite 100 Denver CO 80237 E-MAIL ADDRESS: (303) 414-6000 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Arch Specialty Insurance Company 21199 INSURED WellDyneRX, LLC 1477414 500 Eagles Landing Drive INSURER B : Zurich American Insurance Company 16535 INSURER C : ACE American Insurance Company 22667 INSURER D : Berkley Insurance Company 32603 Lakeland, FL 33810 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 14516082 REVISION NUMBER: XXXxxS x 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 ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY N N FLP006017705 2/16/2022 2/16/2023 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE 1XI OCCUR DAMAGE T PREM SESOEa occurrDence $ 100,000 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 n PRO - POLICY F-1 LOC PRODUCTS - COMP/OP AGG $ 3,000,000 $ OTHER: A AUTOMOBILE LIABILITY N N FLP006017705 2/16/2022 2/16/2023 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ XXX)CS XX ANY AUTO OWNED SCHEDULED AUTOS ONLYNAUTOS BODILY INJURY (Per accident) $ XXX�CSCSCS� Xr PROPERTY DAMAGE Per accident $XXXXXXX HIRED NON -OWNED AUTOS ONLYAUTOS ONLY $ XXXyCS xx A X UMBRELLA LIAB X OCCUR N N FLP006017705 2/16/2022 2/16/2023 EACH OCCURRENCE $ 10,000,000 A EXCESS LIAB CLAIMS -MADE Prof. Liab. RetroDate: 2/16/20 X AGGREGATE $ 10,000,000 DED RETENTION $ $ XXXXX� B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A N WC014390905 2/16/2022 2/16/2023 EROTH- X STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 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 Pharmacy Prof. Liab. N 2/16/2022 2/16/2023 $1M/$3M Retro Date: 2/16/2020 C PBM E&O Liab. =FLPOR046017705 2508130002 2/16/2022 2/16/2023 Limit: $3M/Ret $250K D Crime 500242325 2/16/2022 2/16/2023 Limit: $2M per Occ. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Per Agreement Master Agreement A-2007-278 and current agreement A-20180-131-01 with the City of Santa Ana, Proof of Worlcers' Compensation Coverage. 14516082 City of Santa Ana Risk Management Division 20 Civic Center Plaza Santa Ana CA 92701 ACORD 25 (2016103) 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,— Risk M8118gement DMskrn +� �m REVIEWED & APPROVED BY: @ 1 s88-2o ACo The ACORD name and logo are registered marks of ACORD r Risk Management Specialist off IN Miscellaneous Attachment: M577149 Master ID: 1477414, Certificate ID: 14516082 Excess Liability Schedule Carrier Policy Number Limit Lloyd's of London MCFAL1000459 $25,000,000 Lloyd's of London B0180PC2209645 $30,000,000 m Risk Management DlMsian REVIEWED & APPROVED BY: r Risk Management Specialist