HomeMy WebLinkAboutA4939 - DESERT MEDICAL GROUP EMPLOYEE SCREENING DRUG HEPATITIS PHYSICAL Desert Medical Group
Employee Testing
AGREEMENT #4939
CM signed 8-12-04
CITY OF PALM SPRINGS _--
CONTRACT SERVICES AGREEMENT FOR
Employee Testing
THIS CONTRACT SERVICES AGREEMENT (herein "Agreement") is made and entered
into this c�� day of Q�2004, by and between the CITY OF PALM SPRINGS, a municipal
corporation (herein "Ciily')'and Desert Medical Group, (herein "Contractor").
NOW, THEREFORE, the parties hereto agree as follows:
1.0 SERVICES OF CONTRACTOR
1.1 Scope of Services. In compliance with all of the terms and conditions of
this Agreement, the Contractor shall perform the work or services set forth in the "Scope of
Services" attached hereto as Exhibit "A" and incorporated herein by reference. Contractor
warrants that all work and services set forth in the Scope of Services will be performed in a
competent, professional and satisfactory manner.
1.2 Compliance With Law. All work and services rendered hereunder shall
be provided in accordance with all ordinances, resolutions, statutes, rules, and regulations of
the City and any Federal, State or local governmental agency of competent jurisdiction.
1.3 Licenses, Permits, Fees and Assessments. Contractor shall obtain at its
sole cost and expense such licenses, permits and approvals as may be required by law for the
performance of the services required by this Agreement.
2.0 COMPENSATION
2.1 Contract Sum. For the services rendered pursuant to this Agreement,
Contractor shall be compensated in accordance with the "Schedule of Compensation" attached
hereto as Exhibit "B" and incorporated herein by this reference, but not exceeding the maximum
contract amount of Twenty Four Thousand Nine Hundred Dollars ($24,900.00) ("Contract
Sum').
2.2 Method of Payment. Provided that Contractor is not in default under the
terms of this Agreement, Contractor shall be paid as outlined Exhibit "B" Schedule of
Compensation.
3.0 COORDINATION OF WORK
3.1 Representative of Contractor. Rosanna Somaratne is hereby designated
as being the principal and representative of Contractor authorized to act in its behalf with
respect to the work and services specified herein and make all decisions in connection
therewith.
32 Contract Officer. Sue Mills, PHR is hereby designated as being the
representative the City authorized to act in its behalf with respect to the work and services
specified herein and make all decisions in connection therewith ("Contract Officer'). The City
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Manager of City shall have the right to designate another Contract Officer by providing written
notice to Contractor.
3.3 Prohibition Against Subcontracting or Assignment. Contractor shall not
contract with any entity to perform in whole or in part the work or services required hereunder
without the express written approval of the City. Neither this Agreement nor any interest herein
may be assigned or transferred, voluntarily or by operation of law, without the prior written
approval of City. Any such prohibited assignment or transfer shall be void.
3.4 Independent Contractor. Neither the City nor any of its employees shall
have any control over the manner, mode or means by which Contractor, its agents or
i employees, perform the services required herein, except as otherwise set forth. Contractor
shall perform all services required herein as an independent contractor of City and shall remain
under only such obligations as are consistent with that role. Contractor shall not at any time or
in any manner represent that it or any of its agents or employees are agents or employees of
City.
4.0 INSURANCE AND INDEMNIFICATION
4.1 Insurance. The Contractor shall procure and maintain, at its sole cost
and expense, in a form and content satisfactory to City, during the entire term of this Agreement
including any extension thereof, the following policies of insurance:
(a) Commercial General Liability Insurance. A policy of commercial general liability
insurance written on a per occurrence basis with a combined single limit of a least
$1,000,000 bodily injury and property damage including coverages for contractual
liability, personal injury, independent contractors, broadform property damage, products
and completed operations. The General Liability Policy shall name the City of Palm
Springs, its officers, employees, and agents, as additional insured in accordance with
standard ISO additional insured endorsement form CG2010(1185) or equivalent
language.
(b) Worker's Compensation Insurance. A policy of worker's compensation insurance
in such amount as will fully comply with the laws of the State of California and which will
include $1,000,000 employer's liability.
(c) Business Automobile Insurance. A policy of business automobile liability
insurance written on a per occurrence basis with a single limit liability in the amount of
$1,000,000 bodily injury and property damage, Said policy shall include coverage for
owned, non-owned, leased and hired cars.
(d) Additional Insurance. Policies of such other insurance, including professional liability
insurance in a minimal amount of $1,000,000 if contract has professional liability
exposure, as may be required in Exhibit"C".
All of the above policies of insurance shall be primary insurance. The insurer shall
waive all rights of subrogation and contribution it may have against the City, its officers,
employees and agents, and their respective insurers. In the event any of said policies of
insurance are canceled, the Contractor shall, prior to the cancellation date, submit new
evidence of insurance in conformance with this Section 4.1 to the Contract Officer. No work or
services under this Agreement shall commence until the Contractor has provided the City with
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Certificates of Insurance or appropriate insurance binders evidencing the above insurance
coverages and said Certificates of Insurance or binders are approved by the City.
The contractor agrees that the provisions of this Section 4.1 shall not be construed as
limiting in any way the extent to which the Contractor may be held responsible for the payment
of damages to any persons or property resulting from the Contractor's activities or the activities
of any person or person for which the Contractor is otherwise responsible.
In the event the Contractor subcontracts any portion of the work in compliance with
Section 3.3 of this Agreement the contract between the Contractor and such subcontractor shall
require the subcontractor to maintain the same polices of insurance that the Contractor is
required to maintain pursuant to this Section.
4.2 Indemnification. Contractor agrees to indemnify the City, its officers,
agents and employees against, and will hold and save them and each of them harmless from,
any and all actions, suits, claims, damages to persons or property, losses, costs, penalties,
obligations, errors, omissions or liabilities, (herein "claims or liabilities") that may be asserted or
claimed by any person, firm or entity arising out of or in connection with the negligent
performance of the work, operations or activities of Contractor, its agents, employees,
subcontractors, or invitees, provided for herein, or arising from the negligent acts or omissions
of Contractor hereunder, or arising from Contractor's negligent performance of or failure to
perform any term, provision, covenant or condition of this Agreement, whether or not there is
concurrent passive or active negligence on the part of the City, its officers, agents or employees
but excluding such claims or liabilities arising from the sole negligence or willful misconduct of
the City, its officers, agents or employees, who are directly responsible to the City, and in
connection therewith:
(a) Contractor will defend any action or actions filed in connection
with any of said claims or liabilities and will pay all costs and expenses, including legal costs
and attorneys' fees incurred in connection therewith;
(b) Contractor will promptly pay any judgment rendered against the
City, its officers, agents or employees for any such claims or liabilities arising out of or in
connection with the negligent performance of or failure to perform such work, operations or
activities of Contractor hereunder; and Contractor agrees to save and hold the City, its officers,
agents, and employees harmless therefrom;
(c) In the event the City, its officers, agents or employees is made a
party to any action or proceeding filed or prosecuted against Contractor for such damages or
other claims arising out of or in connection with the negligent performance of or failure to
perform the work, operation or activities of Contractor hereunder, Contractor agrees to pay to
the City, its officers, agents or employees, any and all costs and expenses incurred by the City,
its officers, agents or employees in such action or proceeding, including but not limited to, legal
costs and aftorneys'fees.
5.0 TERM
5.1 Term. Unless earlier terminated in accordance with Section 5.2 below,
this Agreement shall continue in full force until June 30, 2005,
5.2 Termination Prior to Expiration of Term. Either party may terminate
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this Agreement at any time, with or without cause, upon thirty (30) days' written notice to the
other party. Upon receipt of the notice of termination, the Contractor shall immediately cease all
work or services hereunder except as may be specifically approved by the Contract Officer. In
the event of termination by the City, Contractor shall be entitled to compensation for all services
rendered prior to the effectiveness of the notice of termination and for such additional services
specifically authorized by the Contract Officer and City shall be entitled to reimbursement for
any compensation paid in excess of the services rendered.
6.0 MISCELLANEOUS
6.1 Covenant Against Discrimination. Contractor covenants that, by and for
1 itself, its heirs, executors, assigns and all persons claiming under or through them, that there
-1, shall be no discrimination against or segregation of, any person or group of persons on account
of race, color, creed, religion, sex, marital status, national origin, or ancestry in the performance
of this Agreement. Contractor shall take affirmative action to ensure that applicants are
employed and that employees are treated during employment without regard to their race, color,
creed, religion, sex, marital status, national origin or ancestry.
6.2 Non-liability of City Officers and Employees. No officer or employee of
the City shall be personally liable to the Contractor, or any successor in interest, in the event of
any default or breach by the City or for any amount which may become due to the Contractor or
to its successor, or for breach of any obligation of the terms of this Agreement.
6.3 Conflict of Interest. No officer or employee of the City shall have
any financial interest, direct or indirect, in this Agreement nor shall any such officer or employee
participate in any decision relating to the Agreement which effects his financial interest or the
financial interest of any corporation, partnership or association in which he is, directly or
indirectly, interested, in violation of any State statute or regulation. The Contractor warrants that
it has not paid or given and will not pay, or give any third party any money or other consideration
for obtaining this Agreement.
6A Notice. Any notice, demand, request, document, consent, approval, or
communication either party desires or is required to give to the other party or any other person
shall be in writing and either served personally or sent by prepaid, first-class mail, in the case of
the City, to the City Manager and to the attention of the Contract Officer, CITY OF PALM
SPRINGS, P.O. Box 2743, Palm Springs, California 92263, and in the case of the Contractor, to
the person at the address designated on the execution page of this Agreement.
6.5 Interpretation. The terms of this Agreement shall be construed in
accordance with the meaning of the language used and shall not be construed for or against
either party by reason of the authorship of this Agreement or any other rule of construction
which might otherwise apply.
6.6 Integration; Amendment. It is understood that there are no oral
agreements between the parties hereto affecting this Agreement and this Agreement
supersedes and cancels any and aft previous negotiations, arrangements, agreements and
understandings, if any, between the parties, and none shall be used to interpret this Agreement.
This Agreement may be amended at any time by the mutual consent of the parties by an
instrument in writing.
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6.7 Severability. In the event that part of this Agreement shall be declared
invalid or unenforceable by a valid judgment or decree of a court of competent jurisdiction, such
invalidity or unenforceability shall not affect any of the remaining portions of this Agreement
which are hereby declared as severable and shall be interpreted to carry out the intent of the
parties hereunder unless the invalid provision is so material that its invalidity deprives either
party of the basic benefit of their bargain or renders this Agreement meaningless.
6.8 Waiver. No delay or omission in the exercise of any right or remedy by a
nondefaulting party on any default shall impair such right or remedy or be construed as a
waiver. A party's consent to or approval of any act by the other party requiring the parry's
consent or approval shall not be deemed to waive or render unnecessary the other parry's
consent to or approval of any subsequent act. Any waiver by either party of any default must be
in writing and shall not be a waiver of any other default concerning the same or any other
provision of this Agreement.
6.9 Attorneys' Fees. If either party to this Agreement is required to initiate or
defend or made a party to any action or proceeding in any way connected with this Agreement,
the prevailing party in such action or proceeding, in addition to any other relief which may be
granted, whether legal or equitable, shall be entitled to reasonable attorney's fees, whether or
not the matter proceeds to judgment.
6.10 Corporate Authority. The persons executing this Agreement on behalf of
the parties hereto warrant that (i) such parry is duly organized and existing, (ii) they are duly
authorized to execute and deliver this Agreement on behalf of said party, (iii) by so executing
this Agreement, such party is formally bound to the provisions of this Agreement, and (iv) the
entering into this Agreement does not violate any provision of any other Agreement to which
said party is bound.
SIGNATURES ON NEXT PAGE
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IN WITNESS WHEREOF, the parties have executed and entered into this Agreement as of the
date first written above.
CITY OF PALM SPRINGS
ATTEST: a municipal corporation
City Clerk City Manager
Agreement rivc,1177,1der $25 000 Q r ,,„! rr� ; l
n unOha�N,.. x r c!r fG4'Ip C h`!_„
Vevaeweat ssna@ approved by W i�_��✓'�
CONTRACTOR: Desert Coll tract!lfg9eck one:_Individual_Partnershi4corporation
275 N. El Cielo Road
Palm SpriiN fiS&92262 (�7 ID.te 11,Y
Corporations require two notari p q FAig1Sf4MhVTne from each of the following: A. C an of Board, President, or any Vice
President:AND B.Secretary,Assistant Secretary,Treasurer,Assistant Treasurer,qr Ch' f F' a cial Officer).
$ I-) ' . {\
By: By:
Signature (notarized) Signature(notarized)
Name: a '. , , ��G III ��9 WI/ P Name: 46L " -/�
1,
Title: \/- �- 01i (t7jA .)-4-6 Title:
Address: G,� � JV. b... - ._af Address:
Slate of_� State of Th I
Counyof 9p s1b;CA--- ASI Counyof fir/ s
On___before me, On before me, ,
personally appeared personally appeared
personally known to me (or proved to me on the basis-of personally (mown to me (or proved to me on the basis of
satisfactory evidence) to be the person(s) whose name(s) satisfactory evidence) to be the person(s) whose name(s)
is/are subscribed to the within instrument and acknowledged is/are subscribed to the within instrument and acknowledged
to me that he/she/they executed the same in his/her/their to me that he/she/they executed the same in his/her/their
authorized capacity(ies), and that by his/her/their signature(s) authorized capacity(ies), and that by his/her/their signature(s)
on the instrument the person(s), or the entity upon behalf of on the instrument the person(s), or the entity upon behalf of
which the person(s)acted,executed the instrument. which the person(s)acted,executed the instrument.
WITNESS my hand and official seal. WITNESS my hand and official seal.
Notary Signature: Notary Signature:
Notary Seal: Notary Seal:
Contractor shall perform a variety of pre-employment screening and inoculation services on an
as-needed basis to support the activities of the City's Human Resources Department.
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SCHEDULE B
SCHEDULE OF COMPENSATION
Total compensation for services and expenses provided hereunder shall not exceed
$24,900.00.
DMV Physicals $50.00
TB (PPD)Test $15.00
Hepatitis A Vaccine $62.00
Hepatitis B Vaccine $56.00 (per shot series of 3)
CLASS 1:
Physical (UA) Vision $50.00
Drug Screen Collection $10.00
Drug Screen Test $22.00
TOTAL FEES $82.00
CLASS 2:
Physical (UA) Vision $50.00
Whisper Test $10.00
Drug Screen Collection $10.00
Drug Screen Test $22.00
TOTAL FEES$92.00
CLASS 3:
Physical (UA) Vision $ 61.00
Drug Screen Collection $ 10.00
Drug Screen Test $ 22.00
T.B. Test $ 15.00
Spirometry $ 35.00
Chem. Panel $ 13.50
Meta Panel $ 13.50
Treadmill $125.00 (Rao/Bellaci)
Hepatitis B Antigen $ 10.00
Hepatitis A Antibody $ 22.00
Hepatitis B Antibody $ 20.00
Hepatitis C Antibody $ 30.00
TOTAL FEES $377.00
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EXHIBIT "C"
SPECIAL CONDITIONS
Section 4.1 (c), 'Business Automobile Insurance' is eliminated.
Section 4.1 (d), "Additional Insurance" -A policy of medical professional liability insurance
written on an occurrence or claims made basis with limits of a minimum of$1,000,000 is
required.
a
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Jul • 12 . 2004_ 5 :4 8 P M Na •5063 P - 1
ACORD� CERTIFICATE OF LIABILITY INSURANCE o-1iiziz0o
PRODUCER (714)990-4430 FAX (714)255-0872 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown of CA Inc Lic OR02587 ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE
DBA: Heal chCare Professionals' IRS Services HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO Box 9699
Brea, CA 92822-9699 INSURERS AFFORDING COVERAGE NAIC 9
INSURED Desert medical Group Inc INSURERA: St Paul/Fidelity & Guaranty Ins
275 N. E1 Cielo Way INSURERS:
Suite C INSURER C:
Palm Springs, CA 92262 INSURERD;
INSURER t
OVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.41$*SUEDOR
N
ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY MAY PERTAIN•THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND COPOLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ME TVPE OF INSURANCE POLICYNUMNER POUCYEPFECTVE POLICYEXINRATION LIMITGSNE UJIEILITY BKO1598191 12/O8/2003 12/68/2004 EACROCCURRENCE- 0X COMMERCuu.GENERALLIABILITY DAMAG TO RENTEDOCLAWSMADE 1OCCUR MEDEXP(Anyanewwn) 00
A PERSONA,SAOV INJURY S 1 00pON
GENERAL AGGREGATE B 2,000,00
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP)OPAGG $ 2,000,00
x POLICY ;GAT 7 LOC
AVTOMOWLE LIABILITY COMBINED SINGLE LIMIT
ANY AUTO
(Enacddent) S
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (PU Paso") $
HIREDAUTOS
BODILY INJURY S
NON-OWNED AUTOS (Pw accidvt)
PROPERTY DAMAGE %
GARAGELMBIOTY AUTO ONLY-EA ACCIDENT S
ANY AUTO OTHERTHAN EA ACC S AUTO ONLY: AGG S
EXCESSA MBRELLr�A LIABILITY EACH OCCURRENCE 3 u
OCCUR CLAIMS MADE AGGREGATE S
5
DEDUCTIBLE 5
RETENTION 5 S
WORKERS COMPENSATION AND WC STATU- OTH-
EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNERIEXECUTIVE EL EACHACCIDENT 5
OFnCERIAEMBER EXCLUDED? E.L.DISEASG-[A Q.1ttOY[ S
11 yH,d?6tf®e Modal
SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMB S
DTN�T BKO1598191 12/08/2003 12/08/2004 Contents Limit $1,514,700
A a Contents
peciall Form including Computer Hardware Included
Special
Theft
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDGRSEMENTI SPECUU.PROVISIONS
ulti-specialty medical Group (including occupational medicine)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE MOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
WMRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL
RATS WRITTEN NOTICE TO THE.CERTIFICATE HOLDER NAMED TO THE LEFT
City Of Palm Springs mr FIUIUp MAIL CH TILE SHALLI OBL GADON OR LMNLRY
3200 East Tahquitz Canyon Way OFA UPON TH INSUR P.ITS AG RE RSENTATIVES.
Palm Springs, CA 92263 AUPCOOM R�RF;3 NT nVE
It
ACORD 25(2001168) ®ACORD CORPORATION 1088
TDC CERTIFICATE OF INSURANCE
• Claims Made Medical Professional Liability:
Insured's Name&Professional Office Premises:
This certificate is issued as a matter of information
Desert Medical Group and confers no rights upon the certificate holder.
275 North El Cielo Way This certificate does not amend, extend or alter the
Palm Springs, California 92262 coverage afforded by the policy described below.
Producer&Address(if applicable):
Stop Loss Insurance Brokers, Inc,
The Above Insured is: One World Trade Center, Suite 1980
. I ® A Named Insured ❑ An Additional Insured Long Beach, California 90831
` ❑ A Rostered Physician ❑ An Additional Named Insured
Telephone: (800)603.3311 Facsimile(562)435.4007
Specialty: Policy Number: 0067202
Retroactive Date: Policy Period: Issue Date:
91111986 01101104 To: 01101105 11612003
Coverage Limits of Liability
Professional Liability-per claim $ 1,000,000
Professional Office Premises Liabilitv
A. Bodily Injury Liability-per claim $ ----
B. Property Damage Liability-per claim $
C. The Per Accident Limit of Liability shall not exceed $
Annual Aggregate Limit of Liability per Policy Year Shall Not Exceed $ 3,000,000
Certificate Holder:
I. LOCUM TENENS AND ADDITIONAL INSUREDS SHARE LIMITS OF LIABILITY WITH THE NAMED INSURED,
II. SHOULD THE ABOVE DESCRIBED POLICY BE CANCELED OR THE TERMS AND CONDITIONS OF THE POLICY BE CHANGED
BEFORE THE EXPIRATION DATE THEREOF,THE DOCTORS'COMPANY IS UNDER NO OBLIGATION OR LIABILITY OF ANY KIND
TO NOTIFY THE CERTIFICATE HOLDER.
III. PHOTOCOPIES OF THE CERTIFICATE OF INSURANCE ARE DEEMED AS VALID AS THE ORIGINAL. n
Authorized Representative(if applicable)
THE DOCTORS'COMPANY
185 GREENWOOD ROAD,P.O.BOX 2900,NAPA,CA 94558-0900
(707)225.0100,(e00)421-ease
nAT (MMmDNY)
ACORD,M CERTIFICATE OF doe=aBLITY NSURANCE 07.16.04
PRODUCER THIS CFATIPICATE IS ISSUED AS A MATTER OF INFORMATION
Stop Loss Insurance Brokers, Inc. ONLY AND CONFERS NO RIGHT'S UPON THE CERTIFICATE
IdCLOEP- THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
One World "Grade Center, Suite 1950 ALTERTHE COVERAGE AFFORDED DYTME POLICIES BELOW
Long Reach, California 90831 INSURERS AFFORDING COVERAGE:
INSURED INSURER A- St Paul/-travelers
Desert Medical Group INSURER B:
Heritage Network Provider INaultereC:
8510 Balboa Boulevard, Suite 275 INSURER D:
Northridge, California 91325 INSURER E:
COVERAGES
NE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDINO
ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CVERTIFICATF MAY BE ISSUED OR MAY
PERTAIN,THE INSURANCE AFFORDED DY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL OF THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
MR
LTF TYPE OF INSURANCE POLICY NUMBER •au°yaTECfroB r°Irym�arax
BATe IMNMY DATE Try, LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any One Flm) $
CLAIMS MADE OCCUR MED EXP(Any One Person) $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG
POLICY PRO- LOC
JEOT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
ANY AUTO (Ea Accitlenl)
ALL OWNED AUTOS BODILY INJURY
SCHEDULED AUTOS (Per I'mun)
HIREDAUTOS BODILY INJURY $
NON-OWNED AUTOS (Pe{AC(ddent)
PF2OPERTY�AMAGE $(Per Accident)
GARAGE LUIBIUTY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA $
_., AUTO ONLY: ACC
AGG $
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ -
WORKERSCOPENSATIONAND W"TUMITS ER $
EMPLOYERS LIABILITY TC2JUBd19J196103 U/9/03 8/1/p4
EL-EACH ACCIDENT S1,D00�00D
EL DISEASE-EA EMPLOYEE $1,000,000
OTHER - .. EL-POLICY LIMIT $1,000 ODD
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLE81EXCLUSIONSADOED BYE 0C)RSEMENTISPECIAL PROVISIONS
CEPTIFICATE HOLDER w°Irrork,Nwlsaxvmer,Lettoe CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLK'IM RE CANCELLED BEFORE T E EXPIRATION
DATE THEREOF,THE ISSUING INWRER WILL ENOSAUGR-;O-MAIL—A—DAYS WRITTEN
NOTICETO THE CERTIFICATE NOLDER NAMED TD THE LEFT,BUT FAIWRE 2P DO.=SMA6
iMP(#YE Np-0pL-I&ATgN DI'-I.WGIH7KOP AN.YX{NP.yPONSJ{PJNSURER r"-e.:a:::OR
T—
I a�PEnt]RA
kCOR025S
€=ORD CORPORA110H 1988
, ..F., nnn•ni a.n_ni _rnn �nnnwcer.vnC�•nnlr ouv�nuO vnnn.unon,r Donn �nin •[� „ ��
z 'A RPM CERTIFICATE OF LIABILITY INSURANCE o% s/20a
PRODUCER (714)990-4430 FAX (714)255-0872 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Brown & Brown of CA Inc Lic OB02587 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
DBA: Heal thCare Professionals' Ins Services HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO Box 9699
Brea, CA 92822-9699 INSURERS AFFORDING COVERAGE NAIC#
INSURED Desert Medical Group Inc INSURERA St Paul/Fidelity & Guaranty Ins
Attn: Kay Etsell-Gillette INSURER
275 N El Cielo Way Suite C INSURER
Palm Springs, CA 92262 INSURERD:
INSURER E
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDINI
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 ADD-L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS_
GENERAL LIABILITY BKO1598191 12/08/2003 12/08/2004 EACH OCCURRENCE $.- 1,000.;000
X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S • . 1,000,000
CLAIMS MADE ff] OCCUR MED EXP(Any one person) S 5,D00
A PERSONAL&ADV INJURY $- 1,ODD,Poo
GENERAL AGGREGATE $ 12,000-,000
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG 2,000i,ODD
X POLICY PRO- _
JECT LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
ANY AUTO (Ea accident)
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS
BODILY INJURY $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN EA ACC $
AUTO ONLY AGO $
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $
OCCUR 171 CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND WC STATU- OTH-
EMPLOVERS'LIABILITY
ANY PROPRIETOPoPARTNEWEXECUTIVE - _-- - -- - - E.L.EACH..ACCIDENT $ - --
OFFICER/MEMBER EXCLUDED? E L DISEASE-EA EMPLOYE $
If yes,describe under
SPECIAL PROVISIONS below E L DISEASE-POLICY LIMIT $
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Multi-Specialty Medical Group
Certificate holder is also named as Additional Insured
Form C attached
*Ten Day Notice of Cancellation for non-payment of premium.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
City of Palm Springs BUT FAILURE TO MAIL SUCH/yOTIC\BHA LL IMPOSE NO
OBLIGATION OR LIABILITY
3200 East Tahquitz Canyon Way OF/ANY NDUPON THE N.BRIER,ITS AGENTS ORRIS RESENTATIVES.
Palm Springs, CA 92263 AUTH RIZ DR PRESENTATIV
ACORD 25(2001/08) OACORD CORPORATION 1988
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)
a
r
7
Z
Policy Number: RKO1598191
Owners, Lessees Or Contractors (Form Q
ADDITIONAL INSURED
Changels)Effective 07/29/2004
r-
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
LIABILITY COVERAGE PART
m
a Schedule -
Name of Person or Organization:
m
rn
° CITY OF PALM SPRINGS
m 3200 EST TAHOUITZ CANYON WAY
o PALM SPRINGS,CA 92263
U
a
1. SECTION II - WHO IS AN INSURED is amended to valid and collectible 'other insurance" is provided
include as an insured the person or organization shown by a person or organization who is not shown in
in the Schedule, but only with respect to liability arising the schedule. Then we will share with that valid
out of "your work"for that insured by or for you. and collectible 'other Insurance" by the method
described below.
2. With respect to 1. above the following additional
provision applies: If all of the valid and collectible 'other insurance"
permits contribution by equal shares, we will
SECTION IV. 5. Other Insurance is replaced by the follow this method also Under this approach, each
following: insurer contributes equal amounts until it has paid
its applicable limit of insurance or none of the loss
5. Other Insurance. remains, whichever comes first.
The insurance afforded by this Coverage Part is If any of the valid and collectible 'other insurance"
primary insurance and we will not seek does not permit contribution by equal shares, we
contribution from any valid and collectible 'other will contribute by limits. Under this method, each
nsurance11 available to the Insured unless the Insurer's share is based on the ratio of its
applicable limit of insurance to the total applicable
limits of insurance of all insurers.
CL/BF 2245 09 99 Includes copyrighted material of Insurance e Services Office,Inc.,with its permission Page 1 of 1
Copyrighted,Insurance Services Office, Inc,1984