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HomeMy WebLinkAboutOccupational Health Centers of California dba Concentra Medical Centers; 2024-12-19;City Attorney Approved Version 5/22/2024 Page 1 AGREEMENT FOR HEALTHCARE SERVICES OCCUPATIONAL HEALTH CENTERS OF CALIFORNIA, A MEDICAL CORPORATION, dba CONCENTRA MEDICAL CENTERS THIS AGREEMENT is made and entered into as of the ______________ day of December, 2024, by and between the City of Carlsbad, California, a municipal corporation ("City") and Occupational Health Centers of California, a Medical Corporation, dba Concentra Medical Centers, a medical corporation ("Contractor"). RECITALS A. City requires the professional services of a consultant that is experienced in healthcare services including pre-employment medical testing. B. Contractor has the necessary experience in providing professional services and advice related to healthcare services. C. Contractor has submitted a proposal to City and has affirmed its willingness and ability to perform such work. NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, City and Contractor agree as follows: 1. SCOPE OF WORK City retains Contractor to perform, and Contractor agrees to render, those services (the "Services") that are defined in attached Exhibit "A," which is incorporated by this reference in accordance with this 2. STANDARD OF PERFORMANCE While performing the Services, Contractor will exercise the reasonable professional care and skill customarily exercised by reputable members of Contractor's profession practicing in the Metropolitan Southern California area, and will use reasonable diligence and best judgment while exercising its professional skill and expertise. 3. TERM The term of this Agreement will be effective for a period of five (5) year(s) from the date first above written. 4. TIME IS OF THE ESSENCE Time is of the essence for each and every provision of this Agreement. 5. COMPENSATION The total fee payable for the Services to be performed during the initial Agreement term shall not exceed forty-five thousand dollars ($45,000) per Agreement year. No other compensation for the Services will be allowed except for items covered by subsequent amendments to this Agreement. Incremental payments, if applicable, should be made as outlined in attached Exhibit "A." Contractor shall invoice City weekly and City shall remit payment to Contractor within thirty (30) days of receipt of invoice. City agrees to pay any sales, use, excise or similar taxes applicable to the Services provided for hereunder. Docusign Envelope ID: FDA69189-767D-40A1-A65E-784FB7ABAEC9 19th Agreement's terms and conditions. City Attorney Approved Version 5/22/2024 Page 2 6. STATUS OF CONTRACTOR Contractor will perform the Services in Contractor's own way as an independent contractor and in pursuit of Contractor's independent calling, and not as an employee of City. Contractor will be under control of City only as to the result to be accomplished, but will consult with City as necessary. The persons used by Contractor to provide services under this Agreement will not be considered employees of City for any purposes. The payment made to Contractor pursuant to the Agreement will be the full and complete compensation to which Contractor is entitled. City will not make any federal or state tax withholdings on behalf of Contractor or its agents, employees or subcontractors. City will not be required to pay any workers' compensation insurance or unemployment contributions on behalf of Contractor or its employees or subcontractors. Contractor agrees to indemnify City within thirty (30) days for any tax, retirement contribution, social security, overtime payment, unemployment payment or workers' compensation payment which City may be required to make on behalf of Contractor or any agent, employee, or election, City may deduct the indemnification amount from any balance owing to Contractor. 7. SUBCONTRACTING Contractor will not subcontract any portion of the Services without prior written approval of City. If Contractor subcontracts any of the Services, Contractor will be fully responsible to City for the acts and omissions of Contractor's subcontractor and of the persons either directly or indirectly employed by the subcontractor, as Contractor is for the acts and omissions of persons directly employed by Contractor. Nothing contained in this Agreement will create any contractual relationship between any subcontractor of Contractor and City. Contractor will be responsible for payment of subcontractors. Contractor will bind every subcontractor and every subcontractor of a subcontractor by the terms of this Agreement applicable to Contractor's work unless specifically noted to the contrary in the subcontract and approved in writing by City. 8. OTHER CONTRACTORS The City reserves the right to employ other Contractors in connection with the Services. 9. INDEMNIFICATION Contractor agrees to defend (with counsel approved by the City), indemnify, and hold harmless the City and its officers, elected and appointed officials, employees and volunteers from and against all claims, damages, losses and expenses including attorneys fees arising out of the performance of the work described herein caused by any negligence, recklessness, or willful misconduct of the Contractor, any subcontractor, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable. Contractor and only to the extent required by Civil Code Section 2782.8, which is fully incorporated herein, Contractor the negligence, recklessness, or willful misconduct of the Contractor, and, upon Contractor obtaining a - Docusign Envelope ID: FDA69189-767D-40A1-A65E-784FB7ABAEC9 subcontractor of Contractor for work done under this Agreement. At the City's If Contractor's obligation to defend, indemnify, and/or hold harmless arises out of 's performance as a "design professional" (as that term is defined under Civil Code section 2782.8), then, 's indemnification obligation shall be limited to claims that arise out of, pertain to, or relate to final adjudication by a court of competent jurisdiction. Contractor's liability for such claim, including the cost to defend, shall not exceed the Contractor's proportionate percentage of fault. The parties expressly agree that any payment, attorney's fee, costs or expense City incurs or makes to or on behalf of an injured employee under the City's self administered workers' compensation is included as City Attorney Approved Version 5/22/2024 Page 3 a loss, expense or cost for the purposes of this section, and that this section will survive the expiration or early termination of this Agreement. 10. INSURANCE Contractor will obtain and maintain for the duration of the Agreement and any and all amendments, insurance against claims for injuries to persons or damage to property which may arise out of or in agents, representatives, employees or subcontractors. The insurance will be obtained from an insurance carrier admitted and authorized to do business in the State of California. The insurance carrier is required to have a current Best's Key Rating of not less than "A-:VII"; OR Approved Surplus Line Insurers OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. 10.1 Coverages and Limits. Contractor will maintain the types of coverages and minimum limits indicated below, unless Risk Manager or City Manager approves a lower amount. These minimum amounts of coverage will not constitute any limitations or cap on Contractor's indemnification obligations under this Agreement. City, its officers, agents and employees make no representation that the limits of the insurance specified to be carried by Contractor pursuant to this Agreement are adequate to protect Contractor. If Contractor believes that any required insurance coverage is inadequate, Contractor will obtain such additional insurance coverage, as Contractor deems adequate, at Contractor's sole expense. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. 10.1.1 Commercial General Liability (CGL) Insurance. including personal & advertising injury, with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. 10.1.2 Automobile Liability. (if the use of an automobile is involved for Contractor's work for City). $2,000,000 combined single-limit per accident for bodily injury and property damage. 10.1.3 Workers' Compensation and Employer's Liability. Workers' Compensation limits as required by the California Labor Code. Workers' Compensation will not be required if Contractor has no employees and provides, to City's satisfaction, a declaration stating this. 10.1.4 Professional Liability. Professional medical malpractice liability appropriate to for a period of five years following the date of completion of the work. 10.2 Additional Provisions. Contractor will ensure that the policies of insurance required under this Agreement contain, or are endorsed to contain, the following provisions: 10.2.1 The City will be named as an additional insured on Commercial General Liability which shall provide primary coverage to the City. 10.2.2 Contractor will obtain occurrence coverage, excluding Professional Liability, which will be written as claims-made coverage. Docusign Envelope ID: FDA69189-767D-40A1-A65E-784FB7ABAEC9 connection with performance of the services by Contractor or Contractor's with a surplus line insurer on the State of California's List of (LASLI) with a rating in the latest Best's Key Rating Guide of at least "A:X"; ________________ Insurance written on an "occurrence" basis, Contractor's profession with limits of not less than $1,000,000 per claim. Coverage must be maintained City Attorney Approved Version 5/22/2024 Page 4 10.2.3 If Contractor maintains higher limits than the minimums shown above, the City requires and will be entitled to coverage for the higher limits maintained by Contractor. Any available insurance proceeds in excess of the specified minimum limits of insurance 10.2.4 This insurance will be in force during the life of the Agreement and any extensions of it and will not be canceled without thirty (30) days prior written notice to City sent by certified mail pursuant to the Notice provisions of this Agreement. 10.3 Providing Certificates of Insurance and Endorsements. Prior to City's execution of this Agreement, Contractor will furnish certificates of insurance and endorsements to City. 10.4 Failure to Maintain Coverage. If Contractor fails to maintain any of these insurance coverages, then City will have the option to declare Contractor in breach, or may purchase replacement insurance or pay the premiums that are due on existing policies in order to maintain the required coverages. Contractor is responsible for any payments made by City to obtain or maintain insurance and City may collect these payments from Contractor or deduct the amount paid from any sums due Contractor under this Agreement. 10.5 Submission of Insurance Policies. City reserves the right to require, at any time, complete and certified copies of any or all required insurance policies and endorsements. 11. BUSINESS LICENSE Contractor will obtain and maintain a City of Carlsbad Business License for the term of the Agreement, as may be amended from time-to-time. 12. ACCOUNTING RECORDS Contractor will maintain complete and accurate records with respect to costs incurred under this Agreement. All records will be clearly identifiable. Contractor will allow a representative of City during normal business hours to examine, audit, and make transcripts or copies of records and any other documents created pursuant to this Agreement. Contractor will allow inspection of all work, data, documents, proceedings, and activities related to the Agreement for a period of four (4) years from the date of final payment under this Agreement. 13. OWNERSHIP OF DOCUMENTS All work product produced by Contractor or its agents, employees, and subcontractors pursuant to this Agreement is the property of City. In the event this Agreement is terminated, all work product produced by Contractor or its agents, employees and subcontractors pursuant to this Agreement will be delivered at once to City. Contractor will records. 14. COPYRIGHTS Contractor agrees that all copyrights that arise from the services will be vested in City and Contractor relinquishes all claims to the copyrights in favor of City. 15. NOTICES The name of the persons who are authorized to give written notice or to receive written notice on behalf of City and on behalf of Contractor under this Agreement are: Docusign Envelope ID: FDA69189-767D-40A1-A65E-784FB7ABAEC9 and coverage will be available to the City." have the right to make one (1) copy of the work product for Contractor's City Attorney Approved Version 5/22/2024 Page 5 For City: For Contractor: Name Paul Ho Name Concentra Health Services, Inc. Title HR Manager Title Attn: Legal Contracts Dept Human Resources Address 5080 Spectrum Drive, Suite 1200W CITY OF CARLSBAD ADDISON, TEXAS 75001 Address 1635 Faraday Ave Phone 800-232-3550 Carlsbad CA 92008 Email legalcontracts@concentra.com Phone Email 760-621-1223 Bao.Ho@carlsbadca.gov Each party will notify the other immediately of any changes of address that would require any notice or delivery to be directed to another address. 16. CONFLICT OF INTEREST Contractor shall file a Conflict of Interest Statement with the City Clerk in accordance with the requirements of the City of Carlsbad Conflict of Interest Code. The Contractor shall report investments or interests as required in the City of Carlsbad Conflict of Interest Code. Yes No If yes, list the contact information below for all individuals required to file: Name Email Phone Number 17. GENERAL COMPLIANCE WITH LAWS Contractor will keep fully informed of federal, state and local laws and ordinances and regulations which in any manner affect those employed by Contractor, or in any way affect the performance of the Services by Contractor. Contractor will at all times observe and comply with these laws, ordinances, and regulations and will be responsible for the compliance of Contractor's services with all applicable laws, ordinances and regulations. Contractor will be aware of the requirements of the Immigration Reform and Control Act of 1986 and will comply with those requirements, including, but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants whose services are required by this Agreement. 18. CALIFORNIA AIR RESOURCES BOARD (CARB) ADVANCED CLEAN FLEETS REGULATIONS -duty package delivery vehicles operated in California may be subject to the California Air Resources Board (CARB) Advanced Clean Fleets regulations. Such vehicles may therefore be subject to requirements to reduce emissions of air pollutants. For more information, please visit the CARB Advanced Clean Fleets webpage at https://ww2.arb.ca.gov/our-work/programs/advanced-clean-fleets. Docusign Envelope ID: FDA69189-767D-40A1-A65E-784FB7ABAEC9 □ Contractor's vehicles with a gross vehicle weight rating greater than 8,500 lbs. and light City Attorney Approved Version 5/22/2024 Page 6 19. DISCRIMINATION AND HARASSMENT PROHIBITED Contractor will comply with all applicable local, state and federal laws and regulations prohibiting discrimination and harassment. 20. DISPUTE RESOLUTION If a dispute should arise regarding the performance of the Services the following procedure will be used to resolve any questions of fact or interpretation not otherwise settled by agreement between the parties. Representatives of Contractor or City will reduce such questions, and their respective views, to writing. A copy of such documented dispute will be forwarded to both parties involved along with recommended methods of resolution, which would be of benefit to both parties. The representative receiving the letter will reply to the letter along with a recommended method of resolution within ten (10) business days. If the resolution thus obtained is unsatisfactory to the aggrieved party, a letter outlining the disputes will be forwarded to the City Manager. The City Manager will consider the facts and solutions recommended by each party and may then opt to direct a solution to the problem. In such cases, the action of the City Manager will be binding upon the parties involved, although nothing in this procedure will prohibit the parties from seeking remedies available to them at law. 21. TERMINATION In the event of the Contractor's failure to prosecute, deliver, or perform the Services, City may terminate this Agreement for nonperformance by notifying Contractor by certified mail of the termination. If City decides to abandon or indefinitely postpone the work or services contemplated by this Agreement, City may terminate this Agreement upon written notice to Contractor. Upon notification of termination, Contractor has five (5) business days to deliver any documents owned by City and all work in progress to City address contained in this Agreement. City will make a determination of fact based upon the work product delivered to City and of the percentage of work that Contractor has performed which is usable and of worth to City in having the Agreement completed. Based upon that finding City will determine the final payment of the Agreement. City may terminate this Agreement by tendering thirty (30) days written notice to Contractor. Contractor may terminate this Agreement by tendering thirty (30) days written notice to City. In the event of termination of this Agreement by either party and upon request of City, Contractor will assemble the work product and put it in order for proper filing and closing and deliver it to City. Contractor will be paid for work performed to the termination date; however, the total will not exceed the lump sum fee payable under this Agreement. City will make the final determination as to the portions of tasks completed and the compensation to be made. 22. COVENANTS AGAINST CONTINGENT FEES Contractor warrants that Contractor has not employed or retained any company or person, other than a bona fide employee working for Contractor, to solicit or secure this Agreement, and that Contractor has not paid or agreed to pay any company or person, other than a bona fide employee, any fee, commission, percentage, brokerage fee, gift, or any other consideration contingent upon, or resulting from, the award or making of this Agreement. For breach or violation of this warranty, City will have the right to annul this Agreement without liability, or, in its discretion, to deduct from the Agreement price or consideration, or otherwise recover, the full amount of the fee, commission, percentage, brokerage fees, gift, or contingent fee. 23. CLAIMS AND LAWSUITS By signing this Agreement, Contractor agrees that any Agreement claim submitted to City must be asserted as part of the Agreement process as set forth in this Agreement and not in anticipation of Docusign Envelope ID: FDA69189-767D-40A1-A65E-784FB7ABAEC9 City Attorney Approved Version 5/22/2024 Page 7 litigation or in conjunction with litigation. Contractor acknowledges that if a false claim is submitted to City, it may be considered fraud and Contractor may be subject to criminal prosecution. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act applies to this Agreement and, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of information. If City seeks to recover penalties pursuant to the False Claims Act, it is entitled to recover its litigation costs, including attorney's fees. Contractor acknowledges that the filing of a false claim may subject Contractor to an administrative debarment proceeding as the result of which Contractor may be prevented to act as a Contractor on any public work or improvement for a period of up to five (5) years. Contractor acknowledges debarment by another jurisdiction is grounds for City to terminate this Agreement. 24. JURISDICTION AND VENUE This Agreement shall be interpreted in accordance with the laws of the State of California. Any action at law or in equity brought by either of the parties for the purpose of enforcing a right or rights provided for by this Agreement will be tried in a court of competent jurisdiction in the County of San Diego, State of California, and the parties waive all provisions of law providing for a change of venue in these proceedings to any other county. 25. SUCCESSORS AND ASSIGNS It is mutually understood and agreed that this Agreement will be binding upon City and Contractor and their respective successors. Neither this Agreement nor any part of it nor any monies due or to become due under it may be assigned by Contractor without the prior consent of City, which shall not be unreasonably withheld. 26. THIRD PARTY RIGHTS Nothing in this Agreement should be construed to give any rights or benefits to any party other than the City and Contractor. 27. ENTIRE AGREEMENT This Agreement, together with any other written document referred to or contemplated by it, along with the purchase order for this Agreement and its provisions, embody the entire Agreement and understanding between the parties relating to the subject matter of it. In case of conflict, the terms of the Agreement supersede the purchase order. Neither this Agreement nor any of its provisions may be amended, modified, waived or discharged except in a writing signed by both parties. This Agreement may be executed in counterparts. Docusign Envelope ID: FDA69189-767D-40A1-A65E-784FB7ABAEC9 City Attorney Approved Version 5/22/2024 Page 8 28. AUTHORITY The individuals executing this Agreement and the instruments referenced in it on behalf of Contractor each represent and warrant that they have the legal power, right and actual authority to bind Contractor to the terms and conditions of this Agreement. Executed by Contractor this___________ day of _______________________, 20____. CONTRACTOR CITY OF CARLSBAD, a municipal corporation of the State of California Occupational Health Centers of California, a Medical Corporation, dba Concentra Medical Centers By: By: (sign here) Judy Von Kalinowski Human Resources Director Kathy T. Le, MD, MPH; President & Treasurer (print name/title) ATTEST: By: SHERRY FREISINGER, City Clerk (sign here) By: John R. Anderson, DO; Vice President Deputy City Clerk (print name/title) If required by City, proper notarial acknowledgment of execution by contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups. Group A Group B Chairman, Secretary, President, or Assistant Secretary, Vice-President CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CINDIE K. McMAHON, City Attorney BY: _____________________________ Deputy / Assistant City Attorney Docusign Envelope ID: FDA69189-767D-40A1-A65E-784FB7ABAEC9 12 December 24 [ DocuSigned by: ~~~ By: j~ R._. ~ ~ Deputy City Clerk City Attorney Approved Version 5/22/2024 Page 9 EXHIBIT A SCOPE OF SERVICES AND FEE The following fees will be in effect through December 31, 2025. At the beginning of each subsequent twelve (12) month period of this Agreement, starting with January 1, 2026, the Fees for the prior twelve (12) month period shall be automatically increased by four percent (4%). Service Fee per Service Audiogram $42.00 BBP Written Medical Opinion 0.00 Behavioral Health Screen 0.00 Cardiac Risk Assessment $55.00 Cardiovascular Stress Test $249.00 DOT Physical $84.00 EKG Resting $20.00 Firefighter Exam $75.00 Gen Hlth Pnl 1 331431 (Chem23,CBC,UA,TSH) $63.00 Heat Stress Questionnaire 0.00 Hemoccult FOBT FIT Test $100.00 Hep B Recombivax (3 shots) #1 $158.00 Hep B Recombivax (3 shots) #2 $158.00 Hep B Recombivax (3 shots) #3 $158.00 Hepatitis B Surface Antibody Quant 8475 $62.00 Hepatitis C Antibody 8472 w reflex RNA $34.00 Heplisav-B (2 shot series) #1 $158.00 Heplisav-B (2 shot series) #2 $158.00 HIV 1/2 Ag/Ab Fourth gen w/Reflexes 91431 $143.00 HPE Company Defined-Level 1 $115.00 INT Eval Grip Strength w/Dynamometer* $71.00 Law Enforcement Physical $75.00 MMR Titer 5259 $25.00 OSHA Physical Medical Opinion Letter 0.00 OSHA Respirator Questionnaire $25.00 Physical Customer Defined Level 2 (15-30 min) $75.00 Prostatic Specific Antigen (PSA) 5363SB $120.00 Pulmonary Function Test $35.00 Rapid eCup+/9B (10Pnl NoTHC)-32477N $57.00 RPR with reflex to FTA-ABS 36126 $75.00 Sleep Apnea Screen $35.00 TB Risk Assessment $35.00 TB Skin Test $30.00 TB Symptom Screen $66.00 Docusign Envelope ID: FDA69189-767D-40A1-A65E-784FB7ABAEC9 City Attorney Approved Version 5/22/2024 Page 10 Varicella-Zoster IgG Antibody 4439SB $138.00 Vision Acuity Complete (Titmus) $20.00 Vision Color Hardy Rand Rittler $20.00 Vision Color Ishihara 14 Plates $20.00 X-Ray Chest-1 View $121.00 X-Ray Chest-2 View $51.00 Docusign Envelope ID: FDA69189-767D-40A1-A65E-784FB7ABAEC9 OTHER: (Per accident) (Ea accident) $ $ 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 THISCERTIFICATE 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO OFFICER/MEMBER EXCLUDED? DESCRIPTION OF OPERATIONS belowIf yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence)CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC HIREDAUTOS ONLY Docusign Envelope ID: FDA69189-767D-40A1-A65E-784FB7ABAEC9 ~ ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 12/5/2024 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 ~2tI~cT Concentra Unit Graham Company, wgN:o l'vtl: 215-567-6300 I FAX a Marsh & Mclennan Agency, LLC company (A/C Nol: 215-405-2694 One Penn Square West ~flJ~ss: Concentra Unit®arahamco.com Philadelphia PA 19102 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A : Columbia Casualty Companv 31127 INSURED CONCGR0-01 INSURER B : Liberty Mutual Fire Ins. Co. 23035 Occupational Health Center of New York, PA INSURER c : Allied World Assurance Company, AG dba Concentra Medical Centers 5080 Spectrum Drive, Suite 1200 West INSURER D : Employers Insurance of Wausau 21458 Addison TX 75001 INSURER E : LM Insurance Corporation 33600 INSURERF: COVERAGES CERTIFICATE NUMBER: 876579354 REVISION NUMBER: INSR ADDL SUBR POLICYEFF POLICY EXP LTR TYPE OF INSURANCE ,.,c,n lwun POLICY NUMBER IMM/DD/YYYYl IMM/DD/YYYYl LIMITS A X COMMERCIAL GENERAL LIABILITY y Ei!,24032244581-8 1/1/2024 1/1/2025 1,000,000 :-r2fessomal Lia 0 500,000 ~ $1M Claim/$3M Ag 1,000,000 3,000,000 ~ □ □ 3,000,000 8 AUTOMOBILE LIABILITY y AS2-631-510199-324 4/1/2024 4/1/2025 2,000,000 ~ X ~ ~ ~ ~ ~ ~ A X UMBRELLA LIAB M y HMC 4032235752 1/1/2024 1/1/2025 9,000,000 ~ EXCESSLIAB 10,000,000 IX I ., ftftft ftftft 8 WORKERS COMPENSATION WA?-63D-510199-354 4/1/2024 4/1/2025 X I I I E AND EMPLOYERS' LIABILITY Y/N WA5-63D-510199-314 4/1/2024 4/1/2025 □ N/A 1,000,000 (Mandatory in NH) 1,000,000 1,000,000 D Property YAC-L9L-477341-014 1/1/2024 1/1/2025 SEE BELOW C Excess Liability C023701-009 1/1/2024 1/1/2025 $1 OM Each Occurrence $1 OM Aggregate DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) PRIMARY LIABIL TY POLICY includes General Liability Coverage on an Occurrence Basis and Professional Liability Coverage on a Claims Made Basis. UMBRELLA LIABILITY COVERAGE includes Excess General Liability on an Occurrence Basis and Excess Professional Liability on a Claims Made Basis. Both Coverages are excess of a $3,000,000 Self-Insured Retention each Occurrence/Claim subject to a $18,000,000 Aggregate. INDIANA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE -Continental Casualty Company-Policy #HAZ 4032244595-10; Effective 1/1/2024-1/1/2025 - $500,000 Each Medical lncident/$1,500,000 Aggregate Per Insured or Surgeon See Attached ... CERTIFICATE HOLDER City of Carlsbad 1635 Faraday Ave Carlsbad CA 92008 ACORD 25 (2016/03) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Docusign Envelope ID: FDA69189-767D-40A1-A65E-784FB7ABAEC9 AGENCY CUSTOMER ID: CONCGRO-01 --------------------LO C #: -------- ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED Graham Company, Occupational Health Center of New York, PA dba Concentra Medical Centers POLICY NUMBER 5080 Spectrum Drive, Suite 1200 West Addison TX 75001 CARRIER I NAICCODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE KANSAS PHYSICIAN PROFESSIONAL LIABILITY COVERAGE -Continental Casualty Company-Policy #HAZ 4032244600-10; Effective 1/1/2024-1/1/2025 - $500,000 Each Medical lncident/$1,500,000 Aggregate Per Insured or Surgeon LOUISIANA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE -Columbia Casualty Company-Policy #HAZ 4032244614-10; Effective 1/1/2024-1/1/2025 - $100,000 Each Medical lncident/$300,000 Aggregate Per Insured or Surgeon NEBRASKA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE -Continental Casualty Company-Policy #HAZ 4032244628-10; Effective 1/1/2024-1/1/2025 -$500,000 Each Medical lncident/$1,000,000 Aggregate Per Insured or Surgeon PENNSYLVANIA PHYSICIAN PROFESSIONAL LIABILITY COVERAGE-Columbia Casualty Company-Policy #HAZ 4032244631-10; 1/1/2024-1/1/2025 - $500,000 Each Medical lncident/$1,500,000 Aggregate Per Insured or Surgeon WISCONSIN PHYSICIAN PROFESSIONAL LIABILITY COVERAGE -Continental Casualty Company-Policy #HAZ 4032244659-10; 1/1/2024-1/1/2025- $1,000,000 Each Medical lncident/$3,000,000 Aggregate Per Insured or Surgeon PROPERTY COVERAGE: Risk of Physical Loss or Damage to Covered Property subject to policy terms and conditions. WORKERS COMPENSATION -Occupational Health Centers of California, A Medical Corporation -Liberty Mutual Insurance Corp. -Policy #WA5-63D-510199-314; Effective: 4/1 /2024-4/1 /2025 WORKERS COMPENSATION -Occupational Health Centers of Southwest, P.A. -Liberty Insurance Corp. -Policy #WA7-63D-510199-404; Effective: 4/1 /2024-4/1 /2025 WORKERS COMPENSATION -Occupational Health Centers of Southwest, P.A. -Liberty Mutual Insurance Corp. -Policy #WC5-631-510199-254 (WI); Effective: 4/1 /2024-4/1 /2025 ADDITIONAL WORKERS COMPENSATION POLICIES: OHC of Arkansas -Liberty Insurance Corp. -Policy #WC7-631-510199-284; Effective: 4/1/2024-4/1/2025 OHC of Southwest (AZ/UT)-Liberty Mutual Fire Insurance Company-Policy #WC2-631-510199-244; Effective: 4/1/2024-4/1/2025 OHC of Delaware-Liberty Mutual Fire Insurance Company-Policy #WC2-631-510199-334; Effective: 4/1/2024-4/1/2025 OHC of Georgia/Hawaii-Liberty Mutual Fire Insurance Company-Policy #WC2-631-510199-384; Effective: 4/1/2024-4/1/2025 OHC of Illinois -Liberty Mutual Fire Insurance Company -Policy #WC2-631-510199-414; Effective: 4/1 /2024-4/1 /2025 OHC of Louisiana -Liberty Mutual Fire Insurance Company -Policy #WC2-631-510199-294; Effective: 4/1 /2024-4/1 /2025 OHC of Michigan -Liberty Mutual Fire Insurance Company-Policy #WC2-631-510199-274; Effective: 4/1/2024-4/1/2025 OHC of Nebraska -Liberty Mutual Fire Insurance Company -Policy #WC2-631-510199-374; Effective: 4/1 /2024-4/1 /2025 OHC of New Jersey-Liberty Mutual Fire Insurance Company -Policy #WC2-631-510199-264; Effective: 4/1/2024-4/1/2025 OHC of North Carolina -Liberty Insurance Corp. -Policy #WC7-631-510199-344; Effective: 4/1/2024-4/1/2025 OHC of Southwest (KS)-Liberty Mutual Fire Insurance Company-Policy #WC2-631-510199-424; Effective: 4/1/2024-4/1/2025 Therapy Centers of Southwest I, PA (OR) -Liberty Mutual Fire Insurance Company -Policy #WC2-631-510199-394; Effective: 4/1/2024-4/1/2025 Therapy Centers of South Carolina, PA-Liberty Mutual Fire Insurance Company-Policy #WC2-631-510199-304; Effective: 4/1/2024-4/1/2025 OHC of Minnesota -Liberty Mutual Fire Insurance Company-Policy #WC2-631-510199-454; Effective: 4/1/2024-4/1/2025 OHC of Alaska -Liberty Mutual Fire Insurance Company -Policy #WC2-631-510199-444; Effective: 4/1 /2024-4/1 /2025 CYBER LIABILITY -Arch Specialty Insurance Company -Policy #NPL2001106-00; Effective: 11/25/2024-11/25/2025 -Limit: $10,000,000 EXCESS CYBER LIABILITY -Homeland Insurance Company of New York-Policy #720002431-0000; Effective: 11/25/2024-11/25/2025 - Limit: $10,000,000 Excess of $10,000,000 CRIME COVERAGE -National Union Fire Insurance Company of Pittsburgh, PA-Policy #02-173-18-50, Effective 11/25/2024 -1/1/2026 -Limit $10,000,000 Coverage is provided for all medical professionals currently or previously employed or contracted by the above Named Insured, but only for professional services performed for or on behalf of the above Named Insured. RE: OHC OF CA/CMC IS BIDDING ON RFP #HR2406 TO PROVIDE MEDICAL SERVICES TO THE EMPLOYEES OF THE NAMED CLIENT. City of Carlsbad is an additional insureds on the above General Liability, Auto Liability and Umbrella Liability Policies and coverage shall apply on a Primary and Non-Contributory basis if required by written contract. Should any of the above described policies be cancelled before the expiration date thereof, Graham Company, a Marsh & Mclennan Agency, LLC company will endeavor to mail 30 days written notice to the certificate holder, but failure to do so shall impose no obligation or liability of any kind upon Graham Company, a Marsh & Mclennan Agency, LLC company, its agents or representatives. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD + $6,158.46 Surplus Lines Tax + $20. Stamping Office Fee Docusign Envelope ID: FDA89189-787D--10A1-A85E-784FB7ABAEC9 CNA Polley Issued by: Producer's lnfonnation: 1. Named Insured and mailing addrea: 2. Policy Period: 3. Retroactive Date: 4. Umitaof Insurance: 5. Premium 8. Endol'Hlllenta Attached to this Policy COUNTERSIGNATURE G-144115-A(ed. 9-02) Columbla Casualty Company 151 N. Franklin St. Chicago, Illinois 60808 Name: RT Specialty, LLC Healthcare Liability Policy Declarations Poli~ HAZ 4032244581-8 Number: Renewal HAZ 4032244581-7 of: Producer Code: 970-085841 Address: 1515 Market Street; Suite 1110 PhiladelDhia, PA 19102 Name: C G I. C oncentra roup Ho dmgs Parent, LL Type of □ Individual Address: 4714 Gettyaburg Road Organization: D Partnership Mechanicsburg, PA 17055 D Joint Venture [K]other Effective date from: 01/0112024 to 01/01/2025 At.12:01 A.M. Standard Time at your mailing address shown above. 06/0112015 Profeleional Liability Each "claim" $1,000,000 Aggregate Limit $ 3,000,000 Commercial General Liabilil)! General Aggregate Limit $ 3,000,000 Products-Completed Operations Aggregate Limit $ 3,000,000 Personal and Advertising Injury Limit $500,000 Each Occurrence Limit $1,000,000 Blanket Contractual Written and Oral Limit $500,000 Fire Legal Limit $500,000 Professional Liability Premium $205,282 General Liability Premium $ Included Total Premium $ 208,282 GSL9010 GSL9013XX GSL13383XX CG2028 GSL14793XX CG2147 G-144122A45 GSL14353XX GSL 14788XXC GSL6554XX GSL63888XX HP2712A G-4331~ G-145858A GSL4019XX ILOO 21 CNA83705XX GSL1099XX CNA88021XX HP2849A CG 20 01 CG 20 37 GSL61560XX CG2011 G-144108A GSL2708XX G-144124-A. 01/04/2024 By: ______________________ _ (Date) Authorized Representative Printed In U.S.A. 4 Docusign Envelope ID: FDA69189-767D-40A1-A65E-784FB7ABAEC9 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Additional premium is a percent of the California Manual Workers Compensation premium. Subject to a minimum premium charge of$ 250 Person or Organization Where required by contract or written agreement prior to loss and allowed by law. Issued by Liberty Insurance Corporation 21814 For attachment to Policy No. WA?-63D-510199-35 Issued to Concentra Group Holding Parent, LLC Job Description Effective Date: 4/1/2024 Premium$ WC 04 03 06 Page 1 of 1 Ed: 04/1984 4 282 Docusign Envelope ID: FDA69189-767D-40A1-A65E-784FB7ABAEC9 POLICY NUMBER: AS2-631-510199-32 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SCHEDULE Name Of Person(s} Or Organization(s}: Any person or organization whom you have agreed in writing to add as an additional insured, but only to coverage and minimum limits of insurance required by the written agreement, and in no event to exceed either the scope of coverage or the limits of insurance provided in this policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who ls An Insured provision contained in Paragraph A.1. of Section II -Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I -Covered Autos Coverages of the Auto Dealers Coverage Form. CA20481013 © Insurance Services Office, Inc., 2011 Page 1 of 1 Docusign Envelope ID: FDA69189-767D-40A1-A65E-784FB7ABAEC9 POLICY NUMBER: HAZ 4032244581-8 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR TO WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS IN A WRITTEN CONTRACT OR AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a c ontract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 Docusign Envelope ID: FDA69189-767D-40A1-A65E-784FB7ABAEC9 POLICY NUMBER: HAZ 4032244581-8 COMMERCIAL GENERAL LIABILITY CG 20 01 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an add itional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and CG20010413 © Insurance Services Office, Inc., 2012 Page 1 of 1