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AGR-6429.C - EMS QUALITY SOLUTIONS LLC - 2020-21 NURSE EDUCATOR AND EMERGENCY MEDICAL SERVICES AGREEMENT ORANGE FIRE DEPARTMENTPROFESSIONAL SERVICES AGREEMENT Nurse Educator Services] THIS PROFESSIONAL SERVICES AGREEMENT (the "Agreement") is made at Orange, California, on this E;A day of 'Vane. , 2020 (the "Effective Date") by and between the CITY OF ORANGE, a municipal corporation ("City"), and EMS QUALITY SOLUTIONS, LLC, a California limited liability company ("Contractor"), who agree as follows: 1. Services. Subject to the terms and conditions set forth in this Agreement, Contractor shall provide to the reasonable satisfaction of City the services set forth in the Agreement and upon the request of the City, Contractor shall perform to the reasonable satisfaction of the City, the following: an EMS Nurse Educator will be responsible for performing professional level work in developing EMS related lesson plans, providing EMS education and participating in EMS continuous quality improvement (CQI) activities. As a material inducement to the City to enter into this Agreement, Contractor represents and warrants that it has thoroughly investigated and considered the scope of services set forth in Exhibit "A", and fully understands the difficulties and restrictions in performing the work. The services which are the subject of this Agreement are not in the usual course of City's business and City relies on Contractor's representation that it is independently engaged in the business of providing such services. Contractor represents that it is experienced in performing the work and will follow the highest professional standards in performance of the work. All services provided shall conform to all federal, state and local laws, rules and regulations and to the best professional standards and practices. The terms and conditions set forth in this Agreement shall control over any terms and conditions in Exhibit "A," which is attached hereto and incorporated herein by this reference, to the contrary. Bryan Johnson, Emergency Medical Services Manager ("City's Project Manager"), shall be the person to whom Contractor will report for the performance of services hereunder. It is understood that Contractor's performance hereunder shall be under the supervision of City's Project Manager (or his/her designee), that Contractor shall coordinate its services hereunder with City's Project Manager to the extent required by City's Project Manager, and that all performances required hereunder by Contractor shall be performed to the satisfaction of City's Project Manager and the City Manager. 2. Compensation and Fees. a. Contractor's total compensation for all services performed under this Agreement, shall not exceed THIRTY THOUSAND DOLLARS and 00/100 ($30,000.00) without the prior authorization of the City. Fees for all services provided hereunder shall be charged at the hourly rate of SIXTY DOLLARS and 00/100 ($60.00). Said rate may be amended by letter agreement, from time to time, to alter fees and charges applicable hereto provided that said letter agreement is duly signed and approved by the Fire Chief and City Manager. Any amendment to the hourly rate shall not affect the maximum compensation hereunder. b. The above compensation shall include all costs, including, but not limited to, all clerical, administrative, overhead, insurance, reproduction, telephone, travel, auto rental, subsistence and all related expenses. 3. Payment. As scheduled services are completed, Contractor shall submit to City an invoice for the services completed, authorized expenses, and authorized extra work actually performed or incurred. Each such invoice shall state the basis for the amount invoiced, including services completed, the number of hours spent and any extra work performed. City will pay Contractor the amount invoiced within thirty (30) days after the approval of the invoice. Payment of such invoices shall be payment in full for all services, authorized costs and authorized extra work covered by that invoice. 4. Term. This Agreement shall be in full force and effect from July 1, 2020 through June 30, 2021, unless otherwise terminated in accordance with section 19 of this Agreement. 5. Change Orders. No payment for extra services caused by a change in the scope or complexity of work, or for any other reason, shall be made unless and until such extra services and a price therefor have been previously authorized in writing and approved by City as an amendment to this Agreement. The amendment shall set forth the changes of work, extension of time, and adjustment of the compensation to be paid by City to Contractor. 6. Licenses. Contractor represents that it and any subcontractors it may engage, possess any and all licenses which are required under state or federal law to perform the work contemplated by this Agreement and that Contractor and its subcontractors shall maintain all appropriate licenses, including a City of Orange business license, at its cost, during the performance of this Agreement. 7. Independent Contractor. At all times during the term of this Agreement, Contractor shall be an independent contractor and not an employee of City. City shall have the right to control Contractor only insofar as the result of Contractor's services rendered pursuant to this Agreement. City shall not have the right to control the means by which Contractor accomplishes services rendered pursuant to this Agreement. Contractor shall, at its sole cost and expense, furnish all facilities, materials and equipment which may be required for furnishing services pursuant to this Agreement. Contractor shall be solely responsible for, and shall indemnify, defend and save City harmless from all matters relating to the payment of its subcontractors, agents and employees, including compliance with social security withholding and all other wages, salaries, benefits, taxes, exactions, and regulations of any nature whatsoever. Contractor acknowledges that it and any subcontractors, agents or employees employed by Contractor shall not, under any circumstances, be considered employees of City, and that they shall not be entitled to any of the benefits or rights afforded employees of City, including, but not limited to, sick leave, vacation leave, holiday pay, Public Employees Retirement System benefits, or health, life, dental, long-term disability or workers' compensation insurance benefits. 8. Contractor Not Agent. Except as City may specify in writing, Contractor shall have no authority, express or implied, to act on behalf of City in any capacity whatsoever as an agent. Contractor shall have no authority, express or implied, to bind City to any obligation whatsoever. 9. Designated Persons. Only those qualified persons authorized by City's Project Manager, or as designated in Exhibit "A," shall perform work provided for under this Agreement. It is understood by the parties that clerical and other nonprofessional work may be performed by persons other than those designated. 10. Assignment or Subcontracting. No assignment or subcontracting by Contractor of any part of this Agreement or of funds to be received under this Agreement shall be of any force or effect unless the assignment has the prior written approval of City. City may terminate this Agreement rather than accept any proposed assignment or subcontracting. Such assignment or subcontracting may be approved by the City Manager or his/her designee. 11. Time of Completion. Except as otherwise specified in Exhibit "A," Contractor shall commence the work provided for in this Agreement on July 1, 2020 and diligently prosecute completion of the work or as otherwise agreed to by and between the representatives of the parties. 12. Time Is of the Essence. Time is of the essence in this Agreement. Contractor shall do all things necessary and incidental to the prosecution of Contractor's work. 13. Reserved 14. Products of Contractor. The documents, studies, evaluations, assessments, reports, plans, citations, materials, manuals, technical data, logs, files, designs and other products produced or provided by Contractor for this Agreement shall become the property of City upon receipt. Contractor shall deliver all such products to City prior to payment for same. City may use, reuse or otherwise utilize such products without restriction. 15. Equal Employment Opportunity. During the performance of this Agreement, Contractor agrees as follows: a. Contractor shall not discriminate against any employee or applicant for employment because of race, color, religion, sex, national origin, mental or physical disability, or any other basis prohibited by applicable law. Contractor shall ensure that applicants are employed, and that employees are treated during employment, without regard to their race, color, religion, sex, national origin, mental or physical disability, or any other basis prohibited by applicable law. Such actions shall include, but not be limited to the following: employment, upgrading, demotion or transfer, recruitment or recruitment advertising, layoff or termination, rates of pay or other forms of compensation and selection for training, including apprenticeship. Contractor agrees to post in conspicuous places, available to employees and applicants for employment, a notice setting forth provisions of this non-discrimination clause. b. Contractor shall, in all solicitations and advertisements for employees placed by, or on behalf of Contractor, state that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, mental or physical disability, or any other basis prohibited by applicable law. C. Contractor shall cause the foregoing paragraphs (a) and (b) to be inserted in all subcontracts for any work covered by this Agreement, provided that the foregoing provisions shall not apply to subcontracts for standard commercial supplies or raw materials. 16. Conflicts of Interest. Contractor agrees that it shall not make, participate in the making, or in any way attempt to use its position as a contractor to influence any decision of City in which Contractor knows or has reason to know that Contractor, its officers, partners, or employees have a financial interest as defined in Section 87103 of the Government Code. Contractor further agrees that it shall not be eligible to work as the design/build firm for the project that is the subject of this Agreement. 17. Assignment. No assignment by Consultant of any part of this Agreement or of funds to be received under this Agreement shall be of any force or effect unless the assignment has had the prior written approval of City. City may terminate this Agreement rather than accept any proposed assignment. 18. Indemnity. a. To the fullest extent permitted by law, Contractor agrees to indemnify, defend and hold City, its City Council and each member thereof, and the officers, officials, agents and employees of City (collectively the "Indemnitees") entirely harmless from all liability arising out of: 1) Any and all claims under workers' compensation acts and other employee benefit acts with respect to Contractor's employees or Contractor's subcontractor's employees arising out of Contractor's work under this Agreement, including any and all claims under any law pertaining to Contractor or its employees' status as an independent contractor and any and all claims under Labor Code section 1720 related to the payment of prevailing wages for public works projects; and 2) Any claim, loss, injury to or death of persons or damage to property caused by any act, neglect, default, or omission other than a professional act or omission of Contractor, or person, firm or corporation employed by Contractor, either directly or by independent contract, including all damages due to loss or theft sustained by any person, firm or corporation including the Indemnitees, or any of them, arising out of, or in any way connected with the work or services which are the subject of this Agreement, including injury or damage either on or off City's property; but not for any loss, injury, death or damage caused by the active negligence or willful misconduct of City. Contractor, at its own expense, cost and risk, shall indemnify any and all claims, actions, suits or other proceedings that may be brought or instituted against the Indemnitees on any such claim or liability covered by this subparagraph, and shall pay or satisfy any judgment that may be rendered against the Indemnitees, or any of them, in any action, suit or other proceedings as a result of coverage under this subparagraph. b. To the fullest extent permitted by law, Contractor agrees to indemnify and hold Indemnitees entirely harmless from all liability arising out of any claim, loss, injury to or death of persons or damage to property caused by its negligent professional act or omission in the performance of professional services pursuant to this Agreement. C. Except for the Indemnitees, the indemnifications provided in this Agreement shall not be construed to extend any third party indemnification rights of any kind to any person or entity which is not a signatory to this Agreement. d. The indemnities set forth in this section shall survive any closing, rescission, or termination of this Agreement, and shall continue to be binding and in full force and effect in perpetuity with respect to Contractor and its successors. 19. Insurance. a. Contractor shall carry workers' compensation insurance as required by law for the protection of its employees during the progress of the work. Contractor understands that it is an independent contractor and not entitled to any workers' compensation benefits under any City program. b. Contractor shall maintain during the life of this Agreement the following minimum amount of comprehensive general liability insurance or commercial general liability insurance: the greater of (1) One Million Dollars ($1,000,000) per occurrence; or (2) all the insurance coverage and/or limits carried by or available to Contractor. Said insurance shall cover bodily injury, death and property damage and be written on an occurrence basis. C. Contractor shall maintain during the life of this Agreement, the following minimum amount of automotive liability insurance: the greater of (1) a combined single limit of One Million Dollars ($1,000,000); or (2) all the insurance coverage and/or limits carried by or available to Contractor. Said insurance shall cover bodily injury, death and property damage for all owned, non -owned and hired vehicles and be written on an occurrence basis. d. Any insurance proceeds in excess of or broader than the minimum required coverage and/or minimum required limits which are applicable to a given loss shall be available to City. No representation is made that the minimum insurance requirements of this Agreement are sufficient to cover the obligations of Contractor under this Agreement. e. Each policy of general liability and automotive liability shall provide that City, its officers, officials, agents, and employees are declared to be additional insureds under the terms of the policy, but only with respect to the work performed by Contractor under this Agreement. A policy endorsement to that effect shall be provided to City along with the certificate of insurance. In lieu of an endorsement, City will accept a copy of the policy(ies) which evidences that City is an additional insured as a contracting party. The minimum coverage required by Subsection 18.b and c, above, shall apply to City as an additional insured. f. Contractor shall maintain during the life of this Agreement professional liability insurance covering errors and omissions arising out of the performance of this Agreement with a minimum limit of One Million Dollars ($1,000,000) per claim. Contractor agrees to keep such policy in force and effect for at least five (5) years from the date of completion of this Agreement. g. The insurance policies maintained by Contractor shall be primary insurance and no insurance held or owned by City shall be called upon to cover any loss under the policy. Contractor will determine its own needs in procurement of insurance to cover liabilities other than as stated above. h. Before Contractor performs any work or prepares or delivers any materials, Contractor shall furnish certificates of insurance and endorsements, as required by City, evidencing the aforementioned minimum insurance coverages on forms acceptable to City, which shall provide that the insurance in force will not be canceled or allowed to lapse without at least ten (10) days' prior written notice to City. i. Except for professional liability insurance coverage that may be required by this Agreement, all insurance maintained by Contractor shall be issued by companies admitted to conduct the pertinent line of insurance business in California and having a rating of Grade A or better and Class VII or better by the latest edition of Best Key Rating Guide. In the case of professional liability insurance coverage, such coverage shall be issued by companies either licensed or admitted to conduct business in California so long as such insurer possesses the aforementioned Best rating. j Contractor shall immediately notify City if any required insurance lapses or is otherwise modified and cease performance of this Agreement unless otherwise directed by City. In such a case, City may procure insurance or self -insure the risk and charge Contractor for such costs and any and all damages resulting therefrom, by way of set-off from any sums owed Contractor. k. Contractor agrees that in the event of loss due to any of the perils for which it has agreed to provide insurance, Contractor shall look solely to its insurance for recovery. Contractor hereby grants to City, on behalf of any insurer providing insurance to either Contractor or City with respect to the services of Contractor herein, a waiver of any right to subrogation which any such insurer may acquire against City by virtue of the payment of any loss under such insurance. 1. Contractor shall include all subcontractors, if any, as insureds under its policies or shall famish separate certificates and endorsements for each subcontractor to City for review and approval. All coverages for subcontractors shall be subject to all of the requirements stated herein. 20. Termination. City may for any reason terminate this Agreement by giving Contractor not less than five (5) days' written notice of intent to terminate. Upon receipt of such notice, Contractor shall immediately cease work, unless the notice from City provides otherwise. Upon the termination of this Agreement, City shall pay Contractor for services satisfactorily provided and all allowable reimbursements incurred to the date of termination in compliance with this Agreement, unless termination by City shall be for cause, in which event City may withhold any disputed compensation. City shall not be liable for any claim of lost profits. 21. Maintenance and Inspection of Records. In accordance with generally accepted accounting principles, Contractor and its subcontractors shall maintain reasonably full and complete books, documents, papers, accounting records, and other information (collectively, the records") pertaining to the costs of and completion of services performed under this Agreement. City and its authorized representatives shall have access to and the right to audit and reproduce any of Contractor's records regarding the services provided under this Agreement. Contractor shall 0 maintain all such records for a period of at least three (3) years after termination or completion of this Agreement. Contractor agrees to make available all such records for inspection or audit at its offices during normal business hours and upon three (3) days' notice from City, and copies thereof shall be famished if requested. 22. Compliance with all Laws/Immigration Laws. a. Contractor shall be knowledgeable of and comply with all local, state and federal laws which may apply to the performance of this Agreement. b. If the work provided for in this Agreement constitutes a "public works," as that term is defined in Section 1720 of the California Labor Code, for which prevailing wages must be paid, to the extent Contractor's employees will perform any work that falls within any of the classifications for which the Department of Labor Relations of the State of California promulgates prevailing wage determinations, Contractor hereby agrees that it, and any subcontractor under it, shall pay not less than the specified prevailing rates of wages to all such workers. The general prevailing wage determinations for crafts can be located on the website of the Department of Industrial Relations (www.dir.ca.gov/DLSR). Additionally, to perform work under this Contract, Contractor must meet all State registration requirements and criteria, including project compliance monitoring. C. Contractor represents and warrants that Contractor: 1) Has complied and shall at all times during the term of this Agreement comply, in all respects, with all immigration laws, regulations, statutes, rules, codes, and orders, including, without limitation, the Immigration Reform and Control Act of 1986 IRCA); and 2) Has not and will not knowingly employ any individual to perform services under this Agreement who is ineligible to work in the United States or under the terms of this Agreement; and 3) Has properly maintained, and shall at all times during the term of this Agreement properly maintain, all related employment documentation records including, without limitation, the completion and maintenance of the Form I-9 for each of Contractor's employees; and 4) Has responded, and shall at all times during the term of this Agreement respond, in a timely fashion to any government inspection requests relating to immigration law compliance and/or Form I-9 compliance and/or worksite enforcement by the Department of Homeland Security, the Department of Labor, or the Social Security Administration. d. Contractor shall require all subcontractors or subconsultants to make the same representations and warranties as set forth in Subsection 21.b. e. Contractor shall, upon request of City, provide a list of all employees working under this Agreement and shall provide, to the reasonable satisfaction of City, verification that all such employees are eligible to work in the United States. All costs associated with such verification shall be borne by Contractor. Once such request has been made, Contractor may not change employees working under this Agreement without written notice to City, accompanied by the verification required herein for such employees. L Contractor shall require all subcontractors or sub -consultants to make the same verification as set forth in Subsection 21.d. g. If Contractor or subcontractor knowingly employs an employee providing work under this Agreement who is not authorized to work in the United States, and/or fails to follow federal laws to determine the status of such employee, that shall constitute a material breach of this Agreement and may be cause for immediate termination of this Agreement by City. h. Contractor agrees to indemnify and hold City, its officers, officials, agents and employees harmless for, of and from any loss, including but not limited to fines, penalties and corrective measures City may sustain by reason of Contractor's failure to comply with said laws, rules and regulations in connection with the performance of this Agreement. 23. Governing Law and Venue. This Agreement shall be construed in accordance with and governed by the laws of the State of California and Contractor agrees to submit to the jurisdiction of California courts. Venue for any dispute arising under this Agreement shall be in Orange County, California. 24. Integration. This Agreement constitutes the entire agreement of the parties. No other agreement, oral or written, pertaining to the work to be performed under this Agreement shall be of any force or effect unless it is in writing and signed by both parties. Any work performed which is inconsistent with or in violation of the provisions of this Agreement shall not be compensated. 25. Notice. Except as otherwise provided herein, all notices required under this Agreement shall be in writing and delivered personally, by e-mail, or by first class U.S. mail, postage prepaid, to each party at the address listed below. Either party may change the notice address by notifying the other party in writing. Notices shall be deemed received upon receipt of same or within three (3) days of deposit in the U.S. Mail, whichever is earlier. Notices sent by e- mail shall be deemed received on the date of the e-mail transmission. CONTRACTOR" EMS Quality Solutions, LLC 9187 Poinsettia Avenue Fountain Valley, CA 92708 Attn: Catherine Ord Telephone No.: (714) 794-4842 E-Mail Address: cathyord20l5@gmail.com CITY" City of Orange 300 E. Chapman Avenue Orange, CA 92866-1591 Attn: Bryan Johnson Telephone No.: (714) 288-2503 E-Mail Address: bjohnson@cityoforange.org 26. Counterparts. This Agreement may be executed in one or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. Signatures transmitted via facsimile and electronic mail shall have the same effect as original signatures. IN WITNESS of this Agreement, the parties have entered into this Agreement as of the year and day first above written. EMS QUALITY SOLUTIONS, LLC CITY OF ORANGE, a municipal corporation a Californian limited liability company By: V latL By: Printed Name: A . Y ck Otto, City Manager Title: WD ," U ryyvvA o dhe 'D, Printed Name: APPROVED AS TO FORM: Mary E. Bifining Senior Assistant City Atto e NOTE: City requires the following signature(s) on behalf of the Contractor: 1) the Chairman of the Board, the President or a Vice -President, AND (2) the Secretary, the Chief Financial Officer, the Treasurer, an Assistant Secretary or an Assistant Treasurer. If only one corporate officer exists or one corporate officer holds more than one corporate office, please so indicate. OR The corporate officer named in a corporate resolution as authorized to enter into this Agreement. A copy of the corporate resolution, certified by the Secretary close in time to the execution of the Agreement, must be provided to City. EXHIBIT "A" SCOPE OF SERVICES Beneath this sheet.] SCOPE ,IOFSERVICES OFT) CONTRACT NURSE EDUCATOR This EMS Nurse Educator is responsible for performing professional level work in developing and participating in EMS continuous quality improvement (CQI) activities. The following duties are intended to be a representative sample of the duties performed by this Nurse Educator.. Assists in the implementation and update of the continuous quality improvement (CQI) program to identify education and training needs; Performs other duties of a similar nature or level. EDUCATION AND EXPERIENCE: Completion of an accredited RegisteredNurse program and four years of experience in the delivery of emergency medical care; or, an equivalent combination of education. and experience sufficient to successfully perform the essential duties ofthe, job such as those listed above, LICENSES AND CERTIFICATIONS:. California Registered Nurse.Licensure; Valid California Driver's License; DESIRABLE: BSN or Bachelor's degree in relatedfield (or higher) MICN ACLS Instructor PALS Instructor PEPP Instructor BTLS or PHTLS Instructor ARA BLS Instructor; Teaching Methodology Certification (e,g. Instructor 1A and 1 B, or NAEMS Educators Course, or National Fire Academy's Instructional Methodology) KNOWLEDGE OF: Emergency medical. care procedures and practices; Pre -hospital delivery systems, Applicable Federal, State, and Local regulations, protocols, policies, and procedures; Adult learning theory; Continuous Quality Improvement principles; Communicable. diseases; American Heart Association policies, procedures, and standards. SKILL IN: Developing and implementing CQI programs; Delivering continuing education programs; Use of computer software such as Microsoft Word, Excel and PowerPoint; Ability to become proficient in use of specialty Sotiware such as, Image Trend; Crystal Reports, Fire House, Street EMS, etc. Ensuring compliance with applicable regulations, protocols, policies, procedures, and.stamdards; Communication, interpersonal skills as applied to interaction with coworkers, supervisor, the general public, etc. sufficient to exchange or convey information and to receive work direction. CNA HEALTHCARE PROVIDERS SERVICEGANaR Certificate of InOranceDP mnsC OCCURRENCE. POLICY FORM Print Date: 2/0112020 Producer Branch Prefix Policy Number Policy Period 018098 970 HPG" 0656066482 from 02/01/20 to:02101121: at 12:01 AM Standard Time Named Insured and Address: Program Administered by: EMS Quality Solutions Nurses Service Organization 9187 Poinsettia Ave 1100 Virginia Drive, Suite 250 Fountain Valley, CA 92708-2240 -Fort Washington, PA 19034 1- 888-288-3534. www. nmcom Medical Specialty: Code: Insurance is provided by: Nursing Firm 60964 American Casualty Company of Reading, Pennsylvania Excludes Cosmetic Procedures 151 N, Franklin Street Chicago, IL 60666 Professional Liability $1,000,000 each.claim $6,000,000 aggregate Your professional liability limits shown above include the following: Good Samaritan Liability ' Malplacement Liability Personal Injury Liability Sexual Misconduct Included in the PL limit shown above subject to $ 25,000 aggregate sublimit Coverage Extensions License Protection. Defendant Expense Benefit Deposition Representation Assault Includes Workplace Violence Counseling Medical Payments First Aid Damage to Property of Others Enterprise Privacy Protection - Claims Made Retroactive Date: 2/0112018 Defense inside limits) 25, 000 per proceeding S 25,000 aggregate 1, 000 per day limit 25,000 aggregate. S 10,000 per deposition 10,000 aggregate 25, 000 per incident 25,000 aggregate 25, 000 per person 100,000 aggregate 10, 000 per incident 10,000 aggregate 10. 000 per incident 10.000- aggregate 25, 000 per incident 25,000 aggregate Workplace Liability Workplace Liability Included, in Professional Liability Limit shown above Fire & Water Legal Liability Included in the PL limit shown above subject to $150,000 aggregate. sublimil Total: $ , 2K00 Base Premium $269.00 Policy Forms & Endorsements(Please see attached list for a general description of many common policy ferns and endorsements.) G- 121500-0 G-121503-0 G-121501-Cl G-145184-A G-147292-A GSL15564 GSLISS65 GSL17101 GSL13424 GSL13425 CNA80052 G-123846-D04 CNA81753. CNA81768 CNA82011 CNA795116 ONA79575 GSL-5587 Medical " Speciality : is amended to Include Consulting Services (GSL-5587) Keep this document In a safe.plate,31 andproof of payment ere your proof of mverage, There is no coverege in rorca unless the premium is paid in fultln order Chairman of th Hoard Secretary to activate your coverage, please remit premium in full by the eNecave date of this CeitlBcate of tnsunmoe. Master Policy # 188711433 G-141241- 8 (0312010) Coverage Change Date: Endorsement Change Date: POLICY FORMS & ENDORSEMENTS Thefollowing are the policy forms and endorsements that apply to your currentprofessional liability insurance policy. COMMON POLICY FORMS & ENDORSEMENTS FORM # DESCRIPTION G- 121500-0 Common PolicyConditions G-121503- C Workplace Liability Form G-121501- Cl Occurrence Policy Form. California G-145184- A Policyholder Notice - OFAC Compliance Notice G-147292- A Policyholder Notice - Silica; Mold & Asbestos Disclosure GSLi5564 Sexual Misconduct Subiimits of Liability Professional liability & Sexual Misconduct Exclusion GBLl 5585 Healthcare Providers Professional Liability. Assault Coverage GSL17101 Exclusion of Specified Activities Reuse of Parenteral Devices and Supplies GSLI3424 Services to Animals' GSL13425 Business Owner Coverage Extension. Endorsement CNA80052 Distribution or Recording of Material or Information in Violation of Law Exclusion Endorsement G-12384E- D04 California Cancellation and Non -Renewal CNA81763 Coverage &. Cap on Losses from Certified Acts Terrorism CNA81758 Notice - Offer of Terrorism Coverage & Disclosure of Premium GNA82011 Related Claims Endorsement- - CNA79575 Exclusion ofCosmetic Procedures CNA79516 Enterprise Privacy Protection GSL5587 Consulting Services Liability Endorsement PLEASE REFER TO YOUR CERTIFICATE OF INSURANCE FOR THE. POLICY FORMS &ENDORSEMENTS SPECIFIC TO YOUR STATE AND YOUR POLICY PERIOD. For NJ residents: The PLIGA sumharge shown on theCertificateof Insurance Is the NJ Property 8. Liability Insurance Guaranty Association. For KY residents: The Surcharge shown on the Certificate of Insurance is the KY Firefighters and. Law Enforcement Foundation Program Fundand the KY LGPT is the. KY Local Government Premium Tax which includes charges at a municipality andlor county level.. Far WV residents: The surcharge shown on the Certificate of Insurance is the WV Premium Surcharge. For FL residents: The FIGA Assessment shown on the Certificate of Insurance is the FL Insurance Guaranty Association 2012 Regular Assessment. Form#: G-141241-B ( 03/2010) Named insured: EMS.Quality Solutions Master Policy#:A 88711433 Policy#: 0860066482 nk'o City of Orange / Division 'CITY, OF ORANGE" Business License i. 30PE. Chapman Ave. ` .BUSINESS3 .s ? P.O. Box 11024 i LICENSE CERTIFICATE A .Orange, CA 92856-8124 - www.cityoforange.org ORU1209A 518 1 As 0.412 000000sle 00.0003.0085 51e;+ Business License No. 189690 - III1i1111I111 Ih111i11rIIPi111tgrllyllurldlrJ1111161rI1 Expiration Date 1113012020 E M S QUALITY SOLUTIONS LLC -, Business Tax Schedule Flat Tax 9187 POINSETTIA AVE Business Type Service FOUNTAIN VALLEY CA 92708.2240 Ownership LLC Federal Tax 10 No. 82-3772267 IMPORTANT INFORMATION: Please vefify all information. If any changes occur, please contact the Business License Division at (7141744-2270. Remember to renew your Business _License within one month'of the Expiration Date, even if you don't receive a Renewal Notice. If the last day of the month (Penalty Date) falls on holiday}'weekend, or city closure day, make sure payments at City Hall are received by 5:30 pm on the last business day prior to this to avoid late penalties. Payments postmarked or paid on-line after the Penalty :Date will also incur late penalties of 25% per month, Closing your business or no longer working in Orange? If you are taxedunder a Gross Receipts classification (see Tax Schedule above), you,must contact. the City within 30 days of the business activity ceasing. Failure to do this may result:in late penalties, a $50 Non Compliance Fee, or having your account sent to a Collection Agency. If you pay with a Flat Tax, you must sign, date, and return your Renewal Notice to dose your account. - New location? Please call to have the location authorization on your Business License updated - there is a $10.00 fee for this. Please display the Certificate below in public view. Thank you for doing business in the City of Orange! FOLD OR DETACH HERE FOR DISPLAY BUSINESS LICENSE CERTIFICATE This certificate is to be displayed at your piece of business. It Issued Without verification that the holder is subject to or exempt from licensing by the State of California. This certificate does not constitute a permit to operate a -business in violation of any7aw or ordinance; Business E M S QUALITY SOLUTIONS LLC Name: Business 9187 POINSETTIA AVE Location:, FOUNTAIN VALLEY CA 92708-2241 Business Phone: 714)7944842 Owner / CATHERINE A ORD Officer. CEO Business Type: SERVICE CITY OF ORANGE 300 E. Chapman Ave Orange, CA 92866 714) 744.2270 vrxw. cltyofomnga.ofg Business License Number: 189690 Expiration Date: 11130/ 2020 opening Date: 12/18/2017 Business Description: Consulting Services Conditions I Remarks: Personal Umbrella Declaration Page Policy Number: 60558-89.69 Effective: 1/28/2020 12:01 AM Expiration: 1/28/2021 12:01 AM Named Insured(s): Michael M Ord Catherine A Ord 9187 Poinsettia Ave Fountain Vly, CA 92708 e-mail extraord2Qgmaii.com Address(es): Underwritten By: Truck Insurance Exchange 6301 Owensmouth Ave. Woodland Hills, CA 91367 Rated Exposures (Item 2) Exposure Type _ _ _ _ Quantity Owner Occupied Residence 1 Schedule of Underlying Insurance (Item 3) FARMERS INSURANCE Premiums (item 1) Policy Premium $786.00 Thisisnotabill. Exposure Type _ Quantity Motorized Vehicle 3 You have told us you have underlying Insurance policies with liability limits listed below. If the underlying policies terminate or the liability limits are less than shown below, in the event of a covered loss we will only pay those damages we would have paid if the limits and policies were in place as scheduled. You must keep the coverages and limits below in effect to avoid gaps in your protection. Limit of Insurance Insurance Carrier Policy Number Coverage _ _ (in thousands of dollars) Farmers Insurance Exchange 194125891 Auto Liability 500/500/100 Mid-Centurylnsurance Company 931185911 Homeowner 300 9187 Poinsettia Ave, Fountin Vly, CA 92708-2240 Limits (Item 4) Limit Coverage Type_ eochoccunence General Liability $3,000,000 Retained Limit $250 Driver Information Name Driver Status Michael M Ord Covered Catherine A Ord Covered farmers.com Policy No. 60558-89-69 Limit Coverage Type _ _ _ _ _ leach occurrence_ Uninsured/Underinsured Motorist Not Covered Name _ _ Dri_verStatus Matthew Ord Excluded Questions? Manage your account: Call youragent Peter D O'Hara at(714) Go to wwvw.farmers.com to access 523-7660 or email youraccount anytime! pohara@farmersagent.com 56.6178 Id Edition 3-19 12/19/2019 Page 1 of Declaration Page (continued) Policy and Endorsements This section lists the policy form number and any applicable endorsements that makeup your insurance contract. Any endorsements that you have purchased to extend coverage on your policy are also listed in the coverages section of this declarations document: 56-52803rd ed.; CA029 1 st ed.; CA 103A 1 st ed.; E0117 1 st ed.; E01181 st ed.; J6951 A 1 st ed.; 25-8531 10-12 Other Information Excluded driver in the household. The Attorney -In -Fact (AIF) or Management Fee for your renewed policy will never exceed 20%of the policy's premiums and will be paid out of the premiums. You may wish to consider this information in deciding whether to acceptor decline this offer to renew your policy. Information on Additional Fees The "Fees" stated in the "Premiums/Fees" section on page 1 apply on a per -polity, not an account basis. The following additional fees also apply: 1. Service Charge per installment(Inconsideration of our agreement to allow you to pay in installments): For Recurring Electronic Funds Transfer(EM: $0.00(applied peraccount) For Recurring Credit/Debit Card plans: $5.00 (applied per account) For all other payment plans: $5.00 (applied per account) If this account is for more than one policy, changes in these fees are not effective until the revised fee information is provided for each policy. Countersignature D-11 ) Authorized Representative farmers.com 2. Late Fee: $10.00 (applied per account) 3. Returned Payment Charge: $25.00 (applied per check, electronic transaction, or other remittance which is not honored by your financial institution for reasons including, but not limited to, insufficient funds or a closed account) 4. Reinstatement Fee: $0.00 (applied per policy) One or more of the fees or charges described above may be deemed a part of premium under state law. Policy No. 60558-89-69 Questions? Manage your account: Call your agent Peter D O'Hara at(714) Go to www.farmers.com to access 523-7860 or email your account any time! pohara@farmeNagent.com 566178 MEdifion 3.19 Page2of2 Auto Insurance Declaration Page Policy Number: 19412.58.91 Effective: 7/28/2020 12:01 AM Expiration: 1/28/2021 12:01 AM Named lnsured(s): Michael M Ord CatherineAOrd 9187 Poinsettia Ave Fountain Vly, CA 92708 e-mail extraord2@gmail.com Address(es): Underwritten By: Farmers Insurance Exchange 6301 Owensmouth Ave. Woodland Hills, CA 91367 Household Drivers FARMERS INSURANCE Premiums/Fees Policy Premium $1,809.60 Fees( -also see Information on Additional $2.64 Fees below) Policy Premium and Fees $1,812.24 This is not a bill. All persons who drive or will occasionally be driving any of the cars on the policy should be listed below. If anyone is missing or needs to be added, such as a newly licensed driver, you should contact your agent or the company to add that person before they begin to drive any of the cars covered on the policy. Name Driver Status Name DriverStatus Michael MOrd Covered CatherineAOrd I...._.........._............ _................... ...... ..... Mattatthew ..Or._d Excluded Vehicle Information Covered Veh. # Year/Make/Model/VIN Coverage Deductible Limit 1 2014 Ford Truck Flex4D 2Wd Limited Comprehensive: 250 2FMGK5D85EBDI5030 Collision: 250 2 2005 Gmc Truck Yukon 4 Door 4X2 Comprehensive: 500 1GKEC13T95R120296 Collision: 500 3 M0 Ie*ep Wrangler 2DSwb4X4Rubic Comprehensive: 500 1C4BJWCG3FL695115 Collision: 500 Coverage Information Limits - Coverage _ opplicable to all vehicles)___ Bodily Injury Liability 500,000 each person 500,000 each accident Property Damage Liability 100,000 each accident Permissive User Limit of Full (See Permissive User Liability** Limit of Liability in your policy) farmers.com PolicyNo. 19412-58-91 Premiums by Vehicle Vehicles Vehicle2 Vehicle 3 247. 00 $143.80 $201.20 161. 70 $122.40 $130.60 Included Included Included Questions? Manage your account: Call your agent Peter D O'Hara at(714) Go to www.farmers.com to access 523- 7860 or email your account any time! pohara@farmersagent. com 566176 2nd Editian 3-19 5/2/2020 Page 1 of4 Declaration Page (continued) Limits Premiums by Vehicle Coverage C ____ pqpli oble to all vehiclescLesL.........— A-----f,16MedcaI Vehicle) Vehlcfe2 Vehicle 3 average 1,000 each person VI50 12.60 Uninsured Motorist Bodily 25,000 each person 29.00 23.90 22.10 Injury 50,000 each accident Comprehensive 25.10 48.20 33.00 Collision 248.30 101.20 132.50 Additional Equipment 1,000 Included Included Included Uninsured Motorist Property 3.90 5.10 4.40 Damage With Collision Towingand Road Service Not Covered Not Covered I...._.. ....... ....... - ... - .... .... . ...... ... . .. .......... ..... I ...- ..... . ........ ..... -- GlassDeductible Buyback $1.30 $4.80 Loss of Use K5: $50 per day/ $ 1,000 max 26.40 $24.00 Not Covered 3.30 25.80 Total Premium Per Vehicle $758.10 $486.00 $565.50 11111 Policy Premium $1,809.60 Fee Detail Vehicle I Vehicle2 VehkIe3 Total Anti -Fraud Fee $0.88 $0.88 $0.88 $2.64 lw- Fees $2.64 llll Policy Premium and Fees Discounts Discount Type Applies to Vehicle(s) Anti -Lock Brakes 1,2,3 Auto/Home 1,-2,3- Multiple Car .... .. 2, 3 ilityStab Control Auto/Umbrella ... .. Xnt'f-T,h_eft' Dv'*c'e Lienholder andAdditional Interest Vehicle 2015jeep Wrangler2D Swb 4X4 Rubic VIN: IC4BJWCG3FL695115 farmers.corn Policy No. 19412-58-91 1,812.24 DiscountType Applies to Vehicle(s) Good Driver 1,2,3 1 .. Passive Restraint 1,2,3 Group -NurseNurse 1,2.3 11 ........ - ........ ......... Safe Driver I . .......................... ....... 1,2,3 Auto/CEA 1,2,3 Lienholder Wells Fargo PO Box 29296 Phoenix, AZ 85038-9296 Loan Number Not Applicable Questions? Manage your account: Call your agent Peter D O'Hara at (714) Go to wm.farmers.com to access 523-7860 or email your account any time! pohara@faTMersagent.com 566176 Zndfffion 3-19 Page 2of4 Declaration Page (continued) Rating Information Details Vehiclel Vehicle-2 Vehicle Garaging Zip 92708 92708 92708 Current Annual Mileage 10,000 3,000 5,000 Previous Annual Mileage 10,000 3,000 5,000 Vehicle Usage Other Use Commuter Use Other Use Years of Driving Experience 39-43 44-48 N/A Policy and Endorsements This section lists the policy form number and any applicable endorsements that makeup your insurance contract. Any endorsements that you have purchased to extend coverage on your policy are also listed in the coverages section of this declarations document: 56-56841 st ed.; CAI 252nd ed.;J69603rd ed.; J69622nd ed.; J70341 st ed.; 25-8531 10-12 Other Information YOUR POLICY INCLUDES THE FULL PERMISSIVE USER LIMITOFLIABILITY. PLEASE SEE PERMISSIVE USER LIMITOF LIABILITY IN YOUR POLICYFOR FURTHER INFORMATION. You may be eligible for a different rate but with different coverage from Farmers Specialty Insurance Company. Please contact your Farmers' agent to discuss your options. Vehicle 1,23- Deductible reduced to$ 100 for glass loss. The Attorney- I n -Fact (AIF) or management fee for your renewed policy will never exceed 20% of the policy's premiums and will be paid out of the premiums. You may wish to consider this information in deciding whether to accept or decline this offer to renew your policy. You have the right to designate an additional third party to receiveany notice ofcancellation for nonpayment ofyour premium for thispolicy. Please contact your Farmers' agent ifyou would like to add, change, or remove a designee. Farmers Friendly Reviews area great way to make sure you are receiving all the discounts for which you qualify, and identify any potential gaps in coverage. Contact your agent to learn more about the policy discounts, coverage options, and other product offerings that may be available to you. farmers.com Policy No. 19412-58-91 Questions? Manage your account: Call your agent Peter 0 O'Hara at(714) Go to www.farmers.com to access 523-7860 or email your account any time! pohara©farmersagent.com 56-6176 2nd Edition 3-19 Page 3 of Declaration Page (continued) Information on Additional Fees The"Fees" stated in the "Premiums/Fees"section on page 1 apply on a per -policy, not an account basis. The following additional fees also apply: 1. Service Charge per installment (inconsideration of our 2. Late Fee: $15.00 (applied per account) agreement to allow you to pay in installments): 3. Returned Payment Charge: $25.00 (applied per check, For Recurring Electronic Funds Transfer (EFT): $0.00 electronic transaction, or other remittance which is not applied per account) honored by your financial institution for reasons including, For Recurring Credit/Debit Card plans: $5.00 (applied per but not limited to, insufficient funds or a closed account) account) ' 4. Reinstatement Fee: $18.40 (applied per vehicle, 20% For all other payment plans: $7.00 (applied per account.) discount will apply for Good Drivers) If this account is for more than one policy, changes in these fees are One or more of the fees or charges described above maybe not effective until the revised fee information is providedforeach deemed apart of premium under applicable state law. policy. Countersignature Authorized Representative farmers.com Polity No. 19412-58-91 Questions? Manage youraccount: Callyouragent PetetD O'Hara at(714) Gotowmv.farmers.com to access 523-7860 or email your account any time! pohara@farmersagent.com 566176 2nd Edition 3.19 Page4of4