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JFK Memorial Hospital / Health Screenings 17adgra MEMORANDUM TO: Frank J. Spevacek, City Manager FROM: Christopher Escobedo, Community Resources Director DATE: September 22, 2017 received by Clerk's Ofice 10/17/2017 RE: John F. Kennedy Memorial Hospital Free Screenings for Health Fair AGR#HealthFair2017 Attached for your signature is an agreement with John F. Kennedy Memorial Hospital to offer FREE screenings to seniors and the community. Please sign the attached agreement(s) and return to the City Clerk for processing and distribution. Requesting department shall check and attach the items below as appropriate: N/A Contract payments will be charged to account number: N/A Amount of Agreement, Amendment, Change Order, etc.: N/A A Conflict of Interest Form 700 Statement of Economic Interests from Consultant(s) is attached with no reportable interests in LQ or _ reportable interests N/A A Conflict of Interest Form 700 Statement of Economic Interests is not required because this Consultant does not meet the definition in FPPC regulation 18701(2). Authority to execute this agreement is based um: N/A Approved by the City Council on April 18.2017 N/A City Manager's signature authority provided under Resolution No. 2015-045 for budgeted expenditures of $50,000 or less. This expenditure is $ and authorized by contract approved by N/A Initial to certify thot 3 written informal blds or proposals were received and considered in selection The fallowing required documents are attached to the agregment; X Insurance certificates as required by the agreement (approved by Risk Manager on 10117 en rniate) NIA Performance bonds as required by the agreement (originals) N/A City of La Quinta Business License number N/A A requisition for a Purchase Order has been prepared (amounts over $5,000) N/A A copy of this Cover Memo has been emailed to Finance (Sandra) se Revlsed May 2017 INDEMNITY AND HOLD HARMLESS AGREEMENT THIS INDEMNITY AGREEMENT AND HOLD HARMLESS ("Agreement") is hereby entered into by the City of La Quinta ("City") and John F. Kennedy Memorial Hospital ("Agency") as of September 21, 2017. RECITALS A. Agency has proposed to provide. The Agency has proposed to provide Blood Pressure, Body Mass Index, and Glucose Screenings to members of the community at the La Quinta Wellness Center ("Services"). The "Service" will consist of the following] ("Services"). Blood Pressure Screening: Screening will consist of use of blood pressure cuff and stethoscope- measures systolic pressure heart beats and diastolic pressure between heart beats. Body Mass Index Measurement (BMI): Participant body weight, height, age and sex is entered into a hand held body fat analyzer machine. Participant holds the grip electrodes and the machine measures the percent of body fat. Body mass index is calculated by the machine. The results are explained using a chart showing normal and abnormal values for body fat percent and BMI. Blood Glucose: the nurse will prick the participant's finger and place a drop of blood on the test strip and insert the strip into a glucose meter. The glucose meter will provide results in 3 seconds. The results are entered on the result form and will show normal values for blood glucose. If the participant has abnormal results they are advised to discuss the results with their doctor. B. The City wishes to have Agency provide the Services at a location where its senior citizens, and other residents of the City can obtain this service. NOW, THEREFORE, in consideration of performance by the parties of the mutual promises, covenants, and conditions herein contained, the parties agree as follows: Section 1 The foregoing Recitals are true and correct and are hereby incorporated herein by this reference and are expressly made a part of this Agreement. Section 2 2.1 Agency shall defend (with counsel selected by the City), indemnify, and hold harmless the City and its officers, employees, and agents (collectively, "Indemnified Parties") from and against any liability (including liability for claims, suits, actions, arbitration proceedings, administrative proceedings, regulatory proceedings, losses, expenses or costs of any kind, whether actual, alleged or threatened, including, without limitation, incidental and consequential damages, court costs, attorneys' fees, litigation expenses, and fees of expert consultants or expert witnesses) incurred in connection therewith and costs of investigation, where the same arise out of, are a consequence of, or are in any way attributable to, in whole or in part, the performance of this Agreement by Agency or by any individual or entity for which Agency is legally liable, including but not limited to officers, agents, employees, or subcontractors of Agency, excepting only those claims, actions, obligations, losses, liabilities, judgments, or damages arising out of the sole negligence, active negligence, or willful misconduct of the Indemnified Parties. IieviccJ April 2015 2.2 In the event the Indemnified Parties are made a party to any action, lawsuit, or other adversarial proceeding alleging negligent or wrongful conduct on the part of Agency, Agency shall provide a defense (with counsel selected by the City) to the Indemnified Parties, or at the City's option, reimburse the Indemnified Parties on an ongoing monthly basis their costs of defense, including reasonable attorneys' fees, incurred in defense of such claims. 2.3 In addition, Agency shall be obligated to promptly pay any final judgment or portion thereof rendered against the Indemnified Parties. Section 3 3.1 Prior to the execution and throughout the duration of this Agreement, Agency shall maintain insurance in conformance with the requirements set forth below. Agency may use existing coverage to comply with these requirements. If that existing coverage does not meet the requirements set forth here, Agency shall have it amended to do so. Agency acknowledges that the insurance coverage and policy limits set forth in this Section 3.1 constitute the minimum amount of coverage required. Any insurance proceeds in excess of the limits and coverage required in this Agreement and which is applicable to a given Toss, will be available to City in the event of a loss covered by this Agreement. Agency shall provide the following types and amounts of insurance; A. Commercial General Liability Insurance using Insurance Services Office "Commercial General Liability" policy form CG 00 01, with an edition date prior to 2004, or the exact equivalent. Coverage for an additional insured shall notbe limited to its vicarious liability. Defense costs must be paid in addition to limits. Limits shall be no less than $1,000,000 per occurrence for all covered losses and no less than $2,000,000 general aggregate. B. Workers' Compensation on a state -approved policy form providing statutory benefits as required by law with employer's liability limits no less than $1,000,000 per accident for all covered losses. C. Professional Liability or Errors and Omissions Insurance as appropriate shall be written on a policy form coverage specifically designed to protect against acts, errors or omissions of the consultant and "Covered Professional Services" as designated in the policy must specifically include work performed under this agreement. The policy limit shall be no Tess than $1,000,000 per claim and in the aggregate. The policy must "pay on behalf of" the insured and must include a provision establishing the insurer's duty to defend. The policy retroactive date shall be on or before the effective date of this agreement. 3.2 Agency agrees to provide evidence of the insurance required herein, satisfactory to City, consisting of: (a) certificate(s) of insurance evidencing all of the coverages required and, (b) an additional insured endorsement to Agency's Commercial General Liability policy using ISO Form CG 20 10 with an edition date prior to 1988, which form shall include coverage for completed operations. The additional insured endorsement shall expressly name City, and its officers and employees as additional insureds on the policy(ies) as to Commercial General Liability coverages, and completed operations coverages, with respect to liabilities arising out of Agency's performance of the Services under this Agreement. 3.3 Proof of compliance with these insurance requirements, consisting of endorsements and certificates of insurance, shall be delivered to City prior to Agency commencing performance of any of the Services described in this Agreement. Revised April 2015 3.4 Copies of this Agreement and any other forms of communication between the parties shall be directed to the addresses set forth below: To City: CITY OF LA QUINTA Attention: Susan Maysels, City Clerk 78-495 Calle Tampico La Quinta, California 92253 ATTEST: To Consultant Vendor Name: John F. Kennedy Memorial Attn: Gary L. Honts, Chief Executive Officer Address: 47111 Monroe Street City ST ZIP: Indio, CA 92201 John F. Kennedy Memorial Hospital ("Agency") By:r� Gary L. Honts Its: Chief Executive Office CITY OF LA QUINTA ("City") By: Chris Escobedo, Director, Community Resources Susan Maysels, City Clerk APPROVED AS TO FORM: � �yr r � 4 fF. By:,C�L.0 • _ - William H. Ihrke, City Attomey Revised April 2015 AJ RD' CERTIFICATE OF LIABILITY INSURANCE k DATE 7/19/2017 DYYYY, THS 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(les) 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 certilicato holder in Ilou of such undorsemont(sI. PRODUCER Arthur J. Gallagher & Co, Insurance Brokers of CA- Inc. LIC #0726293 505 N. Brand Boulevard, Suite 600 Glendale CA 91203 CO'`ITAC r >tAMjir Global Risk Management MORE rFAx wC tlu.exli:818�539_2300 l mate 818-539-1801 ss.grm_certiflcates@ajg.com ANREss.grm_certlficates@ajg.com NNSIra= : AFFOROOIGCOVERAGE RAC r etsuRERA:National Union Fire Insurance Compan of 19445 INSURED TENEHEA-02 Tenet Healthcare Corp- 1445 Ross Ave, Ste. 1400 Dallas, TX TX 75202-2703 eNsuReR El:Various 6938919 ersurrFR r-: _ — INSURER P: 31.000.000 INSURER E 1f....�, I:1(:L(:UR INSURER F'] THIS IS TC CERTIFI' THAT TtiE POLICIES OF INSURANCE LISTED RELOW HAVP.. BEEN ISSUED TO THE INSURED NAMED MOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL -HE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED EY PAID CLAIMS 1N$RR OF INSURANCE .... ATYPE NSVD WVO POLICY 40 RIBS ii Jr.IBR MlnfIYVYYI 1 ei yYyYY l LIMITS A x COMMERCIAL GENERAL LIABILITY Y 6938919 611/2017 6/1/2018 ',ACP(CC.ILIRR^;Cr• 31.000.000 1f....�, I:1(:L(:UR tAISCIGGTTO nano jag r1U$fS;Ert ;q -s L__ MED EXP (Mt one-pttrohl 31.000.000 310,000 31,000000 PERSONAL &ADV INJURY dirt. AGGRLGATF LIMIT a PPL IES PER GENERAL AGGREGATE 53.000.000 X PCI -ICY 11 _I .,-, I_ I LO, PRODUC IS - CJMP;OPAGG 51.000.090 O WEN' AUTOMOBILE LIABILITYIMaLL- COmBIRED UMIJ i — ANY AUTO NED •I-- BODILY INJURY (=e( psrscn) _ .__ OJ 4Ui^S 0%1:1 HIHL-0 /,L.TOSONLI 1 s -I ULA AUTOS NON -OW -IIID AJ.31'0ti ONLY PODfLY INJURY (Per axidenl) •FRGPFR7Yt5AVACE Per =WEN} 2 - T' S UMBRELLA LIAR _ OCCUR EACH OC(. URRE1,CE 5 EXCESS LIAB CLAIMS-r,S..l'F - AGvR6G:11 L- j r DE0 j j a&1 NRCN'. 3 8 WORKERS COMPENSATION EMPLOYERS' LIABILITY YrN See Attached 6,11/2017 6/1/2018 Y; 17,7-7 TUTF 1 1 ern AND ANT PROPR ETOR.PARTNER'EXECUTIVEEL DF`ICFRR:I SV BER EXCLUDED? N NlA EACH.SCC DEE i' - ..... 3Y.ODO QOR prlandamry in NH) If vu, Soscrbc undar E I_ DISEASE - EA E:APLOYEC 57,nAD, 000 DF_SCRIPT ION Okr OPERATIONS bet,: E L DISEASE- FOLIC Y LIMIT 82.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS ! VEHICLES [ACORD 101, Additional Remarks Schodule, may ba attached it more space is raqui od) Insured / Facility' JFK Memorial Hospital participation in La Quinta Wellness Center Annual Health Fair on September 21, 2017 La Quinta Wellness Center and The City of La Quinta, its officers and employees are Included as additional insured with respect to general liability but solely as respects to general liability ansing out of the Named Insured's operations or premises owned by or reeled by the Named Insured, excluding contract or agreements for professional services, and subject to the terms and conditions of the referenced policy as required by written contract. CERTIFICATE HOLDER City of La Quints 78-405 Calle Tampico La Ouinta CA 32253 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. AUTHORIZED REPRESENTATIVE d 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ACCIUL)DATE(MMIDDIYYYY) _ CERTIFICATE OF LIABILITY INSURANCE _ 09,'2112017 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(les) 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 thls certificate does not confer rights to the certificate holder in IIeu of such endorsernent(s). PRODUCER Morph Management ServL'es Cnyw,., G;,, G:,verners Square, isftflil4, Floor 2 23 Liine Pee Bay AYa ttla Grand Cayman,Kl' 1-1102 CI.1102160225-THING-5M-17.16 UMW:1 _.MnNIE. .... - - , - ( PHONE I FAX :SAX. HO. .LAE: _-_—. -. (AIC, 1101 -- - NAIC k _ E-MAIL ?1017JiC7rs• -_ - -- - _ INSURER(S) AFFORDING COVERAGE _ ` INSURER A:IheHeat(hcareInsuranceCor!Xrraton INSURER D:_-_ _ INSURED .0019 `- Kdnr,rAy !.lemer,al HCSpll5 47-111 Monrce Street Indio, CP, 92201 INSURER 0 - IlaUREH 0 1 H5 URER.E !HSUPER F COVERAGES CERTIFICATE NUMBER: CHI -006740427.01 REVISION NUMBER: 2 11-113 IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, TI -IE 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. rNtin - - . IAMU5ULtR (1R TYPE OF INSURANCE 11k3(L vivo POLICY NUMBER POLICY EFF (4AINYYYY) POLICY -EXP t _ _ _ _.... _ �__ IMreiltlrvYYYt 1 LIMITS X f COMMERCIAL GENERAL LIABILITY ^i EACH OCCUR<.C'JCE 13 5.000,000 A X CLAIMS -MADE OCCUR 2017-03 06101..2017 0601/2018 bAAfAC�ETgRESTED p Mi5.5-!E4 m�Yfiert4A_.__-- X I Henkel Frofosslonal bat) (65M SIR) MEll pSp (Any Une earilanli $ C `b!,.':. M' -= __ _ 1 GEK'LACCR=GALE LIMIT APFLIE_S PER I PERSONAL$^DVTr1JUBY GENSRAL ACGf(EGATE f _ ( ? 5 n0 000 [hpolicy •_ F'iR• t ; La PROCUCTS- COi.1P:OPAGG I € AUTOMOBILE LIABILITY C6ft1$1T .T5 SINGLE OM (La acc:dont) s ' - I ANY AUTO • BODILY INJURY (Per person) S I{ 377/'HED nous °Ky.AUTOS - SCMEDULEO 5ODILY INJURY (Pe: accidenp - S iiIRED AUTOS ONLY' .__ NON-t)WNEr] 02)103 ONLY 4 FFi(YLREY tigiAG - -..- (Par acc•aen4 i S• UMDRELLA LIAR EXCESS uAD I 1 OCCUR Li CLAIMS.MADE EACH OCCURRENCE 5 AGGREGATE & DEI) . I REIILRI•IQN$_ S WORKERS COMPENSATION ANC EMPLOYERS' LIABILITY Y;N 0111.10 1 RIE I Ull,'JV3(ipILI of Xl_(11U 1 NL IICrHR.',C`arll=rtl_Y-(:L(ID)-D') , I Mandaloly in NI -I) i If Yeti, de.cr•I-.e under L-$SCRiI'IICN OF OPF(2NTIOR5E0I r N)A I p- ll-Tn I r�1H- -- L--'. i • -- E1 EACH ACCIDENTql -- -- E L 0150009 -EA EMPLOYEE S. 0L DISEASE- POLICY LIMIT S GESC RIP1 ION OF OPERA HUNS !LOCATIONS /VEHICLES (ACORD 101, AdalhonaI Remarks Schedule, may be a Ilachod if more space in roquirod( Participaflos in La Cuinla Wellness Center Annual Heallh Fair on September 21, 2017 CERTIFICATE HOLDER Cu; 01 La OunLa V:'elinnsc: Center 78130 Avenida La Fonda La Quetta, CA 92253 ACORD 25 (2016/03) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE TFI1=fiEOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE 1 - 1 I 1 1968.'LOi 6 ACORD FORPORA_T1ON. AIS rights reserved. The ACORD name and logo are registered (narks of ACORD Tenet Healthcare Corporation Workers' Compensation Program Layer Insurance Company -"Policy Number Policy Term NAIC No. Work Comp - AOS (AR,CO,CT,DE,GA,HI,IA,ID,IN,KS,MD,MI,MN,M O,MS,MT,NE,NM,NV,NY,OK,OR, RI,SC,SD,TN,T X,WV) New Hampshire Insurance Company' 63724405 06/01/17-06!01!16 23641 Work Comp - AZ, VA New Hampshire Insurance Company 63724402 06/01/17- 06/01/18 23841 Work Comp - CA American Home Assurance 63724400 - ' 06/01/17- 06/01/18 19380 Work Comp- FL Work v. Illinois National Insurance Co. 63724401 06/01/17- 06/01/18 23817 Work Comp- IL,KY,NC,NH,UT,VT New Hampshire Insurance Company 63724403 06/01/17-06/01/18 23841 Work Comp -NJ, PA New Hampshire Insurance Company 63724404 06/01/17- 06/01/18 23841 Work Comp-MA,ND,OH,WA,WI,WY New Hampshire insurance Company 63724406 06/01/17- 06/01/18 23841 Work Comp -ME NewHampsnlre Insurance Company 63724407 06/01/17- 06/01/18 23841 Excess Work Comp -AL, CA, LA National Union Fire Insurance Company of Pittsburgh, Pa 6583161 06/01/17- 06/01/18 19445 Excess Work Comp - MI (VHS of Michigan, Inc) Safety National Casualty Corp SP4055638 09/01/16 - 06/01/18 15105 POLICY NUMBER: 6938919 COMMERCIAL GENERAL LIABILITY CG 20 11 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designation Of Premises (Part Leased To You): PER THE CONTRACT OR AGREEMENT Name Of Person(s) Or Organization(s) (Additional Insured): ANY PERSON OR ORGANIZATION FROM WHOM YOU LEASE PREMISES OR WHO MANAGES PREMISES YOU OWN AND TO WHOM YOU BECOME OBLIGATED TO INCLUDE AS AN ADDITIONAL INSURED UNDER THIS POLICY AS A RESULT OF ANY LEASE OR MANAGEMENTAGREEMENT YOU Additional Premium: $ INCLUDED Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to include as an additional insured the person(s) or organizatian(s) shown in the Schedule, but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises, 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person(s) or organization(s) shown in the Schedule, However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and CG 20 11 04 13 2. If coverage provided to the additional insured is required by a contract 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 Suction III — 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. © Insurance Services Office, Inc., 2012 Page 1 of 1 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only whao this endorsement Is Issued subsequent ter preparation of the policy). This endorsement, effective 12:01 AM 06/01/2017 issued to TENET HEALTHCARE CORPORATION By NEW HAMPSHIRE INSURANCE COMPANY forms a part of Policy No. WC 63724405 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. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE ENTERED INTO A CONTRACT, A CONDITION OF WHICH REQUIRES YOU TO OBTAIN THIS WAIVER FROM US. THIS ENDORSEMENT DOES NOT APPLY TO BENEFITS OR DAMAGES PAID OR CLAIMED: 1. PURSUANT TO THE WORKERS' COMPENSATION OR EMPLOYERS' LIABILITY LAWS OF KENTUCKY, NEW HAMPSHIRE, OR NEW JERSEY; OR, 2. BECAUSE OF INJURY OCCURRING BEFORE YOU ENTERED INTO SUCH A CONTRACT. The premium charge for the endorsement is INCLUDED This form is not applicable in California, Kentucky, New Hampshire, New Jersey, North Dakota, Ohio, Texas, Utah, or Washington. This form is not applicable in Missouri when there is a construction code on the policy and there is Missouri premium or exposure. WC 00 03 13 Countersigned by (Ed. 04/84) Authorized Representative BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below, (The following "attaching clause" need be completed only when this endorsement is lesued subsequent to preparation or the policy). This endorsement, effective 12:01 AM 06/01/2017 forms a part of Policy No. WC 63724400 Issued to TENET HEALTHCARE CORPORATION By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. We have a right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against any person or organization with whom you have a written contract that requires you to obtain this agreement from us, as regards any work you perform for such person or organization. The additional premium for this endorsement shall be 2.00 % of the total estimated workers compensation premium for this policy. WC 04 03 61 (Ed. 11f90) Countersigned by Authorized Representative WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 06/01/2017 forms a part of Policy No- WC 63724401 Issued to TENET HEALTHCARE CORPORATION By ILLINOIS NATIONAL INSURANCE CO, We have the right to recover our payments from anyone liable for an injury covered by thls 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, This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE ENTERED INTO A CONTRACT, A CONDITION OF WHICH REQUIRES YOU TO OBTAIN THIS WAIVER FROM US. THIS ENDORSEMENT DOES NOT APPLY TO BENEFITS OR DAMAGES PAID OR CLAIMED: 1, PURSUANT TO THE WORKERS' COMPENSATION OR EMPLOYERS' LIABILITY LAWS OF KENTUCKY, NEW HAMPSHIRE, OR NEW JERSEY; OR, 2, BECAUSE OF INJURY OCCURRING BEFORE YOU ENTERED INTO SUCH A CONTRACT. This form is not applicable in California, Kentucky, New Hampshire, New Jersey, North Dakota, Ohio, Texas, Utah, or Washington. This form is not applicable in Missouri when there is a construction code on the policy and there is Missouri premium or exposure. WC 00 03 13 , (Ed. 04/84) Countersigned by Authorized Representative WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it Is attached effective on inception date of the policy unless a different date is indicated below. (The following "attaching douse" need be completed only when this endorsement is Issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 06/01/2017 forms a part of Policy No. WC 63724402 Issued to TENET HEALTHCARE CORPORATION By NEW HAMPSHIRE INSURANCE COMPANY We have the right to recover our payments from anyone liable far 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, This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE ENTERED INTO A CONTRACT, A CONDITION OF WHICH REQUIRES YOU TO OBTAIN THIS WAIVER FROM US. THIS ENDORSEMENT DOES NOT APPLY TO BENEFITS OR DAMAGES PAID OR CLAIMED: 1. PURSUANT TO THE WORKERS' COMPENSATION OR EMPLOYERS' LIABILITY LAWS OF KENTUCKY, NEW HAMPSHIRE, OR NEW JERSEY, OR 2. BECAUSE OF INJURY OCCURRING BEFORE YOU ENTERED INTO SUCH A CONTRACT. This form is not applicable in California, Kentucky, New Hampshire, New Jersey, North Dakota, Ohio, Texas, Utah, or Washington. This form is not applicable in Missouri when there is a construction code on the policy and there is Missouri premium or exposure. WC 00 03 13 (Ed. 04184) Countersigned by • Authorized Representative WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it is attached effective on inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 06/01/2017 Issued to TENET HEALTHCARE CORPORATION By NEW HAMPSHIRE INSURANCE COMPANY forms a part of Policy No. WC 63724403 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. This agreement shall not operate directly or Indirectly to benefit any one not named In the Schedule, Schedule ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE ENTERED INTO A CONTRACT, A CONDITION OF WHICH REQUIRES YOU TO OBTAIN THIS WAIVER FROM US. THIS ENDORSEMENT DOES NOT APPLY TO BENEFITS OR DAMAGES PAID OR CLAIMED: 1. PURSUANT TO THE WORKERS' COMPENSATION OR EMPLOYERS' LIABILITY LAWS OF KENTUCKY, NEW HAMPSHIRE, OR NEW JERSEY, OR 2. BECAUSE OF INJURY OCCURRING BEFORE YOU ENTERED INTO SUCH A CONTRACT. This form is not applicable In California, Kentucky, New Hampshire, New Jersey, North Dakota, Ohio, Texas, Utah, or Washington. This form Is not applicable in Missouri when there is a construction code on the policy and there is Missouri premium or exposure. WC 00 03 13 Countersigned by (Ed. 04184) Authorized Representative WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement changes the policy to which it Is attached effective on inception date of the policy unless a different date is indicated below. (The fallowing "attaching clause" need be completed only when this endorsement Is issued subsequenl to preparation of the policy), This endorsement, effective 12:01 AM 06/01/2017 forms a part of Policy No. WC 63724404 Issued to TENET HEALTHCARE CORPORATION By NEW HAMPSHIRE INSURANCE COMPANY 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. This agreement shall not operate directly or indirectly to benefit any one not named in the Schedule. Schedule ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE ENTERED INTO A CONTRACT, A CONDITION OF WHICH REQUIRES YOU TO OBTAIN THIS WAIVER FROM US. THIS ENDORSEMENT DOES NOT APPLY TO BENEFITS OR DAMAGES PAID OR CLAIMED: 1. PURSUANT TO THE WORKERS' COMPENSATION OR EMPLOYERS' LIABILITY LAWS OF KENTUCKY, NEW HAMPSHIRE, OR NEW JERSEY, OR 2, BECAUSE OF INJURY OCCURRING BEFORE YOU ENTERED INTO SUCH A CONTRACT. This form is not applicable in California, Kentucky, New Hampshire, New Jersey, North Dakota, Ohio, Texas, Utah, or Washington. This form is not applicable in Missouri when there is a construction code on the policy and there is Missouri premium or exposure. WC 00 03 13 Countersigned by (Ed. 04184) Authorized Representative