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Tenet Health/Indemnity Agreement 09INDEMNITY AND HOLD HARMLESS AGREEMENT �%UET /�eFj/�/�fj�f�.y This Indemnity Agreement and Hold FIarmless ("Agreement") is hereby entered into by the City of La Quinta ("City") and//Desert Regional Medical Center, ("Agency") for services to be rendered on October 6, 2009. RECITALS A. The Agency has proposed to provide the following three free screenings to seniors and other members of the community at the La Quinta Senior Center ("Services"): Body Mass Index Measurement (BMI): participant height, weight, age and sex is entered into the HBF-306 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 a test strip and insert the strip into a glucose meter. Glucose meter will provide results in three seconds. The results are entered on the result form will show normal values for blood glucose. If' the patient has abnormal results they are advised to discuss the results with their doctor. If the patient does not have a doctor, a referral phone number will be provided so they may seek medical assistance. Brown Bag: Participants bring all their medications they have at home for review from a pharmacist. The Brown Bag reviews could help to identify and fill gaps in patient's knowledge about the purpose of their medicines and how to use them, thereby contributing to improved compliance and the benefits that patients derive from their medications. 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 I The foregoing Recitals are true and correct and are hereby incorporated herein by this reference and are expressly made a part of this Agreement. CADocuments and Settings\gcokcy.visbaIALocal SettingsATemporary Internet FIIcsVOLKICDADcscrt Reg FRFF Scrngs- IHH AGN1T - 10-6-09.DOC Section 2 2.1 Agency shall defend, indemnify and hold harmless the City .and its officers, employees, and agents (collectively, "Indemnified Parties") from and against any and all of claims, causes of action, obligations, losses, liabilities, judgments, or damages, including reasonable attorneys' fees and costs of litigation (collectively "Claims") arising out of and/or in any way relating to the Agency's activities in the performance of the Services described in this Agreement, or to the Agency's acts and/or omissions in providing or administering the same, 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. 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 the Agency, the Agency shall provide a defense 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, the 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 loss, 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 not be 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. CAnocuments and seltings\geofGcy.% sbaFLocaI Settings\Temporary Intcmet FilesVOLK ICDADesert Reg FREE Scmgs- IHIH MiMT - 10-6-09.DOC 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. 3.2 Agency agrees to provide evidence of the insurance required herein, satisfactory to the City, consisting of: (a) certificate(s) of insurance evidencing al I of the coverages required and, (b) an additional insured endorsement to Agency's general liability policy using ISO Form CG 20 10 with an edition date prior to 2004. The additional insured endorsement shall expressly name the City, its officers, and employees as additional insureds on the policy (ies) as to commercial general liability bodily injury and property damage 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 escribed in this Agreement. i DESERT REGIONAL MEDICAL CENTER ("Agency") By: h' D EE Dcd/E Its: 4ye-- CITY OF LA QUINTA ("City") 1'--X WeF By: //) �_ Thomas P. Genovese, City Manager APPROVED AS TO FORM: M. ?i ather ne Jenso ty Attorney CADocuments and Scltings\gcolrrcy.vlsbulALocal Settings\Temporary Internet Fi1csV01_KICDADesert Reg FREE Songs- Inn AOMI' - 10-6-09.DOC THE HEALTHCARE INSURANCE CORPORATION Box 1Q51GT * Barclay House * 3' floor * Shedden Road * Georgetown, Grand Cayman * Cayman Islands, B.W.I. CERTIFICATE OF INSURANCE DATE ISSUED: June 1. 2009 ISSUED TO: Desert Regional Medical Center ADDRESS: 1150 N. Indian Canyon Way Palm Springs, CA 92262 CLAIMS -MADE POLICY #2009-05 066C: RE: All employees of Insured are provided coverage under this policy, including residents, interns, nurse practitioners, nurse midwives, athletic trainers, physician assistants, profusionists, therapists, social workers, CRNA's podiatrists, paramedics and employed physicians while acting within the scope of their duties as such. Also covered are authorized Volunteers and facility Medical Directors while acting within the scope oftheirduties as such. THIS IS TO CERTIFY that insurance has been effected with THE HEALTHCARE INSURANCE CORPORATION (the "Company",) under Policy Number 2009-05 as follows: INSURED: Desert Regional Medical Center and/or Desert Hospital Comprehensive Cancer Center ADDRESS 1150 N. Indian Canyon Way Palm Springs, CA 92262 COVERAGE: Comprehensive General Liability, Medical Professional Liability, Contractual Liability, Personal Injury Liability, Druggist's Liability, Managed Care Organizations' Errors and Omissions Liability, Employment Practices Liability, and Miscellaneous Professional Liability WRITTEN ON A CLAIMS -MADE BASIS. AMOUNT OF INSURANCE: Not less than $5,000,000 per claim (Professional Liability). Not less than $5,000,000 per claim (General Liability). SELF -INSURED RETENTION: $5,000,000 POLICY TERM: June 1, 2009 at 12:01 A.M. to June 1, 2010 at 12:01 A.M. LOCAL TIME at the address of the Insured. THIS CERTIFICATE is not transferable and may be cancelled by giving thirty days written notice to the party to which this Certificate is issued prior to the effective date of the cancellation of the insurance described herein. THIS CERTIFICATE is for information only; it is not a contract of insurance, but attests that a policy as numbered herein, and as it stands at the date of this Certificate, has been issued by the Company. Said policy is subject to change by endorsement and cancellation in accordance with its terms. EFFECTIVE DATE OF THIS CERTIFICATE: June 1, 2009, CERTIFICATES EXPIRES: June 1, 2010, unless cancelled sooner. cc: Captive Insurance Services, Inc. 13737 Noel Road Dallas, TX 75240 Signed by INDEMNITY AND HOLD HARMLESS AGREEMENT This Indemnity Agreement and Hold Harmless ("Agreement") is hereby entered into by the City of La Quinta ("City") and Tenet Health System Desert, Inc., dba, ("Agency") for services to be rendered October 27, 2011. RECITALS A. The Agency has proposed to provide the following free screenings to seniors and other members of the community at the La Quinta Senior Center ("Services"): Flu Immunizations: will offer 300 flu immunizations, medical supplies and personnel to administer the injections. 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: Sertinn 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 Cross Indemnification. Agency and City shall defend, indemnify and hold harmless each other and each other's officers, employees, and agents (collectively, "Indemnified Parties") from and against any and all claims, causes of action, obligations, losses, liabilities, judgments, or damages, including reasonable attorneys' fees and costs of litigation (collectively "Claims") arising out of and/or in any way relating to the other party's activities in the performance of the Services described in this Agreement, or to the other party's acts and/or omissions in providing or administering the same, 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. 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 one party, the other party shall provide a defense to the Indemnified Parties, or at the other party'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, the responsible party shall be obligated to promptly pay any final judgment or portion thereof rendered against the Indemnified Parties. SArtlnn 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 loss, 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 equivalent. Coverage for an additional insured shall not be 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 bylaw with employer's liability limits no less than $1,000,000 per accident for all covered losses. 3.2 Agency agrees .to provide evidence of the insurance required herein, satisfactory to the City, consisting of: (a) certificate(s) of insurance evidencing all of the coverages required and, (b) an additional insured endorsement to Agency's general liability policy using ISO Form CG 20 10 with an edition date prior to 2004. The additional insured endorsement shall expressly name the City, its officers, and employees as additional insureds on the policy lies) as to commercial general liability bodily injury and property damage 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. Tenet Health System Desert, Inc., dba Its: CITY OF LA QUINTA ("City") Ah�o�ma2enovese, City Manager APPROVED AS TO FORM: 1 By: /// , M.Aatfi4ine Jenson, Attorney '``� h® CERTIFICATE OF LIABILITY INSURANCE 09(MM1DD 11 O09/27/DD/11 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 pollcy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 1-818-539-2300 Arthur J. Gallagher & Co. Insurance Brokers of California, Inc. License #0726293 CONTACT NAME:PHONE FAX o Eat: A/C No: 505 North Brand Boulevard, Suite 600 E-MAIL maribel eanchez4la ADDRESS: jg.com INSURERS AFFORDING COVERAGE NAIC# Glendale, CA 91203-3944 INSURER A: NATIONAL UNION FIRE INS CO OF PITTS 19445 INSURED Tenet Healthcare Corp. INSURERB: CHARTIS SPECIALTY INS CO 26883 INSURER C: ILLINOIS MAIL INS CO 23817 INSURER D: NEW HAMPSHIRE INS CO 23841 1445 Rosa Avenue, Suite 1400 INSURER E: CHARTIS CAS CO 40258 Dallas, TX 75202-2703 INSURER F: COVERAGES CERTIFICATE NUMBER: 23231408 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A GENERAL LIABILITY 2449468 06/oi/1 06/01/12 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE To RENTED PREMISES Ea ocnafar a $ 1, 000, 000 MED EXP (Any one person) § 10,000 CLAIMS -MADE � OCCUR PERSONAL S ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 ' GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $2,000,000 X POLICY PRO- lOC § A AUTOMOBILE LIABILITY 3506314 COMBINED SINGLE LIMIT Ea accident 2,000,000 B 3506316 - Garage Keepers 06 /O1/1 06 /O1/12 X ANY AUTO BODILY I NJURY(Par person) $ B ALL OWNED SCHEDULED 3506315 - Phy Damage 06/01/1 06/01/12 AUTOS AUTOS BODILY INJURY Per acdtlent ( ) § HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Pm. .dent § Phys Dmge/Ded $ 250,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ C WORKERS COMPENSATION 015883628 (MO,NI) 06/01/1 06/01/12 X WCSTATU- OTH- AND EMPLOYERS' LIABILITY YIN E.L. EACH ACCIDENT $2,000,000 D ANY PROPRIETOR/PARTNERIEXECUTIVE 015883624 (ADS) 06/01/1 06/01/12 OFFICERIMEMSER EXCLUDED'! NIA E.L. DISEASE - EA EMPLOYEE $ 2,000,000 C (Mandatory In NH) 015883626 (FL) 06/01/1 06/01/12 A If yyes, describe under - DESCRIPTIONOFOPERATIONSbelow 1192902 AL -CA -LA 06/01/1 06/Ol/12 E.L. DISEASE -POLICY LIMIT $2,000,000 A NC Ik Empl Liab 015883625 (CA) 06/01/1 06/01/12 EL Limits 2,000,000 E NC s Empl Liab 015883627 (GA) 06/01/1 06/01/12 EL Limits 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ADach ACORD 101, Additional Remarks Schedule, if more space Is required) Insured/Facility: Desert Regional Medical Center, 1150 N. Indian Canyon Dr., Palm Springs, CA 92262 Re: BMI/ Blood Pressue / Blood Glucose Screenings and Flu Immunizations. The City of La Quints, its officers, and employees are included as Additional Insureds with respect to General Liabilit but solely as respects to Liability Arising out of the Named Insured's Operations or Premises Owned by or rented by the Named Insured, excluding contracts or agreements for Professional Services, and subject to the terms and conditions of the referenced policy as required by written contract per the attached form. CERTIFICATE HOLDER rehlrri I ATInN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of La Quinta THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P. O. Box 1509 AUTHORIZED REPRESENTATIVE La Quints, CA 92247 USA --Vaw� ACORD 25 (2010105) lauj epp 7T7T1cnA ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL 2449468 COMMERCIAL GENERAL LIABILITY CG 20 1101 96 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): ' AS PER CONTRACT OR WRITTEN AGREEMENT 2. Name of Person or Organization (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 addi- tional insured under this policy as a result of any lease or management agreement you enter into with such parties. 3. Additional Premium: (If no entry appears above, the information required to complete this endorsement will be shown in the Decla- rations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization 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 or organization shown in the Schedule. CG 20 1101 96 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1 0 THE HEALTHCARE INSURANCE CORPORATION 29 Lime Tree Bay Avenue n' Cxwernors Square, P.O. Box 1051, Bd0 4, 2"" II ' Grand Cayman KY -I - I.IW'I Cayman Islands CERTIFICAT[ OF fMLF A\K,E DATE ISSUED: June 1, 2011 ISSUED TO: Desert Regional Medical Center ADDRESS: It 50 N. Indian Canyon Way Palm Springs, CA92262 C1AINIS P1/01' POLICY #2011-05066G RE: All employees of Insured are provided coverage under this policy, including residents, intems, nurse practitioners, nurse midwives, athletic trainers, physician assistants, profusionists, therapists, social workers, CRNA's podiatrists, paramedics and employed physicians while acting within the scope of their duties as such. Also covered are authorized Volunteers and facility Medical Directors while acting within the scope of their duties as such. THIS IS TO CERTIFY that insurance has been effected with THE HEALTHCARE INSURANCE CORPORATION (the "Company".) under Policy Number 2011-05 as follows: INSURED: Desert Regional Medical Center and/or Desert Hospital Comprehensive Cancer Center ADDRESS 1150 N. Indian Canyon Way Palm Springs, CA92262 COVERAGE: Comprehensive General Liability, Medical Professional Liability, Contractual Liability, Personal Injury Liability, Druggist's Liability, Managed Care Organizations' Errors and Omissions Liability, Employment Practices Liability, and Miscellaneous Professional Liability WRITTEN ON A CLAIMS -MADE BASIS. AMOUNT OF INSURANCE: Not less than $5,000,000 per claim (Professional Liability). Not less than $5.000,000 per claim (General Liability). SELF4NSURED RETENTION: $5.000,000 POLICY TERM: June 1, 2011 at 12:01 A.M. to June 1, 2012 at 12:01 A.M. LOCAL TIME at the address of the Insured. THIS CERTIFICATE is not transferable and may be cancelled by giving thirty days written notice to the parry to which this Certificate is issued prior to the effective date of the cancellation of the insurance described herein. THIS CERTIFICATE is for information only: it is not a contract of insurance, but attests that a policy as numbered herein, and as it stands at the date of this Certificate, has been issued by the Company. Said policy is subject to change by endorsementand cancellation in accordance with its terms. EFFECTIVE DATE OF THIS CERTIFICATE: June 1, 2011. CERTIFICATES EXPIRES: June 1, 2012, unless cancelled sooner. cc: Captive Insurance Services, Inc, 1445 Ross Avenue, Ste. 1400 Dallas, TX 75202 06i_Er�har. Signed by INDEMNITY AND HOLD HARMLESS AGREEMENT This Indemnity Agreement and Hold Harmless ("Agreement") is hereby entered into by the City of La Quinta ("City") and Tenet Health System Desert, Inc., dba, ("Agency") for services to be rendered on October 4, 2011. RECITALS A. The Agency has proposed to provide the following three free screenings to seniors and other members of the community at the La Quinta Senior Center ("Services"): Body Mass Index Measurement (BMI►: participant height, weight, age and sex is entered into the HBF-306 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 a test strip and insert the strip into a glucose meter. Glucose meter will provide results in three seconds. The results are entered on the result form will show normal values for blood glucose. If the patient has abnormal results they are advised to discuss the results with their doctor. If the patient does not have a doctor, a referral phone number will be provided so they may seek medical assistance. 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. Sectinn 2 2.1 Cross Indemnification. Agency and City shall defend, indemnify and hold harmless each other and each other's officers, employees, and agents (collectively, "Indemnified Parties") from and against any and all claims, causes of action, obligations, losses, liabilities, judgments, or damages, including reasonable attorneys' fees and costs of Litigation (collectively "Claims") arising out of and/or in any way relating to the other party's activities in the performance of the Services described in this Agreement, or to the other party's acts and/or omissions in providing or administering the same, 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. 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 one party, the other party shall provide a defense to the Indemnified Parties, or at the other party'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, the responsible party shall be obligated to promptly pay any final judgment or portion thereof rendered against the Indemnified Parties. Sartinn i 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 loss, 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 equivalent. Coverage for an additional insured shall not be 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. 3.2 Agency agrees to provide evidence of the insurance required herein, satisfactory to :the City, consisting of: (a) certificate(s) of insurance evidencing all .of the coverages required and, (b) an additional insured endorsement to Agency's general liability policy using ISO Form CG 20 10 with an edition date prior to 2004. The additional insured endorsement shall expressly name the City, its officers, and employees as additional insureds on the policy lies) as to commercial general liability bodily injury and property damage 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. Tene ealth s em D ert, Inc. dba enc 1 By Its: 0�40CJK jo%u `/' cy'Kcc< CITY OF LA QUINTA ("City") n Thomas P. Genovese, City Manager APPROV D AS TO R By: M. Kathe ne Jenson ity Attorney P!," 1.27- f 1 AC R"@ CERTIFICATE OF LIABILITY INSURANCE °oil /2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not Confer rights to the certificate holder in lieu of such endorsements . PRODUCER 1-818-539-2300 Arthur J. Gallagher & Co. Insurance Brokers of California, Inc. License #0726293 505 North Brand Boulevard, Suite 600 CONTACT PHONE FAX A/C No: EMAIL matibel sanchez@a com ADDRESS: jg• INSURERS AFFORDING COVERAGE NAICd Glendale, CA 91203-3944 INSURER A: NATIONAL UNION FIRE INS CO OF PITTS 19445 INSURED INSURER B: CHARTIS SPECIALTY INS CO 26883 Tenet Healthcare Corp. INSURER CILLINOIS NATL INS CO 23817 INSURER 0:$'$K' RAMPSHIRE INS CO 23841 1445 Rose Avenue, Suite 1400 INSURER E: CHARTIS CAS CO 40258 Dallas, TX 75202-2703 INSURER F : COVERAGES CERTIFICATE NUMBER: 23231408 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN$R LTR TYPE OF INSURANCE OLSUBR POLICY NUMBER POLICY EFF MMILDIDmYY LIMITS A GENERAL LIABILITY 2449468 06/01/1 06/01/12 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAG O N PREMISES (Ea oocurrencel $1,000,000 CLAIMS MADE 111 OCCUR MED EXP(Any one person) $ 10,000 PERSONAL S ADV INJURY $1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGO $2,000,000 $ X POLICY PRO- LOC • AUTOMOBILE LIABILITY 3506314 COMBINED SINGLE LIMIT Ea accident 2,000,000 B X 3506316 - Garage Keepers 06/01/1 06/01/12 BODILY INJURY (Per person) $ B ANY AUTO 3506315 - Phy Damage 06/01/1 06/01/12 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON-OHIREDAUTOS nDAMAGE (Per accident) $ AUTOS Phys Dmge/Ded $ 250,000 UMBRELLA LIAR OCCUR - EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION$ $ C WORTH- KERS COMPENSATION 015883628 (MO,wI) 06/01/1 06/01/12 X TORY WC LIMIT ER AND EMPLOYERS' LIABILITY YIN E.L. EACH ACCIDENT $ 2,000,000 D ANY PROPRIETOWPARTNERIEXECUTIVE 015883624 (ADS) 06/01/1 06/01/12 C OFFICERIMEMBER EXCLUDED'! iN (Mandatory In NH) NIA 015883626 (FL) 06/01/1 06/01/12 E.L. DISEASE - EA EMPLOYEE f 2,000,000 A I(yes describe under DESCRIPTION OF OPERATIONS below 1192402 AL -CA -LA 06/01/1 06/01/12 E.L. DISEASE -POLICY LIMIT $ 2.000 000 A NC & Empl Liab 015883625 (CA) 06/01/1 06/01/12 EL Limits 2,000,600 E NC & Empl Liab 015883627 (GA) 06/01/1 06/01/12 EL Limits 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space Is required) Insured/Facility: Desert Regional Medical Center, 1150 N. Indian Canyon Dr., Palm Springs, CA 92262 Re: BMI/ Blood Pressue / Blood Glucose Screenings and Flu Immunizations. The City of La Quinta, its officers, and employees are included as Additional Insureds with respect to General Liabilit but solely as respects to Liability Arising out of the Named Insured's Operations or Premises Owned by or rented by the Named Insured, excluding contracts or agreements for Professional Services, and subject to the terms and conditions of the referenced policy as required by written contract per the attached form. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of La Quinta THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. O. Box 1504 AUTHORIZED REPRESENTATIVE Quinta, CA 92247 ��' K sw_ a USA �wwl�l_ 01988.2010 ACORD CORPORATION. All ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD laujepp 2R2T140R POLICY NUMBER: GL 2449468 COMMERCIAL GENERAL LIABILITY CG 20 1101 96 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 1. Designation of Premises (Part Leased to You): AS PER CONTRACT OR WRITTEN AGREEMENT 2. Name of Person or Organization (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 addi- tional insured under this policy as a result of any lease or management agreement you enter into with such parties. 3. Additional Premium: (If no entry appears above, the information required to complete this endorsement will be shown in the Decla- rations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization 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 or organization shown in the Schedule. CG 20 11 01 96 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1 13 THE HEALTHCARE INSURANCE CORPORATION 23 Lime Tree Day Avenue : Governors Square, P.O. Box I D51, Bdn'I, 2'tl It ' Grand Cayn mn KY- I -I l W 4 CaVinan Islands CFRTIFICATE OF rN5u RA\cE DATE ISSUED: June 1, 2011 ISSUED TO: Desert Regional Medical Center ADDRESS: 1150 N. Indian Canyon Way Palm Springs, CA92262 CLAIMS-NINA: POLICY #2011-05 066G RE: All employees of Insured are provided coverage under this policy, including residents, interns, nurse practitioners, nurse midwives, athletic trainers, physician assistants, profusionists, therapists, social workers, CRNA's podiatrists, paramedics and employed physicians while acting within the scope of their duties as such. Also covered are authorized Volunteers and facility Medical Directors while acting within the scope of their duties as such. THIS IS TO CERTIFY that insurance has been effected with THE HEALTHCARE INSURANCE CORPORATION (the "Company",) under Policy Number 2D11-05 as follows: INSURED: Desert Regional Medical Center and/or Desert Hospital Comprehensive Cancer Center ADDRESS 1150 N. Indian Canyon Way Palm Springs, CA92262 COVERAGE: Comprehensive General Liability, Medical Professional Liability, Contractual Liability, Personal Injury Liability, Druggist's Liability, Managed Care Organizations' Errors and Omissions Liability, Employment Practices Liability, and Miscellaneous Professional Liability WRITTEN ON A CLAIMS -MADE BASIS. AMOUNT OF INSURANCE: Not less than $5.000.000 perclaim (Professional Liability). Not less than $5.000,000 per claim (General Liability). SELF4NSURED RETENTION: $5.000.000 POLICY TERM: June 1, 2011 at 12:01 A.M. to June 1, 2012 at 12:01 A.M. LOCAL TIME at the address of the Insured. THIS CERTIFICATE is not transferable and may be cancelled by giving thirty days written notice to the party to which this Certificate is issued priorto the effective date of the cancellation of the insurance described herein. THIS CERTIFICATE is for information only: it is not a contract of insurance, but attests that a policy as numbered herein, and as it stands at the date of this Certificate, has been issued by the Company. Said policy is subject to change by endorsement and cancellation in accordance with its terms. EFFECTIVE DATE OF THIS CERTIFICATE: June 1, 2011. CERTIFICATES EXPIRES: June 1. 2012, unless cancelled sooner. cc: Captive Insurance Services, Inc. 1446 Ross Avenue. Ste. 1400 Dallas, TX 75202 Signed by Indemnity and Hold Harmless Agreement IF—tJET HEAL TI{�AKfG Gor2P.� This Indemnity Agreement and Hold Harmless ("Agree nt") is hereby entered into . effective October 1, 2011 by the City of La Quinta ("City") and JFK Memorial Hospital, Inc., a California Corporation doing business as John F. Kennedy Memorial Hospital ("Agency"). RECITALS fl°El� A. The Agency has proposed to provide Body Mass Index Screenings to seniors and other members of the community at the La Quinta Senior Center ("Services"). B. Services shall be rendered beginning October 4, 2011 through October 25, 2012. The City wishes to have Agency provides the following Services: Body Mass Index Measurement (BMI): participant height, weight, age and sex is entered into the HBF-306 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. C. 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, indemnify and hold harmless the City and its officers, employees, and agents (Collectively, "Indemnified Parties") from and against any and all of claims, causes of action, obligations, losses, liabilities, judgments or damages, including reasonable attorneys' fees and costs of litigation (collectively "Claims") arising out of and/or in any way relating to the Agency's activities in the performance of the Services described in this Agreement, or to the Agency's acts and/or omissions in providing or administering the same, 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. 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 the Agency, the Agency shall provide a defense 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, the 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 loss, 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 equivalent. Coverage for an additional insured shall not be 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. Business Auto Coverage on ISO Business Auto Coverage form CA 00 01 including owned, non -owned and hired autos, or the exact equivalent. Limits shall be no less than $1,000,000 per accident, combined single limit. If Agency owns no vehicles, this requirement may be satisfied by a non -owned auto endorsement to the general liability policy described above. If Agency or Agency's employees will use personal autos in any way on this project, Agency shall obtain evidence of personal auto liability coverage for each such person. C:\Documents and Settings\deborahmales\Local Settings\Temporary Internet Files\OLK496Uohn F Kennedy Memorial IHH agreement Ldoc D. Excess or Umbrella Liability Insurance (Over Primary) if used to meet limit requirements, shall provide coverage at least as broad as specified for the underlying coverages. Such policy or policies shall include as insureds those covered by the underlying policies, including additional insureds. Coverage shall be "pay on behalf," with defense costs payable in addition to policy limits. There shall be no cross liability exclusion precluding coverage for claims or suits by one insured against another. Coverage shall be applicable to City for injury to employees of Agency, subcontractors or others involved in the provision of services under this Agreement. The scope of coverage provided is subject to approval of City following receipt of proof of insurance as required herein. E. 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 less 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 the City, consisting of: (a) certificate(s) of insurance evidencing all of the coverages required and, (b) an additional insured endorsement to Agency's 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 the City, its officers, and employees as additional insureds on the policy (ies) as to commercial general liability bodily injury and property damage 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. John F. Kennedy Memorial Hospital ("Agency") By: Its: C:\Documents and Settings\deborah.wales\Local Settings\Temporary Internet Files\OLK496Uohn F Kennedy Memorial lHH agreement Ldoc CITY OF LA QUINTA ("City') t]By. Thomas P. Genovese, City Manager qrZFt/ Zp APPROVED AS TO FORM: r7r,� 7. ♦! By: M. Katherine Jenson, City Attorney CADocaments and Settings\deborah walcOxcal Settings\Temporary Internet Files\OLK496Vohn F Kennedy Memorial lHH agreement Ldoc SIGNED IN COUNTERPART A Manager Thomas P. Genovese, City C:1Dmnnems and Shcingskleborah.,,alesV-acal Seltit>ss\Tdnporary LNamet Files\01-K496V*bn F Kentedy Menwdal INH ag"MIlt I.doc A"10 1,)-141 ACORbe CERTIFICATE OF LIABILITY INSURANCE 4 D09/27 /2011 DDI 09/27 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: N the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endoreement(s). PRODUCER 1-818-539-2300 Arthur J. Gallagher 6 Co. Insurance Brokers of California, Inc. License #0726293 CONTACT PHONE I FAX Na: E-MAIL meribal eanchezma ADDRESS: jg•com 505 North Brand Boulevard, Suite 600 INSURERS AFFORDING COVERAGE NAICA Glendale, CA 91203-3944 INSURERA: NATIONAL UNION FIRE INS CO OF PITTS 19445 INSURED Tenet Healthcare Corp. INSURER B: CHARTIS SPECIALTY INS CO 26863 INSURER C ILLINOIS HATL INS CO 23817 INSURER D: MEN HAMPSHIRE INS CO 23841 1445 Rose Avenue, Suite 1400 INSURER E: CHARTIS CAS CO 40258 Dallas, TX 75202-2703 INSURER F : COVERAGES CERTIFICATE NUMBER: 23228535 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF IMMMONYYYJ POLICY EXP IMM!DDNYYYILIMNS A GENERAL LIABILITY 2449468 06/01/1 06/01/12 EACH OCCURRENCE $ 2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Eao "nce $ 1,000,000 CIAIMS-MADEry] OCCUR MEDEXP(Anyonepmaon) $ 10,000 PERSONAL 4 ADV INJURY $ 1,000,000 GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMPIOP AGO000X POLICY PRO-LOC A AUTOMOBILE LIABILITY 350631E COMBINED SINGLE LIMIT Ea accidentX R$2,000,000 000B3506316 - Garage Keepers O6/01/1 06/Ol/12 ANY AUTO BODILY INJURY(Per person) B ALL OWNED SCHEDULED 3506315 - Phy Damage O6/01/1 06/01/12 AUTOS AUTOS BODILY INJURY(Per accident)HIRED PerE ^, AMAGE AUTOS AUTOSWNED Phys Dmge/Ded 0 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ H AGGREGATE $ EXCESS UAS CLAIMS.MAOE DED I I RETENTIONS $ C WORKERS COMPENSATION 015883628 (MO,NI) 06/Ol/1 06/01/12 WC STATU- OTH- X AND EMPLOYERS•LIABIIm YIN E.L. EACH ACCIDENT $ 2,000,000 D ANY PROPRIETORIPARTNER/EXECUTIVE 015883624 (ADS) 06/01/1 06/01/12 OFFICERIMEMBEC EXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE $2,000,000 (Mandator, In NHR 015883626 (FL) 06/03./1 06/01/12 A II ee,deeTION under DESCRIPTION OF OPERATIONS below 1192402 AL -CA -LA 06 /Ol/1 06/01/12 E.L. DISEASE -POLICY LIMIT E 2,000,000 A NC a Rmpl Liab 015883625 (CA) 06/01/1 06/01/12 XL Limits 2,000,000 S NC 6 Empl Liab 015883627 (GA) 06/01/1 06/01/12 EL Limits 2,000,000 DESCRIPTLON OF OPEMTIONS I LOCATIONS I VEHMLES (AN O ACORD IDl, AddNlonal RemeM SeMdule, it more."ca Ia mulred) Insured/Facility: John F. Kennedy Memorial Hospital BNI Screenings at the La Quints Senior Center, October 4, 2011 through October 25, 2012 The City of Is Quints, its officers, and employees are included as Additional Insureds with respect to General Liabilii but solely as respects to Liability Arising out of the Named Insured's Operations or Premises Owned by or ranted 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 per the attached form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of La Quinta THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P. O. Box 1504 AUTHORIZED REPRESENTATIVE Is Quints, CA 92247 II6A �OVA^7 .f 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) daynick 23228535 The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL 2449468 COMMERCIAL GENERAL LIABILITY CG 20 11 01 96 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 1. Designation of Premises (Part Leased to You): AS PER CONTRACT OR WRITTEN AGREEMENT 2. Name of Person or Organization (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 addi- tional insured under this policy as a result of any lease or management agreement you enter into with such parties. 3. Additional Premium: (If no entry appears above, the information required to complete this endorsement will be shown in the Decla- rations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization 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 or organization shown in the Schedule. CG 20 1101 96 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1 13 SEP, 26. 2011 10:41AM 7607758014 NO.810 P. 2 THE HEALTHCARE INSURANCE CORPORATION Z.i Lane Tree Bay Avenue a Gove@nenP Squall PA Box 1051, Bdg 4, 2"B • Gr"Cayn= KW 1-1102 • CaymenIsiands CERTIFICATE OF INSUPANCE O.MM+4ADE POIIGY DATE ISSUED: June 1, 2011 #2011.06 027G ISSUED.TO: John F. Kennedy Memorial Hospital ADDRESS: 47-1111 Monroe Street Indio, CAS220i Attn: Aran Timmerman RE: All employees of Insured are provided coverage under this polloy, Including residents, intems, nurse practitioners, nurse midwives, athletic tremors, physician assistants prahtstoolsts, therapists, social workers, CRNA's podiatft. paramedics and employed physicians while acting within the scope of their duties as such. Also covered are authorized Volunteers and facility Medical Directors white acting within the scope of their duties as such. THIS IS TO CERTIFY that insurance has been effected with THE HEALTHCARE INSURANCE CORPORATION Rhe'Company",) under Policy Number 2011-05 as follows: INSURED: John F. Kennedy Memorial Hospital ADDRESS 47-111 Monroe Street Indio, CAS2201 COVERAGE: Comprehensive General Liability, Medical Professional Liability, Contractual Liability, Personal Injury Liability, Druggist's LlabtUty, Managed Care Organizations' Errors and Omissions UabiOty, Employment Practices Liability, and Miscellaneous Professlortal Liability WRITTEN ON A CLAIMS -MADE BASIS. AMOUNT OF INSURANCE: Not less than 116,000,000 per claim (Professional Liability). Not less than S5,000,000 per claim (Can" Liability). SELFaNSURIED RETENTION; $5,000,000 POLICY TERM: June 1, 2011 at 12:01 A.M. to June 1, 2012 at 12fl1 A.M. LOCAL TIME at the address of the Insured. THIS CERTIFICATE is not transferable and may be cancelled by giving thirty days written notice to the party to Which this CoMcate Is issu ad priorto tha affective dale of the cancellation of the insurance desodbad hera@h. THIS CERTIFICATE is for information only, it is not a contact of insurance, but attests that a policy as numbered herein, and as It stands at the date of this OedHlcate, has been issued by the Company. Said polloy Is subject to change by endorsement and cancellation in accordance with Its terms. EFFECTIVE DATE OF THIS CERTIFICATE: June 1, 2011. CERTIFICATES EXPIRES; June 1, 2012, unless cancelled sooner. cc; Captive Insurance Services, Inc, 1445 Ross Avenue, Ste.1400 Dallas, TX 75202 Sign ad by INDEMNITY AND HOLD HARMLESS AGREEMENT This Indemnity Agreement and Hold Harmless ("Agreement") is hereby entered into by the City of La Quinta ("City") and Tenet HealthSystem Desert, Inc., dba Desert Regional Medical Center ("Agency") as of October 25, 2012 through October 25, 2013. RECITALS A. The Agency has proposed to provide 200 free Flu Immunizations, medical supplies and personnel to administer the injections to seniors and other members of the community at the La Quinta Senior Center ("Services"). 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, indemnify and hold harmless the City and its officers, employees, and agents (collectively, "Indemnified Parties") from and against any and all of claims, causes of action, obligations, losses, liabilities, judgments, or damages, including reasonable attorneys' fees and costs of litigation (collectively "Claims") arising out of and/or in any way relating to the Agency's activities in the performance of the Services described in this Agreement, or to the Agency's acts and/or omissions in providing or administering the same, 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. 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 the Agency, the Agency shall provide a defense 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, the Agency shall be obligated to promptly pay any final judgment or portion thereof rendered against the Indemnified Parties. 1 SA (City of La Quinta) effect 10.25.12 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 loss, 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 not be 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. Business Auto Coverage on ISO Business Auto Coverage form CA 00 01 including owned, non -owned and hired autos, or the exact equivalent. Limits shall be no less than $1,000,000 per accident, combined single limit. If Agency owns no vehicles, this requirement may be satisfied by a non -owned auto endorsement to the general liability policy described above. If Agency or Agency's employees will use personal autos in any way on this project, Agency shall obtain evidence of personal auto liability coverage for each such person. D. Excess or Umbrella Liability Insurance (Over Primary) if used to meet limit requirements, shall provide coverage at least as broad as specified for the underlying coverages. Such policy or policies shall include as insureds those covered by the underlying policies, including additional insureds. Coverage shall be "pay on behalf," with defense costs payable in addition to policy limits. There shall be no cross liability exclusion precluding coverage for claims or suits by one insured against another. Coverage shall be applicable to City for injury to employees of Agency, subcontractors or others involved in the provision of services under this Agreement. The scope of coverage provided is subject to approval of City following receipt of proof of insurance as required herein. 2 SA (City of La Quinta) effect 10.25.12 E. 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 less 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 the 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 the City, 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. Tenet HealthSystem Desert, Inc. dba Desert Regional Medical Center ("Agency") By: 0,� �-5' Ken Wheat, COO Its: Interim Chief Executive Officer Date: Z/2! CITY OF LA QUINTA ("City") B r ek, City Manager Date: 0 APPROVED AS TO FORM: By: SIGNED IN COUNTERPART M. Katherine Jenson, City Attorney 3 SA (City of La Quinta) effect 10.25.12 E. 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 less than $1,000,000 per claim and in the aggregate. The policy must "pay on behalf of the insured and must include a provision establishing the insurer's duty to defend. The policy retroactive date shall be on or before the effective date of this agreement. 3.2 Agency agrees to provide evidence of the insurance required herein, satisfactory to the City, consisting of: (a) certificate(s) of insurance evidencing all of the coverages required and, (b) an additional insured endorsement to Agency's Commercial general liability policy using ISO Form CO 20 10 with an edition date prior to 1988, which form shall include coverage for completed operations. The additional insured endorsement shall expressly name the City, its officers, and employees as additional insureds on -the policy (ies) as to commercial general liability coverages, -and completed operations coverages, with respect to liabilities arising out of Agency's performance of the Services under this Agreement. 3.3 Proof of compliance with these insurance requirements, consisting of endorsements and certificates of insurance, shall be delivered to City prior to Agency commencing performance of any of the Services described in this Agreement. Tenet HealthSystem Desert, Inc. dba Desert Regional Medical Center ("Agency,) By:5— Ken Wheat, COO Its: Interim C 'ef Executive Officer Date: 9 do /a .CITY OF LA QUINTA _ ("City$,) By: SIGNED IN COUNTERPART Frank J. Spevacek, City Manager Date: APP;PC AS TO F Y. rine Jens n, Attorney SA (City of Le Quinta) effect 10.25.12 A,gvr tV TL Tv A �® CERTIFICATE OF LIABILITY INSURANCE ow DATEos/3(1/o12/2012 YI 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 be endorsed. If SUBROGATION IS WANED, 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 endorsemefd(s). PRODUCER 1-818-539-2300 Arthur J. Gallagher & Co. Insurance Brokers of California, Inc. License #0726293 CONTACT "ME:PHON FAX ac No: 505 North Brand Boulevard, Suite 600 E4MIL ADDRESS: 9rm Certificateeaajg.Com INSURE $ AFFORDING COVERAGE NAICIf Glendale, CA 91203-3944 INSURER A: NATIONAL UNION PIRH INS CO OF PITTS 19445 INSURED Tenet Healthcare Corp. INSURER B: CHARTIS SPECIALTY INS CO 26883 INSURERC: NBW NANPSHIRB IN3 CO 23841 INSURER D: ILLINOIS NATL INS CO 23817 1445 Rose Avenue, Suite 1400 INSURER E: Dallas, TX 75202-2703 INSURER F: COVERAGES CERTIFICATE NUMBER: 27471782 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR rypE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF IMMIDDfYYYY1 POLICY EXP (MMMDffYYY)LIMITS A GENERAL LIABILITY 4406391 06/01/1 06/01/13 EACH OCCURRENCE $ 2,000,000 R COMMERCIAL GENERAL LIABILITY PRREMSES Es occurrence $ 1,000,000 MED EXP (Any one person) $ 10,000 CLAIMS -MADE � OCCUR PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $2,000,000 R POLICY PR0. LOC $ A AUTOMOBILE LIABILITY 4982756 COMBINED SINGLE LIMIT Fa accident 2,000,000 B 4982840 -Garage Keepers 06/01/1 X B ALL AUTO ALL OS SCHEDULED 4982839 - Ph Damage Y 9 06 /Ol/1 06/01/13 06/Ol/13 BODILY INJURY (Per person) $ AUTOS AUTOS BODILY INJURY (Per accident) S PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS - Phys Damage/Ded $ 250,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ A WORKERS COMPENSATION 1192507 AL -CA -LA 06/01/1 06/01/13 R WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN - E.L. EACH ACCIDENT $ 2,000,000 C ANY PROPRIEfOMPARTNEWEXECUTIVE 033464583 (ND,OH,NA,NI, ) 06/01/1 06/01/13 OFFICERIMEMBER EXCLUDED'! N❑ NIA E.L. DISEASE - EA EMPLOYEE $2,000,000 C (Mandatary In NNl 033464580 (ADS) 06/01/1 06/01/13 D Kyes RIPTIOe under D es,desTIONOF OPERATIONS below 033464582 (FL) 06/01/1 06/01/13 E.L. DISEASE -POLICY LIMIT 2, $ 000, 000 A NC 4 Empl Liab 033464581 (CA) 06 01 1 06/01/13 EL Limits 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more apace is required) - Insured/Facility: Desert Regional Medical Center, 1150 N. Indian Canyon Dr., Palm Springs, CA 92262 Re: HMI/ Blood Pressue / Blood Glucose Screenings and Flu Immunisations. The City of In Quints, its officers, and employees are included as Additional Insureds with respect to General Liabilit but solely as respects to Liability Arising out of the Named Insured-s Operations or Premises Owned by or rented by the Named Insured, excluding contracts or agreements for Professional Services, and subject to the terms and conditions of the referenced policy as required by written contract per the attached form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of La Quinta THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. P.. O. Box 1504 AUTHORIZED REPRESENTATIVE Is Quinta, CA 92247 USA �Owra ACORD 25 (2010105) marisan 01988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL 4406391 COMMERCIAL GENERAL LIABILITY CG 20 11 01 96 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 1. Designation of Premises (Part Leased to You): AS PER CONTRACT OR WRITTEN AGREEMENT 2. Name of Person or Organization (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 management agreement you enter into with such par- ties. 3. Additional Premium: (If no entry appears above, the information required to complete this endorsement will be shown in the Declara- tions as applicable to this endorsement.) . WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization 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 or organization shown in the Schedule. CG 20 11 0196 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1 13 THE HEALTHCARE INSURANCE CORPORATION 23 Lime Tree Hay Avenue * Governors Squae, p.0. Box I051, Bdg 4, 2" fl * Grand Cayman KY-1-1102 Cayman Islands CERTIFICATE OF INSURANCE DATE ISSUED: June 1, 2012 ISSUED TO: Desert Regional Medical Center ADDRESS: 1150 N. Indian Canyon Way Palm Springs, CAM62 CLAIMS -MADE POLICY #2012-05 06BG RE: All employees of Insured are provided coverage under this policy, including residents, intents, nurse Practitioners, nurse midwives, athletic trainers, physician assistants, profusionists, therapists, social workers, CRNA's podiatrists, paramedics and employed physicians while acting within the scope of their duties as such. Also covered are authorized Volunteers and facility Medical Directors while acting within the scope of their duties as such. CORPORATION (the "Company"J under Policy Number 2012-05 as follows: INSURED: Desert Regional Medical Center and/or Desert Hospital Comprehensive Cancer Center ADDRESS 1150 N. Indian Canyon Way Palm Springs, CAS2262 COVERAGE: Comprehensive General Liability, Medical Professional Liability, Contractual Liability, Personal Injury Liability, Druggist's Liability, Managed Care Organizations' Errors and Omissions Liability, Employment Practices Liability, and Miscellaneous Professional Liability WRITTEN ON A CLAIMS -MADE BASIS, AMOUNT OF INSURANCE: Not less than $5,000,000 per claim (Professional Liability). Not less than $5,000,000 per ciaim (General Liability). SELF -INSURED RETENTION: $5,000,000 POLICY TERM: June 1, 2012 at 12:01 A.M. to June 1, 2013 at 12:01 A.M. LOCAL TIME at the address of the Insured. THIS CERTIFICATE is not transferable and may be cancelled by giving thirty days written notice to the party to which this Certificate is issued prior to the effective date of Ina cancellation of the insurance described herein. THIS CERTIFICATE is for information only it is not a contract of insurance, but attests that a policy as rttficate, has been issued by the Company. Said policy numbered herein, and as it stands at the dais of this Ce is subject to change by endorsement and cancellation in accordance vtitli its terms. EFFECTIVE DATE OF THIS CERTIFICATE: June 1, 2012. CERTIFICATES EXPIRES: June 1, 2013, unless cancelled sooner. cc: Captive Insurance Services, Inc. 1445 Ross Avenue, Ste. 1400 Dallas, TX 75202 Signed by i INDEMNITY AND HOLD HARMLESS AGREEMENT This Indemnity Agreement and Hold Harmless ("Agreement") is hereby entered into by the City of La Quinta ("City") and Tenet HealthSystem Desert, Inc., dba Desert Regional Medical Center ("Agency") as of October 25, 2012 through October 25, 2013. RECITALS A. The Agency has proposed to provide the following four free screenings to seniors and other members of the community (collectively identified as "Participant") at the La Quinta Senior Center ("Services"). 1. Body Mass Index Measurement (BMI): participant height, weight, age and sex is entered into the HBF-306 hand held body fat analyzer machne. 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. 2. Blood Glucose: the nurse will prick the participant's finger and place a drop of blood on a test strip and insert the strip into a glucose meter. Glucose meter will provide results in three 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. If the participant does not have a doctor, a referral phone number will be provided so they may seek medical assistance. 3. Blood Pressure Screening: screening will consist of use of blood pressure cuff, stethoscope — measuring systolic pressure of heart beats and diastolic pressure between heart beats. 4. Pulse Oximeter Screening: measures resting heart rate and oxygen saturation (level) by placement of index finger in oximeter. 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 I The foregoing Recitals are true and correct and are hereby incorporated herein by this reference and are expressly made a part of this Agreement. 1 SA (City of La Quints — Screenings) effect 10.25.12 Section 2 2.1 Agency shall defend, indemnify and hold harmless the City and its officers, employees, and agents (collectively, "Indemnified Parties") from and against any and all of claims, causes of action, obligations, losses, liabilities, judgments, or damages, including reasonable attorneys' fees and costs of litigation (collectively "Claims") arising out of and/or in any way relating to the Agency's activities in the performance of the Services described in this Agreement, or to the Agency's acts and/or omissions in providing or administering the same, 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. 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 the Agency, the Agency shall provide a defense 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, the 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 loss, 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 not be 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. 2 SA (City of La Quinta — Screenings) effect 10.25.12 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. Business Auto Coverage on ISO Business Auto Coverage form CA 00 01 including owned, non -owned and hired autos, or the exact equivalent. Limits shall be no less than $1,000,000 per accident, combined single limit. If Agency owns no vehicles, this requirement may be satisfied by a non - owned auto endorsement to the general liability policy described above. If Agency or Agency's employees will use personal autos in any way on this project, Agency shall obtain evidence of personal auto liability coverage for each such person. D. Excess or Umbrella Liability Insurance (Over Primary) if used to meet limit requirements, shall provide coverage at least as broad as specified for the underlying coverages. Such policy or policies shall include as insureds those covered by the underlying policies, including additional insureds. Coverage shall be "pay on behalf," with defense costs payable in addition to policy limits. There shall be no cross liability exclusion precluding coverage for claims or suits by one insured against another. Coverage shall be applicable to City for injury to employees of Agency, subcontractors or others involved in the provision of services under this Agreement. The scope of coverage provided is subject to approval of City following receipt of proof of insurance as required herein. E. 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 less 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 the 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 the City, 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 SA (City of La Quinta — Screenings) effect 10.25.12 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. Signature follow on next page Tenet HealthSystem Desert, Inc. dba Desert Regional Medical Center ("Agency") By: 0 � `-5- Ken Wheat, COO Its: Interim C ief E eecutive Officer Date:/a— CITY OF LA QUINTA r . S cek, City Manager Date: D �' APPROVED AS TO FORM: -- M. Katherine Jenson, City Attorney 4 SA (City of La Quinta— Screenings) effect 10,25.12 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. Signature follow on nextpage Tenet HealthSystem Desert, Inc. dba Desert Regional Medical Center C'Agency's By: 0 0 Ken Wheat, COO Its: Interim Cl 'ef E iecutive Officer Date: 9 e?o d— CITY OF LA QUINTA («City") By: SIGNED IN C : U; .:: RPAW Frank J. Spevacck, City Manager Date: 4 SA (City of La Quinta— Scn:enings) effect 10.25.12 -..I 4L/V VJ' 11116" A� oe CERTIFICATE OF LIABILITY INSURANCE °~ °05/31/20 a"' 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 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 endorsements . PRODUCER 1-818-539-2300 Arthur J. Gallagher & Co. Insurance Brokers of California, Inc. License 00726293 505 North Brand Boulevard, Suite 600 CONTACT NAME: PHONE FAX INC, No. Eau INC,No: Ed1ApODRILESS: 9 rm certificatesaajg• com INSURE S AFFORDING COVERAGE NAIC# Glendale, CA 91203-3944 INSURERA: NATIONAL UNION FIRE INS CO OF PITTS 19445 INSURED INSURER B: CHARTIS SPECIALTY INS CO 26883 Tenet Healthcare Corp. INSURER C: NEW HAMPSHIRE INS CO 23841 INSURER D: ILLINOIS NATL INS CO 23817 1445 Rose Avenue, Suite 1400 INSURER E: Dallas, TX 75202-2703 INSURER F: rnvcm AIMCQ PFGTICICATC AIIIWRCC• 27471792 RFVICIrTN NI IMRFR• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE D L U O POLICY NUMBER MM�OY♦YErry PM%DDY EXP LIMNS A GENERAL LIABILITY 4406391 06/01/1 06/01/13 EACH OCCURRENCE It 2,000,000 X DAMAGE O ETD 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ MED EXP(My one person) $ 10,000 CLAIMS -MADE lxl OCCUR PERSONAL S ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG It 2,000,000 IS X POLICY F PRO LOC A AUTOMOBILE LIABILITY 4982756 COMBINED SINGLE LIMIT2,000,000 Ea acddent B X 4982840 -Garage Keepers 06/01/1 06/Ol/13 BODILY INJURY (Per person) $ B ANY AUTO 4982839 - Phy Damage 06/01/1 06/01/13 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED PROPERTY DAMAGE Per acddent $ HIREDAUTOS AUTOS Phys Damage/Ded $ 250,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION It $ A WORKERS COMPENSATION 1192507 AL -CA -LA 06/Ol/1 06/01/13 X WC STATD- OTH- C AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE YIN 033464583 (ND, OH, WA, WI, ) 06/01/1 06/01/13 E.L. EACH ACCIDENT $ 2,000,000 E.L. DISEASE - EA EMPLOYEE $ 2,000,000 C OFFICEWMEMBER EXCLUDED? N❑ (Mandatory In NH) NIA 033464580 (ADS) 06/Ol/1 06/01/13 E.L. DISEASE-POLICYLIMIT $2,000,000 D Ifyes descnbaunder DE SCRIPTION OF OPERATIONS below 033964582 (FL) O6/O1/1 06/01/13 A WC 8 Empl Liab 033464581 (CA) 06 01/1 06/Ol 13 7EL Limits 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, AddNlonal Remarks Schedule, N more apace is required) Insured/Facility: Desert Regional Medical Center, 1150 N. Indian Canyon Dr., Palm Springs, CA 92262 Re: BMI/ Blood Pressue / Blood Glucose Screenings and Flu Immunizations. The City of La Quints, its officers, and employees are included as Additional Insureds with respect to General Liabilit but solely as respects to Liability Arising out of the Named Insuredrs Operations or Premises Owned by or rented by the Named Insured, excluding contracts or agreements for Professional Services, and subject to the terms and conditions of the referenced policy as required by written contract per the attached form. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE of La Quints THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. O. BOX 1504 1 AUTHORIZED REPRESENTATIVE Quints, CA 92247 USA I e KW'e4aA_ ©1988-2010 ACORD reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD marisan POLICY NUMBER: GL 4406391 COMMERCIAL GENERAL LIABILITY CG 20 11 0196 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 1. Designation of Premises (Part Leased to You): AS PER CONTRACT OR WRITTEN AGREEMENT 2. Name of Person or Organization (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 management agreement you enter into with such par- ties. 3. Additional Premium: (If no entry appears above, the information required to complete this endorsement will be shown in the Declara- tions as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization 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 or organization shown in the Schedule. CG 20 1101 96 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1 13 THE HEALTHCARE INSURANCE CORPORATION 23 Lime Tree Bay Avenue * Governors Square, P.O. Box 1051, Bdg 4, 2"fl * Grand Cayman KY-1-1102 * Cayman islands CERTIFICATE OF INSURANCE DATE ISSUED: June 1, 2012 ISSUED TO: Desert Regional Medical Center ADDRESS: 1150 N. Indian Canyon Way Palm Springs. CA92262 CLAIMS-MAOE POLICY #2012-05 066G RE: All employees of Insured are provided coverage under this policy, including residents, interns, nurse Practitioners, nurse midwives, athletic trainers, physician assistants, profusionists, therapists, social workers, CRNA's podiatrists, paramedics and employed physicians while acting within the scope of their duties as such. Also covered are authorized Volunteers and facility Medical Directors while acting within the scope of their duties as such. THIS IS TO CERTIFY that insurance has been effected with THE HEALTHCARE INSURANCE CORPORATION (the "Company",) under Policy Number 2012-05 as follows: INSURED: Desert Regional Medical Center and/or Desert Hospital Comprehensive Cancer Center ADDRESS 1150 N. Indian Canyon Way Palm Springs, CA92262 COVERAGE: Comprehensive General Liability, Medical Professional Liability, Contractual Liability, Personal Injury Liability, Druggist's Liability, Managed Care Organizations' Errors and Omissions Liability, Employment Practices Liability, and Miscellaneous Professional Liability WR ITTEN ON A CLAIMS -MADE BASIS. AMOUNT OF INSURANCE: Not less than $5,000,000 per claim (Professional Liability). Not less than $5,000,000 per claim (General Liability), SELFaNSURED RETENTION: $5,000.000 POLICY TERM: June 1, 2012 at 12:01 A.M. to June 1, 2013 at 12:01 A.M. LOCAL TIME at the address of the Insured. THIS CERTIFICATE is not transferable and may be cancelled by giving thirty days written notice to the party to which this Certificate is issued priorto the effective date of the cancellation of the insurance described herein. THIS CERTIFICATE is for information only; it is not a contract of insurance, but attests that a policy as numbered herein, and as it stands at the date of this Certificate, has been issued by the Company. Said policy is subject to change by endorsement and cancellation in accordance with its terms. EFFECTIVE DATE OF THIS CERTIFICATE: June 1, 2012. CERTIFICATES EXPIRES: June 1, 2013, unless cancelled sooner. cc: Captive Insurance Services, Inc. 1445 Ross Avenue, Ste. 1400 Dallas, TX 75202 Signed by