HomeMy WebLinkAboutScott Hardy, MD - 2021-04-01 i
PROFESSONAL SERVICES CONTRACTBETWEEN
THP. CITY OF HUN17NGTON BEACH AND
_Gott Hard�v . m_fl_
FOR
INDEPENDENT MEDICAL EVALUATIONS WITH
RESPECT TO WORKERS' COMPENSATION CLAIMS
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THIS ACiItLF..MENT ("Agreenucnl") is made and entered into by and between the City of
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Huntington Beach, a municipal corporation of the State of California, hereinafter referred to as j
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"CITY,"and S CZ2rt N+_0 all individual, hereinafter referred to as"PHYSICIAN."
WHEREAS, CITY desires to engage the services of a physician to provide independent
medical evaluations with respect to workers' compensation claims; and
Pursuant to documentation on file in the office of the City Clerk, the provisions of the
Huntington Beach Municipal Code, Chapter 3.03, relating to procurement of professional service
contracts have been complied with; and
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PHYSICIAN has been selected to perfonn said services,
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NOW, THEREFORE, it is agreed by Crry and PHYSICIAN as follows: �
I. SCOPE OF SERVICES
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PHYSICIAN shall provide all services as described in Exhibit "A," which is
attached hereto and incorporated into this Agreement by this reference. These services shall
sometimes hereinafter be referred to as the "PROJECT."
PI YSICIAN hereby designates 8r;doe fG;Iw Gr4..1_, who shall represent it
and be its sole contact and agent in all consultations with CITY during the performance of this i
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Agreement.
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APPROVED AS TO FORM/f X tA- Aj1QQWy i
Y ICHAEL E. GATES
CITY ATTORNEY
12-3187AMV, Standard Contract- Revised I CITY OF HUNTINGTON BEACH
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2. CITY STAFF ASSISTANCE
CITY sliall assign a staff coordinator to work directly with PHYSICIAN in the
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performance of this Agreement.
3, TIME OF PERFORMANCE
Time is of the essence of this Agreement. The services of PHYSICIAN are to
commence on _A{ L1.,_��21- (tile `Commencement Date"). This Agreement shall
automatically renew three(3) years from the Commencement Date, unless terminated as provided
herein. The time for performance of the tasks identified in Exhibit "A" are generally to be shown
in Exhibit "A." This schedule may be amended to benefit the PRO7LiC1' if mutuaily agreed to in
writing by CITY laid PHYSICIAN.
III the event lice Commencement Date precedes the Effective Datc, PHYSICIAN
shall be bound by all terms and conditions as provided herein.
4. COMPENSATION
In consideration of the performance of the services described herein, CffY agrees
to pay PHYSICIAN, on it time and materials basis at the rates specified in hxhibit 1113," attached
hereto and incorporated by reference into this Agreement, n fee, including all costs and expenses,
not to exceed Twenty-nine Thousand Nine-l-lundred Dollars ($29,900.00).
5. EXTRA WORK
in the event CITY requires additional services not included in Exhibit "A", or
changes it, (be scope of services described in Exhibit"A," Pl IYSICIAN will undertake such work
only after receiving written authorization from CITY. Additional compensation for such extra
work shall be allowed only if the prior written approval of CITY is ob(ained.
12-3)87/IME Standard Contract - Revised 2
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6. METHOD OF PAYMF,NT
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PHYSICIAN shall be paid pursuaul to the terms of Exhibit "B."
7. DISPOSITION OF PLANS ESTIMATES AND OTHER DOCUMENTS
PHYSICIAN agrees that title to all materials prepared hereunder, including,but not
linnited to: all original drawings, designs, reports, both field and office notices, calculations,
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computer code, language, data or programs, maps, memoranda, letters and other documents, shall
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belong to CITY, and PHYSICIAN shall turn these materials over to CITY upon termination of
this Agreement or upon PROJECT completion, whichever sliall occur first, These materials may
be used by CITY as it sees fit.
8. HOLD I]ARMLESS
PHYSICIAN hereby agrees to protect,defend,indemnify and hold harnnless CITY,
its officers, elected or appointed off-Icials, employees, agents and volunteers front and against any
and all claims,damages, losses,expenses,judgments,demands and defense costs(including without
limitation, costs and fees of litigation of every nature of liability of any kind or nature) arising out
of or it, connection with PHYSICIAN's (or PHYSICIAN's subcontraclors, if any) negligent (or
alleged negligent)performance of this Agreement or its faihnre to comply with any of its obligations
contained in this Agreement by PHYSICIAN, its officers, agents or employees except such loss or
damage which was caused by the sole negligence or willful misconduct of CITY. PHYSICIAN will
conduct all defense at its sole cost and expense and CITY shall approve selection of PHYSICIAN's
counsel. This indemnity shall apply to all claims and liability regardless of whether ally insurance
policies are applicable. "fhe policy limits do not act as limitation Upon the amount of indemnification
to be provided by PHYSICIAN.
12-318MME Standard Contract- Revised 3
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9. PROFESSIONAL LIABILITY INSURANCE
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PHYSICIAN shall obtain end furnish to CITY a professional liability insurance
policy covering the work performed by it hereunder. This policy shall provide coverage for
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PHYSICIAN's professional liability in an amount not less than One Million Dollars
($1,000,000.00) per occurrence and in the aggregate. Tbc above-mentioned insurance shall not
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contain a self-insured retention without the express written consentof CITY;however an insurance
policy "deductible" of Ten Thousand Dollars ($10,000.00) or less is permitted. A claims-made
policy shall be acceptable if the policy farther provides that:
A. Tbc policy retroactive date coincides wills or precedes the initiation of the
scope of work (inchading subsequent policies purchased as renewals or
replacements).
B, PHYSICIAN shall notify CITY of circumstances or incidents that might
give rise to Suture claims.
PHYSICIAN will make every effort to maintain similar insurance during the
required extended period of coverage following PROJECT completion. If insurance is terminated
for any reason,PI IYSICIAN agrees to purchase an extended reporting provision of at least two(2)
years to report claims arising from work performed in connection with this Agreement.
If PHYSICIAN fails or refuses to produce or maintain the insurance required by
this section or fails or refuses to furnish the CITY with required proof that insunmce has been
procured and is it force and paid for, the CITY shall have the right, at the CITY's election, to
forthwith terminate this Agreement. Such tennination shall not affect PHYSICIAN's right to be
paid for its time and materials expended prior to notification of termination. PHYSICIAN waives
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the right to receive compensation and agrees to indemnify the CITY for any work performed prior
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to approval of insurance by the CITY.
10. CERTIFICATES OF 1NSUBLANCF,
Prior to commencing performance of the work hereunder, PHYSICIAN shall
furnish to CITY certificates of insurance subject to approval of the City Attorney evidencing the
foregoing insurance coverage as required by this Agreement; the certificate shall:
A. provide the name and policy number of each carrier and policy;
B. state that the policy is currently in force; and
C. promise that such policy shnll not be suspended, voided or canceled by
either party, reduced in coverage or in limits except after thirty (30) days'
prior written notice;however,ten(10)days' prior written notice in the event
of cancellation for nonpayment of premium.
PHYSICIAN shall maintain the foregoing insurance coverage in force until the
work under this Agreement is fully completed and accepted by CITY.
The requirement for carrying the foregoing insurance coverage shall not derogate
from PHYSICIAN's defense, hold harmless and indemnification obligations as set forth in this
Agreement. CITY or its representative shall at all times have the right to demand (lie original or a
copy of the policy of insurance. PHYSICIAN shall pay, in a prompt and timely manner, the
premiums on the insurance hereinabove required.
IL INDEPENDENfCONTRACTOR
PHYSICIAN is, and stall be, acting at all times in the 1n:601mance of this
Agreement as an independent contractor herein and not as an employce of CITY. PHYSICIAN
shall secure at its own cost and expense, and be responsible for any and all payment of all taxes,
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social security, state disability insurance compensation, unemployment compensation and other
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payroll deductions for PHYSICIAN and its officers, agents and employees and all business
licenses, if any, in connection with the PROJECT and/or the services to be performed hereunder.
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12. TERMINATION OF AGREEMENT
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All work required hereunder shall be performed in if good and workmanlike j
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Manner. CITY may terminate PHYSICIAN's services hereunder at any time with or without cause,
and whether or not the PROJECT is fully complete. Any termination of this Agreement by CITY
shall be made in writing, notice of which shall be delivered to PHYSICIAN as provided herein.
In the event of termination, all finished and unfinished documents, exhibits, report, and evidence
shall, at the option of the CITY, become its property and slinll be promptly delivered to it by
PHYSICIAN.
13. ASSIGNMENT AND DELEGATION
This Agreement is a personal service contract and the work hereunder shall not be
assigned, delegated or subcontracted by PHYSICIAN to any other person or entity without the
prior express written consent of CITY. If an assignment, delegation or subcontract is approved,
all approved assignees, delegates and subcontractors must satisfy the insurance requirements as
set forth in Sections 9 and 10 hereinabove.
14. Coll YRIGI-ITS/PATENTS
CITY shall own all rights to any patent or copyright on any work, item or material
produced as a result of this Agreement.
15. CITY EMPLOYEES AND OFFICIALS
PHYSICIAN shall employ no CITY official nor ally regular CTTY employee in the
work performed pursuant to this Agreement. No officer or employee of CITY shall have any
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Financial interest in this Agreement in violation of the applicable provisions of the California
Goveriunent Code.
16. NOTICES
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Any notices, certificates, or other communications hereunder shall he given tither
by personal delivery to PHYSICIAN's agent(as designated in Section I bereinabove)or to CITY
as the siuiatiat shall warrant, or by enclosing the same in a sealed envelope, postage prepaid, and
depositing the same in the United States Postal Service, to the addresses specified below. CITY
and PHYSICIAN may designate different addresses to which subsequent notices, certificates or
other communications will be sent by notifying the other party via personal delivery, a reputable
overnight carrier or U.S. certified mail-return receipt requested:
TO CITY: TO PHYSICIAN: ,t`
City of Huntington Beach r + 2t"U
ATI N: Risk Manager ��� /�td
2000 Main Street ��,v y C A �'/�7A/�
Huntington Beach, CA 92648
17. CONSEN"C
When CITY's consent/approval is required under this Agreement, its
consent/approval for one Irausaction or event sliall not be deemed to be a consenthipproval to any
subsequent occurrence of(lie same or any other transaction or event.
18. MODIFICATION
No waiver or modification of any language in this Agreement shall be valid unless
in writing and duly executed by both parties.
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19. SECTION HEADINGS
The titles, captions, section, paragraph and subject headings, and descriptive
phrases at the beginning of the various sections in this Agreement are merely descriptive and are
included solely for convenience; of reference only and are not representative of matters included
or excluded from such provisions, and do not interpret, define, limit or describe, or construe the
intent of the parties or affect the construction or interpretation orally provision of this Agreement.
20. INTERPRETATION OF THIS AGREEMENT
The language of all parts of this Agreement shall in all cases be construed as a
whole, according to its fall' nicaning, and not strictly for or against any of the parties. If any
provision of this Agreement is held by an arbitrator or court of competent jurisdiction to be
unenforceable, void, illegal or invalid, such holding shall not invalidate or affect the remaining
covenants and provisions of this Agreement. No covenant or provision shall be deemed dependent
upon any other unless so expressly provided here. As used in this Agreement, the masculine or
neuter gender and singular or plural number shall be deemed to include the other whenever the
context so indicates or inquires. Nothing contained herein shall be construed so as to require the
commission orally act contrary to law, and wherever (here is tiny conflict between any provision
contained herein and any present or future statute, law, ordinance or regulation contrary to which
the parties have no right to contract, then the latter shall prevail, and the provision of this
Agreement which is hereby affected shall be curtailed and limited only to the extent necessary to
bring it within the requirements of the law.
21. DUPLICATE, ORIGINAL
The original of this Agreement and one or more copies hereto have been prepared
and signed in counterparts as duplicate originals, each of which so executed shall, irrespective of
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the date of its execution and delivery, be deemed an original. Lach duplicate original shall be
deemed an original instrument as against any party who has signed it.
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22. IMMIGRATION
PHYSICIAN shall be responsible for full compliance with the immnigralion and
naturalization laws of the United States and shall, in particular, comply with the provisions of the
United Siales Code regarding employment verification.
23. LEGAL SERVICES SUBCONTRACTING PROHIBITED
PHYSICIAN and CITY agree that CITY is not liable for payment of any
subcontractor work involving legal services, and that such legal services are expressly outside the
scope of services contemplated hereunder. PHYSICIAN undctstands that pursuant to Huntington
Bench CiiP Charter Section 309, (lie City Attorney is the exclusive legal counsel for CITY and
CITY shall not be liable for payment of any legal services expenses incurred by PHYSICIAN.
24. ATTORNEY'S FEES
In the event suit is brought by either patty to construe, interpret and/or enforce the
terms and/or provisions of this Agreement or to secure the performance hereof, each party shall
bear its own attorney's fees, such that the prevailing party shall not be entitled to recover its
attorney's fees from the non-prevailing party.
25. SURVIVAL,
Terms and conditions of this Agreement, which by their sense and context survive
the termination of this Agreement, shall so survive.
26. GOVERNING LAW
This Agreement shall be governed and construed in accordance with the laws of the
State of California.
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27. SIGNATORIES
Each undersigned represents and warrants that its signature herein below has the
power, authority and right to bind their respective parties to each of the terms of this Agreement,
and shall indemnify CITY fully for any injuries or damages to CITY in the event that such
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authority or power is not, in fact, held by the signatory or is withdrawn.
1111YSICIAN's iuilials !.
28. ENTIRETY
The parties acknowledge and agree that they are entering into this Agreement freely
and voluntarily following extensive arm's length negotiation,and that each has had the opportunity
to consult with legal counsel prior to executing this Agreement. The parties also acknowledge and
agree that no representations, induceruents, promises,agreements or warranties,oral or otherwise,
have been made by that party or anyone acting on that patty's behalf, which are not embodied in
this Agreement, and that that party has not executed this Agreement in reliant on any
representation, inducement, promise, agreement, warranty, fact or circumstance not expressly Set
forth in this Agreement. This Agreement, and the attached exhibits, contain the entire agreement
between the parties respecting the subject matter of this Agreement and supersede till prior
understandings and agreements whether oral or in writing between the parties respecting the
subject matter hereof.
29, EFFECTIVE DATE
This Agreement shall be effective on the date of its approval by the City Attorney.
This Agreement shall expire when terminated as provided hereof.
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed
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by and through their mithorized officers.
12-3I87AMl;Standard Contract - Revised 10
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PHYSICIAN
Sc >tr- E-� c ,-6,y Mt7 CITY OF HUNIINGTON BEACH, a
TYpFhRMpN1'SfC1ANY �g municipal corporation of the State of California
Signnlure
Dig or of Human Resources
APPROVED AS TO FORM:
� , tomey
Receive and Ffle
ti `,4TC�
City Qerk `1/8/-21
12.3187nME Standard Contract- Revised 11
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PROFESSIONAL SERVICES CONTRACT BETWEEN
THE CTrY ol: f-IIJNTINGTON BEACH AND
Scott Hqrdy, mD
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INDEPENDENT MEDICAL EVALUA'TONS WITH
RF,SPF,CT TO WORKERS' COMPENSATION CLAIMS
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Table of Contents
IS(;ol)e of Services.....................................................................................................1
2 City Staff Assistance................................................................................................2
3 Time of Performance ...............................................................................................2
4 Compensation ..........................................................................................................2
5 Extra Work...............................................................................................................2
6 Method of Payment..................................................................................................3
7 Disposition of Plans, Estimates and Other Documents ...........................................3
8 Hold Harmless .........................................................................................................3
9 Professional Liability Insurance..............................................................................4
10 Certificates of Insurance..........................................................................................5
11 Independent Contractorr............................................................................................5
12 Termination of Agreement.......................................................................................6
13 Assignment and Subcontracting ..............................................................................6
14 Copyrights/Patents...................................................................................................6
15 City Employees and Officials..................................................................................6
16 Notices .....................................................................................................................7
17 Consent ....................................................................................................................7
18 Modification.............................................................................................................7
19 Section Ileadings .....................................................................................................8
20 Interpretation of this Agreement..............................................................................8
21 Duplicate Original....................................................................................................8
22 Immigration..............................................................................................................9
23 Legal Services Subcontracting Prohibited...............................................................9
24 Attorney's Eees.........................................................................................................9
25 Survivnl....................................................................................................................9
26 Governing Law ........................................................................................................9
27 Signatories................................................................................................................10
28 Entirety.....................................................................................................................to
29 Effective Date..........................................................................................................10
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EXHIBIT "A" i
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STATEMENT OF WORK:
1) AOL—COL EXAMS (exams for the determination of industrial causation).
2) 1'valuation for necessity of appropriate medical treatment
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3) Assessment of employee's present ability to return to work, whether full duty or
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modified. I
4) Advise on condition of maximum medical improvement status.
S) Determine nature and extent of permanent disability, including factors of apportionment
and need for future medical care.
G) Resolve utilization review disputes,
7) Determine the need for spinal surgery pursuant to Labor Code section 4062(b).
PHYSICIAN shall perform the evaluation in full accordance with the standards defined by the
Division of Workers' Compensation of the State of California and the AMA Guides to the
Evnfuation of Permanent Impairment, Fifth Edition. This requires a repot of(lie injury, prior
status, clinical chronology,current status, and past medical history. The physical examination
will document all pertinent positive, negative, and non-physiological findings. For extremity
injuries, measurements must be documented bilaterally, Additionally, PHYSICIAN agrees to:
(i) provide that medical exams will be set within thirty (30) clays of the date of appointment j
request, and (ii) prepare a written report of findings within thirty (30) days of the date of exam or j
evaluation and provide a copy to the parties within said time fianne.
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12-3187/75880
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EXHIBIT "B"
Payment Schedule
1. Missed Appointments
• Fee: $503.75
• Code: MI,200
Applies when:
• Interpreter does not appear for evaluation.
• Injured worker leaves before completion of the evaluation.
• Cancellation within 6 business days of the scheduled appointment.
2. Comprehensive Medical-Legal Evaluations
• Fee: $2,015.00
• Code: M1,201
• Applies to the initial evaluation or the first evaluation in an 18-month period.
• 'rhe evaluation includes review of up to 200 pages of records.
• It must involve an examination of the employee.
• Review of records in excess of 200 pages is reimbursed at a rate of$3.00 per page.
3. hollow-up Medical-Legal Evaluations
• Fee: $1,316.25
• Code: ML202
• Applies to any subsequent comprehensive evaluation within 18 months of the initial
evaluation.
• This fee includes review of up to 200 pages of records that were not reviewed as part of
the initial evaluation.
• Review of records in excess of 200 pages (records not reviewed at initial evaluation)
reimbursed at a rate of$3.00 per page.
4. Supplemental Medical-Legal Evaluations
• Fee: $650.00
• Code: M203
• Does not involve an examination of the patient.
• Results in preparation of a narrative medical report.
• Review of records in excess of 50 pages reimbursed at a rate of$3.00 per page.
• Fees for a supplemental report are not allowed if:
o Records reviewed were provided to the physician for review before the initial or
follow-up evaluations.
o Supplemental report addresses an issue the parties asked the physician to address
in a prior coed-legal evaluation.
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5. Medical-Legal Testimony
• Fee: $455.00 per hour (or physician's usual and customary fee, if lower)
• Code: ML204
• Physician is entitled to bill a minimum of 2 hours for deposition.
• If the deposition is canceled within fewer than 8 calendar days prior notice, physician is
entitled to bill 1 hour of time.
6. Medical-Legal Review of Sub Rosa Evidence
• Fee: $325.00 per hour (or physician's usual and customary fee, if lower)
• Code: ML205
• No minimum time allotment.
• Physician must capture time spent reviewing evidence to the nearest quarter-hour,
verified under penalty of perjury.
• The fee does not include production of a medical-legal report. The fee for time spent
reviewing the recording will be included in the billing for the initial, follow-up or
supplemental medical- report.
7. Court-Ordered Evaluations
• When a medical-legal evaluation is ordered by a Workers' Compensation Judge, the
Judge has authority and discretion to apply the appropriate modifier to that evaluation.
8. The parties agree that the City is not obligated to pay compensation to the PHYSICIAN
except for agreed upon medical services and care. Failure of PHYSICIAN to provide a
written medical report within 30 days of the date of the exam subjects PHYSICIAN to non-
payment for services rendered.
9. PHYSICIAN billing shall conform to the requirements listed in section 9795 of Title 8 of
the California Code of Regulations. Charges for services rendered will be reviewed in
accordance with section 9795 to determine appropriate level of service.
10. City shall pay PHYSICIAN within forty-five (45) days following receipt from
PHYSICIAN of invoices for services rendered and for which payment has not previously
heen made, provided that PHYSICIAN shall submit all invoices within ninety (90) days
after the date of service.
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12-3187/75880 2
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III NORCAL MUTUAL
Certificate of Insurance
Cer illcaU Holder: Insured's Name and Address: Producer.
Scott E Hardy,M.D. Scott Elden Hardy, M.D.
2703 N.Bristol Street 2703 N.Bristol Street
Suite H-2 Suite H-2
Santa Ana,CA 92706 Santa Ana,CA 92706
Policy Number.70217ON Effective Dafe:10/30/202D Expiration Date:10/30/2021
Insured Type:® Named Insured ❑Insured ❑Locum Tenens Coverage AType:❑Shared Limits ®Separate Limits
Specialty:Occupational Medicine
Important:This certificate certifies that the policy shown above has been Issued and includes coverage for the Insured shown for
the period indicated,subject to the policy's provisions and the required payment of premium.It is not an insurance policy and is
issued for informational purposes only.It confers no rights upon the certificate holder and does not create a contract between
NORCAL Mutual Insurance Company(NORCAL Mutual)and the certificate holder,nor does it amend,extend,or alter the policy's
coverage.Notwithstanding any requirement or provision of any contract or other document with respect to which this certificate
may be issued or may pertain,the insurance afforded by the policy is subject to the provisions of the polity.
The Insured is responsible for informing certificate recipients of any policy changes,including declination of issuance or
cancellation before the expiration date.An Insured's failure to provide such notice imposes no obligation or liability of any kind
upon NORCAL Mutual,its agents or representatives.
PORM
Coverages and limits of Coverage Provided TCI
Coverage A:Medical Professional Limits of Covera
Liability Insurance-Claims Made MICHAEL E•C14TE5
CM F�TNtGTI ATTORNEY EIEACH
Retroactive Date: 10/30/2002 $1,000,000 E61V .{Rfr�ilkmit
53,000,000 Aggregate Limit Per Policy Period
Coverage B:Administrative Limits of Coverage:
Defense Insurance- Claims Made
Retroactive Date: 10/30/2002 $50,000 Each Administrative Proceeding or Employment-Related Civil Action Limit
$50,000 Aggregate Limit Per Endorsement Period
Coverage C:Information and Limits of Coverage:
Network Security Insurance-
Claims Made
Retroactive Date: 10/30/2002 $100,000 Each Claim,Regulatory Privacy Proceeding,or Loss Limit
$100,000 Aggregate Limit Per Endorsement Period
By: NORCAL Mutual Insurance Company Date Issued:September 15,2020
��5��— 4&_,o dZQiyc.d.Lrv,
T.Scott Diener Kellie N.Sorenson
President&CEO Secretary
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12/01/2014
575 MARKET STREET,SUITE 1000,SAN FRANCISCO,CA 94105 T 844ANORCAL NORCALMUTUAL.COM