HomeMy WebLinkAboutZan Lewis, MD - 2021-04-01 i
PROFF ONAL SERVICES CONTRACT 1313TWE1 N
TIIP, CITY OF I-IUNTINGTON B13ACII AND
z_Qn_ue ��m2
FOR
INDEPENDENT ML'DICALEVALUATIONS WITH
R.ESPLCI"1'O WORKERS' COMPENSA'I ION CLAIMS
THIS AGREEMENT ("Agreement") is made and entered into by and hotweon the City of
Huntington Beach, it municipal corporation of the State of California, hereinaAer referred to as
"CITY," End Zah tan LewhS M.-
9., an individual, hereinafter referred to as "PHYSIMAN."
WIIIRLAS, CITY desires to engage the services of a physician to provide independent
medical evaluations with respect.to workers' compensation claims; and
Pursuant to documentation oil file in the office of the City Clerk, the provisions of the
f-lontington Beach Municipal Code, Chapter 3.03, relating to procurement of professional service
contracts have been complied with;and
PHYSICIAN has been selected to perform said services,
NOW, THE IU."IFO10-1, it is agreed by CITY and III-lYSICIAN as follows:
I. ,'CS ,OPF 01 SLRVICEE
PHYSICIAN shall provide all services as described in li.xhibii "A," which is
attached hereto and ilicorpora(ed into this Agrceniont by this reformer, Thcsc services shall
sometimes liereinaitcr be referred to as the "PROJ1iCT."
PI-IYSICIAN hereby dmigaatcs Zoty% ell S M1_, who shall represent it j
and be its sole contact and agent in all consultations with CITY during the performance of (his
Agreement,
APPROVED AS TO FORM/FCC m- kt�U,I(6i
Y _
ICIIAEL E. GATE
CITY ATTORNEY
CEIY OF h1UN'I'IN(iTON BEACH12-31 s7mvin Siandard Contract- Revised I
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2, CITY STAFF ASSISTANCE
CITY shall assign a staff coordinator to work directly with PHYSICIAN in the
performance of this Agreement.
3. TIME OF PERFORMANCP
Time is of the essence of this Agreement. The services of PHYSICIAN are to
comcuencc on .ARrJU ,292]`. (tire "Coumiencement Date"), "This Agreenrout shall
automatically renew three(3) years from the Commencement Date, unless terminated as provided
herein. The time for performance of the hislcs identified in Exhibit"A" are generally to be shown
in Exhibit "A." This schedule cony be amended to benefit the PRO—ICI' if mutually agreed to in
writing by CITY and PHYSICIAN.
In the event the Comu:enccment Date prcecdes the Effective Date, PHYSICIAN
shall be bound by all terms aad conditions as provided herein.
4. COMP}-NSA'J1ON
In consideration of tile performanco of the services described herein, CITY agrees
to pay PHYSICIAN, oil a time and materials basis tit the rates specified in Exhibit 1,13," attached
hereto and incorporated by reference into this Agreement, a fee, including all costs attd expenses,
not to exceed'Twenty-nine Thousand Nine-FIundfed Dollars ($29,900,00).
5. EX•1'M WORK
In the event CITY requires additional services not included in Exhibit "A", or
changes in (he scone of services described is Exhibit "A," PHYSICIAN will undertake such work
only after receiving written au(horizatiou from CITY. Additional compensation for such extra
work shall be allowed only if the prior written approval of CITY is obtained.
i9,318711Mr•, Standard Contract- Revised 2
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C, METHO OB PAYMENT
PHYSICIAN shut! be paid pursuant to the terms of CxMhh "BY
7. DISPOSPfION OF PLANS, 2STIMATES AND OTHER
PHYSICIAN ngrccs that lido to all materials prepared hereunder, including, but not
limited to, all original drawings, designs, reports, both field and office uoticcs, calculations,
computer code, language,data or programs, maps, nncoloranda, letters and other documents, shall
Wong to CITY, and N-IYSICIAN shall turn those materials over to CITY upon termination of
tli s Agreement or upon PROJECT completion, Whichever shall occur first, These Inatcrials nitly
be tised by CITY as it sees fit.
S. HOLD IJARMLESS
PHYSICIAN licreby agrees to protect, defend, indemnify and hold harmless CITY,
its officers, elected or appointed officials, employees, agents and volunteers from nod against tiny
and all claims,damages, losses,expen ,ju scSdgmwwq demands and defense costs(including without
lilnllnlion, costs and fees of litigation of every wre or liability of any kind or nature) arising out
of or in cc»utecki n with PHYSICIAN's (or PHYSMIAN's sit beonlractors, if tiny) negligent (or
alleged nogligent)performance of this Agreement or its failure to comply%vWi any of its obligations
contained in this Agreement by PHYSICIAN, its officers, agents or cnnployces except such loss or
damage which was caused by the sole negligence or willful misconduct of CTI'Y. PHYSICIAN will
conduct all defense at its 4ole cost Ind expense and CITY shall approve selection of PHYSICIAN's
counsel. This indeninvy shell apply to all clninns and liability regardless of Whether arty nnstunacc
pol!Gies nreapplicable, The policy limits do not aetaslimitation upon theamomAofindurnidUMUO),
to be provided by PHYSICIAN,
12-3187/1Me Standard Contract- Rcviscd 3
9. LIABILITY INSURANCI.,
PHYSICIAN shall obtain and furnish to CITY a professional liability insurancc
policy covering the work perfa•med by it hereunder. This policy shall provide coverage for
PHYSICIAN's profea,4lonal liability in an amount not less than One Million Dollars
I
($1,000,00010) per occurrence and in the aggregate. Thu abovemucntioned insurancc shall not
cou(ain a self-hamd retention without tho express written consent of CITY; however an insurance
policy "deductible" of 1% Thousand Dollars ($10,000r00) of less is pormiuml. A claims-made
policy shall be acceptable if the policy lit,tlier provides that:
A. 'Pile policy vetroactive date coincides with or precales the initiation of the
scope of work (including subsequent policies purchased as ren Ovals or
replauements).
13. PHYSICIAN shall notify CITY of circumstances or incidents that might
give rise to future claims,
PHYSICIAN will make every effort to maintain similar insurancc during rho
required extended period of coverage following PROJECT completion, if insurancc is terminated
i
for any reason,PHYSICIAN 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.
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If PHYSICIAN fails or rofltses to produce or maintain the insurancc required by
(his section or fails or refuses to furnish the CITY with required proof that insurancc has been
procured and is in force and paid for, the CITY shalt have the right, at the CITY's election, to
forthwith termhum this AgmetnenL Such termiuttion shall not atIecl PHYSICIAN's right to be
paid for its lime and ma(erials expended prior to nodnealion of tcrininalion. PHYSICIAN waives
103187/1Mt3 Sunidard Contract- Revised I
the right to receive compensation and agrees to indemnify the CITY for any work performed prior
to approvat of insurance by the CITY.
10, CEl-'F FICAI'ES OF INSURANCE
Prior to conmmencing performance of the work hcrcunder, PIYSICIAN shall
furnish to CITY certificates of iusurencc subject to approval of the City Attorney evidencing the
f rotpAng insurance coverage as requimd by Ihls Agreement; the certificate shall:
A. provide the name and policy number of each carrier and policy;
13. state that the policy is currently in force; and
C. promise that such policy shall not be Suspended, voided or canceled by
either party, reduced iu coverage or in limits except after thirty (30) days'
prior written nolicc;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 CUY.
The requirement for carrying All; tol'egolmg insurance col,wage shall not derogate
from PI-MICIAN's defense, hold humans and iudenmification obligations as set forth in this
Agreement. CITY or its rcpresumutive shall of all limes have the right to demand the original or a
copy of (lie policy of insurance. PHYSICIAN shall pay, in a prompt and timely manner, (lie
premiums oil the insurance:hereinabove,required.
11. INDEPiSNDEN'I'CONTIUIC'I'O1Z
PHYSICIAN is, and shall bc, acting at all times in the performance of' this
Agreement as all independent contractor herein and not as an employee of CITY. PHYSICIAN
shall secure at its own cost and expense, and be responsible for any and all payment of all taxcS,
103 HIMMIS Swndard Contract - Revised 5
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social security, stato disability insurance compensation, ,memployment compensatio❑ and other
payroll decluctions for PHYSICIAN anti Its officers, agents and employees and all business
licenses, if any, in connection with the,PROJECT and/or the services to be performed hereunder.
12, TERMINLIfI N OF AGIMEMENT
All work required hereunder shall be performed in it good mid workmanlike
manner. CITY muy terminate PHYSICIAN's services licreuncler at any timo with or without cause,
and whether or not the PROJECT is fully complete. Any termination of this Agreement by CITY
shalt be made in writing, notice of which shall be delivered to PHYSICIAN es provided herein,
In the event of termination, all finished and unfinished documents, exhibits, report, and eviclence
shall, at the option of the CITY, become its property and shall be promptly delivorcd to it by
PHYSICIAN.
13. A�S1C:i ;v f: T All 1 I3GA'ITON
This Agreement is it personal service contract and the work hereunder shall not be
assigned, dclugated or subcontracted by PHYSICIAN to any other persoi or entity without the
prior express written coiseut of CITY. If an assignment, delegation or subcontract is approved,
all approval assiguecs, delegates and subcontractor's must aatlsf} the insurance 1'CC(Llll'CmCntS as
set forth in Sections 9 and 10 liereinabove.
11. COPYRIGT-ITS/PA"1� S
CITY shall own all rights to any palenl or copyright on any work, item or matoriat
produced its a result of this Agreement.
15. QIj_Y_£;MPLOYEE9 AN1) OFFICIALS
PTYSICIAN shall employ no CITY official nor ally rogular CITY employee in the
work pol-formed pursuant to this Agreement. No officer or employee of CITY shall have any
12-31 s7lIMB Standard Conh'act• Revised 6
financial interest in this Agreement in violation of the applicable provisions of the California
Government Code,
IV N1171CLS
Any notices, certificates, or other communications heretmder shall be given Dither
by personal delivory to PI IYSICIAN's agent(as designated in Suction 1 heroinabove)or to CITY
aS the MUMAW1 11811 WRITant, or by enclosing the same in it scaled envelopo,postage prepaid, and
depositing the same in the United Stites Postal Sorvicc, to the addresses specified below. CITY
and PHYSICIAN may designate different addrosscs to which subsequent notices, certifioates or
other communications will be scut by notifying the other party via personal delivery, a reputable
overnight carrier or U.S, certified mail-return receipt requested:
TO CITY: TO PHYSICIAN:
City of Huntington Beno11 _701" t QM L-Z')PS M.D
A•I'FNI: Risk Manager 1 00 1�5_T_La �Tt.1S0
2000 Main Slreet SAS �iNA G.�9 2-7b 5
I-Imltiugtou Beach, CA 92648
17. CONSI3NT
Whoa CPry,s consent/approval is required under this Agreement, its
consent/approval for one transaction or event shall not bo deemed to be a consent/approval to any
subsequent occurrence of the same or any other Imusaction or event.
18. MODIPiCAT1ON
No waiver or modifienlion of any language in this Agreement shall be valid unless
in Writing and duly executed by both parties.
12-7187/IMe Standard Conlra d - Revised 7
19. SP..CTION HISAM NUT
The titles, captions, section, paragraph and subject headings, and descriptive.
phrases at (lie beginning of the various sections in this Agreement tare merely descriptive and are
included solely fbr conveuicnce. ofroforcuoc only and are notreprosentntivc of natters iticludod
or excluded from such provisions, and do not interpret, define, limit or describe, or construe the
intent of the parties or affect the coustrklclion or inierprctat!oil of any provision of this Agreement.
20, 1N"173RPRF,'rKrION OF THIS AGREEMENT
The language of all parts of this Agreement shall ill Fill cases be construed as a
whole, according to its fair nleatlhlg, and not strictly for a• against any of the panics. If any
provision of this Agreement is held by an arbitrator or court of Competent flll'ISdietioll 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 lierc, As used ill this Agreement, the nlnsculiue or
neutor gender and singular or plw'al number shall be. deemed to include the other whenever flee
context so indicates or requires, Nothing contained herein shall be construed so its to require the
oonlnlission of any act.COl-Arary to law, and wherever there is any conflict betwcon any provision
conlained herein and ally present or lillurc statute, law, ordinance or regulation contrary to which
the parties leave no right to contract, then (lie latler shall prevail, and the provision of this
Agreement which is hereby id'fccted shall be mutailed and limited only to 1110 extent uecessay to
bring It within the requirements of the law,
21. DUPLICAIT OIZ1Gln1AL
The original of this Agreement and one or moro copies hereto have,been prepared
and Signed ill counterparts as duplicate originals, each of which so executed shall, irrespective of
I2-31 E7AMP,Standard Contract - Revised 8
the dote of its execution and delivery, be deemed on original, Each duplicate: original shad! be
deemed an original instrument as against any party who has sigued it.
22. fMM1GRATfON
PHYSICIAN shot! be responsible for full compliance with the immigration au:d
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naturalization laws of the United Slates and shall, in pnrlicu!ar, comply with the provisions of the
United Slale.s WE regarding employment vo•Rullon.
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 Iogal services are expressly outside the
scope of services contemplated hereunder. RHYSICIAN understands that pursuant to Ffunliaigtnn
peach Qlp Chortcr Section 309, the City Attorney is the exclusive legal counsel for CITY and
CITY shall not be liable for payment of nny legal services expenses incurred by PHYSICIAN.
24. ATTORNEY'S F1;13S
In the event suit is brought by either party to construe, interpret and/or enforce the
terms and/or provisions of this Agreement or to secure the perfurnrance hereof, each party shall
bear its own atloraey's fees, such that the prevailing party shall not be entitled to recover its
attorney's fees from the nor-pravailingpnrty.
2.5. St�ZViYA L
Terms and conditions of this Agreement, which by their Sense and context survive
(lie termination of this Agreement, Shall so Survive.
21 C3O NBUNING LAW
1%is Agreement shall be governed and Construed In accordance with the haws of the
State of California.
113187AMB Standard Contract• Revised 9
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27, SIGNA'1'ORIIRS
haeh undersigned resivesenls nml Warranin that A signature herein below has the
power, authority and right to bind their respective parties to each of the terms of this Agreement, I
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and shall indenutify CITY fully for any injuries or damages to CITY in the event (hat such
authority or power is not, in fact,held by the signatory or N withdrawn,
I'IIVSICIAN's initials
28.
The parties acknowledge and agree Ihat they no em mhy into this Agreement Beaty
and voluntarily following extensive arm's length negotiation, and that each has had the opportunity
to emmult with legal ammsel prior to oxecu rig this Agreement. 'I71e parties also ack.nowlcdgo and
agree that no rcpresenlWon% inducements, promises,agreements or warranties, oral or otherwise,
have been made by that party or anyone acting on that party's behalf, which are not embodied in
this Agreement, and that that party has not executed this Agrccment ill reliance on any
representation, inducement, promise, agreement, warranty, fact or chmuristance not expressly set
forth in this Agreement. This Agreement, and (he attached exhibits, wm(ain the entire agreemoni
between the parties respecting the subject mutter of this Agreement and supersede all prior
imderstantings and agrcenieats whether' a'al or in writing between the partics respecting (he
sttbjcct matter hereof,
29, E?lSFCT[ F DATL
This Agreement shall be effective on the date of its approval by the City Attorney.
'Phis Agreement shall expire when terminated as provided hereof.
IN WITNESS WI IERSOF, the parties hereto have caused this AgrwmwA to be executed
by and through their authorized officers.
im Rma Standard Contract - Revised 10
PHYSTCiAN
Zah fah le%z15 M CITY OF HUNTINGTON BEACH, a
municipal unicipal corporation of the State of California
bil ctor of Human Resources
I
APPROVED AS TO FORM;
Lai��-
sty Attorney
Recelve and File
�1 �&746
Ctty Clerk -11FI,2/
12.3181/1MP Standard Contract- Revised 1 l
PROFESSIONAL SERVICES CONTRAC F BETWEEN
'11F113 CITY OF HUM'1NG'1.'ON 13EACI1 AND
ZQr� Bwi �mD
FOR
INDEPENDENT MEDICA1, EVALUAfONS WITH
R.I SPECT TO WORKERS' COMPENSATION CLAIMS
Table of Contents
1 Scope of Services.....................................................................................................1
2 City Staff Assistance................................................................................................2.
3 Time of Perlbrmance ...............................................................................................2
4 Compensation ..........................................................................................................2
5 Extra Work...............................................................................................................2
6 Method ofPnyment..................................................................................................3
7 Disposition of Plans,Estimates and Other Documents ...........................................3
8 Hold Harmless ......................................................................................... ...............3
9 Professional Liability Insurance..............................................................................4
10 Cer(McalesofInsurance................„,..,.,........,.......,.,,..........,,..................................5
11 Independent Contractorr............................................................................................5
12 TerminatiouofAgreemcnL......................................................................................6
13 Assignment qnd Suheontraeting ..............................................................................6
14 Copyrights/Pal tell ls...................................................................................................6
15 City Employees and Offleials..................................................................................6
16 Notices .................... ................ ..............................7
17 Consent ....................................................................................................................7
isModification.............................................................................................................7
19 Section Iieadings .....................................................................................................8
20 Interpretation of this Agreement..............................................................................8
21 Duplicate Original....................................................................................................8
22 Immigra(ion..............................................................................................................9
2.3 L.egnl Services Subcontracting Prohibited...............................................................9
24 Attorney's Fees.........................................................................................................9
2.5 Survivfil....................................................................................................................9
26 Governing Law........................................................................................................9
27 Signntorics................................................................................................................10
28 Entirety.....................................................................................................................to
29 Effective Date..........................................................................................................10
12,3187milso
EXHIBIT "A"
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STATIiMI?N'1'OIL th'UR1C:
1) AOE -COF,EXAMS (exams for tiic determination of industrial enusation).
2) Evaluation for necessity of approprinto medical treatment.
3) Assessmetll of employee's present ability to return to work, whother full cluly or
modified.
4) Advise on condition of maximum medical improvement status.
5) Determine nature and extent of permanent disability, iuchtcling fRCtOCS of apportioamcnt
and need for fulure medical care,
G) Resolve utilization review disputes.
7) Determine the need for spinal surgery pursuant to l.,abor Codu section 4062(b).
PHYSICIAN shall perform the evaluation in full accordance with the standards defined by the
Division of Workers' Compensntion of the State of California and file AMA Guides to the
EVnlu"Itloll of PcrinnnclU Lnpoirmew, Fiftll Edition. 'fills requires a report of the injury, prior
status, clinictll Chronology, current status, and past medical history. The physical examiutition
will document all pertinent posilivo, nogntiye, and non-physiological findings. For extremity
in urics, measurements must be documented bilaterally. Additionally, PHYSICIAN agrees to:
(i) provide that medical exams will be set within thirty (30) clays of the dote of appointment
request, and (ii) prepare a written report of findings within thirty (30) cloys of the elate of exam or
evaluation and provide n copy to (lie,panics within said timo frame,
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12.318717SH80
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EXHIBIT "B"
Payment Schedule
I. Missed Appointments
• Fee: $503.75
• Code: M1,200
Applles when:
• Interpreter does not appear for evaktation.
• 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: M L201
• Applies to the initial evaluation or the first evaluation in an 18-month period,
• 'Elie,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, Follow-up Medical-Legal Evaluations
• Pee: $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 ot•
follow-up evaluations.
o Supplemental report addresses an issue the parties asked the Physician to address
in a prior med-legal evaluation,
12-3187n5880 I
5. Medical-txgal 'restitnony
• Fcc: $455.00 per hour (or physician's usual and customary fee, it'lower)
• Code: M1,204
• 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 Ice, if lower)
• Codc: MT,205
• No minimum time allotment.
• Physician must capture time spent reviewing evidence to the nearest quarter-hour,
verified under penalty of perjury.
• The fee does nor include production of a medical-legal report. '1'hc 1ec for tine spent
reviewing the recording will be included in the billing for the initial, follow-up or
supplcnental medical- report.
7. Court-Ordered Evaluations
• When a medical-legal evaluation is ordered by a Workers' Compensation Juclgc, file
Judge has authority and discretion to apply the appropriate modifier to that evaluation.
9, The parties agree that the City is not obligated to pay compensation to the PAYSIMAN
except for agreed upon medical services and care. Failure of PHYSICIAN to provide a
written medical report within 30 days ofthe 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 7.'itic 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 PlAYSICIAN within forty-five (45) days following receipt front
PHYSICIAN of invoices for services rendered and for which payment has not previously
been made, provided that PHYSICIAN shall submit all invoices within ninety (90) days
alter the date of service.
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12-3187/75890 2
MAR. 31. 2021 2:25PM Nil. 3181 -P. 2-
A**",\THEDOCTORSCOMPANY
CERTIFICATE OF INS 92A&ICE Issue Date: 03/31/2021
Effective Date: 01/01/2021 A Claim,1,e Profess10 Uablllly Policy
First Named insured. IMPORTANT NOTICE: This document is issued as
Ortho Group of Orange County a matter of information and does not confer rights
Suit N. Tustin Avenue to any recipient. This document is not binding, is
Suite 250 not part of the Policy described below, and does
Santa Ana, CA 92705 not change or extend the coverage Provided by that
Policy.
Insured: 2;,en 1 Lewis MD _ — —
Specialty: SUR01 -Surgical Spec-Office Min Surg and Procedumss Only
Poll Number Polic Period-
0427852 From: 01f0112021
Retroactive Date: To: 01/01l2022
DO rture Period:
06127119T7 From: NIA
To: N/A
The Insured above is
® A Named Insured Agency and Address:
The Doctors Company Insurance
❑A Locum Tenens Services
❑An Additional Insured 15260 Ventura Boulevard, Suite 200
Sherman Oaks, CA 91403
(800)8$2-8872
f[r APPROVED AS TO FORM
UMR$OF UABIUTY ClaiCITY ATTORNEY
Aggregate
Limit: S2�R�HUNTIr3GTONBEACH
Aggregate Limit $8,000,000
I. Locum Tenens and Additional Insureds share Limits of Liability with the applicable Named Insured.
II. Individuals who occupy a"slot'share Limits of Liability with all others who occupy the same 'slot'during the
Policy Period
Ill. Photocopies of this document are deemed as valid as the original.
IV. The Policy, including Endorsements, determines the coverage provided. Some Claims may not be covered
by the terms of the Policy, or may be subject to restrictions such as lower Limits of Liability.
V. If the Policy, or coverage for any person, is canceled for any reason or if the terms of the Policy are
changed,we will notify the First Named Insured (and any additional Named Insureds as required by
applicable state law). Coverage is not in effect unless and until all payments are received when due.
VI. If a Departure Period is indicated, the Policy will not respond to Probable Claim Events arising from
Professional Services Incidents or Review Incidents that take place during the designated period; however,
the Policy will respond if we receive a Claim Report during this period.
MPL003 (04/15) 100 Paget of 1 MCO2003 31276366-00
Insured
185 Graerwood Road•P.O.Box 2900,Napa,CA 9455"900 (707)22&-0100*(800)421-Z366 w .thad=ors awn