HomeMy WebLinkAboutRichard Burke, DPM - 2021-04-01 PROP} SSONAL SERVICES CONTRACT 13):MEIN
THE CITY OF HUNI-INGPON BEACH AND
Rirhxd_Ourke, pPm
FOR
INDII-TENDENI'IVIFINCAL EVALUATIONS WITH
ItESI'IiC'1''I'O WORKERS' COMPENSATION CLAIMS
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THIS AGIM_-'MEN"1 ("Agreenicnl") is made and entered into by and between the City of
Huntington lkach, a nnulicipal curporalion of the State of California, lrorcinaReF referred to as j
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"CITY", and 6•IZ1em'—).}3t~tkf D"I't Individual, hercivafler referred toas"PHYSICIAN."
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WIIEREAS, 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
I untington Beach Municipal Cade, Chapter 3.03, relating to procurement of professional service
contracts have been complied with;and
PHYSICIAN has been selected to perform said services,
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NOW,THEREFORF, it is agreed by CITY and PHYSICIAN as follows:
1. SCOPE OF SERVICES
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PHYSICIAN shall provide all services as described in Exhibit "A," which is
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attached hereto mid incorporated into this Agreement by this reference. These sclvices shall
somctiutcs hereinafter be referred to as the "I'ROJEiC."f."
PI IYSICIAN hereby designates R •Qt6 110 r ot`I_ who shall represent it i
and be its sole contact and agent in all consultations with CITY during the performance of Ihis
Agreement.
APPROVED AS TO FOR M/Ft7r�
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8y• j
J ICHAEL E. GATES
CITY ATTORNEY
12-3187/1ML Standard Contract- RCVISed I CITY OF HUNTINGTON BEACH
2. CITY STAFF ASSISTANCE
CITY shall flssigll a stuff cou;dillatol' to work directly with PI IYSICIAN in the
petforntance of this Agreement.
3. TIME OF PERFORMANCE
Time is of the essence of (his Agreement, The services of PHYSICIAN arc to
canuncnce on -Apr-1.1...2VI _- (tile "Commencement Date"). This Agreement shall
automatically renew Ihrce(3) years from the Commencement Date, unless terminated as provided
herein. The time for performance of the tasks idewiiied in Exhibil "A" are generally to bo shown
in Exhibit "A." This schcdu!c may be amended to benefit tite PROJECT if mutually agreed to in
writing by CITY and PHYSICIAN.
In the event the Commencement Date precedes the Lffective Date, PI-IYSICIAN
shall be bound by all terms and conditions as provided herein.
4. COMPENSATION
In consideration of the performance of the services described herein, CITY agrees
to pay PHYSICIAN, on a time and materials basis at the t.ntes specified in Exhibit "B " attached
hereto and incorporated by reference into this Agreement, a fee, including all costs and expenses,
not to exceed 'I'welity-nine Thousand Nine-l-lundred Dollars($29,900.00).
5. EXTRA WORK
Ill rile event CITY requires additional services not included in Exhibit "A", of
changes in the scope of services described in Exhibit "A," PI IYSIC1AN will undettake such work
WAY aftc receiving written aulltoriration from CITY. Additional compensation for such extra
work shall be allowed only if the prior written approval of CITY is obtained.
i2-3 187/IfvlE Standard COntract- Revised 2
G, METHOD OF PAYMIiN'r
PHYSICIAN shall be paid pursuant to the tern is of Exhibit '.B."
7. DISPOSITION OF PLANS ESTIMATES AND OTH11M DOCUMENTS
PI IYSICIAN agrees that title to all materials prepared hereunder, including, but not
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limited to: all original drawings, designs, reports, both field and office notices, calculations,
computer code, language, data or programs, maps, memoranda, letters and other documents, shall
belong to CITY, and PHYSICIAN 9111111 turn these materials over to CITY upon teen ination of
this Agreement or upon PROJECT completion, whichever shall occur first. These materials may
be used by CITY as it sees fit.
8. HOLD HARMLESS
PHYSICIAN hereby agrees to protect,defend, indemnify and hold harmless CITY,
Rs officers, eicctcd or appointed officials, employees, agents and volunteers from 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 or liability of any kind or nature) arising out
of or in connection with PHYSICIAN'S (or PHYSICIAN's subcontractors, if any) negligent (or
alleged negligo10 performance of this Agreement or its L+dore IU comply with any of ltS obligations
contained in this Agreemcot 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 Cl'I'Y shall approve scicetion of P[lYSICIAN's
counsel. This indemnity shall apply to all claims and liability regardless of whcthcr any insumnec
policies are applicable. 'Hx policy limits do not act as limitation upon the amount of indemnification
to be provided by PHYSICIAN.
12-718711MH Standard (:ontract- RCVISed 3
9. EL�QFLSSIONAI_LIAAII,ITY INSURANCE
111-1YS!CIAN shall obtain and furnisli to CITY a professional liability insurance
policy covering the work performed by it hercululer. This policy shall provide coverage for
PHYSICIAN's professional liability in tin amount not less than One Million Dollars
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(b1,000,000.00) per occurrence and in the aggregate. The above-mentioned insurance sliall not
contain a self-inttn'ed retention witbout the express written consent of CITY;howaver an insurance
policy "deductible" of Tcn Thousand DOIlilis ($10,000.00) or Icss is permitted. A claims-made
policy shall be acceptable if the policy further provides that:
A. The policy retroactive date coincides with or precedes the initiation of the
scope of work (including subsequent policies purchased as renewtils or
replacements),
13, PHYSICIAN shall notify CITY of circumstances or incidents that might
give rise to future claims.
PHYSICIAN will make every effort to maintain similar insurance curing the
t'egtiired extended period of coverage following YIZOIBC't'connplction. !f insurance is terminated
for tiny reason,PHYSICIAN agrees to purchase all extended repu•ling provision of al 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 insurance has been
procured and is in force and paid for, the CITY shalt have the right, at the CITY's election, to
forthwith terminate this Agreement. Such tcrnnination shall not affect PIIYS1CIAN's right to be
paid for its lime and materials expended prior to notification of termination. PHYSICIAN waives
12.3187/IMt.• Standard Contract - Revised 4
the right to receive compwim don and agrees to indemnify tite CITY for any work performed prior
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to approval of insurance by the CITY.
10, CERTIFICATES OF INSURANCi
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
b regoing insurance covetage as required by dis Agmen ent; the cad5calc 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. (hat such policy shall no( be suspended, voided or canceled by
either party, reduced in coverage or in limits except after thirty (30) days'
prior written notice; however,tell(10)clays' prior written notice in the event
of cancellation for nonpayment of premium.
PHYSICIAN shall maintain the foregoing insurance coverage in force until (lie
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 hulen Motion obligations as set forth ill this
Agrcemcut. CITY or its representative shall at all times have the right to demand the original or a
copy of the policy of insurance. PHYSICIAN shall pay, in it prompt and timely milliner, the
premiums an the insurance hmunabovc required.
11. INDEPENDENT CONTRACTOR
PHYSICIAN is, and shall be, acting a( all times in the performance of (his
Agrecmont as an independent cotaractor herein and not its an Crtployce of CITY. PHYSICIAN
shall secure at is own cost and expense, and be responsible for any and all payment of all taxes,
12-318WIME Standard Contract - RcVISe(I 5
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social security, state disability instu•ance compensation, uncmploytuenl compensation and other
payroll dcchrctiotS for PHYSICIAN and its officers, agents and employees and all business
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licenses, if any, ill connection with the PROJECT and/or the services to be perfomecl hereunder.
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12. TERMINATION OP AORIiEMENT
All work required hereunder shall he peformed in tt good and workmatrlike
manner. CITY may terminate PHYSICIAN's Services hereunder at any time with or without cause,
Mld whether or not the PROJECT is fully complete. Any termination of this Agrecorenl by CITY
shall be ivade in writing, notice of which shall be delivered to PHYSICIAN as provided lietein.
In the event of termination, all finished and unfinished documents, exhibits, report, and evidence
shall, at the option of Lie CITY, become its properly and shall 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 hereirabove.
14. COPYR101ITSMATI NTS
CITY spoil 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 shnll employ no CITY official nor any regtdar CITY employee in the
work performed pursuant to this Agreement. No officer or employee of CITY shall have any
i7-3 is7 imp,Standard Contract- Revised 6
financial interest in this Agreement in violation of the applicable provisions of the California
Government Code.
t6. NOTICES
Any notices, certificates, or other communications liereandcr shalt be given either
by personnl delivery to PI IYSICIAN's ngenl(as designeted in Section I hcrcinabove) or to CITY
as the situation shall warrant, or by enclosing the same in a sealed envelope, postage prepaid, and
depositing the Silme in the United Stales Postal Scrvicr., to Elio addresses spccilicd below. CITY
end PHYSICIAN may designate different addresses to which subsequent notices, certificates or
other communications will be sent by notifying the other party via poisoned delivery, a reputable
overnight carrier or U.S. certified mail-return receipt requested:
TO CITY: TO PHYSICIAN:
City of Iluutinglon Beach B f2N4\a r� fir^kR 1-)P(YN F Cr�-�11�,,v 1C
ATfN: Risk Manager �'1Ipl ��_ Y111'1Cl Pa- ire
2000 Main Slrcet
Huntington Beach, CA 92648
17. CONSEN"I'
Whet, CfI'Y's consent/approval is required under this Agmenient, its
cmisenUappi ova I for uric transaction or event shall not be deenied to be a consent/approval to any
subsequent occurrence of the same or any other liausaclion or event.
18. MODIFICATION
No waiver or modifielion of ally language in this Agreement shall be valid unless
in Writing and duly executed by both parlics.
I')-3187/)MF Standard C.omrnct - Revised 7
19. SECTION 1JEADIN(IS
'file titles, captions, section, Imagraph and subject buildings, end descriptive
phrases at the beginning of the various sections in this Agreement are nnerely descriptive and arc
inchldud solely for convenicncc of reference only and are not representative of matters included
or excluded tionl such provisions, and do not interpret, define, IIMIL or describe, or construe the
intent of the parties or affect rile emranNon or niterpmiatlon of(lily provision of this Agreement.
20. IN'II;Riw-gATION Oh T111S AGREEMENT
'file language of all parts of this Agrccmcut shall in all cases be construed as it
whole, nccording to its fair inclining, and not strictly for or against any of the panicy ff any
provision of this Agreement is held by an arbitrator or court of competent jurisdiction to be
uuenfurceable, void, illegal or invalid, such holding shall not invalidate or aflcct the remaining
covenants dial proviAo11s of Th Agreement. NO covenant of provision shall be deemed dependent.
upon any other unless so expressly provided here. As used in this Agreement, the nlasculine of
neuter gender and singular or plural number shall be deemed to include the other whenever the
context so indicates or requires. Nothing contained herein shall be construed so as to require the
commission of any act cuMnwy to law, and wherever there is any conflict between tiny 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. DLJPLICA,rc ORIGINAL
The original of this Agreement and one or more copies hereto have been prepared
and signed ill counterparts as duplicate odgimds, each of Well so executed shall, irrespective of
12-1187/11AH Standard Contract - Revised 8
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the date of its execution and delivery, be deemed an original. Each duplicalc original shall be
deemed an original instrument as against any party who has signed it.
22, 1Mtv1IGRATION
PHYSICIAN shall be responsible for full compliance will+ the itnriigration and
naturalixatiat laws of the Uniled Stales and shall, in particular, comply with the provisions of[tic
United Srrues Code regarding employment verification.
23. LEGAL SERVICES SUIICON'1'IIACTING PRO11111 "I ED
PHYSICIAN and CITY agree that CITY is not liable for pnvmatt of any
subcontractor work involving legal services, taus that such legal services are expressly outside the
scope of services contemplated hercundcr. PHYSICIAN understands that pursuant to Ilunlinglota
Beoch C'i!p Charter Section 309, (lie City Attorney is the exclusive legal counsel for CITY and
CITY shall not be liable far payment of any legal services expenses incurred by PHYSICIAN.
24. A'FroR IEY'S FEES
In the event suit is brought by either party to construe, interpret and/or enforce the
teens and/or provisions of this Agreement or to secure the perfmvrance hereof, each Pliny shall
bear its own attm'ncy's fees, such that the prevailing party shall not be entitled to recover its
attorncy'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 shail be governed and construed in accordance with the laws of the
State of California.
12-3187/IME Standard Contract- Revised 9
27. SIGNATORI S
SO 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.
1'llYSICIAN's initials
28. ENTIRI 1'Y
Tlic parties acknowledge and agree that they arc catering into this Agmmum,t freely
and vohuntarily following extensive arm's length negotiation; turd that each has had the opportunity
to consult with legal counsel prior to executing this Agrecmcpt. The panics also acknowledge and
agree that uo representations, inducements,promises,agreements or warranties, oral or otherwise,
have been made by that pnriy or anyone acting on that puty's behalf, which arc not cmbodit:6 in
this Agrccment, and that that party has not executed this Agreement in reliance on any
represurrUdIon, iuducement, promise, agreemeui, warranty, fact or circumstance not expressly set
forth in this Agreement. This Agmmucnt, and the a0ached exhibits, contain the entire agreement
between the parties respecting the suhjcct matter of this Agrccment and supersede a1I prior
tmderstandings and agrccmcnls whether oral or in writing between the parties respecting the
subject matter hereof.
29. EhhECT[VE DATE
'Phis Agrccment shall be offectivc on the date of its approval by the City Attorney.
This Agreement small expire Awl terminated as provided hereof.
IN WITNESS WIIEREOP, the parties hereto have caused this Agreement to be executed
by and through their aulhorizcd offiCw's.
I2-71S7/1Mr.Standard Contract - Revised 10
PHYSICIAN
CITY OF HUN TNOTON BEACH,a
rawts — municipal corporation of the State of California
Slp -
Di or of Human Resources
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APPROVfv AS TO FORM:
g City Attorney
Receive and" �� 9,4r Filen - /
4n d ll4j - '
City Clerk q1g�=� '
12.3187AME Standard Contract- Revised 1 I
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PROFESSIONAL SFIRVICRr CONTRACTIIETWEEN
THE CITY OF HUNTING I'ON BEACH AND
_Richard OVERLDRO
FOR
INDIVENDENT MEDICAL, 13VALUATONS Wff}•I
RISPIiC;I"1'O WORKERS' COMPENSATION CLAIMS
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Table of Contents
IScope. of Service.......................................................................................................I
2 City Staff Assistance................................................................................................2
3 Time of Pcrfonnanec...............................................................................................2
4 Compensation ..........................................................................................................2
5 L'stra 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 Contractor............................................................................................5
12 Termination of Agreement.......................................................................................6
13 Assignment and Subcontracting..............................................................................6
14 Copyrights/Patents...................................................................................................6
15 City Employees and Offirials..................................................................................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 I..egal Services Subcontracting Prohibited...............................................................9
24 Attorney's Fees.........................................................................................................9
25 Survival....................................................................................................................9
26 Govurning I.a A. ........................................................................................................9
27 Signatories................................................................................................................10
28 } ntlrely.....................................................................................................................10
29 1 ffective Date ..........................................................................................................10
12-3187n588o
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EXIIII3YC "A„
STATENENh'OF WORK:
l) AOE—COP.EXAMS (exams for the determination of industrial causation).
2) Evaluation for necessity of'appropriate medical treatment.
3) Assessment of employee's present ability to return to work, whether full duty or
modified.
4) Advisc on condition of maximum medical improvement status.
5) Determine nature and extent of peruraucn(disability, including fnetOrs of apportionment
and aced for future medical care.
6) Resolve utilization review disputes.
7) Determine the need for spianl 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' Coiupensation of the State of California and the AMA Guides to the
Evaluation of Permnneat Impnimicnt,1,10h Edition. This requires it report of the injury, prior
status, clinical chronology, current status, and past medical history. The physical examination
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Will (leCUalenl Ill pertinent Positive, negative, aid non-physiological findings• For exlrumity !
injuries, measurements must be documented bilaterally. Additionally, PHYSICIAN agrees to:
(i) provide that medical exams will be set within thirty (30) days of the dnle of appoinUuent
request, and (ii) Prepare a written report of findings within thirty (30) days of the date of exam Or
evaluation mid provide it copy to the parties within said tinre frame.
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12-3197175880
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.
• The 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
• Pee: $1.316.25
• Code: ML202
• Applies to any subsequent comprehensive evaluation within 18 months of the initial
evaluation.
• This fee includes review crop 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 it rate of$3.00 per page.
4. Supplemental Medical-Legal Evaluations
• Fcc: $650.00
• Code: M203
• Does not involve an examination of the patient.
• Results in preparation of a narrative medical report.
• Review of records is 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 cvalualions.
o Supplemental report addresses an issue the parties asked the physician to address
in a prior need-legal evaluation.
12-3187/75880 1
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5. Medical-Legal Testimony
• Pee: $45.5,00 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 I 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: M1,205
• No minimum time allotment.
• Physician must capture time spent reviewing evidence to the nearest quarter-hour,
verified under penalty of perjury.
• The fec 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-Ordcred 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.
S. 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
been made, provided that PHYSICIAN shall submit all invoices within ninety (90) days
after the date of service.
12-3187/75880 2
CERTIFICATE OF INSURANCE
CxYlificate Huldcc
The City Of Huntington Beach _
2000 Main Street
I luntington Beach,CA 92648 A I ICI ED RL• NTATIVC
THIS CERTIFICATE ISSUED AS A MATTER OF INFORNIATION ONLY AND CONFERS NO RIGHTS UPON THE.
CERTIFICATE HOI.DFR.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NRCATIVFI.Y AMEND,RXTF.Nft
OR ALTER THE COVER LGE AFFORDED BY THE POLICY BELOW.
ISSUE DATE: 09/01/2021
INSURED: B. Richard Burke,DPdl
17n1 W. Romneya#e
.Ina helm,(.'A 92801
APPROVED
3v:
ELEICG,gTF-
POL1C'YHOLDER(if different than the Insured): `m nF M ATTORND
N'17NGTON t..__
COMPANY AFFORDING COVERAGE. Podiatry Insurance Company of America
3000 Meridian Boulevard
Suite 400
Franklin,T iN 37067
THIS IS TO CERTIFY THAT THE POLICY OF TNCITRANCE LISTED BELOW HAS BEEN ISSUED TO THE.INSITRF.D
NAMED ABOVE FOR THE POLICY PERIUD INDICATED:
TYPE OF INSITRANCE: Professional Liahilih -Clafms-Made
ENSURED'SPROFESSION: Podiatric
POLICY I YPE' healthcare Professional
POLICY NUMBER: 1PDINIIli8M0
EFFECTIVE DATE: 12/01/2020 RETROACTIVE DATE: 02102Y1977
EXPIRATION DATE: 12101/2021 EXCLUSIONS:None
PIUNlARY" LIMITS OF Podiatry-Surgical
LIABILITY: S1.000,0001S3,000.000
PICA-1 ICP-COI 03 11 &Podiatry Insurance Company of America