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HomeMy WebLinkAboutOrange County EMT (OC EMT) Corp - 2025-05-05 (2) COLLEGE/PREHOSPITAL PROVIDER AGREEMENT TO PROVIDE SUPERVISED FIELD SERVICE EXPERIENCE FOR EMS.PROGRAM STUDENTS This.COLLEGE/PRE-HOSPITAL PROVIDER AGREEMENT(hereinafter referred to as "Agreement") is entered into by and between OCEMT Corp, a California stock corporation,(hereinafter referred to as"COLLEGE") and the City of Huntington Beach Fire Department, (hereinafter referred to as""PROVIDER"). COLLEGE and PROVIDER shall be individually referred to as a"Party" and collectively be referred to herein as the"Parties." RECITALS A. COLLEGE maintains an emergency medical services program for students studying in the fields of Emergency Medical Technician Basic ("EMT-B"), Emergency Medical Technician Intermediate ("EMT-I"), and Emergency Medical Technician Paramedic ("EMT-P") training (hereinafter collectively referred to as the "EMS Program"); and B. The EMS Program has certain requirements for students to gain supervised field experience while enrolled in the EMS Program; and C. PROVIDER supplies emergency medical services to the community, which lends itself to the provision of said supervised field experience for the students of the EMS Program; and D. PROVIDER has agreed to provide supervised field experience for the students of the EMS Program,subject to the terms and conditions below; and E. PROVIDER shall retain complete responsibility for fire protection, disaster preparedness and response,fire prevention,rescue,hazardous materials mitigation, technical rescue response, medical emergency services, and public service assists (hereinafter. called "FIRE SERVICES"). Students in the program are restricted from performing any FIRE SERVICES that are.not EMS related;and F. The students training experience will provide observation of the day to day responsibilities of the 'PROVIDER as well as provide the required hours and field experience in emergency medical patient care in correlation with the Orange County EMT Internship Field Guide in accordance with the pertinent sections of Division 9 of Title 22 of the California code of Regulations and Division 2.5 of the California Health and Safety Code. The PROVIDER shall retain ultimate responsibility at all times for the care of all patients.receiving EMS treatment. NOW, THEREFORE, in consideration of the mutual covenants contained herein,the Parties hereto agree as follows: OCEMT 2024, AGREEMENT 1. The COLLEGE shall: a. Assume full responsibility for the preparation of instructors for positions in the EMS Program. b. Be responsible for the development,organization,and implementation of the EMS Program curriculum under the direction of a qualified EMS Program Director. • c. Administer exams and supervise the students admitted .to the EMS Program at the time of acceptance and throughout the period of time prescribed for the student's completion of the EMS Program. d. Provide certificated instructors to teach all prescribed courses in the EMS Program, including any instruction or training which may be carried on at the PROVIDER. The instructors and the Director of EMS Program shall be named, appointed, and,assigned by the COLLEGE in accordance with its established procedures for employment of instructional personnel. e. Provide each new instructor the opportunity to participate in an orientation with the PROVIDER. This orientation shall be arranged through mutual agreement of the COLLEGE and the PROVIDER. f. Provide all instructional supplies and equipment as needed for the EMS Program, except those which the PROVIDER hereinafter specifically agrees to provide. g. Provide administrative functions, including admission, counseling, scheduling, attendance, accounting, and achievement records in connection with the EMS Program, similar to those maintained for all other students at California EMS Academy. h. Furnish copies of class schedules and student rotation assignments to the PROVIDER, prepared by the EMS Program Director after consultation with the PROVIDER. i. Provide documentation that recognizes that the. EMT - Paramedic program meets national standards and is an accredited program through CAAHEP and CoAEMSP. OCEMT.2024 j. Provide PROVIDER a copy of the Emergency Notification Form for each student prior to participation in the EMS Program Field Training. • k. Provide the students with the proper Personal Protective Equipment (PPE) for their internship 2. The PROVIDER shall provide the following: a. Cooperation and counsel of the.PROVIDER to help ensure success of the EMS Program. b. As broad an experience as possible with opportunities for observation, participation, or independent activity involving day to day responsibilities of emergency medical patient care through the • program offered by PROVIDER. c. Retain complete control and responsibility of victim/patient care as well as supervision and oversight of students participation at all times. 3. Should emergency treatment be necessary for students in the event of accident or sudden illness,the cost of such treatment shall be covered by the Student. It will be the duty and obligation of the COLLEGE to insure that.a claim is properly filed with the COLLEGE'S risk Management Department. The parties agree that the standards of the EMS Program shall be maintained at a level equal to or exceeding those required by the state of California as outlined inTitle 22, Division 9 of the California Health and Safety Code. The student must make notification to their preceptor (while on duty or off duty) if the student begins to show signs and symptoms of Covid-19. 4. The Parties agree that the students and staff of the COLLEGE participating in the EMS Program are not employees or agents of the PROVIDER,nor shall they become employees or agents of the PROVIDER by virtue of their participation • in the EMS Program, but shall be subject to and shall abide by all PROVIDER rules,regulations, and policies,including,but not limited to: those governing professional conduct, confidentiality, discrimination, affirmative action, substance abuse, and Blood Borne Pathogen Control Plan. In the event a student fails or refuses to do so, the PROVIDER reserves the right, in its sole discretion,to deny the use of its facilities and services by such student. 5. Each student in the EMS Program, prior to beginning field training with PROVIDER, shall have on file, documentation of health status with the COLLEGE'S EMS Program Director including: documentation of negative TB test within the previous year, and current Hepatitis B vaccination. This documentation shall be provided to PROVIDER upon request. OCEMT 2024 6. The number of students participating in the EMS Program who are assigned to PROVIDER shall be determined by mutual agreement of the Parties. 7. Per Division 9 of Title•22 of the California Code of Regulations; no more than one (1) EMT student, of any level, shall be assigned to a.response vehicle at any one time during the student's field training. 8. Students are not authorized to drive any PROVIDER vehicle, but may ride in such vehicles during their participation in this program when driven by a PROVIDER employee. 9. A strict code of confidentiality of victim/patient information shall be maintained by all participants in the EMS Program. a. Students will sign a Statement of Confidentiality as part of their Orientation. This signature binds the student to maintain patient confidentiality throughout the field experience. No copies of patient records shall be made, and no records or copies thereof shall be removed from the PROVIDER at any time for any reason. b. The discussion, transmission, or narration in any form by students of any individually identifiable client/patient information, medical or otherwise, obtained in the course of the EMS Program is strictly forbidden. Students shall use de-identified information only in any discussions about the clinical experience with the COLLEGE, its employees,or agents as a necessary part of the practical experience. c. In the event of a Student's failure to comply with the confidentiality requirements stated herein, or his/her refusal to enter into a confidentiality agreement as required by this section to receive field experience and supervision from PROVIDER, this student shall be denied approval to participate in the EMS Program.. 10.Initial Term and Renewal a. The term of this Agreement shall be from the last date of final execution to December 31st,2029. b. One hundred eighty (180) days prior to the date of expiration of this Agreement. COLLEGE shall give PROVIDER written notice of whether COLLEGE intends to extend this Agreement or enter into a new agreement with PROVIDER forEMS Program Services. 11.Termination OCEMT 2024 Either party to this,Agreement may terminate this Agreement for any reason by providing a written notice of termination to the other party hereto no less than thirty(30) days prior to the expiration of the term hereof. If such notice is given unilaterally by PROVIDER or COLLEGE, PROVIDER agrees those students enrolled at the time in the COLLEGE'S EMS Program may be permitted to complete their field training pursuant to and under this agreement in the sole discretion of the PROVIDER on the condition the COLLEGE agrees to continue the effectiveness of the provisions of this Agreement with regard to the students. 12.Discrimination The COLLEGE employees,agents,and students accessing PROVIDER resources hereunder shall not discriminate in the provision of services, allocation of benefits,accommodation in facilities,or employment of personnel on the basis of race,religion,medical condition,disability,marital status,sex,age,or sexual orientation and shall comply with all other requirements of law regarding nondiscrimination and affirmative action including those laws pertaining to the prohibition of discrimination against qualified handicapped persons in all programs or activities. For the purposes of this Agreement,distinction on the grounds of race,religion,medical condition,disability,marital status,sex,age, or sexual orientation include,but are not limited to,the following: a. Denying an eligible person or providing to an eligible, person any service or benefit which is different,or is provided in different manner or at a different time from that provided to other eligible persons under this Agreement. b. Subjecting an eligible person to segregation or separate treatment in any manner related to his/her receipt of any service or benefit,except when necessary for infection control. c. Restricting an eligible person in any way in the enjoyment of any advantage or privilege enjoyed by others receiving a similar service or benefit. d. Treatment of an eligible person differently from others in determining whether he/she has satisfied any eligibility, membership, or other requirement or condition which individuals must meet in order to be provided the same or similar service or benefit. e. The assignment of times or places for'the provision of services on the basis of race,religion,medical condition, disability, marital status,sex, age or sexual orientation of the eligible person to be served. 13.Insurance OCEMT 2024 COLLEGE shall purchase and maintain during the duration of this.Agreement and after the expiration of this Agreement as provided below, the following insurance coverage: a. Worker's compensation and employer's liability coverage for COLLEGE'S legal and statutory obligations for damages due to bodily injuries either by accident or disease, occurring to. COLLEGE'S employees, agents, or servants as a result of employment. Workers' Compensation Insurance, as required by the State of California and Employer's Liability Insurance with a limit of not less than$1,000,000 per accident for bodily injury and disease.Workers'Compensation: (1) Cancellation: Required insurance policies shall not be canceled or the coverage reduced until a thirty (30) day written notice of cancellation has been served upon the City except ten(10) days shall be allowed for non-payment of premium. (2) Waiver of Subrogation: A waiver of subrogation stating that the insurer waives all rights of subrogation against the City,its officials,officers,employees,agents,and volunteers. b. General liability covering COLLEGE, its agents, students, employees, and servants for bodily injury personal injury, or property damage claims arising out of the premises, products or activities of the COLLEGE. Minimum limits of liability for the above coverage shall be $1,000,000 per occurrence and $3,000,000 aggregate for bodily injury and property damage. c. Professional liability covering COLLEGE, its agents, employees, and servants for,bodily injury and personal injury claims of victim/patients arising out of the rendering or failure to render care by Staff, COLLEGE or its agents, students, employees or servants. Minimum limits of liability shall be $1,000,000 per incident and $3,000,000 annual aggregate. In the event such coverage is through a"claims made policy and is either cancelled,replaced or non-renewed,COLLEGE shall obtain and maintain extended coverage ("tail") insurance covering occurrences during the effective period of-this Agreement. d. All students performing field work, internships and similar activities who are registered in for-credit courses for which the internships are required are covered with the.COLLEGE'S general and/or professional liability insurance with blanket policies. e. The policies required hereunder shall provide for written notice to Provider at least thirty (30) days prior to the cancellation or modification of any above-mentioned insurance. OCEMT 2024 • f. COLLEGE shall provide PROVIDER with certificates of insurance as evidence that all coverage required under this Agreement listed above have been obtained and are in full force and effect. PROVIDER shall be named on all policies required under this Agreement as an additional insured per the requirements of this Agreement. Certificates of Insurance must be supplied within five (5) days of effective date of this Agreement,and thereafter prior to the expiration date noted upon each certificate. Such policies and the insurers thereunder shall be subject to reasonable and good faith approval by PROVIDER. 14.Indemnification and Hold Harmless To the fullest extent permitted by applicable law, COLLEGE shall and does agree to indemnify,protect,defend and hold harmless PROVIDER,its agencies, departments, directors, officers, agents, Board of Supervisors, elected and appointed officials and representatives (collectively, "indemnitees") for,from and against any and all liabilities, claims, damages, losses, liens, causes of action, suits awards, judgments and expenses, attorney and /or consultant fees and costs,taxable or otherwise, of any nature,kind, or description of any person or enemy, directly or indirectly arising out of, caused by, or resulting from (1) the services performed hereunder,by COLLEGE and student, or any part thereof, (2) the Agreement, including any approved amendments or modifications,or(3) any negligent act of omission of COLLEGE and student its officers, employees, subcontractors, agents, or representatives (collectively, "liabilities"). Notwithstanding the foregoing, the only liabilities with respect to which COLLEGE'S obligation to indemnify, including the cost to defend,the Indemnities does not apply is with respect to Liabilities resulting from the sole negligence or willful misconduct of an Indemnitee,or to the extent such claims to not arise out of,pertain to or relate to the Scope of Work in the Agreement. To the fullest extent permitted by applicable law, PROVIDER shall and does agree to indemnify,protect,defend and hold harmless COLLEGE,its agencies, districts,special districts and departments,their respective directors,officers elected, and appointed officials, employees, agents and representatives (collectively, "Indemnitees") for, from and against any and all liabilities, claims, damages, losses,liens, causes of action, suits, awards,judgments, and expenses, attorney and/or consultant fees and costs, taxable or otherwise, or any nature,kind or description or any person or entity, directly or indirectly arising out of, caused by,, or resulting from (1) the Services performed hereunder by PROVIDER,or any part thereof,(2)the Agreement,including any approved amendments or modifications, or (3) any negligent act or omission of PROVIDER, its officers, employees, subcontractors, agents, or representatives (collectively, "Liabilities"). Notwithstanding the foregoing, the only Liabilities with respect to which PROVIDER'S obligation to indemnify, including the cost to defend,the Indemnitees does not apply is with respect to OCEMT 2024 Liabilities resulting from the negligence or willful misconduct of an Indemnitee,or to the extent such claims do not arise out of,pertain to or relate to the Scope of Work in the Agreement. 15.Disputes COLLEGE shall select and appoint a"Contract Administrator"who shall,,under the supervision and direction of COLLEGE,be available for contract resolution • or policy intervention with PROVIDER,when,upon determination by the EMS Manager, Captain, or Chief, that a situation exists under this Agreement in which a decision.to:serve the interest of COLLEGE has the potential to conflict with PROVIDER'S interest or policy. Any dispute concerning a question of fact arising under the terms of this,Agreement which is not disposed of within a reasonable period of time by the,COLLEGE and PROVIDER shall be brought to the attention of the Director or Chief Administrator (or designated representative) of each organization for joint resolution. For purposes of this provision,a."reasonable period of time"shall beaten(10) calendar days or less. COLLEGE and PROVIDER agree to continue with the responsibilities under this Agreement during any dispute. Disputes that are not resolved informally by and between COLLEGE and PROVIDER representatives may be resolved, by mutual agreement of the parties,through alternate forms of dispute resolution including,but not limited to mediation or non-binding arbitration. The costs associated with the selected form of dispute resolution such as mediation or non-binding arbitration shall be shared, equally among the participating parties. If the alternate form of dispute resolution does not resolve the issue(s),the parties reserve the right to seek remedies as provided by law or in equity. Venue for litigation shall be in Orange County. 16.Delivery of Notices Any notices to be served pursuant to this Agreement shall be considered delivered when deposited in the United States mail and address to: PROVIDER COLLEGE Huntington Beach Fire Department Orange County EMT 2000 Main Street 26489 Rancho Parkway Huntington Beach,CA 92648 Lake Forest,CA. 92630 Provisions of this section do not preclude any notices being delivered in person to the addresses shown above. Delivery in person shall constitute service hereunder,effective when such service is made. 17.Entire Contract OCEMT 2024 This agreement contains the whole contract between the parties for the provision of Preceptor Services. It may be amended or modified upon the mutual written consent of the parties hereto. This Agreement does NOT supplement other specific agreements entered into by both parties for equipment or facilities,and excepting those equipment or facilities agreements, this Agreement cancels and supersedes any previous agreement for the same or similar service. This Agreement may be executed in duplicate counterpart originals, each of which is deemed to be an original,and all of which when taken shall constitute one and the same instrument. In WITNESS WHEREOF,the duly authorized officials of the parties hereto have, in their respective capacities, set their hands as of the date first here in above written. DATED: 6/25/2024 ORANGE COUNTY EMT Name: Corey Gremel Program Director Title: By: ,244-x-¢1 DATED: Huntington� Beach Fire Department C�Name: 12-1 '' Title: (1.-tsts Receiv and Fil BY: / \ ti ArhitK City Clerk ,5/5/25 APPROVED AS TO FORM By: r4A- Gk" F,. MICHAEL J.VIGLIOTTA CITY ATTORNEY CITY OF HUNTINGTON BEACH OCEMT 2024 ACRU® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/21/2025 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 endorsement(s). PRODUCER CONTACT NAME: Lindsay Luxenberg Sav-Lux Insurance Services (A( rc No,Est): 949-444-9969 FAX No): 949-420-2156 P.O.Box 74913 ADDRESS: Lindsay@savlux.com INSURER(S)AFFORDING COVERAGE _ NAIC 0 San Clemente CA 92673 INSURER A: Mesa Underwriters Specialty Insurance INSURED INSURER B: State Compensation Insurance Fund 35076 Orange County EMT INSURER C: American Casualty Company of Reading,Pennsylvania 20427 26489 Rancho Parkway South INSURER D: Unit 150 INSURER E: Lake Forest CA 92630 INSURER F: COVERAGES CERTIFICATE NUMBER: 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. TNSR TYPE OF INSURANCE ADDL SUBR- POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MMIDD/YYYY1 (MMIDD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR PREMISES(Eatoccurrence) S 100,000 MED EXP(Any one person) $ 5,000 A Y Y MP000400701871007 05/28/2024 05/28/2025 PERSONAL d ADV INJURY S Excluded GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 4,000,000 X POLICY PET I 1 LOG PRODUCTS-COMP/OP AGG S Excluded OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS — NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTION$ S WORKERS COMPENSATION XPER OTH- STATUTE ER AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBER EXCLUDED? Y NIA Y 923834820 06/01/2024 06/01/2025 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Professional Liability 0127309331 06/01/2024 06/01/2025 Limit:$2,000,000 Claim/$5,000,000 Agg DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached I1 more space Is required) The City of Huntington Beach Fire Department is listed as additional insured. APPROVED AS TO FOR By: MICHAEL J.VIGLIOTTA CITY ATTORNEY CERTIFICATE HOLDER CANCELLATI FV in-HUNTINGlt,hf BEACH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN The City of Huntington BeachFire Department ACCORDANCE WITH THE POLICY PROVISIONS. 2000 Main St AUTHORIZED REPRESENTATIVE, ,C_ Huntington Beach CA 92648 tiu i2/ e-vetziey ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD POLICY NUMBER MP0004007018710 COMMERCIAL GENERAL LIABILITY CG 20 26 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s)Or Organization(s) The City of Huntington Beach, its Officers, Elected or Appointed Officials, Employees, Agents, and Volunteers. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. Section II — Who Is An Insured is amended to in- clude as an additional insured the person(s) or or- ganization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property dam- age" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations;or B. In connection with your premises owned by or rented to you. CG 20 26 07 04 ©ISO Properties, Inc., 2004 Page 1 of 1 POLICY NUMBER:MP000400701871007 COMMERCIAL GENERAL LIABILITY CG20010413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance (2) You have agreed in writing in a contract or Condition and supersedes any provision to the agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the additional insured. This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance;and CG 20 01 04 13 ©Insurance Services Office,Inc.,2012 Page 1 of 1 insured Copy Resolution No.2008-63 it lS' yter -n k NV ,; CITY OF HUNTINGTON BEACH Ham,,.z:: b 2000 Main Street ,`z,. Huntington Beach, CA 92648 ,.s DECLARATION OF PERM'I EE I certify that no vehicle(s) will be used or operated in the performance of the task(s) or event(s) for which this permit is granted. I authorize the City of Huntington Beach to immediately and retroactively revoke the license or permit issued in connection with or in the performance of said task(s) or event(s) if any vehicle(s) is used. Signature of Permittee 14-Qm", Corey name Creme! Company name(if applicable) OCEMT Corp. Date signed 4/23/2025 16407 EXHIBIT I POLICY NUMBER: 1.P000400701871007 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location(s)Of Covered Operations Or Organization(s): The City of Huntington Beach, its 26429 Rancho Parkway, Suite 150 Lake Forest, CA 92630 Officers, Elected or Appointed Officials, Employees, Agents, and volunteers. Information required to complete this Schedule, if not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for"bodily injury", "property This insurance does not apply to"bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused,in whole or in part,by: 1. Your acts or omissions;or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed;or However: 2. That portion of "your work" out of which the injury or damage arises has been put to its 1. The insurance afforded to such additional intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law;and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 04 13 CO Insurance Services Office, Inc.,2012 Page 1 of 2 Insured Copy