Loading...
HomeMy WebLinkAboutSunrise Multispecialist Medical Center - 2025-12-18 • SERVICE AGREEMENT BETWEEN THE CITY OF HUNTINGTON BEACH AND SUNRISE MULTISPECIALIST MEDICAL CENTER FOR PRE-EMPLOYMENT MEDICAL EXAMS THIS AGREEMENT("Agreement") is made and entered into by and between the City of Huntington Beach, a municipal corporation of the State of California, hereinafter called "City,"and Sunrise Multispecialist Medical Center, hereinafter referred to as "Contractor." Recitals A. The City desires to retain a Contractor having special skill and knowledge in the field of pre-employment medical exams. B. Contractor represents that Contractor is able and willing to provide such services to the City. C. In undertaking the performance of this Agreement, Contractor represents that it is knowledgeable in its field and that any services performed by Contractor under this Agreement will be performed in compliance with such standards as may reasonably be expected from a comparable company or firm in the field. Contractor has been selected to perform these services pursuant to Huntington Beach Municipal Code Chapter 3.02. NOW, THEREFORE, it is agreed by City and Contractor as follows: 1. Scope of Services Contractor 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." Contractor hereby designates William Nuesse, M.D., who shall represent it and be its sole contact and agent in all consultations with City during the performance of this Agreement. 2. City Staff Assistance City shall assign a staff coordinator to work directly with Contractor in the performance of this Agreement. 25-17165/393436 1 3. Compensation a. City agrees to pay, and Contractor agrees to accept as total payment for its services, the rates and charges identified in Exhibit "B." The total sum to be expended under this Agreement, shall not exceed One Hundred Thousand Dollars ($100,000.00) during the term of this Agreement. b. Payment by City shall be made within thirty (30) days following receipt of proper invoice evidencing work performed, subject to City accounting procedures. Payment need not be made for work which fails to meet the standards of performance set forth in the Recitals which may reasonably be expected by City. c. Contractor shall be paid pursuant to the terms of Exhibit"B." 4. Term Time is of the essence of this Agreement. The services of Contractor are to commence/2//$'/a5, or as soon as practicable after the execution of this Agreement by City (the "Commencement Date") and terminate three (3)years from Commencement Date, unless terminated earlier in accordance with the provisions of this Agreement. Contract may be extended for 2 additional one-year periods if mutually agreed to in writing by both parties. The time for performance of the tasks identified in Exhibit"A" are generally to be shown in Exhibit"A." This schedule and Term may be amended to benefit the Project if mutually agreed to in writing by City and Contractor. In the event the Commencement Date precedes the Effective Date, Contractor shall be bound by all terms and conditions as provided herein. 5. Extra Work In the event City requires additional services not included in Exhibit "A" or changes in the scope of services described in Exhibit"A," Contractor 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 obtained. 6. Disposition of Plans, Estimates and Other Documents Contractor agrees that title to all materials prepared hereunder, including, without limitation, all original drawings, designs, reports, both field and office notices, calculations, computer code, language, date or programs, maps, memoranda, letters and other documents, shall belong to City, and Contractor shall turn these materials over to City upon expiration or termination of this Agreement or upon Project completion, whichever shall occur first. These materials may be used by City as it sees fit. 25-17165/393436 2 7. Hold Harmless Contractor hereby agrees to protect, defend, indemnify and hold harmless City, its officers, elected or appointed officials, employees, agents, and volunteers from and against any and all claims, damages, losses, expenses,judgments, demands and defense costs, and consequential damage or liability of any kind or nature, however caused, including those resulting from death or injury to Contractor's employees and damage to Contractor's property, arising directly or indirectly out of the obligations or operations herein undertaken by Contractor, caused in whole or in part by any negligent act or omission of the Contractor, any subcontractors, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable, including but not limited to concurrent active or passive negligence, except where caused by the active negligence, sole negligence, or willful misconduct of the City. Contractor will conduct all defense at its sole cost and expense and City shall approve selection of Contractor's counsel. This indemnity shall apply to all claims and liability regardless of whether any insurance policies are applicable. The policy limits do not act as a limitation upon the amount of indemnification to be provided by Contractor. 8. Workers Compensation Insurance Pursuant to California Labor Code Section 1861, Contractor acknowledges awareness of Section 3700 et seq. of this Code, which requires every employer to be insured against liability for workers' compensation; Contractor covenants that it will comply with such provisions prior to commencing performance of the work hereunder. Contractor shall obtain and furnish to City workers' compensation and employer's liability insurance in an amount of not less than the State statutory limits. Contractor shall require all subcontractors to provide such workers' compensation and employer's liability insurance for all of the subcontractors' employees. Contractor shall furnish to City a certificate of waiver of subrogation under the terms of the workers' compensation and employer's liability insurance and Contractor shall similarly require all subcontractors to waive subrogation. 9. General Liability Insurance In addition to the workers' compensation and employer's liability insurance and Contractor's covenant to defend, hold harmless and indemnify City, Contractor shall obtain and furnish to City, a policy of general public liability insurance, including motor vehicle coverage covering the Project/Service. This policy shall indemnify Contractor, its officers, employees and agents while acting within the scope of their duties, against any and all claims arising out of or in connection with the Project/Service, and shall provide coverage in not less than the following amount: combined single limit bodily injury and property damage, including products/completed operations liability and blanket contractual liability, of One Million Dollars ($1,000,000)per occurrence. If 25-17165/393436 3 coverage is provided under a form which includes a designated general aggregate limit, the aggregate limit must be no less than One Million Dollars ($1,000,000)per occurrence. If coverage is provided under a form which includes a designated general aggregate limit, the aggregate limit must be no less than One Million Dollars ($1,000,000) for this Project/Service. This policy shall name City, its officers, elected or appointed officials, employees, agents, and volunteers as Additional Insureds, and shall specifically provide that any other insurance coverage which may be applicable to the Project/Service shall be deemed excess coverage and that Contractor's insurance shall be primary. Under no circumstances shall said above-mentioned insurance contain a self- insured retention, or a"deductible"or any other similar form of limitation on the required coverage. 10. Automobile Liability Insurance Contractor shall obtain and furnish to City an automotive liability insurance policy covering the work performed by it hereunder. This policy shall provide coverage for Contractor's automotive liability in an amount not less than One Million Dollars ($1,000,000.00)per occurrence and a separate "Additional Insured Endorsement"page listing both the policy number and naming the "City of Huntington Beach, its officers, elected or appointed officials, employees, agents and volunteers" as additional insured on the endorsement. The above-mentioned insurance shall not contain a self-insured retention, "deductible" or any similar form of limitation on the required coverage except with the express written consent of City. 11. Certificate of Insurance Prior to commencing performance of the work hereunder, Contractor shall furnish to City a certificate 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 shall 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. Contractor shall maintain the foregoing insurance coverage in force until the work under this Agreement is fully completed and accepted by City. This requirement for carrying the foregoing insurance coverage shall not derogate from Contractor'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 the 25-17165/393436 4 original or a copy of the policy of insurance. Contractor shall pay, in a prompt and timely manner, the premiums on the insurance hereinabove required. 12. Independent Contractor Contractor is, and shall be, acting at all times in the perfoiiiiance of this Agreement as an independent contractor herein and not as an employee of City. Contractor shall secure at its own cost and expense, and be responsible for any and all payment of all taxes, social security, state disability insurance compensation, unemployment compensation and other payroll deductions for Contractor 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. 13. Conflict of Interest Contractor covenants that it presently has no interests and shall not have interests, direct or indirect, which would conflict in any manner with performance of services specified under this Agreement. 14. Termination This Agreement may be terminated by the City upon thirty (30) days written notice of termination. In such event, Contractor shall be entitled to receive and the City shall pay Contractor compensation for all services performed by Contractor prior to receipt of such notice of termination, subject to the following conditions: a. As a condition of such payment, the Director may require Contractor to deliver to the City all work product completed as of such date, and in such case such work product shall be the property of the City unless prohibited by law, and Contractor consents the City's use thereof for such purposes as the City deems appropriate. b. Payment need not be made for work which fails to meet the standard of performance specified in the Recitals of this Agreement. 15. Exclusivity and Amendment This Agreement represents the complete and exclusive statement between the City and Contractor, and supersedes any and all other agreements, oral or written, between the parties. In the event of a conflict between the terms of this Agreement and any attachments hereto, the terms of this Agreement shall prevail. This Agreement may not be modified except by written instrument signed by the City and by an authorized representative of Contractor. The parties agree that any terms or conditions of any purchase order or other instrument that are inconsistent with, or in addition to, the terms and conditions hereof, shall not bind or obligate Contractor or the City. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein. 25-17165/393436 5 16. Assignment Inasmuch as to this Agreement is intended to secure the specialized services of Contractor, Contractor may not assign, transfer, delegate, or subcontract any interest herein without the prior written consent of the City and any such assignment, transfer, delegation or subcontract without the City's prior written consent shall be considered null and void. Nothing in this Agreement shall be construed to limit the City's ability to have any of the services which are the subject to this Agreement performed by City personnel or by other Contractors retained by City. 17. City Employees and Officials Contractor shall employ no City official nor any regular City employee in the work performed pursuant to this Agreement. No officer or employee of City shall have any financial interest in this Agreement in violation of the applicable provisions of the California Government Code. 18. Notices Any notices, certificates, or other communications hereunder shall be given either by personal delivery to Contractor's agent (as designated in Section 1 hereinabove) or to City as the situation 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 below. City and Contractor 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 U.S. certified mail-return receipt requested: To City: Contractor: City of Huntington Beach Sunrise Multispecialist Medical Center Attn: Director of Public Works Attn: William Nuesse, M.D./Mary Ann 2000 Main Street Nuesse, D.O. Huntington Beach, CA 92648 867 S. Tustin Street Orange, CA 92866 19. Consent When City's consent/approval is required under this Agreement, its consent/approval for one transaction or event shall not be deemed to be a consent/approval to any subsequent occurrence of the same or any other transactions or event. 25-17165/393436 6 20. Modification No waiver or modification of any language in this Agreement shall be valid unless in writing and duly executed by both parties. 21. 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 of any provision of this Agreement. 22. Interpretation of this Agreement The language of all parts of this Agreement shall in all cases be construed as a whole, according to its fair meaning, 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 requires. Nothing contained herein shall be construed so as to require the commission of any act contrary to law, and wherever there is any 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. 23. 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 the date of its execution and delivery, be deemed an original. Each duplicate original shall be deemed an original instrument as against any party who has signed it. 24. Immigration Contractor shall be responsible for full compliance with the immigration and naturalization laws of the United States and shall, in particular, comply with the provisions of the United States Code regarding employment verification. 25-17165/393436 7 25. Legal Services Subcontracting Prohibited Contractor 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. Contractor understands that pursuant to Huntington Beach City Charter Section 309, the City Attorney is the exclusive legal counsel for City; and City shall not be liable for payment of any legal services expenses incurred by Contractor. 26. Confidentiality Contractor recognizes that in the performance of its duties under this Agreement, it must conduct its activities in a manner designed to protect information of a sensitive nature from improper use or disclosure. Contractor warrants that it will use reasonable efforts consistent with practices customary in the facilities management industry in recruiting, training and supervising employees and in otherwise performing its duties hereunder in order to achieve this result. In the furtherance of this, Contractor agrees, at the request of the City, to require its employees to execute written undertakings to comply with the foregoing confidentiality provision. 27. Discrimination Contractor shall not discriminate because of race, color, creed, religion, sex, marital status, sexual orientation, age, national origin, ancestry, or disability, as defined and prohibited by applicable law, in the recruitment, selection, training, utilization, promotion, termination or other employment related activities. Contractor affirms that it is an equal opportunity employer and shall comply with all applicable federal, state and local laws and regulations. 28. Jurisdiction—Venue This Agreement and all questions relating to its validity, interpretation, performance, and enforcement shall be government and construed in accordance with the laws of the State of California. This Agreement has been executed and delivered in the State of California and the validity, interpretation, performance, and enforcement of any of the clauses of this Agreement shall be determined and governed by the laws of the State of California. Both parties further agree that Orange County, California, shall be the venue for any action or proceeding that may be brought or arise out of, in connection with or by reason of this Agreement. 29. Professional Licenses Contractor shall, through the term of this Agreement, maintain all necessary licenses, permits, approvals, waivers, and exemptions necessary for the provision of the services hereunder and required by the laws and regulations of the United States, the State of California, the City of Huntington Beach and all other governmental agencies. Contractor shall notify the City immediately and in writing of her inability to obtain or 25-17165/393436 8 maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 30. Attorney's Fees 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 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. 31. Survival Terms and conditions of this Agreement, which by their sense and context survive the expiration or termination of this Agreement, shall so survive. 32. Governing Law This Agreement shall be governed and construed in accordance with the laws of the State of California. 33. Signatories Each undersigned represents and warrants that its signature hereinbelow 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 authority or power is not, in fact, held by the signatory or is withdrawn. 34. Entirety (a) 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, 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 Agreement in reliance on any representation, inducement, promise, agreement warranty, fact or circumstance not expressly set forth in this Agreement. (b) All Exhibits referenced herein and attached hereto shall be incorporated as if fully set forth in the body of this Agreement. 25-17165/393436 9 35. Effective Date IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by and through their authorized officers. This Agreement shall be effective on the date of its approval by the Mayor. This Agreement shall expire when terminated as provided herein. CONTRACTOR CITY OF HUNTINGTON BEACH, a SUNRISE MULTISPECIALIST MEDICAL municipal corporation of the State of CENTER California By: Mayor Print name ITS: (circle one) Chairman/President/ Vice President 46416 � City Clerk /2//glaL AND By: INITIATED AND APPROVED: Print name ITS: (circle one) Secretary/Chief Financial Officer/Asst. Secretary-Treasurer 1j Fire Chief APPROVED AS TO FORM: fP,JC (t.� City Attorney REVIEWED AND APPROVED: City Manag COUNTERPART 25-17165/393436 10 35. Effective Date . IN WITNESS WHEREOF,the parties hereto have caused this Agreement to be executed by and through their authorized officers. This Agreement shall be effective on the date of its approval by the Mayor. This Agreement shall expire when terminated as { provided herein.. CONTRACTOR CITY OF HUNTINGTON BEACH, a SUNRISE MULTISPECIALIST MEDICAL municipal corporation of the State of CENTER California . . . alvb......._ BY; � Mayor.- wp 10-g ; Print name. ITS:.,(circle one) Chairman/ resident/. Vice President. City Clerk AN .. . '.. .. ID By:M - -D, U. INITIATED AND APPROVED: P. ru :. ITS: (circle one Secretor }lief Financial -,—.-- Officer/Asst; Secretary-Treasurer Fire Chief: APPROVED AS TO FORM: cp.,(,6,-- ----- , ft.,. Attorney . . .City REVIEWED AND APPROVED:' City Manager COUNTERPART 25-.17165/393436 . 10 , .. • EXHIBIT "A" A. STATEMENT OF WORK: (Narrative of work to be performed) Provide comprehensive occupational physical examinations in compliance with applicable federal, state, and industry-specific standards, including NFPA, 1582, DOT, OSHA, and employer-specific requirements. The exams are intended to determine medical fitness for duty for pre-employment, periodic, return-to-work, and other job-related eavlauations B. CONSULTANT'S DUTIES AND RESPONSIBILITIES: SEE ATTACHED EXHIBIT A C. CITY'S DUTIES AND RESPONSIBILITIES: D. WORK PROGRAM/PROJECT SCHEDULE: • 25-17165/393436 11 dd EXHIBIT A Sunrise Multispecialist Medical Center Background and Project Summary I" The City of Huntington Beach seeks a qualified provider to conduct pre-employment medical examinations and occupational health services in support of its public workforce, including safety- sensitive roles such as Fire and other Public Safety personnel. As_outIined in RFP No. 2025-0710, the objective is to ensure that candidates and employees are medically fit to perform the essential functions of their positions while maintaining compliance with regulatory guidelines, including those set by the California Commission on Peace Officer Standards and Training(POST) and the National Fire Protection Association(NFPA) 1582. Sunrise Multispecialist Medical Center has over 30 years of experience delivering occupational health services to public agencies and private employers, including Air Force, educational institutions, and private sector businesses. Our centrally located facility in Orange County is fully equipped to conduct medical evaluations, diagnostic testing, immunizations, and treatment as outlined in the City's scope of work. We understand that the City requires medical examinations and screenings to be conducted on the provider's premises, with appointments scheduled within seven(7)business days of referral, except in cases involving special circumstances. Our team is committed to meeting this scheduling expectation while maintaining prompt communication and documentation practices in coordination with City personnel. The services Sunrise will provide include: • Pre-placement physical evaluations tailored to the essential job functions of each position • Diagnostic testing such as tuberculosis screening(via PPD, chest x-ray, or blOod test) and immunization testing(MMR, varicella,hepatitis, etc.) • Fitness for Duty evaluations, including both industrial and non-industrial assessments • Direct communication with applicants and City staff throughout the evaluation process • Final electronic submission of evaluation outcomes within 48 hours of completion • Walk-in access for pre-placement TB and drug testing • • Secure recordkeeping and monthly itemized billing • Consultations and updates provided to City staff as requested • Sunrise Multispecialist Medical Center's objective is to ensure safe and timely placement of candidates and support long-term workforce health and compliance through responsive, high-quality occupational medical services. Scope of Work The purpose of this agreement is to provide comprehensive occupational physical examinations in compliance with applicable federal, state, and industry-specific standards, including NFPA 1582, DOT,OSHA, and employer-specific requirements. The exams are intended to determine medical fitness for duty for pre- placement, periodic, return-to-work, and other job-related evaluations. 61Page pppi Sunrise Multispecialist Medical Center Methodology Section 1. Implementation Plan i.Project Management Methods and Controls Our clinic utilizes a comprehensive, process-driven approach to manage occupational health service contracts.We implement strict protocols to ensure compliance,efficiency, and reliability across all exam classes(A—G),which include a wide variety of services such as TB tests, DOT/non-DOT drug screens,audiograms, PFTs, and full NFPA 1582-compliant physicals.A dedicated Pre-employment Coordinator is responsible for tracking and processing all exams to ensure timely and accurate service delivery. Our management controls include: - Dedicated Project Manager - Electronic Health Records (EHR) Ga - Standardized Clinical Protocols -Service-Level Agreements (SLAs ii.Stakeholder Engagement and Documentation We prioritize communication and transparency with both internal and external stakeholders.Our strategy includes: - Sharing regular updates - Gather feedback throughout the process to make improvements - Quickly address any issues through the process and make amends where needed. iii.Other Implementation Strategies - Flexible Scheduling }f}` Multilingual Staff and Cultural Competency 1'. 2. Client Satisfaction and Scope Compliance To ensure a high level of satisfaction and compliance with the Scope of Work outlined in the RFP and the pricing table: -Customized Exam Bundles -Continuous Improvement -Transparent Costing -Employee Experience Focus - Rapid Turnaround 3. Project Schedule and Deliverables Below is a representative schedule for implementation and ongoing delivery: Final results from the General Pre-placement Physical Exam to be reported within 7 business days once the provider has completed their review and evaluation. During this process,the provider ensures that the candidate meets or exceeds all medical and physical requirements necessary. xy Fi Class A The PPD and drug screening process typically takes between 30 minutes to 3 hours,depending on the donor and any specific testing requirements or delays(e.g., hydration issues or inability to provide a sample immediately). Results for the PPD skin test are provided following a mandatory reading conducted 48 to 72 hours after placement. Rapid drug screening results are typicallyavailable same dayand are reported along with all other services. rt It 7IPage ��s Sunrise Multispecialist st Medical Center Class B The General Pre-placement Physical Exam for a Public Safety Dispatcher is a comprehensive medical evaluation designed to assess a candidate's overall health and fitness for duty. It includes vital signs measurement, a full physical examination (covering areas such as neurological, cardiovascular, and musculoskeletal systems), a back range of motion check, and gross hearing and vision tests (including near,far, depth, color, and peripheral vision). Additional screenings include a dipstick urinalysis for blood, glucose, and protein, a 4-panel NON-DOT urine drug screen, a PPD skin test for tuberculosis, and a formal audiogram. The exam concludes with a physician's summary addressing any medical concerns relevant to the job's physical and cognitive requirements. Class C The General Pre-placement Physical Exam includes a review of vital signs (temperature, pulse, respiration, blood pressure, height, and weight), a comprehensive physician's examination (head to toe), and a back range of motion assessment. It also includes a gross hearing test, bilateral visual screening(near, far, depth, color, peripheral), and a dipstick urinalysis (blood, glucose, protein). Additional components—depending on the position—may include a 4-panel non-DOT urine drug screen, audiogram, PPD (TB) skin test, OSHA respirator questionnaire, pulmonary function test (PFT)with interpretation, DOT exam and certification, and DOT SAMHSA urine drug test. A physician's summary concludes the exam,with comments related to job-specific requirements. Class D The General Pre-placement Physical Exam includes assessment of vital signs (temperature, pulse, respiration, blood pressure, height, and weight) and a comprehensive physical examination by a physician covering all major body systems. It also includes a back range of motion test, gross hearing test, and bilateral vision screening (near, far, depth, color, and peripheral).Additional evaluations include a dipstick urinalysis (for blood, glucose, and protein), a PPD (TB)skin test, a 4-panel non-DOT urine drug screen, an audiogram, and a pulmonary function test(PFT)with interpretation.The exam concludes with a physician's summary addressing the candidate's suitability for the job based on medical findings. jj Class E The POST General Pre-placement Physical Exam is a thorough medical evaluation designed to ensure candidates meet job-specific health and fitness standards. It includes vital signs assessment, a comprehensive physical examination (head to toe), and a back range of motion test. Screenings include gross hearing, bilateral vision (near, far, depth, color, peripheral), dipstick urinalysis (blood, glucose, protein), and a PPD (TB)skin test. Additional tests include a 4-panel non-DOT urine drug screen, oral fluid.THC drug screen, audiogram using an OSHA-approved sound booth, chest X-ray with interpretation, and a treadmill stress test (Bruce Protocol). Laboratory work involves a complete blood count (CBC), comprehensive metabolic panel or Chemistry Profile 23, and spirometry. Respirator evaluation includes a questionnaire and certificate. Imaging of the lumbar/sacral { spine is performed, and candidates are also assessed or offered the Hepatitis B vaccine series. The exam concludes with a physician's summary focused on job-related fitness. Class F The Class F pre-placement physical exam follows NFPA 1582 standards and evaluates a candidate's medical fitness for duty. It includes vital signs, a full physician's examination, back range of motion, gross hearing and 8 ( Page vision tests, and an audiogram. Additional evaluations include spine/lumbosacral X-ray, TB test,tetanus vaccine, DOT 4-panel drug screen, urinalysis, pulmonary function test, and lab work for CBC, chemical panel, and immunity titers (MMR, Hepatitis B &C,Varicella). An optional DOT/DMV exam may be requested, which includes a full medical exam,vision, and labs,with a report identifying any Category A or B conditions that could impact job performance.The final report also outlines necessary vaccinations and indicates whether the candidate is medically cleared with "no restrictions"or has "possible restrictions,"with explanation Class G The Class G pre-placement physical exam, compliant with NFPA 1582 standards, is a thorough medical evaluation to assess a candidate's readiness for duty in physically demanding roles. It includes vital signs, a comprehensive physician's examination, back range of motion, gross hearing test,vision screening, and an audiogram using an OSHA-approved sound booth. Imaging studies include spine/lumbosacral and C-spine X-rays, and a chest X-ray with interpretation. Cardiac assessment involves an EKG and treadmill stress test (Bruce Protocol).Additional components include a physical performance test,TB test,tetanus vaccine, DOT 4-panel drug screen, urinalysis, pulmonary function test with interpretation, and the OSHA respirator questionnaire. Laboratory testing covers CBC, chemical panel, and immunity titers for MMR, Hepatitis B and C, and Varicella. A physician's summary is provided, addressing job-specific medical requirements. An optional DOT/DMV exam may be requested, which includes a full medical exam,vision, and labs,with a report identifying any Category A or B conditions that could impact job performance.The final report also outlines necessary vaccinations and indicates whether the candidate is medically cleared with "no restrictions" or has "possible restrictions," with explanation. 4. Roles of City Staff vs. Contractor Task City Staff Responsibility Our Firm's Responsibility Employee Identification Identify employees needing Use classification to apply proper exams and their respective exam protocol classifications(A—G) Scheduling Share employee contact and Manage scheduling, reminders,and job type info (or allow self- rescheduling scheduling) Exam Preparation Distribute and collect pre- Review documentation;follow up for exam forms(if applicable) completeness Result Handling Receive reports through Generate and transmit medical secure channel documentation securely and timely Compliance Oversight Flag special requirements or Adjust service protocols accordingly updates to City policy 9 ) Page Sunrise Multispecialist Medical Center Staffing 1 Providers: Our providers include three physicians and two full time physician assistants employed Monday through Friday and five part-time physician assistants; all participate in weekend and night coverage. Our Physician Assistants are certified FMCSA Commercial Driver Medical Examiners for DMV DOT commercial driver evaluations and are listed on the NRCME website for reporting of DOT driver evaluation results. Dr. William Nuesse, M.D., brings over 30 years of experience in the occupational medical services arena in pre-employment physicals and evaluation and treatment of work injuries. His prior background in law enforcement as a deputy sheriff in San Bernardino gives him insight into the training and daily demands and challenges police officers face both physically and mentally: He is a certified Medical Review Officer(MRO). As the Medical Director, he oversees the physician assistants on a daily basis and addresses non-routine pre-employment and work injury issues. He works directly with employees and work injury patients regularly. He works closely with employers to safely and appropriately place candidates in job positions. He regularly participates in Continuing Medical Education to maintain his Radiography Supervisor and Operator permit to continually improve his and our provider x-ray preliminary reading skills. He is the CLIA Medical Director for laboratory services at Sunrise, and a staff physician at OC Global Medical Center in Santa Ana. The Medical Director plays a central and supervisory role in the successful delivery of occupational health services outlined in this project. As a licensed physician and expert in occupational medicine,the Medical Director is responsible for clinical oversight, regulatory compliance, quality assurance, and direct collaboration with all project staff including case review and medical determinations. This comprehensive involvement of the Medical Director ensures that all services are not only clinically sound but also aligned with the operational and legal expectations of the City of Huntington Beach, supporting a safe, efficient, and legally compliant hiring process. b; Dr. Kenneth Grubbs, D.O.,brings 25 years of experience in occupational pre-employment and work injuries. He regularly performs new hire and annual physicals for both police officers and firefighters, including treadmill testing. He has a thorough knowledge of both the Peace Officer Standards and Training(POST)medical examination and evaluation and the National Fire Protection Association (NFPA) standards that qualified candidates must meet for hire and continued employment. He is mindful of those medical conditions that cause concern and require more thorough evaluation for the safety of the officers and firefighters and the public when clearing candidates. He follows the health of police officers and firefighters annually to monitor for any changes that warrant more frequent testing either by their employee's private physician or on a work-related basis. He is very available to discuss any concerns with employers. He is a staff physician at Providence St.Joseph's Medical Center. With specialized expertise in occupational medicine and deep familiarity with California POST and NFPA 1582 standards. This role combines clinical leadership with operational oversight to ensure that all medical ! services for the City of Huntington Beach—particularly those involving Fire and Public Safety personnel— are completed with precision, regulatory compliance, and efficiency. With a focused background in public safety occupational health and specialized training in POST and NFPA 1582 standards, Dr.Grubb's ensures the City receives expert-level evaluation services tailored to the unique physical and safety demands of Fire and other personnel.This expertise is central to the City's ability to make informed, defensible hiring decisions and maintain a medically fit workforce. 10iPage it Dr. Mary-Ann Nuesse, D.O., brings an emphasis to standardization of testing and examinations of employees. She is certified as a Medical Review Officer (MRO) since 2001 and oversees the DOT and non- DOT drug and alcohol testing program. She routinely discusses drug test results with donors with careful ( documentation that donors are properly educated and informed at the beginning of the Verification Process of their obligations and rights in accordance with 49 CFR Part 40 Section 40.135 and 40.171 l� ;; including offering split-specimen testing process and explaining the process of contacting the MRO to make this request within 72 hours. She communicates as needed with certifying scientists at the SAMSHA lab when questions arise from donors regarding medication. She has 25 years of experience in occupational medical services working directly with patients. She is a Radiography Supervisor and Operator and maintains her skills in x-ray reading and is a staff physician at OC Global Medical Center in Santa Ana. As the Project Manager,she plays a vital role in the day-to-day coordination, execution, and delivery of Et occupational medical services for the City of Huntington Beach. Serving as both a clinical provider and operational lead,the Project Manager bridges medical expertise with project administration to ensure services are delivered accurately, efficiently, and in alignment with the City's expectations. With dual expertise in medicine and project oversight, this ensures the City receives both high-quality clinical care and seamless administrative coordination, supporting a streamlined and compliant hiring and employee fi? evaluation process. Sung Lee, PA-C and Neil Chen, PA-C 14 As licensed and experienced Physician Assistants,they play a key clinical role in supporting the delivery of occupational health services to the City of Huntington Beach. Working under the supervision of the Medical Director and in coordination with the Project Manager, our PA's are responsible for conducting physical exams, medical screenings, and health assessments for a broad range of City personnel.The PA's responsibilities are focused on ensuring quality, consistency, and timely service for employees while maintaining compliance with applicable health and employment standards. it { Clinical Staff: Five Full Time Office Medical Assistants: Our medical assistants, Emma, Natalie, Karin, Ariana, and Candice are dedicated to assisting employees with pre-employment physicals and drug screen paperwork processing. They prioritize breath alcohol testing before urine or oral fluid drug screens, assist employees ( and route patients quickly to the back office. Back Office Medical Assistants: Our clinics back office medical assistants, Carolina,Justin, and Kevin assist patients with the various drug tests,vision tests and weight lift tests; EKGs, audiograms, point of care and other testing.They assist the physician with stress treadmill testing. X-ray Technicians: Our two full-time x-ray technicians, Kevin and Karin are proficient with x-rays. Part-Time x-ray technicians provide weekend and night coverage. tl NIOSH Approved Trained Spirometry Technicians: Our staff includes three Medical Assistants, Candice, Carol, and Karin, who have undergone NIOSH approved Spirometry Training and are current in their training to date. DOT Drug and Alcohol Certification:We have an On-site Collector Trainer, Candice. Our staff are Certified Collectors for DOT urine and oral fluid drug and breath alcohol testing per CFR 49 Part 40 regulations. Our is bathroom conforms to these regulations; our staff closely follows protocol in these regulations starting with 111Page proper photo ID of employees to completing the testing paperwork and routing specimens to the lab and appropriate notification to employers. Our Pre-Employment Services Coordinator, Candice, acts as the one of the primary administrative liaison for the City of Huntington Beach. With 7 years of experience in occupational health administration, she specializes in managing appointment scheduling,provider coordination, and the secure routing of medical documentation. She will communicate directly with City departments to confirm job requirements and ensure that medical providers are briefed on the physical demands and essential functions of each position. Our Pre- Employment Services coordinator plays a key role in ensuring quality service,regulatory compliance, and smooth communication between the clinic and City representatives. Worker's Compensation Coordinators:Our two Worker's Compensation Coordinators, Karin and Ariana, work directly with patients with work injuries,from appointment scheduling to prompt submission of referrals for studies, STAT and routine specialist consults for timely care of orthopedic or other urgent conditions. They maintain case management with consistent follow through to ensure patient care goals and objectives are continually being met and claims are progressing appropriately. kS +{i IE ri 1 i 9 id ff f4 it y'•,, 12I Page s••: WA TL.L, .Aill FL I` `ESS , Practice Information Sunrise Multispecialiat!Medical Center 1991-Cprreut Medical Director d:.Active Staff Physic1= 367 South Tustin Avenue Orauge.CA 92366 Tel(714)771-1420; Fax(714)771-691S Residency& University of California,Irvine July 1990-June 1993 Internship ResideucriuFamiliFMedicine 101 Tire City Drive South;Oran_e,CA92363-3293 Fifth Pathway New York Medical College at ICington Hospital , July 1939-June 1990 Internship Alid-Hudson Family Health Services Institute 41 F=mih•Practice Drive,Kingston,New York 12401 Ratatinelnternshia San Gorgonio Pass Mantorial Hospital July 1932-June 1933 600 North I-.i,�'h'?3 Sprigs Avenue Benzine,CA 92220-3090 Medical Decree Autonomous University of Guadalajara Dec 1977-Dec 1931 School of Medicine Guadalajara,Jalisco,Mexico Pre-Medical California StateUnnersitt•,San Bernardino Sept 1974-June I977 B.S.Health Sciencea,Minor Biological Science Graduate Studies in Biochemistry 5500 University Park-nay,San Bernardino,CA 92407-2393 Social Service Christian Medical Society Missionary Clinic,Guadalajara,Mexico 1934-1983 License# California License A49740 Issued 7;19;91 ,03:31.r202 7 DEai Cart&UPIN T DEA Certificate BN 286836S Issued 1991 ENA10r31;202 7; UPLN 4•F26696 Board Certification Diplomate American Board of Fa lily Practice 1993 Fellow,Ansetican Academy of Family Practice 2001-current Diplomat=_,American Board ofExaminETE in Crisis 2001 Intervention,American Colleee of Forensic Medicine Diplomats,American Board of Hospital Physicians 2000 Specialized Tr isinu in Occupational Medicine Medical Review Officer Recertific oa,A-42atRC). ROCC Oct 2003-Mar 2030 Radiography X-Ray Supervisor and Operator Permit,State of California Jul 2002-Current p CLL�CertiEcaticnLabotatory Director,Sunrise Medical,1D 05009.21223 Cured Substance Abuse Professiosal'Alcohol Testing/:On-site Testing,AA2a0 Oct 19,2001 Breath Alcohol Testin_Proficiency'in Operation of EBT Sept 30,2002-Cur rent -American.Collette of Occupational and Entirosmtental edirane, Practice Guidelines Course Nov 13,2041 .2+17-FitTestihn,United WesternMedical Center 1991-Current San Bernardino Catrnty Sheriffs Academy,Certificate of Completion June 10,1976 Leagusnes Spoken Enslislr and Spanish Hospital Privileges Western Medical Center,Santa Ana Jan 1993 Current 1001 N.Tustin Avenue, Santa Ana,CA 92705 Professional Associations AnnErican College of Occupational and Environmental Medicine 1993-Current Medical Review Offer Certification Council Feb 2015-Current American Academy of Fanmity Phrsi-i-M a 1991-Current American Medical Association 1993-Current is 13IPage t k • iAIA.RY-1-"L NUESSE. D.O. tPractice Information Sunrise Multispecialist Medical Center 2000—Current ! Assistant Medical Director&Active Staff Physician ' 867 South Tustin Avenue Orange,CA 92866 Tel(714)771-1420 t Fax(714)771-6918 z Residency& Pacific Hospital of Long Beach July 1997-Nov 2000 I Internship Family Practice Residency Program 2776 Pacific Avenue Long Beach,CA 90806 i Medical Degree Western University of Health Sciences August 1993-June 1997 College of Osteopathic Medicine Doctor of Osteopathic Medicine E.Second Street,Pomona,CA 91766 s i if Pre-Medical California State University,Fullerton Sept 1990—July 1993 j: Bachelor of Science in Biochemistry is 800 N.State College Blvd,Fullerton,CA 92831 Professional Information Year CertifiedfLicensed Expiration Date License Number: 20A7305 12115198 01/3112027 DEA Certificate: By 6147727 1993 10/3112027 UPLY#t: H 13082 iBoard Certification Board Eligible,American Osteopathic Board of Family Physicians !. Special Training in Occupational Medicine Medical Review Officer Certification,AAMRO/MROCC Oct 2001-recert in process Radiography X-Ray Supervisor and Operator Permit,State of California July 2002-Current $ Trainer,DOT Breath Alcohol Technician Current ri Department of Transportation Breath Alcohol Technician&Calibration May 2003-May 2008 11 Technician Certificate Igtrt r et ,Inc.(49 Crit Part 40 Procedures) Department of Transportation Drug Screen Collector Certificate July 2003-July 2008 { Central Drug Systems,C-SA?A ((49 CFR Part 40 Procedures) ii Mask Fit Testing,Sunrise Muftisp ecialistMedical Center Current }? American College of Occupational and Environmental Medicine, � Practice Guidelines Course Nov 13,2004 F Substance Abuse Professional:Alcohol Testing/On-site Testing,AAMRO Oct 19,2001 t pf Languages Spoken English and Spanish i! Hospital Privileges Western Medical Center,Santa Ana 2000-Current aII 1001 N.Tustin Avenue; Santa Ana,CA 92705 '� Professional Associations Medical Review Officer,A MROIMROCC Oct 2001-Current if American Osteopathic Association 1997-Current gAmerican College of Osteopathic Family Physicians 1998-Current s i 4S w u . c, 11 ;r i 14IPage ;! Kenneth E.Grubbs, D.O. Grubbs Medical Inc Kennegrubbs@cs.com Experience CEO/Medical Director 2008-Present Grubbs Medical Inc • Consultant to SeaBright Insurance Company,Paladin Medical and CompPartners a Physician Guide interacting with Patients, Employers,Treating Physicians,Claims Examiners and others,to expedite appropriate medical care in a cost effective manner, utilizing appropriate medically accepted guidelines an formulating processes/procedures to overcome barriers to this goal in order to get patients to Maximum Medical Improvement with quality medical care. • Consultant to Sunrise Multispecialist Medical Center including complex patient cases In Family Medicine,Workers Compensation Occupational and Environmental,and Urgent Care Cases. • Direct Patient Care,Triage,and Coordination of medical care as the Primary Treating Physician. • Medical Consultant on various legal proceedings. • Provide on-site coverage for physicians on a temporary basis • Medical Review Officer • Expert Witness Testimony Physician/Surgeon 2007-Present Sunrise Multispecialist Medical Center,Orange • Direct Patient care in busy mixed patient practice • Consult,x-ray review,lab review,Medical Review Officer(Drug Testing),etc. • Quality control and improvement Medical Director 1994-2007 US Health Works, Orange • Oversee busy blended medical practice encompassing the full spectrum of Family Practice,Occupational and Environmental Medicine,Urgent Care,Travel Medicine and Medical Consulting • Supervise,train and clinical consultant to Physicians and Physician Assistants with an emphasis on practicing Evidence Based Medicine. Initiate,educate and ensure compliance of Clinical Providers Quality Assurance and Best Practices Protocols. Direct Hands-On patient care.Generate multi-million dollar revenues. On-Site Medical Director 1998-2000 Boeing-Space and Aeronautics Anaheim • Consultant to Safety,Health and Environmental Awareness(SHEA).Analysis/Medical supervision on Beryllium,Heavy Metal, Immediate Danger-to-Life Atmosphere(iOLA),sick-building syndrome and other exposures. N ® Developed programs to bring medical evaluations and workers compensation injuries in-house.Closely interact with (; Insurance Adjusters and Case Managers to facilitate care and expedite recovery for injured workers.Consult and case review of selected work comp cases with AIG Insurance. r • Co-developed,implemented and supervised Return-to-Work(RTW)program for industrial and non-industrial injury/illness resulting n savings of over$1 Million per 4,000 employees. Staff and Per-Diem Physician at various clinics 1992-1997 • Sunrise Medical Orange and Anaheim.Hills • Universal Care Medical Group Garden Grove and • Greaney Medical Group Anaheim Santa Ana Education • Doctorate of Osteopathic Medicine(D.O.) 1991 College of Osteopathic Medicine of the Pacific(COMP)/Western University of Health Sciences(WUHS)-Pomona,CA Kenneth E.Grubbs,D.O.Continued 15lPage • Bachelor of Arts(B.A.)1986 California State University,Fullerton(CSUF)Major Biological Sciences, Minor Biochemistry Fullerton,CA • Associate of Arts(A.A.)1983 Orange Coast College Costa Mesa,CA Post-Graduate • 1991-1994 Internship/Residency in Family Medicine Department,University California Irvine-Medical Center,Orange,CA • Chief Resident UCI-MC and Community Clinic of Orange County(CCOC)1993-1994 • Externships at Long Beach Veterans Hospital(LEVA),Western Medical Center-Santa Ana(WMC-SA), Lamont Community Health Clinic Licensure Osteopathic Medical Board of California#20A6349 Nevada State Board of Osteopathic Medicine#714 Certificates - Board Certification-American Board of Family - Osteopathic Physicians and Surgeons of California Medicine (OPSC) - American Association of Medical Review Officers - American Osteopathic Association(AOA) (AAMRO) - California Medical Association(CMA) - X-Ray Supervision License - American Medical Association (AMA)-past - Diplomat-National Board of Osteopathic Medical - American College of Osteopathic Family Examiners(NBOME) Physicians(ACOFP)-past - Orange County Medical Association.(OCMA) - California Association of Interns and Residents - American Academy of Family Physicians(AAFP) (CAIR)-past Volunteer University of California Irvine (UCI) Department of Family Practice Resident Faculty Task Force Preceptor-UCI Medical Student Objective Clinical Examinations(OSCE) Teaching Assistant—Freshman History taking/Physical Diagnosis Course and Sophomore Refresher(COMP) Teaching Assistant-Freshman Osteopathic Principles and Practices(COMP) Research "The Elderly,Advanced Directives and Resuscitation"Presented October 1993 Western Regional Meeting of the Society of Teachers of Family Medicine;Lake Tahoe, NV t. tt IS { II it fY it 16 ) Page I.`t Sung Lee, PA-C 2020—Present Physician Assistant—Occupational Health Neil Chen, PA-C 2023—Present Physician Assistant—Occupational Health _ Relevant Experience • Conducts pre-employment and periodic medical evaluations for City employees, ensuring each assessment aligns with the physical demands and essential job functions of the role. • Performs clinical screenings including vision, hearing, pulmonary function,TB testing, immunization review, and other diagnostic evaluations as required by employer protocols. • Provides professional documentation of clinical findings and helps ensure timely delivery of final evaluation results to City representatives., • Communicates with applicants when clarification or follow-up is needed and assists in coordinating further assessments as required. • Supports quality assurance efforts and helps maintain consistency in service delivery and clinical accuracy across all occupational health services. • Adheres to all HIPAA, OSHA, and ADA standards when managing patient records and interacting with employees. Core Competencies • Occupational &Pre-Employment Health • Employee Wellness & Fit-for-Duty Evaluations Assessments ( • Physical Exams & Health Screenings • Clinical Coordination with Employers • HIPAA-Compliant Documentation • EMR Documentation & Records Review • Diagnostic & Functional Testing • Regulatory&Standards Compliance 1 Education Physician Assistant Studies—Marshall B. Ketchum University- Fullerton, CA UCLA—Irvine, CA Licensure&Certifications • Licensed Physician Assistant—State of California • NCCPA Certified • Certified FMCSA Commercial Driver Medical Examiner with the NRCME • HIPAA&OSHA Compliance Training Emma Espinoza 2016—Present Front Office Medical Assistant Natalie Alcantar 2024—Present Front Office Medical Assistant/Medical Records Relevant Experience • Greets and checks in patients for pre-employment physicals, drug testing,tuberculosis screening, and fitness- for-duty exams for city, school district, and private clients. • Coordinates with the Pre-Employment Services Coordinator and medical staff to confirm appointments,verify eligibility, and prepare charts for clinical evaluations. • Inputs patient demographics and employer-specific information into EMR systems to ensure accurate tt documentation for providers and final reporting. r; I.4 171 Page • Maintains strict confidentiality while handling and routing sensitive medical records,test results, and clearance forms in accordance with HIPAA guidelines. • Assists in managing walk-in patient flow for TB and drug testing, supporting short wait times and smooth processing. • Provides front-line support to employer contacts by responding to appointment-related inquiries,services and coordinating paperwork. Core Competencies • Patient Check-In & Intake • HIPAA Compliance • Appointment Scheduling&Coordination • Walk-In & High-Volume Office Flow • Chart Preparation • EMR/ EHR Data Entry • Employer Communication & Documentation • Customer Service &Conflict Resolution Certifications • Medical Assistant Certification if Candice Olson 2t118— Present Medical Assistant and Pre-Employment Services Coordinator Relevant Experience • Greets and checks in patients for pre-employment physicals, drug testing,tuberculosis screening, and fitness-for-duty exams for city,school district, and private clients. • Manages end-to-end scheduling of pre-employment medical evaluations,TB testing, drug screenings, and fitness-for-duty exams for public agency and private-sector clients. • Assists in managing walk-in patient flow for TB and drug testing, supporting short wait times and smooth processing. • Coordinates with municipal employers to ensure accurate communication of job functions, physical requirements, and testing protocols to providers. • Processes clinical documentation and exam results, routing final disposition reports to employers via secure email or fax. • Maintains strict confidentiality while handling and routing sensitive medical records,test results, and clearance forms in accordance with HIPAA guidelines. ►? • Tracks case status and responds to employer inquiries. • Collaborates closely with the Medical Director, Project Manager(D.O.), and clinical staff to ensure smooth case flow and service delivery. Core Competencies ( •. Pre-Employment Medical Coordination • Regulatory Compliance • Patient Check-In & Intake, Chart Preparation • Tailored Scheduling and Administrative • Client and Provider Communication Support • Appointment Scheduling& Logistics • Walk-In & High-Volume Office Flow l • Document Management & Routing • EMR/ EHR Data Entry • HIPAA Compliance • Customer Service & Conflict Resolution Certifications • DOT Professional Specimen Collector and • Certified Breath Alcohol Technician Collector Instructor • NIOSH Approved Spirometry Technic fk ix 'Wage E I Carolina Franco 2014—Present Back Office Medical Assistant Justin Riedel 2024—Present Front Office/Back Office Medical Assistant Karin Siglar 2023—Present Back Office Medical Assistant/X-Ray Tech/Workers Comp Kevin Gonzalez 2023—Present Back Office Medical Assistant/X-Ray Tech Relevant Experience • Assists providers with a wide range of clinical services including pre-employment physicals, drug testing,TB screenings,immunizations,vision, hearing tests; lab based testing. • Prepares examination rooms, obtains patient vitals and histories, and performs testing procedures including audiometry, spirometry, EKGs, and urinalysis. • Maintains accurate patient documentation using EMR systems, ensuring all occupational and private patient records are complete, HIPAA-compliant, and ready for physician review. • Assists with clinical care for private walk-in patients, supporting minor procedures, wound care, injections, and urgent medical needs. • Ensures cleanliness, supply restocking, and adherence to infection control and clinic safety protocols. Core Competencies • Occupational &Pre-Employment Medical • Clinical Support for Private Urgent Care Services Patients • Vital Signs, EKGs,TB, and Drug Testing • Physician Assistance During Exams & • Medical Documentation & EMR Entry Procedures • Audiometry & Pulmonary Function Testing • Exam Room Prep • HIPAA & OSHA Compliance Certifications • Medical Assistant Certification • DOT Professional Specimen Collector • NIOSH Approved Spirometry Certified • Certified Breath Alcohol Technician ii t1 ty \'1 i Cr • 19IPage Sunrise Multispecialist Medical Center Qualifications Sunrise Multispecialist.Medical Center is an urgent care medical center specializing in occupational medical services including both pre-employment and work-related injuries. We have been providing the services listed in the Scope of Services section for over three decades to both public agencies and private sector employers. Our clients include local city police and fire departments,the County of Orange employees including the Sheriff's Department and other departments, a military air base, local universities and school districts, as well as many local private businesses. Please reference the References of Work Performed Form (Page 21)for some of the public agencies and private agencies we have been providing these services for in the most recent five years. Our clinic specializes in pre-employment medical screenings, workplace injury care, return-to-work evaluations, 1 and public safety fitness assessments. We are deeply familiar with the medical and administrative standards that govern employment in public safety, including the California POST(Peace Officer Standards and Training) guidelines and NFPA 1582 medical standards for fire personnel. { Similar Projects and Clients Served We have provided similar occupational medical services to: • March Air Reserve Base—Annual physicals, occupational health testing • City of Orange—Pre-placement and annual exams,TB and drug testing. Occupational injury treatment. • Cal State University Fullerton Police Department- POST Pre-placement exams • University of California Irvine: Occupational Health Department- Pre-employment testing • City of Santa Ana- Public safety fitness evaluations, immunizations, annual and pre-employment screenings. Occupational injury treatment. s We are experienced in working under defined timelines, coordinating multi-step evaluations, and delivering secure documentation to HR departments in accordance with city-specific protocols. Key Staff and Team Structure Our multidisciplinary team includes board-certified physicians, physician assistants, and experienced administrative personnel dedicated to occupational medicine and client satisfaction. r, Medical Oversight and Clinical Leadership kF 4` • Dr. William H. Nuesse, M.D., F.A.A.F.P.—Medical Director Provides overall clinical oversight, supervises all medical protocols, and serves as the final reviewer i of complex fitness-for-duty and injury evaluations. • Dr. Mary Ann Nuesse, D.O. —Project Manager&Clinical Lead Oversees daily clinical operations, coordinates care delivery for municipal clients, and specializes in evaluations guided by POST and NFPA 1582 standards. • Dr. Kenneth Grubbs, D.O.—Supervising Physician Brings deep experience in urgent care and occupational health; conducts exams and reviews screening protocols for compliance and quality. 2g1Page References•of Work Performed Form (List 5 Local Iteference3) Cotnany Name;Sunrise Multispecialist Medical Center M • 1. Name of Reference: arch Air Reserve Base • Address: 6450 8th Street, March Air Reserve Base, CA 92518 Contact Name: Michael Goodman Phone Number: 951-6554962 Email: Michael.goodman.5@us.aftriil Dates of Business:2022.to Current 7. Name of Reference: City of Orange Fire Department Address: 1176 E. Chapman Ave., Orange, CA 92866 Contact Name: Andy Lauridsen Phene Number:714-288-2506 Alauridsen@cityoforange.org Dates of Business; 2019 to Current 3. Name of Reference: Cal State University Fullerton Police Department Address: 800 North State College Blvd., Fullerton,CA 92831 Contact Na211C: Mary Weuve Phone Number; 657-278-3302 1.7,111,01; Mweuve@fullerton.edu Dates of Business:2018 to Current 1. Name of Referelioe; University of California Irvine: Occupational Health Department Address: 101 The City Drive Contact Name: Pamela Samuelson Phone Number: 714-456-8300 „.._..„.„. „.... email: Pisamuel@hs.uci.edu Dates of Rosiness:2017 to Current 5. Name of Reference: City of Santa Ana Address: 20 Civic Center Plaza, M-28, Santa Ana,CA 92701 Contact Name; Luisa Najera Phone Number: 714-647-6959 ...„ , Email: 'LnajeraCt santa-ana.org 2019 to Current Dates of Business: 211Page „ , EXHIBIT "B" Payment Schedule (Fixed Fee Payment) 1. CONSULTANT shall be entitled to monthly progress payments toward the fixed fee set forth herein in accordance with the following progress and payment schedules. SEE ATTACHED EXHIBIT B 2. Delivery of work product: A copy of every memorandum, letter, report, calculation and other documentation prepared by CONSULTANT shall be submitted to CITY to demonstrate progress toward completion of tasks. In the event CITY rejects or has comments on any such product, CITY shall identify specific requirements for satisfactory completion. 3. CONSULTANT shall submit to CITY an invoice for each monthly progress payment due. Such invoice shall: A) Reference this Agreement; B) Describe the services performed; C) Show the total amount of the payment due; D) Include a certification by a principal member of CONSULTANT's firm that the work has been performed in accordance with the provisions of this Agreement; and E) For all payments include an estimate of the percentage of work completed. All billing shall be done monthly in fifteen (15) minute increments and matched to an appropriate breakdown of the time that Was taken to perform that work and who performed it. Each month's bill shall include a total to date. That total shall provide the total fees and costs incurred to date for the project. A copy of memoranda, letters, reports, calculations, and other documentation prepared by CONSULTANT may be required to be submitted to the CITY to demonstrate progress towards completion of tasks. In the event the CITY rejects or has comments, on any such product, CITY shall identify specific requirements for satisfactory completion. Upon submission of any such invoice, if CITY is satisfied that CONSULTANT is making satisfactory progress toward completion of tasks in accordance with this Agreement, CITY shall approve the invoice, in which event payment shall be made within thirty (30) days of receipt of the invoice by CITY. If CITY does not approve an invoice, CITY shall notify CONSULTANT in writing of the reasons for non-approval and the schedule of performance set forth in Exhibit "A" may at the option of CITY be suspended until the parties agree that past performance by CONSULTANT is in, or has been brought into compliance, or until this Agreement has expired or is terminated as provided herein. 25-17165/393436 12 4. Any billings for extra work or additional services authorized in advance and in writing by CITY shall be invoiced separately to CITY. All extra work or additional services will be in accordance with the extra work or additional services and if CITY is satisfied that the statement of hours worked and costs incurred is accurate. Any dispute between the parties concerning payment of such an invoice shall be treated as separate and apart from the ongoing performance of the remainder of this Agreement. • 25-17165/393436 13 ! . i EXHIBIT B FEE PROPOSAL Class A ' , „ ' , . , , . . . - • ' Cost • ' PPD(TB)Skin Test . S50.00 4-Panel Non-DOT Urine Rapid Drug Screen S39.00 •• ., ' ' '' ;H. : 'Cost Medical History Questioimaire Included in Exam General Pre-placement Physical Exam: S80.00 • Vital Signs: temperature,pulse,respiration,blood pressure,height, and weight. • Physician's Examination:head,eyes, ears.nose and throat,neck, chest,heart abdomen, extremities,back,neurological.vascular. lymphatic,and skin. • Range of Motion:back exam. • Gross hearing test. Physician's summary.including comments related to job requirements. Dipstick Urinalysis:blood,glucose,and protein. Included in Exam Visual screening bilateral:near.far,depth,color,and_peripheral. . •S25.00 PPD(TB)Skin Test $50.00 4-Panel Non-DOT Urine Rapid Drug Screen / $35.00 1 Audiogram $40.00 POST Medical Examination Report—Public Safety Dispatcher Included in Exam TOTAL EXAM COST: .:$233.0D i .„Class C. ', • •.: • : . . ' ,.,„ . < ' ' - Cost Medical History Questionnaire Included in Exam • General Pre-placement Physical Exam: 80.00 • Vital Signs:temperature,pulse,respiration,blood pressure.height, and weight. • Physician's Examination:head,eyes, ears,nose and throat neck, : chest,heart abdomen, extremities,back,neurological,vascular, lymphatic,and skin. • Range of Motion:back exam. • Gross hearing test. Physician's summary,including comments related to job requirements. ii Dipstick Urinalysis:blood,glucose,and protein. Included In Exam Visual screening bilateral:near, far.depth,color,andperipheral. $25.00 PPD(TB)Skin Test $50.00 4-Panel Non-DOT Urine Rapid Drug Screen(specific positions) $38.00 .•. Audiogram(specific positions) S40.00 :,. OSHA Respirator Questionnaire(specific positions) $25.00 PFT winterpretation(specific positions) S50.0 DOT Exam and Certification(specific positions) $75.00 DOT SAMFISHA Urine Drug Test(specific positions) $45.00 t; TOTAL EXAM COST: S428.00 : 22 ' Page • Class D Cast Medical History Questionnaire Included in Exam General Pre-placement Physical Exam: $80.00 • Vital Signs:temperature,pulse,respiration,blood pressure,height. and weight. • Physician's Examination:head, eyes,,ears,nose and throat,neck, chest,heart, abdomen_extremities,back,neurological,vascular. lymphatic,and skin_ • Range of Motion: back exam. • Gross hearing test. Physician's summary. including comments related to job requirements. Dipstick Urinalysis: blood, glucose,and protein. Included in Exam Visual screening bilateral: near. far, depth,color,and peripheral. $25.00 PPD(TB) Skin Test $50.40 4-Panel Non-DOT Urine Rapid Drug Screen $38.00 Andiograni $40.00 PFT wiinterpretation $50.00 TOTAL EXAM COST: $283.00 ClasS • .- •• • "• - •" • Cost POST Medical History Questionnaire Included in Exam General Pre-placement Physical Exam: $80.00 • Vital Signs:temperature,pulse,respiration,blood pressure,height, and weight. • Physician's Examination:head, eyes,ears,nose and throat,neck, chest,heart, abdomen, extremities,back,neurological,vascular. lymphatic, and skin. • Range of Motion: back exam. • Gross hearing test. • Physician's summary, including comments related to job requirements. • _Dipstick Urinalysis:blood_glucose, and protein. Included in Exam Visual screening bilateral:near, far, depth, color, and peripheral. $25.00 PPD(TB)Skin Test $50.00 4-Panel Non-DOT Urine Drug Screen $38.00 Marijuana(THC)Oral Fluid Drug Screen $90.00 Audiogram with OSHA Approved Sound Booth(500—8000Hz) $40.00 Chest X-Ray(PA)with Interpretation $60.00 Treadmill Stress Test with Interpretation(Bruce Protocol—12 METS; S5% Maximum Predicted Heart Rate) $200.00 Complete Blood Count(CBC)with Differential/Platelet $24.00 Comprehensive Metabolic Panel or Chemistry Profile 23 $27.00 Spirotuetry $50.00 Respirator Questionnaire—C $25.00 Respirator Certificate S10.00 XR:Lumbar/Sacral $7100 Hepatitis B Vaccine Series 595 per Vaocine: a Ser3::51.55 TOTAL EXAM COST: $1,044.00 • 23 I P a.g e ClaSsf.(N.F.PA 1582 Compliant) Cost , General Pre-placement Physical Exam: $80.00 • Vital Signs: temperature,pulse,respiration,blood pressure,height, and weight. • • Physician's Examination:head, eyes, ears, nose and throat,neck, chest, heart,abdomen,extrennties, back,neurological,vascular, , lymphatic,and skin • Range of Motion: back exam. • Gross hearing test. • Physician's Stlintlrify, including comments related to job requirements. Vision $25.00 Audiogram 540.00 Spine/Lumbosacral X-Ray $70.00 TB Test Tetanus Vaccine $80.00 Drug Screen DOT 4 Panel $45.00 LTA Lab sio.co Pulmonary Function Test with Interpretation $50.00 MNIR Titers $90.00 Hepatitis B and Hepatitis C Titers $69.00 Varicella Titer $33.00 CBC $24.00 Chemical Panel $27.00 DOPDMV Exam for DOT Medical Examiners' Certification(optional—by $75.00 request): • Exam • Vision • Labs:LTA(if different than above) Note:DOT,DMV Et-am—rto DOT thug screen required TOTAL EXAM COST: $768.00 24 IPage Class.G(NEPA 1382 Compliant) Cost General Pre-placement Physical Exam: • $80.00 • Vital Signs: temperature,pulse. respiration, blood pressure, height. and weight. • Physician's Examination:head, eyes, ears,nose and throat,neck, chest,heart, abdomen, extremities.back,neurological,vascular. lymphatic, and skin. • Range of Motion: back exam. • Gross hearing test. • Physician's summary,including comments related to job requirements. Vision $25.00 Audiograin with OSHA Approved Seund Booth(500—8000Hz) $40.00 SpinesLumbosacral X-Ray $70.00 C-Spine 2V X-Ray $60.00 Chest X-Ray(PA&LAT)with Interpretation moo Physical Performance Test NtA EKG $40.00 Treadmill Test(Bruce Protocol- 12 METS: 85%Maximum Predicted Heart Rate) $200.00 TB Test $50.00 Tetanus Vaccine $80.00 ;$ Drug Screen DOT 4 Panel ,$4500 LTA Lab s10.00 iyaiR Titers $50.00 Hepatitis B and Hepatitis C Titers $69.00 Varitella Titer $33.00 C:BC $24.00 Chemical Panel $27.00 OSHA Respirator Questionnaire $25.00 Pulmonary Function Test with Interpretation $50.00 TOTAL EXAM C:OST: $1,078.00 ti 251Page A`O CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/05/2025 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 anADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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: Theresa Simes Theresa Simes(9744876) PHONE FAX 17165 Newhope St Ste F (A/C,NO,EXT):714-966-3000 (A/C,NO):714-966-3013 E-MAIL Fountain Valley CA 92708-4230 ADDRESS: tsimes@farmersagent.com INSURER(S)AFFORDING COVERAGE NAIC N INSURED INSURER A: Truck Insurance Exchange 21709 INSURER B: Farmers Insurance Exchange 21652 WILLIAM H NUESSE M.D. 867 S TUSTIN ST INSURER C: Mid Century Insurance Company 21687 INSURER D: INSURER E: ORANGE CA 92866 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAME ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDTL SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 2,000,000 CLAIMS-MADE X OCCUR DAMAGE 70 RENTED S PREMISES(Ea Occurrence) 1,000,000 MEDEXP(Anyoneperson) $ 10000 A Y N 602378275 05/29/2025 05/29/2026 PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. GENERALAGGREGATE $ 4,000,000 X POLICY n PROJECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ OWNED AUTOS SCHEDULED A BODILY INJURY(Per accident)$ ONLY AUTOS 602378275 05/29/2025 05/29/2026 XHIRED AUTOS X NON-OWNED PROPERTY DAMAGE ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS.MADE AGGREGATE S DED RETENTION$ S WORKERS COMPENSATION PER OTHER $ AND EMPLOYERS'LIABILITY STATUTE ANY PROPRIETOR/PARTNER/ Y/N EL EACH ACCIDENT S EXECUTIVE OFFICER/MEMBER N/A EXCLUDED?(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 It yes,describe under DESCRIPTION OF OPERATIONS below El.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is reyitFr'ed)R0VED AS TO FOR 867 S TUSTIN ST,ORANGE,CA 92866 By: City of Huntington Beach its officers,elected or appointed officials,employees,agents and volunteers'•are listed as Rfi filtggr ins lresl(GLIO f TA CITY ATTORNEY CERTIFICATE HOLDER CANCELLATION CITY OF HUNTINGTON BEACH CITY OF HUNTINGTON BEACH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 2000 MAIN ST DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIV HUNTINGTON BEACH CA 92648 ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION.All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD AC D& CERTIFICATE OF LIABILITY INSURANCE DATE(IAMIDDrvYYY) `� 12/04/2025 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 have ADDITIONAL INSURED provisions or 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 Calhoun&Associates NAME CT Carmen Ponce DBA:Integrity Advisors iac°.Nti.Ext}:800-500-9799 1a c,No):714-664-0614 14771 Plaza Drive,Ste C E-MAIL In Carmen ADDRESS:carmen@Integrity-advisors.com Tustin CA 92780 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:REPUBLIC INDEMNITY CO OF AMERICA 19739 INSURED William H.Nuesse,M.D.and Mary-Ann Nuesse,D.O. INSURER B: Sunrise Multispecialist Medical Center INSURER C: 867 South Tustin Street INSURER D: ORANGE CA 92886 INSURER E: 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. INSR ADDL SUER POLICY EFF POLICY EXP TYPE OF INSURANCE NSD WV POLICY NUMBER (MM/DD/YYYY) (MMIDD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE L -1 OCCUR PREMIS TO RENTED PREMISES(Ea occurrence) $ MED EXP(Any one person) S — PERSONAL&ADV INJURY S — GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S RPOLICY❑ PRO El LOG PRODUCTS-COMP/OP AGG S JECT OTHER $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT s fEa accident) —ANY AUTO BODILY INJURY(Per person) $ — OWNED ^SCHEDULED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS — HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY — AUTOS ONLY (Per accident) _ S UMBRELLALIAB _ OCCUR Ul I EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEO I RETENTIONS S WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY I I STATUTE ER A ANYPROPRIETOR/PARTNERJEXECUTIVE Y/N 25601703 08/01/2025 08/01/2026 E.L.EACH ACCIDENT $1,000,000 • OFFICERIMEMBEREXCLUDEO? T N I A (Mandatory In NH) E.L DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I II I 00 ElO DESCRIPTION OF OPERATIONS!LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION City of Huntington Beach 2000 Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Huntington Beach,CA 92648 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY NUMBER: 602378275 J7238 e;N 1st Edition FARMERS INSURANCE ADDITIONAL INSURED-DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERS COVERAGE FORM APARTMENTOWNERS LIABILITY COVERAGE FORM CONDOMINIUM LIABILITY COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s)Or Organization(s): 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. A. The following is added to Paragraph C.Who Is An Insured of the applicable Coverage Form: Any person(s) or organization(s) shown in the Schedule is also an additional insured, but only with respect to liability for"bodily injury", "property damage"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 in the performance of your ongoing operations or in connection with your premises owned by or rented to you. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law;and b. If coverage provided to the additional insured is 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. B. With respect to the insurance afforded to these additional insureds, the following is added to Paragraph D. Liability And Medical Expenses Limits Of Insurance of the applicable Coverage Form: If coverage provided to the additional insured is required by a contract or agreement,the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement;or 2. Available under the applicable Limits Of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits Of Insurance shown in the Declarations. This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy. J7238-ED1 02-19 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 1 937238 J7238101 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY NUMBER: 602378275 FARMERS J6840 2nd Edition INSURANCE ADDITIONAL INSURED - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSINESSOWNERS COMMON POLICY CONDITIONS With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by the endorsement. SCHEDULE Name Of Additional Insured Person(s) CITY OF HUNTINGTON BEACH Or Organization(s); its officers, elected or appointed officials, employees, agents and volunteers Location Of Covered Operation(s): 2000 Main St Huntington Beach, CA 92648 Effective Date Of Endorsement: 12/04/2025 If no entry appears above,information required to complete this endorsement will be shown in the Declarations. The BUSINESSOWNERS LIABILITY COVERAGE FORM is amended as follows: A. With respect to the additional insured described in Paragraph B.of this endorsement,the following exclusions are added to Paragraph 1.Applicable To Business Liability Coverage under Section B.Exclusions: This insurance does not apply to: 1. "Bodily injury"or"property damage"for which the additional insured(s)is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the additional insured(s)would have in the absence of the contract or agreement. 2. "Bodily injury"or"property damage"occurring after: a. Your ongoing operations at the location of covered operations other than service maintenance or repairs performed by you or on your behalf have been completed;or b. The portion of your ongoing operation out of which the"bodily injury"or"property damage"arises has been put to its intended use by any person or organization. But in no event shall this insurance apply to"bodily injury"or"property damage"arising out of your operations that were completed prior to the effective date of this endorsement. 3. "Bodily injury" or"property damage" arising out of any act or omission of the additional insured(s) or any of its "employees",agents or contractors other than you,except for general supervision by the additional insured(s)of your ongoing operations performed for that additional insured. 4. "Property damage"to: a. Property owned,used or occupied by or rented to the additional insured(s); b. Property in the care custody or control of the additional insured(s) or over which the additional insured(s) exercise physical control;or c. Any work including materials, parts or equipment furnished in connection with such work which is performed for the additional insured by you. J6840-ED2 09-18 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 1 of 2 93-6840 J6840201 B. Section C. Who Is An Insured is amended to include as an insured the person(s) or organization(s) shown in the Schedule, but only to the extent that the additional insured(s) is held liable for"bodily injury" or"property damage" caused in whole or in part by; 1. Your ongoing operations performed for such person or organization at the location designated above; 2. The acts or omissions of your subcontractors acting on"your"behalf on the scheduled project in the performance of your ongoing operations for the additional insured(s)which start and are completed within the effective period of this endorsement;or 3. The acts or omissions of such additional insured(s)in connection with its general supervision of such operations. C. With respect to this endorsement, "wrap up policy" means an Owner or Contractor Controlled Insurance Program providing one or a series of policies designed to cover a specific construction project that insures all of the persons and entities working on such project. The BUSINESSOWNERS COMMON POLICY CONDITIONS are amended as follows: A. With respect to the additional insured described in Paragraph B. of this endorsement,Section H.Other Insurance is replaced by the following: H. Other Insurance 1. Primary and Noncontributory Insurance The coverage provided to an additional insured under this endorsement shall be primary and noncontributory ONLY to any insurance issued directly to the additional insured if: a. The Named Insured agreed in a written contract or written agreement to provide the additional insured coverage on a primary and noncontributory basis; b. Such written contract or written agreement referenced in a.above was executed prior to the issuance of this endorsement; c. The additional insured designated herein has a policy with an Other Insurance provision making that policy excess;and d. There is no"wrap up policy"in effect for the work performed at the location designated in the Schedule of this endorsement. 2. Excess Insurance If there is other valid and collectable insurance available to the additional insured(s)as an additional insured under other policies covering the work performed at the location designated and described in the schedule of this endorsement,this insurance will be excess over those policies. This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy. J6840-ED2 09-18 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 2 of 2 93-6840 J6840202