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Coastal Occupational Medical Group dba Akeso Occupational Health - 2026-01-28
SERVICE AGREEMENT BETWEEN • THE CITY OF HUNTINGTON BEACH AND COASTAL OCCUPATIONAL MEDICAL GROUP DBA AKESO OCCUPATIONAL HEALTH 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 Coastal Occupational Medical Group dba Akeso Occupational Health, 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 Van Duong, 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. 25-17165/393452 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 commenceipn.24c,2az4 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. 25-17165/393452 - 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 coverage is provided under a form which includes a designated general aggregate limit, 25-17165/393452 3 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 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. 25-17165/393452 4 12. Independent Contractor Contractor is, and shall be, acting at all times in the performance 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, p Y 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. 25-17165/393452 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 Coastal Occupational Medical Group Attn: Director of Public Works Attn: Van Duong 2000 Main Street 7700 Irvine Center Drive, Suite 870 Huntington Beach, CA 92648 Irvine, CA 92618 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. 20. Modification No waiver or modification of any language in this Agreement shall be valid unless in writing and duly executed by both parties. 25-17165/393452 6 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. 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; 25-17165/393452 7 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 maintain such permits, licenses, approvals, waivers, and exemptions. Said inability shall be cause for termination of this Agreement. 25-17165/393452 8 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. 25-17165/393452 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 COASTAL OCCUPATIONAL municipal corporation of the State of MEDICAL GROUP dba AKESO California OCCUPATIONAL HEALTH Y s Mayor fkAuffii ., Print name ITS: (circle one) Chairma resident/ l/tiliK Vice President City;4:1441.6 A �lf Clerk I's'�l���Ili Or ND By: -. ✓ Filer( INITIATED AND APPROVED: Print name ITS: (circle one) Secreta /Ch ief Finance Officer/Asst. Secretary-Trre Director of Human Resources APPROVED AS TO FORM: City Attorney REVIEWED AND APPROVED: Mana Cityg COUNTERPART 25-17165/393452 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 COASTAL OCCUPATIONAL municipal corporation of the State of MEDICAL GROUP dba AKESO California OCCUPATIONAL HEALTH By: Mayor Print name ITS: (circle one) Chairman/President/ Vice President City Clerk AND By: INITIATED AND APPROVED: Print name ITS: (circle one) Secretary/Chief Financial Officer/Asst. Secretary-Treasurer Director of Human Resources APPROVED AS TO FORM: City Attorney REVIEWED AND APPROVED: City Manager COUNTERPART 25-17165/393452 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 evaluations B. CONSULTANT'S DUTIES AND RESPONSIBILITIES: SEE ATTACHED EXHIBIT A C. CITY'S DUTIES AND RESPONSIBILITIES: D. WORK PROGRAM/PROJECT SCHEDULE: 25-17165/393452 11 EXHIBIT A eil844N. *44 UleS° • ' Oft" '41;,Lv 6°164 4k1 1/11111.01. , 414.°01;;; • Pre-Employment Medical Exams City of Huntington Beach Invitation #2025-0710 July 10, 2025 PRESENTED BY Hannah Nguyen Chief Operating Officer Corporate Office 7700 Irvine Center Drive, Suite 870 Irvine, CA 92618 Mobile: 714.454.1526 E-mail: hannah.nguyen@akesomedical.com Table of Contents I. COVER LETTER II. BACKGROUND AND PROJECT SUMMARY III. METHODOLOGY IV. STAFFING V. QUALIFICATIONS VI. FEE PROPOSAL I. COVER LETTER Hannah Nguyen Chief Operating Officer 7700 Irvine Center Drive, Suite 870 Irvine, CA 92618 July 10, 2025 Shari Saraye City of Huntington Beach 2000 Main Street Huntington Beach, CA 92648 Subject: Proposal Submission for Request for Proposal (RFP)2025-0710 Pre-Employment Medical Exams Dear City of Huntington Beach Selection Committee: Akeso Occupational Health, formerly ProCare Work Injury Center and Urgent Care is pleased to submit our proposal to provide comprehensive occupational health services for the City of Huntington Beach. We value our longstanding relationship with the City of Huntington Beach, and it has been our honor and privilege to provide occupational health services to the City of Huntington Beach for over 16 years. Our proposal provides our response regarding qualifications, related experience, references, key staffing with project organization, methodology and fee proposal. We are committed to delivering high quality, efficient and compliant medical evaluations tailored to the City's requirements. Akeso Occupational Health is a well-established practice in Orange County, which has provided premier occupational health services to large and small employers for 37 years throughout the city and county. The principals and staff involved with Akeso Occupational Health are highly qualified and familiar with the services requested by the City of Huntington Beach. Akeso Occupational Health specializes in occupational medicine, and we have the highest level of expertise available to complete Pre-Employment Medical Examination and Testing for the City of Huntington Beach. Akeso Occupational Health currently performs similar services for many employers in our service area, including municipalities, state agencies, and federal agencies. Beyond our expertise and ability to provide the services required by the City of Huntington Beach, we take great pride in delivering the highest level of patient care which allows employees to return to work quickly and safely. We provide direct communication between our staff and the City of Huntington Beach to establish trust and to be better, reliable, and collaborative partners. We appreciate the opportunity to present our services and capabilities. We are confident that we can continue to provide the highest quality medical care and maintain our continued partnership with the City of Huntington Beach. a. Vendor Information: Legal Name of Company: Coastal Occupational Medical Group dba Akeso Occupational Health Corporate Address: 7700 Irvine Center Drive, Suite 870, Irvine, CA 92618 Telephone Number: 949.867.4111 Fax Number: 888.AKESOWC E-mail Address: info@akesomedical.com b. Locations: 20 total locations in California, 2 locations in Orange County Primary Clinic Address: 17122 Beach Blvd, #104, Huntington Beach, CA 92647 Primary Clinic Phone Number and Fax Number: Office: (714) 964.4448, Fax: (714) 963-3780 1. om E-mail Address: hb c PrimaryClinic @ akesomedica Primary Clinic Hour of Operations: Monday through Friday, 8:OOam-5:00pm Secondary Clinic Address: 17232 Red Hill Ave, Irvine, CA 92614 Secondary Clinic Phone Number and Fax Number: Office: (949) 752-1111, Fax: (949) 752-1133 Secondary Clinic E-mail Address: irvine@akesomedical.com Secondary Clinic Hour of Operations: 24/7 for new injuries, Monday through Friday, 8:00am-6:00pm, Saturday, 9:OOam-3:00pm by request c. Acknowledgement of Receipt of RFP Addenda: We acknowledge the receipt of all RFP addenda and have taken them into account in preparing our proposal. d. Proposal Validity: We hereby affirm that all information submitted with this proposal including the proposed pricing remains valid for 180 days following the due date of July 10th 2025. e. Authorized Signature:The undersigned is authorized to bind Akeso Occupational Health to the terms of this proposal. f. Truth and Accuracy Statement: Akeso Occupational Health affirms that all information contained in this proposal is true and correct to the best of our knowledge. Respectfully,ly Hannah Nguyen, Chief Operating Officer, Akeso Occupational Health REQUEST FOR PROPOSAL VENDOR APPLICATION FORM TYPE OF APPLICANT: ❑ NEW 0 CURRENT VENDOR Coastal Occupational Medical Group dba Akeso Occupational Health Legal Contractual Name of Corporation: Contact Person for Agreement: Hannah Nguyen Corporate Mailing Address: 7700 Irvine Center Drive, Suite 870 City, State and Zip Code: Irvine, CA 92618 E-Mail Address: hannah.nguyen@akesomedical.com Phone: 714.454. 1526 Fax: Contact Person for Proposals: Hannah Nguyen Title:Chief Operating Officer E-Mail Address: hannah.nguyen@akesomedical.com Business Telephone: 949.867.4111 Business Fax: 888.AKESOWC Year Business was Established: 2018 Is your business: (check one) ❑ NON PROFIT CORPORATION FOR PROFIT CORPORATION Is your business: (check one) O CORPORATION ❑ LIMITED LIABILITY PARTNERSHIP ❑ INDIVIDUAL ❑ SOLE PROPRIETORSHIP ❑ PARTNERSHIP ❑ UNINCORPORATED ASSOCIATION 1 of 2 Names &Titles of Corporate Board Members (Also list Names &Titles of persons with written authorization/resolution to sign contracts) Names Title Phone _ Hannah Nguyen COO 714.454.1526 Federal Tax Identification Number: 71 -0983832 City of Huntington Beach Business License Number: A31 2490 (If none, you must obtain a Huntington Beach Business License upon award of contract.) City of Huntington Beach Business License Expiration Date: 02/28/2026 2 of 2 II. BACKGROUND AND PROJECT SUMMARY Describe your understanding of the City, the work to be done, and the objectives to be accom- plished. Refer to the Scope of Work of this RFP. Understanding the City's Needs The City of Huntington Beach requires a reliable and professional provider of medical exam- ination and testing services to support its employment and human resources functions. The purpose of this contract is to ensure that the candidates and current employees meet specific health and physical capability standards to perform their job functions safely and effectively. This includes pre-employment medical assessments, diagnostic testing, immunizations, tu- berculosis and drug testing, and specialized fitness evaluations. The City needs a contractor who can provide these services with efficiency, accuracy, and timeliness, ensuring a smooth and secure process for both candidates and City personnel. Project Objectives The objectives of this project align with the City's goal of maintaining a healthy and capable workforce. Key objectives include: • Pre-Employment Medical Assessments: To evaluate candidates' physical fitness and ability to meet the physical requirements of their prospective roles. This includes conducting tuberculosis and immunization testing where necessary, ensuring candi- dates are adequately screened for job placement. • Efficient and Timely Processing: The City requires that all pre-employment and fit- ness for duty evaluations be scheduled and completed promptly—within seven busi- ness days of referral, with clear status updates and quick turnaround on report of submissions. • Secure and Confidential Communication: The contractor must manage confidential candidate and employee information securely, adhering to state and federal laws re- garding data privacy and reporting. • Ongoing Consultation and Coordination: Regular updates, prompt responses to City inquiries, and availability for consultation with Human Resources are essential to maintain a high standard of service and effective communication. Expected Outcomes The City expects an efficient, standardized and secure process for medical assessments that: • Enhances Hiring and Onboarding Efficiency: By offering a structured, timely approach to pre- employment medical screening and reducing waiting times. • Promotes a Safe Working Environment: Ensuring that only candidates who are fit for duty are cleared for employment. • Supports Employee Health and Performance: Through periodic fitness-for-duty evaluations and consultations with City personnel on medical issues as needed. • Provides Transparent and Accurate Billing: Through a clear itemization of charges, ensuring transparency in service fees and budget management. By addressing these needs, we strongly believe Akeso Occupational Health will play an essential role in supporting the City's commitment to workforce health, safety, and efficiency. III. METHODOLOGY Provide a detailed description of the approach and methodology to be used to accomplish the Scope of Work of this RFP. The Methodology Section should include: (1) An implementation plan that describes in detail(i) the methods, including controls by which your firm manages projects of the type sought by this RFP; (ii)methodology for soliciting and documenting views of internal and external stakeholders; (iii) and any other project manage- ment or implementation strategies or techniques that the respondent intends to employ in carrying out the work. Implementation Plan Our approach to this project will involve clear methods and strict controls to ensure efficient project management and adherence to the Scope of Work.This plan includes: 1. Project Management Methods and Controls • Appointment Scheduling and Timeliness: Our EMR scheduling system allows us to manage ap- pointments efficiently and maintain availability within the required seven-business-day timeframe. • Quality Control: Regular audits and internal quality reviews will ensure accurate and consistent application of evaluation procedures and prompt reporting. • Compliance with Data Privacy Standards: We utilize secure, HIPAA-compliant systems for man- aging all confidential data, ensuring that candidate and employee information is safeguarded at all times. We adhere to State and Federal laws for record-keeping. 2. Stakeholder Engagement and Documentation • Internal Stakeholders: Our approach includes collaboration with City representatives to define needs, set expectations and review ongoing feedback. We will collaborate closely with the City's Human Resources team to align our processes with City protocols, discussing any proce- dural updates or special cases as they arise. We conduct regular check-ins to gather input from City staff and stakeholders, ensuring the solution remains effective and responsive to any evolving needs. • External Stakeholders: Direct communication with candidates will ensure they are fully in- formed about the evaluation process and requirements. We will maintain an open line of com- munication, allowing for immediate resolution of any questions or concerns. • Documentation: All candidate interactions and evaluation results will be thoroughly docu- mented in our EMR system, with timely status updates and final disposition reports shared with City personnel. 3. Project Schedule and Key Tasks • Kick-off Meeting: Initial consultation with City stakeholders to confirm the project scope, exam schedules, and documentation needs. • System Set-up: Integrate City-specific forms and protocols in our clinic scheduling process. • Staff Training: Prepare staff on City protocols, ensuring consistent quality in exam handling and reporting. • Exam Scheduling and Execution: Begin exam scheduling and conducting exams, with a goal of maintaining a seamless, minimal impact workflow. • Final Reporting and Review: Provide the City with requested forms and clearance summary. (2) Detailed description of efforts your firm will undertake to achieve client satisfaction and to sat- isfy the requirements of the "Scope of Work"section. Client Satisfaction Efforts To achieve and maintain high client satisfaction, we prioritize clear communication, timely responses, and strict adherence to City requirements. Our Project Manager will be accessible for any concerns, ensuring prompt issue resolution and satisfaction throughout the contract duration. We aim to exceed client expectations by delivering consistent, high-quality services through the following strategies: • Clear and Consistent Communication: We will keep City personnel updated with status re- ports, within two business days of any significant updates or at the City's request. We will communicate with the candidate to obtain confidential medical information as necessary for job clearance. • Candidate-Centered Service: Reducing wait times is a priority. We understand and will make every effort to limit a patient's wait time to no greater than 30 minutes. We aim to have all pre-employment medical evaluations scheduled within seven (7) business days of the City's referral with additional walk-in options for tuberculosis and drug testing for part-time or sea- sonal occupations. Our City of HB Coordinators will be engaged with the candidates through- out the process. • Quality Assurance and Feedback: Regular performance assessments will be used to gauge cli- ent satisfaction. Surveys or check-ins with City personnel will allow us to address any areas of improvement proactively. Our providers understand the City's requirement to complete pre- employment evaluations within seven (7) business days after completing medical exams and tests. Our providers will be available as needed to offer consultations to Human Resources regarding medical services. (3) Detailed project schedule, identifying all tasks and deliverables to be performed, durations for each task, and overall time of completion. Project Schedule A detailed project schedule will include all tasks, deliverables, and completion timelines, as outlined below: Task Description Duration Completion Timeframe Establish project timelines, review Within 1 2 week 2 Project Initiationdays scope, assign personnel. Scheduling Process Set up appointment scheduling within 3 days Within 1-2 week Setup EMR system to align with City needs. Initial Evaluations Within 7 business days Start processing referrals from the City. Ongoing Begin per referral Regular Evaluations Conduct assessments, testing, and Ongoing Continuous throughout and Testing report completion as per Scope. contract period Provide updates and final disposition As required Continuous throughout Status Reporting q contract period within 48 hours of exam. Prepare and deliver monthly itemized Recurring- Monthly Monthly Billing Monthly (4) Detailed description of specific tasks you will require from City staff. Explain what the respec- tive roles of City staff and your staff would be to complete the tasks specified in the Scope of Work. Tasks Required from City Staff To ensure smooth project completion, the following tasks will require collaboration with City staff: • Scheduling Coordination: City HR personnel will need to provide the necessary documentation and initiate requests for candidate referrals. The Akeso clinic staff will handle the scheduling. • City Staff Communication and Feedback:To align our services with the City's expectations, reg- ular communication and feedback from City staff regarding candidate experiences, process im- provements, or any issues will be essential. • IT Coordination: We ask the City to help coordinate the Akeso Information Technology team with the appropriate individual(s) with the City to assist with any questions with security with encrypted e-mails or Akeso portal access. IV. STAFFING Provide a list of individual(s) who will be working on this project and indicate the functions that each will perform. Include a resume for each designated individual. Chief Medical Officer Over 30 years' experience combined in internal medicine, occupational medicine and urgent care, NRCME current Telemedicine Consulting Over 16 years' experience 9 'i 4 4...Y i4Mca Physician/Irvine Clinic combined in internal medicine and occupational medicine, Board Certified Occupational Medicine, NRCME current Physician Assistant Over 7 years' experience in (Huntington Beach)/Lead occupational medicine, NRCME Physician Assistant current Staff Physician/Irvine Clinic Over 12 years' experience combined in family medicine and occupational medicine, NRCME ^ .� current Jesse Zepeda, PA-C Physician Assistant/ Over 40 years' experience :! Huntington Beach and Irvine combined occupational and Clinic environmental medicine, NRCME current Van Duong Regional Director of Over 15 years' experience in Operations/Project Manager occupational medicine, DOT certified urine collector and breath alcohol technician, NIOSH certified in spirometry, CAOHC certified in audiometric testing John Kounlavong Clinic Supervisor, Huntington Over 16 years' experience in Beach/Clinic Contact and City occupational medicine, licensed x- of HB Coordinator ray technician/medical assistant, DOT certified urine collector and breath alcohol technician, NIOSH certified in spirometry, CAOHC certified in audiometric testing Cynthia Hedges Front Office Supervisor, Over 13 years' experience in Huntington Beach/City of HB occupational medicine, medical Coordinator assistant, DOT certified urine collector and breath alcohol technician, NIOSH certified in spirometry Hoa Nguyen X-ray Technician and Medical Over 18 years' experience in Assistant/Huntington Beach occupational medicine as X-ray Clinic Technician/Medical Assistant, DOT certified urine collector and breath alcohol technician Jesse Alvarez Clinic Manager, Irvine/Clinic Over 9 years' experience in Contact and City of HB occupational medicine, medical Coordinator assistant, DOT certified urine collector and breath alcohol technician, NIOSH certified in spirometry, CAOHC certified in audiometric testing David Bazabez " Medical Assistant/Irvine Clinic 3 years' experience as Medical Assistant, DOT certified urine collector and breath alcohol is technician Ryan Lai Medical Assistant/Irvine Clinic Over 18 years' experience in occupational medicine as Medical Assistant, DOT certified urine collector and breath alcohol technician Kenny Nguyen ;; Medical Assistant/Irvine Clinic Over 18 years' experience in occupational medicine as Medical Assistant, DOT certified urine collector and breath alcohol technician David Ramos Medical Assistant/Irvine Clinic Over 3 years' experience in occupational medicine as Medical Assistant, DOT certified urine collector and breath alcohol technician r l , X-ray Technician and Medical Over 3 years' experience in Assistant/Irvine Clinic occupational medicine as X-ray .`'trOtthi,:' t Technician/Medical Assistant, DOT L . certified urine collector and �' ' breath alcohol technician Copies of resumes for key personnel can be found in Appendix A V. Qualifications The information requested in this section should describe the qualifications of the firm, key staff and sub-contractors performing projects within the past five years that are similar in size and scope to demonstrate competence to perform these services. Information shall in- clude: (1) Names of key staff that participated on named projects and their specific responsibilities with respect to this scope of work. Our proposed key personnel who will work closely with the team at the City of Huntington Beach bring a wealth of experience and expertise to ensure the successful completion of the services outlined in the scope of work.The following individuals, identified for key roles, have actively participated in projects similar to those described in the RFP. Operations Leadership • Project Manager Van Duong, Area Director of Operations oversees the operations of 3 clinics which include the Huntington Beach, Irvine and Lakewood clinics. She will serve as the Program Manager and the primary contact for City of Huntington Beach. Van has over 15 years of experience in occupational medicine. Van will ensure open and clear communication with the City of Huntington Beach and serve as the liaison between Akeso Occupational Health and the City of Huntington Beach. She will be available to answer questions, coordinate patient care, monitor scheduling and ensure we have the appropriate staffing to maintain service expectations. Currently, Van also serves as the Program Manager as required in the RFP for another large state agency performing similar functions and tasks are required of the City of Huntington Beach. Van collaborates and escalates concerns as needed to the executive leadership team to ensure the clinic effectively completes the work in accordance with the scope of services. She personally holds certifications with NIOSH and CAOHC for spirometry and audiometric testing, respectively. She is also certified to complete collections for drug and alcohol testing and provides oversight of the training and re-certifications of all collectors. • Clinic Contact/City of Huntington Beach Coordinator for Huntington Beach Clinic John Kounlavong supervises the clinic operations at the Huntington Beach Clinic. He will serve as the clinic contact and coordinator for the City of Huntington Beach for the Huntington Beach clinic. John has over 16 years of experience working in occupational medicine. John also works closely with the clinical support staff with day-to-day operations to ensure proper procedures and protocols are followed and will also assist with patient scheduling and results reporting. In addition, he reviews the paperwork including invoicing before it is sent to the City of Huntington Beach. Currently,John also serves as the main clinic contact as required in the RFP for another large state agency. John has been an x-ray technician for over 16 years. He personally holds certifications with NIOSH and CAOHC for spirometry and audiometric testing, respectively. He is also certified to complete collections for drug and alcohol testing. • City of Huntington Beach Coordinator for Huntington Beach Clinic Cynthia Hedges is the front office supervisor at the Huntington Beach Clinic. She will serve as one of the coordinators for the City of Huntington Beach for the Huntington Beach clinic. Cynthia has over 14 years of experience working in occupational medicine. Cynthia also works closely with the clinical support staff with day-to-day operations to ensure proper procedures and protocols are followed and will also assist with patient scheduling and results reporting. Cynthia has been a medical assistant for over years. She personally holds certifications with NIOSH for spirometry and is also certified to complete collections for drug and alcohol testing. • Clinic Contact/City of Huntington Beach Coordinator for Irvine Clinic Jesse Alcaraz oversees the clinic operations at the Irvine Clinic. He will serve as the clinic contact for the Irvine clinic for the City of Huntington Beach. Jesse has over 9 years of experience working in occupational medicine. Jesse works closely with the clinical support staff with day-to-day operations to ensure proper procedures and protocols are followed. Currently,Jesse also serves as the main clinic contact as required in the RFP for another large state agency. Similarly, for the City of Huntington Beach,Jesse will be available to work directly with the clinical support staff with scheduling and results reporting. Jesse has been a medical assistant for 9 years. He personally holds certifications with NIOSH and CAOHC for spirometry and audiometric testing, respectively. He is also certified to complete collections for drug and alcohol testing. Clinical Leadership Dr. Kayvon Yadidi, DO, O.ME is an experienced physician with over two decades of clinical and administrative leadership in occupational and internal medicine. As the current Chief Medical Officer of Akeso Occupational Health and Medical Director of our Huntington Beach clinic, Dr. Yadidi oversees medical operations across our company. Dr. Yadidi clinical career began following his medical training at Western University of Health Sciences and residency and fellowship in Internal Medicine and Ambulatory Care at the University of Southern California. He also earned a Master's in Medical Education from USC, demonstrating his commitment to advancing clinic excellence and medical training. Dr.Yadidi is highly skilled in workers' compensation reporting and compliance with labor code requirements, with additional procedural expertise in minor surgical and musculoskeletal interventions, including arthrocentesis and injections such as PRP and corticosteroids. Dr. Yadidi's clinical philosophy emphasizes quality care, regulatory compliance and provider education positioning him as a respected leader in occupational health. His multi-site leadership, extensive workers' compensation expertise and focus on provider development support the consistent delivery of evidence based, patient-centered care across diverse settings.. Dr.Tracy Lee, Lieutenant Commander of the U.S. Navy is board certified in Occupational Medicine and has extensive working knowledge gained in over 10 years in the field. Dr. Lee holds a master's in environmental health sciences and has worked with hundreds of employers from all industries, naval, manufacturing, agriculture, transportation, hospitals, municipalities, and government agencies. She has experience in helping employers to establish and maintain a healthy and safe work environment. She is a highly trained and experienced resource for employers who need help in understanding and/or complying with the plethora of federal and state regulations relating to workplace safety and health. Dr.Tracy Lee provides medical evaluation and treatment for a wide variety of medical emergencies, occupational injuries/illnesses and perform medical evaluations for surveillance programs. She has helped companies and municipalities in the establishment of pre-placement medical testing, fitness-for-duty and wellness programs. Please refer to the enclosed Curriculum Vitae/Resume for a specific history of Dr.Tracy Lee's education, training, and experience. Our team is fully equipped to leverage its collective experience and skills to meet the City of Huntington Beach's expectations. We are confident that the combination of our clinics' track record and the qualifications of our key personnel positions us as the ideal partner for the City of Huntington Beach's expectations. Sub-Contractors Sleep &Wellness Centers of California, 19742 MacArthur Blvd, #200, Irvine, CA 92612, Maria Prudencio, maria@sleepandwellnessca.com, 949.535.2998—We have referred patients to this facility for sleep study options to help determine what types of treatment options are available. Patients have returned with positive feedback. (2) A summary of the your firm's demonstrated capability, including length of time that your firm has provided the services being requested in this Request for Proposal. The Akeso Occupational Health team of clinicians and clinical supporting staff are knowledgeable of the regulations required to effectively meet the needs of the City of Huntington Beach. Our clinic has been partners with the City of Huntington Beach for over 15 years. All our clinicians are required to complete training and testing to be registered in the National Registry of Certified Medical Examiners (NRCME) which is regulated by the Federal Motor Carrier Safety Administration (FMCSA). Our clinicians have performed thousands of FMCSA exams, as well as hundreds of other DOT subagency examinations in various industries, including aviation (FAA), trucking (FMCSA), railways (FRA), public transit (FTA), and examinations for other special vehicle operations in civilian and military addition, our clinicians have performed firefighter and police officer examinations environments. In for many municipalities and state agencies across Southern California. They understand the physical demands and strenuous physical situations that they face day to day. We have the expertise required to appropriately evaluate the candidates to determine if he/she is physically capable of performing the essential functions of various positions. In addition, our clinicians follow local, state and federal guidelines including POST, NFPA and IAFF. Our Huntington Beach and Irvine clinic employs qualified clinical support staff, this includes personnel who hold drug/alcohol collector certifications to perform DOT collections, National Institute for Occupational Safety and Health (NIOSH) certifications to perform spirometry/pulmonary function testing/respirator mask fit testing and Council for Accreditation in Occupational Hearing Conservation (CAOHC) certification to perform audiometric testing. In addition, all breath alcohol technicians and collectors are subscribed to the ODAPC List-Serve to stay informed of the latest updates and information. (3) Provide at least five local references (Apppendix A) that received similar services from your firm. The City of Huntington Beach reserves the right to contact any of the organizations or individuals listed. Information provided shall include: References 1. Name of Reference: Orange County Transportation Authority Project Description: Preplacement physicals and drug screens Address: 550 S. Main Street, Orange, CA 92863 Contact Name: Steve Elkins Phone Number: 714.560.5575 Email: selkins@octa.net Dates of Business: 9/2019 to present 2. Name of Reference: City of Costa Mesa Project Description: Preplacement and POST Physicals, drug screens, surveillance testing Address: 77 Fair Drive, Costa Mesa, CA 92626 Contact Name: Itzia Carvajal Phone Number: 714.754.5061 Email: itzia.carvaial@costamesaca.gov Dates of Business: 5/2014 to present 3. Name of Reference: UCI Health (formerly Fountain Valley Regional Hospital) Project Description: Preplacement physicals and drug screens Address: 17100 Euclid Street, Fountain Valley, CA 92708 Contact Name: John Rogers Phone Number: 714.966.7282 Email: rogersi4@hs.uci.edu Dates of Business: 3/2018 to present 4. Name of Reference: City of Long Beach Project Description: Preplacement physicals and drug screens Address: 2525 Grand Avenue, Suite 183, Long Beach, CA 90815 Contact Name: Ayisha Thompson Phone Number: 562-570-6966 Email: Ayisha.Thompson@longbeach.gov Dates of Business: 8/2024 to present 5. Name of Reference: Airtech International Project Description: Preplacement physicals and drug screens Address: 5700 Sky Lab Rd., Huntington Beach, CA 92648 Contact Name: Kim Forey Phone Number: 949.702.0383 Email: kforey@airtech.com Dates of Business: 7/2018-Present VI. Fee Proposal Pricing shall be based on the cost of services described in the Scope of Work. The fee must be inclusive of all costs, including but not limited to, direct and indirect costs for labor, overhead, payroll taxes, and benefits. The contractor shall only be paid for services performed. Provide an all-inclusive flat fee per type of exam(i.e., Class A, Class B, etc)and a price for each separate Test Component. Complete the highlighted fields in the Pricing Table. Price List can be found in Appendix B Appendix A-Copies of Brief Resumes for Key Personnel Kayvon Yadidi, D.O., QME Education: University of California UCLA Los Angeles, CA B.S. Degree in Biology June 1989 Western University of Health Sciences Pomona, CA Doctor of Osteopathic Medicine Degree June 1993 Internship: University of Southern California Los Angeles County Medical Center July 1993-June 1994 Residency: Internal Medicine/University of Southern California Los Angeles County Medical Center July 1994-June 1996 Fellowship: General Internal Medicine/Ambulatory Care University of Southern California Los Angeles County Medical Center July 1996-June 1997 Masters: Masters of Medical Education University of Southern California August 1996-December 1997 Certification: Diplomat American Board of Internal Medicine Number 170951 (expired 2008) National Boards of Medical Examiners Parts I, II and III California Physician & Surgeon License DEA License Qualified Medical Examiner Certified X-ray technician supervisor Certified Department of Transportation (DOT) examiner 2 Employment: Jan 2025 Chief Medical Officer Present Akeso Occupational Health Oct. 2013 Medical Director Dec 2024 Proactive Work Health Services May 1, 2012 Medical Director Sept. 2013 Prohealth Medical Group April 2008 Medical Director Sept. 2013 Glendale Memorial Occupational Medical Group August 2003 Medical Director Present Internal Medicine Consultants August 2003 Physician/partner April 2008 Healthline Medical Group, Van Nuys, CA Jan. 2000 Medical Director August 2003 U.S. Health Works, Chatsworth, CA June 1997 Staff Physician Dec. 1999 Healthline Medical Group, Van Nuys, CA July 1996 Staff Physician Division of Internal Medicine June 1997 Los Angeles County Medical Center Dec. 1995 Urgent Care Physician Healthline Medical Group Dec. 1999 Van Nuys, CA Nov. 1994 Staff Physician Dec. 1995 Department of Emergency Medicine Coast Plaza Doctors Hospital,Norwalk, CA Jan. 1987 Assistant Director of Education June 1989 UCLA, AIDS Clinical Research Center Los Angeles, CA Jan. 1987 Assistant to the Editor 3 June 1989 AIDS Medical Update and AIDS Nursing update Jan.1986 Research Assistant Jan.1987 UCLA Projects on Aging Los Angeles, CA Special Skills: Proficient in workers' compensation reporting requirement and language Familiar with labor code laws and regulation Minor surgical procedures and eye procedure Arthrocentesis/injections (including PRP and steroid) Currently responsible in managing 9 industrial clinics With 4 full time physician and 22 mid level providers. Awards: Nomination "Intern of the Year" 1993-1994 Abstract accepted for competition, American College of Physician 1994 Memberships: Credentialing Committee, Promesa Health Pharmacy & Therapeutics Committee, Promesa Health American Osteopathic Association UCLA Alumni Association Languages: English, Persian (Speak, write and read fluently) Spanish (Medical language) References: Available upon request TRACY JOON LEE MD,MPH,MS EDUCATION - American Board of Preventive Medicine Occupational Medicine Board Certification,Jan 2020 - Occupational Medicine Chief Resident(PGY3),University of CA,Irvine,July 2018-Jun 2019 - Occupational Medicine Resident(PGY2),University of CA,Irvine,July 2017-Jul 2018 - MS(Master of Science,Environmental Health Sciences),University of CA,Irvine,Sep 2017-Mar 2019 - MPH,Medical College of Wisconsin,Milwaukee,WI,Sep 2014-Aug 2016 - MD,Medical College of Georgia,Augusta,GA,July 2005-May 2009 - Internal Medicine Internship,Naval Medical Center Portsmouth,VA,Jul 2009-Jun 2010 - BS(Highest/Faculty Honors),Georgia Institute of Technology,Atlanta,GA,Aug 2002-Jun 2005 PROFESSIONAL EXPERIENCE - Medical Director,Akeso Occupational Health,Irvine,CA,Apr 2021-current • Staff physician providing comprehensive clinical occupational health care services to clients throughout Orange County,CA. - Assistant Physician,School of Medicine,University of California,Irvine,Dec 2020-current • Center for Occupational and Environmental Health Clinic and occupational medicine residency program assistant physician. - Physician,WorkCare,Inc.,Anaheim,CA,Oct 2019-current • Incident Intervention Department physician providing occupational medicine consultation services to clients throughout the U.S. - Per diem physician,Concentra Medical Group,CA,Jul 2015-Jun 2022 • Staff physician providing comprehensive clinical occupational health care services to clients and urgent care services throughout CA. - Physician,ProCare Work Injury Center,Irvine,CA,Jan 2020-Apr 2021 • One of three staff physicians providing comprehensive clinical occupational health care services to clients throughout Orange County,CA. - Physician,Naval Medical Center San Diego Occupational Health Unit,Jul 2015-Jul 2017 • Full time licensed civilian physician responsible for the occupational health of 58,000 military and civilian personnel and 260 Navy and Marine Corps commands in the San Diego area. - U.S.Navy Medical Officer(Physician),Lieutenant Commander,US Navy Selected Reservist,Deployment Processing Command-Reserve Support Unit-East(DPC-RSU-E),Jul 2014-Jul 2017 • Physician coordinating a medical team of officers and corpsman to provide medical care such as deployment processing for military personnel.Also served as assistant officer in charge Oct 2015-Dec 2016. - Physician,US HealthWorks Medical Group,San Diego,CA,Feb 2014-Jul 2015 • One of two full time licensed staff physicians at the largest occupational medicine clinic in the national medical group providing comprehensive clinical occupational health and urgent care services. - U.S.Navy Medical Officer(Physician),Jul 2010-Jul 2014 West CSF DET(Center for Security Forces Detachment)North Island,SERE(Survival,Evasion,Resistance,Escape)Medical Department Head,San Diego,CA,Jul 2012-Jul 2014 •Medical department head for MWSS(Marine Wing Support Squadron) 371 in Yuma,AZ(2010-2012),which included a 7-month deployment to Afghanistan as part of Operation Enduring Freedom(OEF).Also served as medical department head at the SERE(Survival,Evasion,Resistance,Escape)School(2012-2014)overseeing a medical staff and students during 20 high-risk survival training evolutions per year at Naval Air Station North Island,San Diego,CA and Remote Training Site Warner Springs,CA. Tina Khosravi, MS, PA-C EDUCATION WESTERN UNIVERSITY OF HEALTH SCIENCES 2015 —2017 Master of Physician Assistant Studies UNIVERSITY OF CALIFORNIA IRVINE 2012 —2015 Bachelor of Science • Biological Sciences, Molecular and Cellular Biology CLINICAL TRAINING&EXPERIENCE Occupational Medicine, Procare Work Injury Center, Huntington Beach, CA 3/10/2018-Present • provide appropriate medical care for occupational injuries. • Ordered diagnostic tests and analyzed diagnostic images. • Performed in-office procedures. • Pre-employment and DOT physicals. rat with physician director and nurse managers to correctproblems and improve • Collaborate p y g P services. Rheumatology, Pacific Rheumatology Medical Ctr, Orange, CA 9/10/2017 —3/9/2018 full time, 3/9/18-present per diem • Provide care for 15-25 (8-10 new patients, rest follow-ups) daily patients, who are suffering from RA,lupus, scleroderma, psoriasis,osteoarthritis, ankylosing spondylitis. • Obtain patient history, conduct exams,made assessments and plans,update the charting • IV infusions,local joint injection. Urgent Care, U.S. Healthworks, Santa Ana, CA 7/1/17—7/31/17 • Performed casting, suturing,work-related injury and eye injury care, and x-ray reading. Pediatrics, Pediatric Medical Group of Riverside, Riverside, CA 6/1/17—6/30/17 • Assisted in circumcisions. • Check wellness of patients, ranging from newborns to 18-year-olds. • Recording proper development. • Performed asthma and COPD patient care. Internal Medicine, Fountain Valley Regional Hospital and Medical Center 4/1/17—4/30/17 • Obtained patient history, conducted exams, made assessments and plans,updated the charting, and reported to physician. • Conducted nursing home rounding twice a week. • Performed asthma and COPD patient care. Obstetrics and Gynecology, Los Alamitos Medical Center, Los Alamitos, CA 2/1/17—2/28/17 • Obtained patient history, conducted exams, made assessments and plans,updated the charting, and reported to physician. • Conducted physical examinations, IUD placements and removals, pap smears,and pessary placements. VAN T. DUONG OBJECTIVE SEEKING A RESPONSIBLE AND CHALLENGING POSITION WITH A GROWTH ORIENTED COMPANY WHERE MY KNOWLEDGE AND EXPERIENCE WILL SIGNIFICANTLY CONTRIBUTE TO THE COMPANY'S FUTURE PROGRESS AND SUCCESS. PROFILE Individual with exceptional planning,organizational and time management skills. Strong multi-tasking talents with the ability to manage multiple,high priority assignments and develop solutions to challenging business problems. Proactive team player with the ability to work independently on assignments and/or special projects as designated. Possess excellent written,verbal and interpersonal skills with exceptional accuracy and attention to detail. Dedicated and devoted individual with a desire to learn. SKILLS • Bilingual, • Over 20 years healthcare • Healthcare regulations • Certified for Department Vietnamese experience, 10 years in and compliance of Transportation Drug occupational health and Alcohol Testing over 10 years' experience • Public and • Quality Improvement and • Electronic Health • Certified for NIOSH and community relations patient safety Records Management CAOHC and Implementation EDUCATION Bachelor of Science,Psychobiology,2004 UNIVERSITY OF CALIFORNIA,LOS ANGELES WORK EXPERIENCE Area Director of Operations Responsible for day-to-day operations for three clinics-Irvine,Huntington Beach and Lakewood. AKESO OCCUPATIONAL HEALTH Ensure clinics are operating within company standards and state's regulatory agencies. Assess clinic Irvine, Huntington Beach, Lakewood processes and workflow to improve patient and client experience. Establish best practices May 2023-present operationally and work with clinicians collaboratively for best clinical outcomes. Recruit,train and certify new team members to ensure coverage and support for all clinics,including certification for Department of Transportation Drug&Alcohol testing and occupational health screening services. Electronic health record development and implementation across centers. Establish and maintain relationships with clients,carriers and case managers for positive patient and client experience. Regional Clinic Manager Responsible for de novo clinic start up. Assisted in electronic health program development and AGILE OCCUPATIONAL MEDICINE implementation for various clinics. Provided training and support for newly acquired clinics. Gardena, California Responsible to develop standard operating procedures for day-to-day operations. Provided training December 2021-May 2023 and support for clinic managers and staff. Responsible for contracts and agreements with clients and vendors including support for operational issues including patient support,referrals and authorizations. Certified staff for Department of Transportation Drug and Alcohol Testing including refresher and error correction training. Maintained compliance with health safety regulations for each clinic. Center Operations Director/Center Provide daily supervision of all aspects of center operations. Managing P&L with over 20 full time Manager employees. Direct,supervise and coordinate functions and activities of a 24/7 center including U.S.HEALTHWORKS/CONCENTRA systems,schedules,budget,materials management and human resources. Establish and maintain Compton, California effective working relationships with staff,providers, employers,patients and insurance carriers. January 2012-December 2021 Monitor and drives key corporate goals and clinical metrics.Daily assessment of center processes, workflows and staffing to ensure smooth day to day operations. CERTIFICATION NIOSH 2017-2028 CAOHC 2017-2028 DOT BAT Alco-Secory IV 2012-2028 DOT BAT Alco-sensor VxL 2019-2026 John Kounlavong Professional Summary: Y Certified X-Ray Technician with 10+years of experience with Akeso Occupational Health. Skilled Medical professional with recognition to title of Office Manager for two of Akeso facilities. Strong Leadership skills with focus on team building, efficiency, and knowledge. Skilled Highlights: • Excellent knowledge of EMR,Microsoft Office/Word/Excel. • Critical thinking to resolve office issues, workflow, and patient charts. • Efficiency,productivity, time management, leadership, team player and exceptional human being. • Medical Professional also respectful and courteous. Experience: Akeso Occupational Health formerly ProCare Work Injury Center (2008 — current) • Limited Xray Tech License (chest extremities and torso-skeletal) providing high quality diagnostic images for interpretation by a licensed radiologist. Apply best practice for radiation protection to patients and minimize radiation exposure. • DOT Urine Drug Screen and,BAT Certified Collector. • Proficiency with DOT Medical Examination. • Patient oriented with excellent communication skills, resolve Client and patients concerns. • Proficiency with Front Desk Reception. • Proficiency with Referral Coordinator. • Perform Pre-employment Physical exams. • Perform venipuncture, injections, and screenings. • Update client protocol and generate new account profile based of client's request. • Custodian of Medical Records. • NIOSH Spirometry Training and Respirator Surveillance Program. • Proficiency with Respirator Fit Testing Education: Modern Technology School 16560 Harbor Blvd#K Fountain Valley, CA 92708 Reference: Tracy J.Lee, MD, MPH, MS—Medical Director Tracy.l@akesomedical.com Dr. Herbert Jennings, MD Herbert.j@akesomedical.com JESSE W . ALCARAZ PROFILE • Medical Assistant with 1.5 years of clinical leadership experience and 8 years of experience in fast-paced, high-volume, and dynamic healthcare organizations. • Specialized in Occupational Medicine for the last 5 years and supported specialty practices such as Podiatry, Orthopedics, General Surgery, and Physiatry. EDUCATION • Technical College (2015) Medical Assistant Certificate • University of California, Riverside (2011-2014) EXPERIENCE Akeso Occupational Health (2022-present) CLINIC MANAGER • Previously Back Officer Supervisor from 2022-2023 • Conducted training on proper techniques for back-office procedures and new services offered by the clinic. • Inventory management which includes ordering and maintaining par levels. • Assisted with the implementation of new EMR system and working to become a super user. • Work with employers, insurances, pharmacies, and providers to ensure a smooth workflow for patients during their visits. • Managed important accounts such as OCTA and Fountain Valley(invoices, reporting). • Provide Translation for patients, providers, and adjusters. U.S. Healthworks/Concentra—Los Angeles, CA(2018—2022 FRONT OFFICE/CLERICAL DUTIES • Registered new injuries,follow up appointments,and other ancillary services. • Ensured documents are reviewed,scanned, and provided to employers in a timely manner. • Continued to grow relationships with employers by answering questions and other inquiries they may have. • Supported surrounding sister centers when needed and volunteered to train in other aspects of the front office in-order to support the center when needed. BACK OFFICE/CLINICAL DUTIES • Certified Occupational Hearing Conservationist • Certified Urine Drug Screen and Breath Alcohol Technician • Certified NIOSH Spirometry and respiratory surveillance training • Proficient in lab draws and familiarity with the test menus from LabCorp and Quest. • Provided support to the neighboring businesses by providing COVID-19 testing. • Assisted clinicians with various pre-employment physicals including DOT and other non-federal services. • Trained new hires with back-office procedures and workflow. • Maintained inventory and completed orders for the center. Appendix B— Price List 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. 25-17165/393452 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. 25-17165/393452 13 EXHIBIT B PRICING TABLE Class A Cost PPD (TB) Skin Test $25 4-Panel Non-DOT Urine Rapid Drug Screen $35 Class B Cost Medical History Questionnaire No cost when completed with physical exam General Pre-placement Physical Exam: $75 • 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. $12 Visual screening bilateral: near, far, depth, color, and peripheral. $35 PPD (TB) Skin Test $25 4-Panel Non-DOT Urine Rapid Drug Screen $35 Audiogram $45 POST Medical Examination Report—Public Safety Dispatcher $10 TOTAL EXAM COST: $237 Class C Cost Medical History Questionnaire No cost when completed with physical exam General Pre-placement Physical Exam: $75 • 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. $12 Visual screening bilateral: near, far, depth, color, and peripheral. $35 PPD (TB) Skin Test $25 4-Panel Non-DOT Urine Rapid Drug Screen (specific positions) $35 Audiogram(specific positions) $45 OSHA Respirator Questionnaire (specific positions) $10 Page 1 of 4 PRICING TABLE PFT w/interpretation(specific positions) $60 DOT Exam and Certification (specific positions) $100 DOT SAMHSHA Urine Drug Test(specific positions) $50 TOTAL EXAM COST: $447 Class D Cost Medical History Questionnaire No cost when completed with physical exam General Pre-placement Physical Exam: $75 • 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. $12 Visual screening bilateral: near, far, depth, color, and peripheral. $35 PPD (TB) Skin Test $25 4-Panel Non-DOT Urine Rapid Drug Screen $35 Audiogram $45 PFT w/interpretation $60 TOTAL EXAM COST: $287 Class E Cost POST Medical History Questionnaire $10 General Pre-placement Physical Exam: $75 • 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. $12 Visual screening bilateral: near, far, depth, color, and peripheral. $35 PPD (TB) Skin Test $25 4-Panel Non-DOT Urine Drug Screen $35 Marijuana(THC) Oral Fluid Drug Screen $60 Audiogram with OSHA Approved Sound Booth(500—8000Hz) $45 Chest X-Ray (PA)with Interpretation $50 Page 2 of 4 PRICING TABLE Treadmill Stress Test with Interpretation(Bruce Protocol— 12 METS; 85% $177 Maximum Predicted Heart Rate) Complete Blood Count(CBC)with Differential/Platelet $26 Comprehensive Metabolic Panel or Chemistry Profile 23 $27 Spirometry $60 Respirator Questionnaire—C $10 Respirator Certificate No cost when completed with physical exam XR: Lumbar/Sacral $70 Hepatitis B Vaccine Series (3) $195 TOTAL EXAM COST: $912 Class F (NFPA 1582 Compliant) Cost General Pre-placement Physical Exam: $75 • 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 $35 Audiogram $45 Spine/Lumbosacral X-Ray $70 TB Test $25 Tetanus Vaccine $60 Drug Screen DOT 5 Panel $50 UA Lab $12 Pulmonary Function Test with Interpretation $60 MMR Titers $50 Hepatitis B and Hepatitis C Titers $60 Varicella Titer $30 CBC $26 Chemical Panel $27 DOT/DMV Exam for DOT Medical Examiners' Certification(optional—by $100 request): • Exam • Vision • Labs: UA (if different than above) Note: DOT/DMV Exam—no DOT drug screen required TOTAL EXAM COST: $725 Page 3 of 4 PRICING TABLE Class G (NFPA 1582 Compliant) Cost General Pre-placement Physical Exam: $75 • 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 $35 Audiogram with OSHA Approved Sound Booth (500— 8000Hz) $45 Spine/Lumbosacral X-Ray $70 C-Spine 2V X-Ray $60 Chest X-Ray(PA&LAT)with Interpretation $60 Physical Performance Test $50 EKG $40 Treadmill Test(Bruce Protocol - 12 METS; 85%Maximum Predicted Heart $177 Rate) TB Test $25 Tetanus Vaccine $60 Drug Screen DOT 5 Panel $50 UA Lab $12 MMR Titers $50 Hepatitis B and Hepatitis C Titers $60 Varicella Titer $30 CBC $26 Chemical Panel $27 OSHA Respirator Questionnaire $10 Pulmonary Function Test with Interpretation $60 TOTAL EXAM COST: $1022 Page 4 of 4 City of Huntington Beach ^ _ Business License P.O. Box 190 ,1 r4r� (714)536-5267 FAX(714) 536-5934 Huntington Beach, CA 92648-2702 1-,'," �a'0t,,:Tv Ca if Robert Torrez Interim Chief Financial Officer AKESO OCCUPATIONAL HEALTH 7700 IRVINE CENTER DR STE 870 IRVINE, CA 92618 Dear Business Owner: Thank you for your payment. Attached is your City of Huntington Beach Business License certificate. Please note that approximately one month prior to the license expiration date,you will be mailed a renewal notice for the upcoming year. If for any reason your renewal notice does not arrive, you are still responsible for renewing and paying your business license prior to the expiration date. Penalties will be incurred if the payment is not received by the expiration date. Please post the business license in public view. If you do not transact business from a fixed location within the City,you must carry this license with you at all times. If a vehicle license plate number is displayed on the Business License certificate below,you must carry a copy of the certificate in that vehicle. Please contact the Business License office if there are any changes to:ownership, address, business name, business vehicle,or type of business conducted.Additionally, please notify our office if you discontinue your business. The Gender Tax Repeal Act of 1995(Act)prohibits a business from discriminating based on a person's gender for prices of similar or like-kind goods and services. However,the Act does not prohibit price differences based on the amount of time, difficulty,or cost of providing the services. In addition to prohibiting discrimination based on a person's gender,the Act requires certain businesses to clearly and conspicuously disclose to customers in writing the pricing for each standard service provided.The posting requirement applies to barbers and hair salons,tailors or businesses providing aftermarket clothing alterations,dry cleaners,and laundries providing services to individuals.To access the Department of Consumer Affairs publication, please use the following webpage: https://www.barbercosmo.ca.gov/consumers/gender_policy.pdf. To access the publication in Korean, Spanish,Vietnamese, Traditional Chinese, Simplified Chinese,or Tagalog, please use the following webpage: https://www.dca.ca.gov/publications/index.shtml There are many resources available to our business owners. Listed below are a few that might be of interest and assistance to you. Office of Business Development-(714)536-5582 Service Corps of Retired Executives-(714)550-7369 Huntington Beach Chamber of Commerce-(714)536-8888 Fictitious Business Name Information-(714)834-2889 CA Department of Tax and Fee Administration-(949)440-3473 Community Development-(714)536-5271 If you have any questions, please call a Business License representative at(714)536-5267. City of Huntington Beach Business License License Number Business Name/Service Address POST IN PUBLIC VIEW A312490 AKESO OCCUPATIONAL HEALTH 17122 BEACH BLVD Unit 104 HUNTINGTON BEACH CA i '"-"- Effective Date �N11N61-0 ----- �' 03/01/2025 Owner/Corporation Pti '; \ Expiration Date KAIN AKESO MEDICAL HOLDINGS LLC I 1•s, 02/28/2026 License Type Zyy o i� PROFESSIONAL SERVICES c �'UP�TV c\;,/,�' Amount Paid � $126.80 THIS LICENSE IS ONLY FOR THE BUSINESS AND TYPE SHOWN. IT IS FOR THE PERSON TO WHOM ISSUED AND IS NON-TRANSFERABLE. RENEWAL IS DUE ON OR BEFORE THE EXPIRATION DATE. . . h I t^ 1� 1 ACORD® DATE(MIAfDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 6/8/2026 i E(MMID NYY /14/2025 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 Lockton Companies,LLC NAME:CT DBA Lockton Insurance Brokers,LLC in CA PHONE FAX (NC. CA license I1E-MAILF157G7 E-MA e EMI: (NC,No): 8110 B Union Ave.,Ste.100 • ADDRESS: Denver CO 80237 INSURER(S)AFFORDING COVERAGE NAIC S dcnver-ccrts@lockton.com INSURER A:American Zurich Insurance Company 40142 INSURED Kain Akeso Medical Holdings,LLC INSURER 8:American Guarantee and Liab.Ins.Co. 26247 1527649 7700 Irvine Center Drive,Suite 870 INSURER c:Arch Specialty Insurance Company 21199 Irvine,CA 92618 INSURER D:Pennsylvania Manufacturers'Assoc Ins Co 12262 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 22624436 REVISION NUMBER: XXXXXXX 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS I A x COMMERCIALGENERAL LIABILITY Y N CPO 4340987-00 6/8/2025 6/8/2026 EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 1,000,000 MED EXP(Any one person) $ 10,000 PERSONAL8ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JEC LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ l� A AUTOMOBILE LIABILITY N COMBINED SINGLE LIMIT N CPO 4340937-00 6/8/2025 G/8/2026 (Ea acddant) $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ XXXXXXX s� OWNED X SCHEDULED BODILY INJURY(Per accdent) $ XXXXXXX AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ XXXXXXX X AUTOS ONLY X AUTOS ONLY (Per accident) i S XXXXXXX B X UMBRELLA LIAB X OCCUR N N AUC 4340988-00 6/8/2025 6/8/2026 EACH OCCURRENCE s 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTIONS $ XXXXXXX WORKERS COMPENSATION OTH- D AND EMPLOYERS`LIABILITY Y/N N 202500-1538156 6/8/2025 6/8/2026 X PER ER ANYIPROP IIE1 O R EXCLUDED?ECUTIVE I I N/A E.L EACH ACCIDENT $ 1,000,000 (Mandatory In NH) , E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below 'E.L.DISEASE-POLICY LIMIT $ 1,000,000 C Professional Liability N N FLP5000777-01 9/30/2025 9/30/2026 SIM ea.claiin/S3M Agg. DED:SIOK C Excess Prof.Liability FLP5000777-01 9/30/2025 9/30/2026 S5M ea.claim/S5M Agg. DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached IF more space Is required) ' Professional Liability and Excess Prof.Liability Claims Made Retro dale:9/30/22(series by entity).City of Huntington Beach,its officers,elected or appointed officials,'nrployccs,agents and volunteers are included as additional insureds,but only insofar as the operations under this contract are concerned to the extent rovideAtj.1 the p li ,linty e d rs nt tssucd or approved by the insurance carrier.insurance provided to Additional insured(s)is primary and non-contributory as per the attached cndog9�RHO)k0ic9 IA is lam' MICHAEL J.VIGLIOTTA CITY ATTORNEY CERTIFICATE HOLDER CANCELLATION OrSee Attache ertsAttachments H SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 22624436 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Huntington Beach WITH THE POLICY PROVISIONS. 2000 Main Street AUTHORIZED REPRESENTATIVE Huntington Beach CA 92648 f _ -�" "' ©1988-20;16 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: CPO 4340987-00 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 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): 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. 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 is added to organization(s)shown in the Schedule,but only with Section III—Limits Of Insurance: respect to liability for "bodily injury", "property If coverage provided to the additional insured is damage" or "personal and advertising injury" required by a contract or agreement, the most we caused, in whole or in part, by your acts or will pay on behalf of the additional insured is the omissions or the acts or omissions of those acting amount of insurance: on your behalf: 1. In the performance of your ongoing operations; 1. Required by the contract or agreement;or or 2. Available under the applicable Limits of 2. In connection with your premises owned by or Insurance shown in the Declarations; rented to you. whichever is less. However: This endorsement shall not increase the 1. The insurance afforded to such additional applicable Limits of Insurance shown in the Declarations. insured only applies to the extent permitted by law;and 2. 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. CG 20 26 0413 ©Insurance Services Office, Inc.,2012 Page 1 of 1 Attachment Code:D672115 Certificate ID:22624436 Policy Number: CPO 4340987-00 1.Section II Who Is An Insured is amended to include as an additional insured any person(s)or organization(s) who leases or rents a part of the premises you own or manage who you are required to add as an additional insured on this policy under a written contract or written agreement,but only with respect to liability arising out of your ownership,maintenance or repair of that part of the premises which is not reserved for the exclusive use or occupancy of such person or organization or any other tenant or lessee. This provision does not apply after the person or organization ceases to lease or rent premises from you.However,the insurance afforded to such additional insured: a. Only applies to the extent permitted by law;and b. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured. 2.With respect to the insurance afforded to the additional insureds under this endorsement,the following is added The most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the written contract or written agreement referenced in Subparagraph EA.of this endorsement; or b. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This Paragraph E.shall not increase the applicable Limits of Insurance shown in the Declarations. 1.The following change applies if this Coverage Part provides insurance to you for"bodily injury"and"property damage" included.in the"products-completed operations hazard": Section II Who Is An Insured is amended to include as an additional insured any person or organization (referred to throughout this Paragraph F.as vendor)who you have agreed in a written contractor written agreement,prior to loss,to name as an additional insured,but only with respect to"bodily injury"or"property damage"arising out of"your products"which are distributed or sold in the regular course of the vendor's business: However,the insurance afforded to such vendor: a. Only applies to the extent permitted by law;and b. Will not be broader than that which you are required by the written contract or written agreement to provide for such vendor. 2.With respect to the insurance afforded to these vendors,the following additional exclusions apply:a.The insurance afforded the vendor does not apply to: (1)"Bodily injury"or"property damage"for which the vendor 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 vendor would have in the absence of the contract or agreement; (2)Any express warranty unauthorized by you; (3)Any physical or chemical change in the product made intentionally by the vendor; (4)Repackaging,except when unpacked solely for the purpose of inspection,demonstration,testing,or the substitution of parts under instructions from the manufacturer,and then repackaged in the original. container; (5)Any failure to make such inspections,adjustments,tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business,in connection with the distribution or sale-of the products; (6)Demonstration,installation,servicing or repair operations,except such operations performed at the vendor's premises in connection with the sale of the product; Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 3 of 12 u-GL-2217-A CW(08/21) • Attachment CoM PhYdLiksQ9Ititific,agttLiMig6Madm or sale by you, have been labeled or relabeled or used as a container, part or ingredient of any other thing or substance by or for the vendor; or (1)"Bodily injury"or"property damage"arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf. However,this exclusion does not apply to: (a)The exceptions contained in Subparagraphs(4)or(6);or (b)Such inspections,adjustments,tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. b.This insurance does not apply to any insured person or organization,from whom you have acquired such products,or any ingredient, part or container, entering into,accompanying or containing such products. C. This insurance does not apply to any of"your products"for which coverage is excluded under this Coverage Part. 3.With respect to the Insurance afforded to the vendor under this endorsement,the following is added to Section Ill The most we will pay on behalf of the vendor is the amount of insurance: a. Required by the written contract or written agreement referenced in Subparagraph F.1. of this endorsement; or b. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This Paragraph F.shall not increase the applicable Limits of Insurance shown in the Declarations. 1. Section II Who Is An Insured is amended to include as an insured any person or organization who is a manager, lessor or governmental entity who you are required to add as an additional insured on this policy under a written contract,written agreement or permit, but only with respect to liability for"bodily injury", "property damage" or"personal and advertising injury"caused,in whole or in part, by: a. Your acts or omissions;or b. The acts or omission of those acting on your behalf; and resulting directly from: a. Operations performed by you or on your behalf for which the state or political subdivision has issued a permit; b. Ownership, maintenance, occupancy or use of premises by you; or c. Maintenance,operation or use by you of equipment leased to you by such person or organization. However,the insurance afforded to such additional insured: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured. 2.This provision does not apply: a. Unless the written contract or written agreement has been executed, or the permit has been issued, prior to the "bodily injury", "property damage"or offense that caused"personal and advertising Injury"; b. To any person or organization included as an insured under Paragraph 3. Who Is An Insured; C.To any lessor of equipment if the"occurrence"or offense takes place after the equipment lease expires; d.To any: (1) Owners or other interests from whom land has been leased by you;or U-GL-2217-A CW(08/21) Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 4 of 12 Attachment CoM de5rgvit180612Pgfjf}ms, if: (a)The"occurrence"or offense takes place after the expiration of the lease or you cease to be a tenant in that premises; (b)The"bodily injury", "property damage"or"personal and advertising Injury"arises out of the structural alterations, new construction or demolition operations performed by or on behalf of the manager or lessor;or (C)The premises are excluded under this Coverage Part. 3.With respect to the insurance afforded to the additional insureds under this endorsement,the following is added to Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the written contract or written agreement referenced in Subparagraph G.1. of this endorsement; or b. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This Paragraph G. shall not increase the applicable Limits of Insurance shown in the Declarations. 1. Section II Who Is An Insured is amended to include as an insured any person or organization who does not qualify as an additional Insured under Paragraphs E. through Paragraph G. of this endorsement so long as you are required to add such person or organization as an additional Insured on this policy under a written contract or written agreement, but only with respect to liability for"bodily injury", "property damage"or"personal and advertising injury" caused, in whole or in part, by: a. Your acts or omissions;or b. The acts or omissions of those acting on your behalf. • However,the insurance afforded to such additional insured: a. Only applies to the extent permitted by law;and b. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured. 2.With respect to the insurance afforded to the additional insureds under this Paragraph H.,the following additional exclusions apply: The insurance afforded to the additional insured under this Paragraph H. does not apply to any person or organization: a. For"bodily injury", "property damage"or"personal and advertising injury"arising out of the rendering or failure to render any professional service; b. For"bodily injury"or"property damage"included in the"products-completed operations hazard"; or c. Who is scheduled as an additional insured under another endorsement attached to this policy. 3.With respect to the insurance afforded to the additional insureds under this Paragraph H.,the following is added to Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: a. Required by the written contract or written agreement referenced in Subparagraph H.1.of this endorsement; or b. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This Paragraph H.shall not increase the applicable Limits of Insurance shown in the Declarations. Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 5 of 12 Attachment Code:D672117 Certificate ID:22498134 Policy Number:CPO 4340987-00 C. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV —Commercial General Liability Conditions: The additional insured must see to it that: 1. We are notified as soon as practicable of an"occurrence"or offense that may result in a claim; 2. We receive written notice of a claim or"suit"as soon as practicable;and 3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not • apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement requires that this coverage be primary and non-contributory. D. For the purposes of the coverage provided by this endorsement: 1. The following is added to the Other Insurance Condition of Section IV — Commercial General Liability Conditions: Primary and Noncontributory insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured provided that: a. The additional insured is a Named Insured under such other insurance;and b. You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional insured. 2.The following paragraph is added to Paragraph 4.b.of the Other Insurance Condition of Section IV—Commercial General Liability Conditions: This insurance is excess over: Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence", offense, claim or"suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by a written contract or written agreement to provide coverage to the additional insured on a primary and non-contributory basis. E. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to Section III—Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the written contract or written agreement referenced in Paragraph A.of this endorsement; 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. All other terms and conditions of this policy remain unchanged. u-GL-1175-F CW(04/13) Includes copyrighted material of Insurance Services Office,Inc.,with its permission. Page 2 of 2 POLICY NUMBER: CPO 4340987-00 COMMERCIAL GENERAL LIABILITY CG 2010 0413 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) Or Organization(s) Location(s)Of Covered Operations 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. 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 with exclusions apply: 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. All work, including materials, parts or 1. Your acts or omissions;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 completed;or designated above. 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. C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III—Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement;or CG 2010 0413 ©Insurance Services Office, Inc.,2012 Page 1 of 1