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HomeMy Public PortalAboutC-17-036 - U.S. Healthworks Medical Group Amendment No. 2, Work Related InjuriesocuSignZnvelopeID:6A1D7DCO-29554094-A361-94A9E1BDOEEFAMENDMENTNO.2TOAGREEMENTFORCONTRACTSERVICESTHISAMENDMENTNO.210THEAGREEMENTFORCONTRACTSERVICES(“AmendmentNo.2”)byandbetweentheCITYOFCARSON,aCaliforniamunicipalcorporation(“City”)andOCCUPATIONALHEALTHCENTERSOFCALIFORNIA,AMEDICALCORPORATION,formerlyU.S.HEALTHWORKSMEDICALGROUP,PROF.CORP.,aCaliforniaCorporation(“Consultant”),iseffectiveasofthe28thdayofFebruary,2020.RECITALSA.CityandU.S.HealthWorksMedicalGroup,ProfessionalCorporation,aCaliforniaCorporation(“U.S.HealthWorks”),enteredintothatcertainAgreementforContractServicesdatedFebruary28,2017(“Agreement”),wherebyConsultantagreedtoprovidemedicalservicesintheareasoftreatmentofwork-relatedinjuries/illnessesforthree(3)yearsforaContractSumof$75,000,withtheoptiontoextendtheTermoftheAgreementfortwo(2)additionalone(1)yearperiods.B.OnFebruary1,2018,U.S.HealthWorkswasacquiredbyConcentraGroupHoldings,LLC(“Concentra”),andConcentracommencedtheprocessofintegratingallU.S.HealthWorksclinicsintoConcentra’snetworkofoccupationalmedicineandurgentcareclinics.C.OnJuly29,2019,ConcentrasoughttheCity’sconsenttoanassignmentoftheAgreementfromU.S.HealthWorksto“OccupationalHealthCentersofCalifornia,aMedicalCorporation,”aCaliforniaCorporationthatisasubsidiaryor“managedprofessionalentity”ofConcentra(“OHCC”),statingthatallservicespreviouslyprovidedbyU.S.HealthWorksundertheAgreementwouldthereafterbeperformedbyOHCC.D.OnDecember11,2019,theCityandConsultantexecutedAmendmentNo.1totheAgreementwherebytheCityandConsultantagreedtoamendtheAgreementtoauthorizetheassignmentoftheAgreementfromU.S.HealthWorkstoOHCC,retroactivetoFebruary1,2019,andtotherebyauthorizetheprovisionoftheservicesundertheAgreementbyOHCCcommencingasofsaiddate,andtoratifyandaffirmthecontinuousanduninterruptedtermoftheAgreementcommencingasofFebruary28,2017.E.BythisAmendmentNo.2,theCityandConsultantnowdesiretoextendthetermoftheAgreementbyoneadditionalyear,fromFebruary28,2020toFebruary27,2021,toincreasetheContractSumbyanadditional$20,000,from$75,000to$95,000,toaccountforsaidextension,andtoupdatethenamesoftheConsultantandCity’srepresentativesandlorpersonnel.01007.0001629282.1AE DocuSignEnvelopeID:6A1D7DCO-29554094-A361-94A9E1BDOEEFF.Exceptasamendedhereby,thisextensionissubjecttothesametermsandconditionasprovidedintheAgreementandAmendmentNo.1.TERMS1.ContractAmendments.TheAgreementisamendedasprovidedherein.Addedtextisindicatedinbolditalics,deletedtextisindicatedinstrilcethrough.a.Section2.1,ContractSum,isherebyamendedandshallnowreadasfollows:“2.1ContractSum.SubjecttoanylimitationssetforthinthisAgreement,CityagreestopayConsultanttheamountsspecifiedinthe“ScheduleofCompensation”attachedheretoasExhibit“C”andincorporatedhereinbythisreference.Thetotalcompensation,includingreimbursementforactualexpenses,shallnotexceedSeventyFiveThousandDollars($75,000)Ninety-FiveThousandDollars($95,000)(the“ContractSum”),unlessadditionalcompensationisapprovedpursuanttoSection1.8.”b.Section3.4,Term,isherebyamendedandshallnowreadasfollows:“3.4Tenn.UnlessearlierterminatedinaccordancewithArticle7ofthisAgreement,thisAgreementshallcontinueinfullforceandeffectuntilcompletionoftheservicesbutnotlaterthanFebruary27,2021exceedingthree(3)yearsfromthedatethereof,unlessCityexercisesattheCity’sdiscretiontheCity’soptionfortwo(2)one(1)additional,separateanddistinct,oneyearrenewals,andexceptasotherwiseprovidedintheScheduleofPerformance(Exhibit“D”).”c.Section4.1,RepresentativesandPersonnelofConsultant,isherebyamendedandshallnowreadasfollows:“4.1RepresentativesandPersonnelofConsultant.ThefollowingprincipalsofConsultant(“Principals”)areherebydesignatedasbeingtheprincipalsandrepresentativesofConsultantauthorizedtoactinitsbehalfwithrespecttotheworkspecifiedhereinandmakealldecisionsinconnectiontherewith:VanDuongDirectorofOperationsAnnSitterReaionalSalesDirectorLosAnaeli01007.0001629282.1AE DocuSigrnveIopeID:6A1D7DCO-2955-4094-A361-94A9E1BDOEEF(Name)(Title)LJ1a1r1UChiefSalesandMarketingOffl(Name)(Title)Itisexpresslyunderstoodthattheexperience,knowledge,capabilityandreputationoftheforegoingprincipalswereasubstantialinducementforCitytoenterintothisAgreement.Therefore,theforegoingprincipalsshallberesponsibleduringthetermofthisAgreementfordirectingallactivitiesofConsultantanddevotingsufficienttimetopersonallysupervisetheserviceshereunder.AllpersonnelofConsultant,andanyauthorizedagents,shallatalltimesbeundertheexclusivedirectionandcontrolofthePrincipals.ForpurposesofthisAgreement,theforegoingPrincipalsmaynotbereplacednormaytheirresponsibilitiesbesubstantiallyreducedbyConsultantwithouttheexpresswrittenapprovalofCity.Additionally,ConsultantshallutilizeonlycompetentpersonneltoperformservicespursuanttothisAgreement.ConsultantshallmakeeveryreasonableefforttomaintainthestabilityandcontinuityofConsultant’sstaffandsubcontractors,ifany,assignedtoperformtheservicesrequiredunderthisAgreement.ConsultantshallnotifyCityofanychangesinConsultant’sstaffandsubcontractors,ifany,assignedtoperformtheservicesrequiredunderthisAgreement,priortoandduringanysuchperformance.”d.Section4.3,ContractOfficer,isherebyamendedandshallnowreadasfollows:“4.3ContractOfficer.TheContractOfficershallbefayeMosetey,DirectorofHumanResourcesandRiskManagementTraceyCurry,CityofCarsonSeniorHumanResourcesorsuchpersonasmaybedesignatedbytheCityManager.ItshallbetheConsultant’sresponsibilitytoassurethattheContractOfficeriskeptinformedoftheprogressoftheperformanceoftheservicesandtheConsultantshallreferanydecisionswhichmustbemadebyCitytotheContractOfficer.Unlessotherwisespecifiedherein,anyapprovalofCityrequiredhereundershallmeantheapprovaloftheContractOfficer.TheContractOfficershallhaveauthority,ifspecifiedinwritingbytheCityManager,tosignalldocumentsonbehalfoftheCityrequiredhereundertocarryoutthetermsofthisAgreement.”e.SectionVofExhibitC,ScheduleofCompensationshallbeamendedtoreadasfollows:01007.0001629282.1AE DocuSignEnvelopeID:6A1D7DCO-2955-4094-A361-94A9E1BDOEEF“V.ThetotalcompensationfortheServicesshallnotexceed$95,000$75,000asprovidedinSection2.1.ofthisAgreement.”2.ContinuingEffectofAgreement.ExceptasamendedbyAmendmentsNo.1and2,allprovisionsoftheAgreementshallremainunchangedandinfullforceandeffect.FromandafterthedateofthisAmendmentNo.2,whenevertheterm“Agreement”appearsintheAgreement,itshallmeantheAgreement,asamendedbyAmendmentsNo.1and2.3.AffirmationofAgreement;WarrantyReAbsenceofDefaults.CityandConsultanteachratifyandreaffirmeachandeveryoneoftherespectiverightsandobligationsarisingundertheAgreement.EachpartyrepresentsandwarrantstotheotherthattherehavebeennowrittenororalmodificationstotheAgreementotherthanasprovidedherein.EachpartyrepresentsandwarrantstotheotherthattheAgreementiscurrentlyaneffective,valid,andbindingobligation.ConsultantrepresentsandwarrantstoCitythat,asofthedateofthisAmendmentNo.2,CityisnotindefaultofanymaterialtermoftheAgreementandthattherehavebeennoeventsthat,withthepassingoftimeorthegivingofnotice,orboth,wouldconstituteamaterialdefaultundertheAgreement.CityrepresentsandwarrantstoConsultantthat,asofthedateofthisAmendmentNo.2,ConsultantisnotindefaultofanymaterialtermoftheAgreementandthattherehavebeennoeventsthat,withthepassingoftimeorthegivingofnotice,orboth,wouldconstituteamaterialdefaultundertheAgreement.4.AdequateConsideration.ThepartiesheretoirrevocablystipulateandagreethattheyhaveeachreceivedadequateandindependentconsiderationfortheperformanceoftheobligationstheyhaveundertakenpursuanttothisAmendmentNo.2.5.Authority.ThepersonsexecutingthisAmendmentNo.2onbehalfofthepartiesheretowarrantthat(i)suchpartyisdulyorganizedandexisting,(ii)theyaredulyauthorizedtoexecuteanddeliverthisAmendmentNo.2onbehalfofsaidparty,(iii)bysoexecutingthisAmendmentNo.2,suchpartyisformallyboundtotheprovisionsofthisAmendmentNo.2,and(iv)theenteringintothisAmendmentNo.2doesnotviolateanyprovisionofanyotherAgreementtowhichsaidpartyisbound.[SIGNATURESONFOLLOWINGPAGEJ01007.0001629282.1AE DacuSlgrEnvelopeID6A1D7DCO-2955-4094-A361-94A9E1BDOEEFINWITNESSWHEREOF,thepartiesheretohaveexecutedthisAmendmentNo.2onthedateandyearfirst-abovewritten.CITY:CiTYOFCARSON,aCaliforniamunicipalcorporaonAertobtaySunnyK.Soltani,CityAttorney[AE]CONSULTANT:OCCUPATIONALHEALTHCENTERSOFCALIFORNIA,AMEDICALCORPORATION,aCaliforniaCorporationDocuSignedby:257Ni3JeffreyWainstein,MDTitle:PresidentandTreasurer,.—.OocuSgneby:By:Lc.iVu,VINainsEDieMinhQ.NguyenTitle:VicePresidentAddress:25124SpringfietdCourtSuite300Valencia,CA91355-1098NOTE:CONSULTANT’SSIGNATURESSHALLBEDULYNOTARIZED,ANDAPPROPRIATEATEESTATIONSSHALLBEINCLUDEDASMAYBEREQUIREDBYTHEBYLAWS,ARTICLESOFINCORPORATION,OROTHERRULESORREGULATIONSAPPLICABLETODEVELOPER’SBUSINESSENTITY.CityCjAPPROVEDASTOFORM:ALESHIRE&WYNDER,LLP01007.0001629282.1AE DocuSignEnvelopeID:6A1D7DCO-2955-4094-A361-94A9E1BDOEEFCALIFORNIAALL-PURPOSEACKNOWLEDGMENTAnotarypublicorotherofficercompletingthiscertificateverifiesonlytheidentityoftheindividualwhosignedthedocumenttowhichthiscertificateisattached,andnotthetruthfulness,accuracyorvalidityofthatdocument.STATEOFCALIFORNIACOUNTYOFLOSANGELESOn___________,2020beforeme,__________________,personallyappeared_________________,provedtomeonthebasisofsatisfactoryevidencetobetheperson(s)whosenames(s)is/aresubscribedtothewithininstrumentandacknowledgedtomethathe/she/theyexecutedthesameinhis/her/theirauthorizedcapacity(ies),andthatbyhis/her/theirsignature(s)ontheinstrumenttheperson(s),ortheentityuponbehalfofwhichtheperson(s)acted,executedtheinstrument.IcertifyunderPENALTYOFPERJURYunderthelawsoftheStateofCaliforniathattheforegoingparagraphistrueandcorrect.WITNESSmyhandandofficialseal.Signature:_____________________________________________OPTIONALThoughthedatabelowisnotrequiredbylaw,itmayprovevaluabletopersonsrelyingonthedocumentandcouldpreventfraudulentreattachmentofthisform.CAPACITYCLAIMEDBYSIGNERDESCRIPTIONOFATTACHEDDOCUMENTLIINDIVIDUALLICORPORATEOFFICERTITLE(S)TITLEORTYPEOFDOCUMENTLIPARTNER(S)LILIMITEDLIGENERALLIATTORNEY-IN-FACTLITRUSTEE(S)NUMBEROFPAGESLIGUARDIAN/CONSERVATORLIOTHER______________________SIGNERISREPRESENTING:DATEOFDOCUMENT(NAMEOFPERSON(S)ORENTITY(IES))____________SIGNER(S)OTHERTHANNAMEDABOVE01007.0001629282.1AE DocuSignEnvelopeID:6A1D7DCO-2955-4094-A361-94A9E1BDOEEFCALIFORNIAALL-PURPOSEACKNOWLEDGMENTAnotarypublicorotherofficercompletingthiscertificateverifiesonlytheidentityoftheindividualwhosignedthedocumenttowhichthiscertificateisattached,andnotthetruthfulness,accuracyorvalidityofthatdocument.STATEOfCALIFORNIACOUNTYOFLOSANGELESOn___________,2020beforeme,__________________,personallyappeared__________________,provedtomeonthebasisofsatisfactoryevidencetobetheperson(s)whosenames(s)is/aresubscribedtothewithininstrumentandacknowledgedtomethathe/she/theyexecutedthesameinhis/her/theirauthorizedcapacity(ies),andthatbyhis/her/theirsignature(s)ontheinstrwnenttheperson(s),ortheentityuponbehalfofwhichtheperson(s)acted,executedtheinstrument.IcertifyunderPENALTYOFPERJURYunderthelawsoftheStateofCaliforniathattheforegoingparagraphistrueandcorrect.WITNESSmyhandandofficialseal.Signature:________________________________________OPTIONALThoughthedatabelowisnotrequiredbylaw,itmayprovevaluabletopersonsrelyingonthedocumentandcouldpreventfraudulentreattachmentofthisform.CAPACITYCLAIMEDBYSIGNERDESCRIPTIONOfATTACHEDDOCUMENT[JINDIVIDUALElCORPORATEOFFICERTITLE(S)TITLEORTYPEOFDOCUMENTElPARTNER(S)C]LIMITEDC]GENERALC]ATTORNEY-EN-FACTElTRUSTEE(S)NUMBEROfPAGESC]GUARDIAN/CONSERVATORElOTHER______________________SIGNERISREPRESENTING:DATEOFDOCUMENT(NAMEOFPERSON(S)ORENTITY(IES))____________SIGNER(S)OTHERTHANNAMEDABOVE01007.0001629282.1AE Af’CERTIFICATEOFLIABILITYINSURANCEZ—DATEIMM100IYYYY)1/7/2020THISCERTIFICATEISISSUEDASAMATTEROFINFORMATIONONLYANDCONFERSNORIGHTSUPONTHECERTIFICATEHOLDER.THISCERTIFICATEDOESNOTAFFIRMATIVELYORNEGATIVELYAMEND,EXTENDORALTERTHECOVERAGEAFFORDEDBYTHEPOLICIESBELOW.THISCERTIFICATEOFINSURANCEDOESNOTCONSTITUTEACONTRACTBETWEENTHEISSUINGINSURER(S),AUTHORIZEDREPRESENTATIVEORPRODUCER,ANDTHECERTIFICATEHOLDER.IMPORTANT:IfthecertificateholderisanADDITIONALINSURED,thepolicy(ies)musthaveADDITIONALINSUREDprovisionsorbeendorsed.IfSUBROGATIONISWAIVED,subjecttothetermsandconditionsofthepolicy,certainpoliciesmayrequireanendorsement.AstatementonthiscertificatedoesnotconferrightstothecertificateholderInlieuofsuchendorsement(s).CONTACTPRODUCERNAME:ConcentraUnitGrahamBuildng’jAjçaE,215676300ZZNa215-40526941PennSquareWestPhiladelphiaPA19102ISURERI5)AFFORINqCDVERAGE_________NAIC#INSURERA ColumbiaCasualtyComp31127INSUREDCONCGRODIINSURERB:AmericanGuarantee&LiabilityIns.Co.26247OccupationalHealthCentersofCalifornia,A,MedicalCorporation,c/cSelectMedicalCorporatioINSURERC:LibertyMutualFireIns.Co.4716OldGettysburgRoadINSURERD:AlliedWorldAssuranceCompanyjjQ_MechanicsburgPA17055INSURERE:42404INSURERF:LibertyMutualInsuranceGroup23043COVERAGESCERTIFICATENUMBER:1223585589REVISIONNUMBER:THISISTOCERTIFYTHATTHEPOLICIESOFINSURANCELISTEDBELOWHAVEBEENISSUEDTOTHEINSUREDNAMEDABOVEFORTHEPOLICYPERIODINDICATEDNOTWITHSTANDINGANYREQUIREMENT,TERMORCONDITIONOFANYCONTRACTOROTHERDOCUMENT\MTHRESPECTTOWHICHTHISCERTIFICATEMAYBEISSUEDORMAYPERTAIN,THEINSURANCEAFFORDEDBYTHEPOLICIESDESCRIBEDHEREINISSUBJECTTOALLTHETERMS,EXCLUSiONSANDCONDITIONSOFSUCHPOLICIESLIMITSSHOWNMAYHAVEBEENREDUCEDBYPAIDCLAIMS_____________________—POLICYEFIMMJDDIVYVYI=AXCOMMERCIALGENERALLIABILITYYYHAZ4032244581-410/11201910/1/2020EACHOCCURRENCE51,000,000iOMETQE.NTE0_]CLAIMS.t.IADEOCCURPREMISESlEaoccurTer.ce($500,000JProfessionalLieMEDEXP(Anyoneperson)$10,000X1MCIaimIS3MAg-PERSONAL&AOVIN]URY$1,000,000GEN’LAGGREGATELIMITAPPLIESPER-GENERALAGGREGATE53,000.0001POLICYL1c0rL1LOCPRODUCTS-CPDPAGO30000OTHERISCAUTOMOBILEUABILITYYYAS2-631-510199-32910/1/201910/1/2020dINGLELIMIT52,000000XANYAUTOBODILYINJURY(Perperson)$AUTOSONLYrULEDBODILYINJURY(Peraccrdect)$HIREDINON-OWNEDPROPERTYDAMAGEs.-AUTOSONLYAUTOSCNLY(ffetacCdeng__AXUMBRELLAUABOCCUR—vHMC4032235752-410/1(201910/1/2020EACHOCCURRENCE$9,000,000EXCESSLIABLCLAIMSMADEAGGREGATE$10,000,000050f1RETENTIONSnonnon—$EWORKERSCOMPENSATIONVWA7-63O-510199-35910/1/201910/1/2020Xj.TUTEERFANDEMPLOYERS’LIABILITYYINWC5-631-510199-36910/1/201910/1/2020—ANYPROPRIETORIPARTNEPIEXECUTIVEBLEACHACCIDENT51,000,000OFFICER/MEMBEREXCLUDEO?N/A---———————IMandatoryInNH)ELDISEASE-EAEMPLOYEE$1,000,000Ifyes,describeunder-DESCRIPTIONOFOPERATIONSbelowELDISEASE-POLICYLIMIT$1,000,000BProperlyZMDO119116-046/1/201910/1/2020SEEBELOW0ExcessLiabilityC023701-00510/1)201910/1/2020SlaMEachOccurrence51DMAggregateCERTIFICATEHOLDERCANCELLATIONSHOULDANYOFTHEABOVEDESCRIBEDPOLICIESBECANCELLEDBEFORETHEEXPIRATIONDATETHEREOF,NOTICEWILLBEDELIVEREDINACCORDANCEWITHTHEPOLICYPROvISIONS.CityofCarson701E.CarsonStreetAUTHORIZEDREPRESENTATIVECarsonCA90745/ACcJRLITBTYPEOFINSURANCEauuti3uBr’POLICYNUMBERt’ULILYCM’IMM/ODIYYYYILIMITSDESCRIPTIONOFOPERATIONS!LOCATIONS!VEHICLESIACORO101,AddItIonalRemarksSchcdule,maybeattacheditmerespaceIsrequIred)UMBRELLALIABILITYCOVERAGEincludesExcessGeneralLiabilityonanOccurrenceBasisandExcessProfessionalLiabilityonaClaimsMadeBasis.BothCoveragesareexcessofa$3,000,000Self-InsuredRetentioneachOccurrence/Claimsubjecttoa$10,000,000Aggregate.PROFESSIONALLIABILITYCOVERAGEincludesCaseManagementServicesincludingtherendenngofcasemanagementorutilizationreviewperformedbyinsuredforothers.INDIANAPHYSICIANPROFESSIONALLIABILITYCOVERAGE-ContinentalCasualtyCompany-Policy#HAZ4032244595-5;Effective10/1/2019-10/1/2020-$400,000EachMedicalIncidenU$1.200,000AggregatePerInsuredorSurgeonSeeAttached...©1988-2015ACORDCORPORATION.Allrightsreserved.ACORD25(2016)03)TheACORDnameandlogoareregisteredmarksofACORD PoJicyNumber:AS2-631-510199-039COMMERCIALAUTOCA20481013THISENDORSEMENTCHANGESTHEPOLICY.PLEASEREADITCAREFULLY.DESIGNATEDiNSUREDFORCOVEREDAUTOSLIABiLITYCOVERAGEThisendorsementmodifiesinsuranceprovidedunderthefollowing:AUTODEALERSCOVERAGEFORMBUSINESSAUTOCOVERAGEFORMMOTORCARRIERCOVERAGEFORMWithrespecttocoverageprovidedbythisendorsement,theprovisionsoftheCoverageFormapplyunlessmodifiedbytheendorsement.Thisendorsementidentifiesperson(s)ororganization(s)whoare“insureds”forCoveredAutosLiabilityCoverageundertheWhoIsAnInsuredprovisionoftheCoverageForm.ThisendorsementdoesnotaltercoverageprovidedintheCoverageForm.SCHEDULENameOfPerson(s)OrOrganization(s):-________________________________________Anypersonororganizationwhomyouhaveagreedinwritingtoaddasanadditionalinsured,butonlytocoverageandminimumlimitsofinsurancerequiredbythewrittenagreement,andinnoeventtoexceedeitherthescopeofcoverageorthelimitsofinsuranceprovidedInthispolicy.InformationrequiredtocompletethisSchedule,ifnotshownabove,willbeshownintheDeclarations.EachpersonororganizationshownintheScheduleisan“insured’forCoveredAutosLiabilityCoverage,butonlytotheextentthatpersonororganizationqualifiesasan‘insured”undertheWhoIsAnInsuredprovisioncontainedinParagraphA.1.ofSectionII-CoveredAutosLiabilityCoverageintheBusinessAutoandMotorCarrierCoverageFormsandParagraphD2.ofSectionI-CoveredAutosCoveragesoftheAutoDealersCoverageForm.CA20481013©InsuranceServicesOffice,Inc.,20fIPage1off255 CNAWAIVEROFRIGHTSOFRECOVERYAPPLICABLETOGENERALLIABILITYCOVERAGEFORMThechangessetforthbelowareapplicableonlytotheCommercialGeneralLiabilityCoverageFormG145566-A,G-145567-A).TheHealthcareLiabilityPolicyCommonConditions(C-i44102-A)areamendedassetforthbelow:ConditionXII.,TransferofRightsofRecoveryisamendedbytheadditionofthefollowing:Solelywithinthescopeofthisendorsementasindicatedabove,wewaiveanyrightofrecoverywemayhaveagainstanypersonororganizationthatyouhaveagreedwith,inwriting,priortothedateofloss,towaiveyourrighttorecoveragainstbecauseofpaymentswemakeundertheCommercialGeneralLiabilityCoverageFormforinjuryordamagearisingoutofyourongoingoperations.Thisendorsementappliesonlyto:AllothertermsandconditionsofthePolicyremainunchanged.Thisendorsement,whichformsapartofandisforattachmenttothePolicyissuedbythedesignatedInsurers,takeseffectontheeffectivedateofsaidPolicyatthehourstatedinsaidPolicy,unlessanothereffectivedateisshown_below,_and_expires_concurrently_withsaid_Policy._________________________GSL6554XX(4-11)PolicyNo:HAZ4032244581-4Page1EndorsementNo:EffectiveDate:10/01/2019InsuredName:ConcentraGroupHoldingsParent,LLC©CNAAtiRightsReserved. POLICYNUMBER:HAZ4032244581-4032244581-4COMMERCIALGENERALLIABILITYCG20010413THISENDORSEMENTCHANGESTHPOLICY.PLEA5READITCAREFULLY.PRIMARYANDNONCONTRIBUTORY-OTHERINSURANCECONDITIONThisendorsementmodifiesinsuranceprovidedunderthefollowing:COMMERCIALGENERALLIABILITYCOVERAGEPARTPRODUCTS/COMPLETEDOPERATIONSLIABILITYCOVERAGEPARTThefollowingisaddedtotheOtherInsuranceConditionandsupersedesanyprovisiontothecontrary:PrimaryAndNoncontributoryInsuranceThisinsuranceisprimarytoandwillnotseekcontributionfromanyotherinsuranceavailabletoanadditionalinsuredunderyourpolicyprovidedthat:(1)TheadditionalinsuredisaNamedInsuredundersuchotherinsurance;and(2)Youhaveagreedinwritinginacontractoragreementthatthisinsurancewouldbeprimaryandwouldnotseekcontributionffomanyotherinsuranceavailabletotheadditionalinsured.CG20010413©InsuranceServicesOffice,lnc.2012PagelofI InthestateofVirginia,thepremiumchargeis5%ofthetotalmanualpremium,subjecttoaminimumpremiumof$250perpolicy.IssuedbyLibertyInsuranceCorporation21814ForattachmenttoPolicyNo.WJ-63D-510199-359EffectiveDatePremium$IssuedtoConcentraGroupHoldingParent,LLCWC000313©1983NationalCouncilonCompensatIonInsurance.Page2of2Ed.0410111984