HomeMy WebLinkAboutC11-393 Mountain Family Health CentersAGREEMENT BETWEEN EAGLE COUNTY AND MOUNTAIN FAMILY HEALTH CENTERS FOR THE PROVISION OF FAMILY PLANNING HEALTH CARE SERVICES This agreement ("Agreement") is entered into this95t-day of 111-;VIIIII%a� 201_, between Eagle County, Colorado ("County"),and Mountain Family Health Centers, a Colorado nonprofit corporation with its principal place of business at 1905 Blake Ave., Suite 101, Glenwood Springs, Colorado 81601 ("Contractor"). WITNESSETH: Whereas, the County, through its Department of Public Health, works to promote the health, safety and welfare of County residents of all ages; and Whereas, in order to promote such health, safety and welfare, the County encourages the provision of family planning health care services for County residents in need; and Whereas, the use of outside providers of such services enhances the ability of the County to promote such health, safety and welfare; and Whereas, Contractor is a provider of such a service and wishes to contract with County. Now, therefore,"in consideration of the foregoing premises and the following promises, County and Contractor enter into this Agreement. I: SCOPE A. In accordance with prevailing medical standards, Contractor shall perform vasectomies for clients of Eagle County Public Health Family Planning Clinic who are over the age of 21, have been referred to Contractor by County, agree to receive services from Contractor, and who have signed the consent for sterilization form attached hereto as Exhibit A ("Clients"). The vasectomy procedure covered under this Agreement shall include one pre-procedure consultation (exam), the vasectomy procedure (procedure), a post procedure sperm count, a post-procedure 3 month clinic visit and all associated lab work involved with the procedure. County is responsible for determining the eligibility of each Client. Contractor shall provide services for up to 13 Clients that are referred by the County during the term of this Agreement. B. Contractor shall not perform any vasectomies for Clients who have not properly signed the consent form attached hereto as Exhibit A. Contractor shall not obtain the consent of any Client who is under the influence of alcohol or other drugs, or who does not appear to be mentally competent. A 30 -day waiting period between the time of consent and the time of the procedure is required with no more than 180 days passing between the date of informed consent and the date that the vasectomy procedure is performed. If the physician performing the vasectomy procedure is not the person obtaining the Client's consent, then there should be an oral explanation of the procedure and its risks and benefits so that the client has been fully informed, understands the vasectomy procedure, and has freely given consent. C. Contractor shall submit monthly reports (See Section VI.F below), in addition to monthly invoices for payment accompanied by a signed consent form for each Client served. II: TERM This Agreement shall commence January 1, 2012 and shall terminate on June 30, 2012. III: COMPENSATION A. During the term of this Agreement, Eagle County will reimburse on a monthly basis Contractor for the costs associated with the vasectomy procedure, as identified above, in an amount not to exceed $625 for each Client served by Contractor. The vasectomy cost agreed upon herein shall include all surgery costs, anesthesia, facility costs, lab fees, one pre- procedure exam, the vasectomy procedure, one post-procedure sperm count and one post- procedure 3 -month clinic visit. Contractor may not charge Clients any additional cost for the services described above. All invoices must be accompanied by a copy of a signed consent for sterilization on the form attached hereto as Exhibit A; payment will not be made unless the County receives the required consent form. B. Contractor may bill County only for the specific services provided during the previous month and may not bill in advance for services not yet provided. County will reimburse Contractor on a monthly basis for Clients served during the previous month upon receipt of properly submitted invoices by Contractor. All lab fees must be concurrent with the Medicare reimbursement rate. C. Payment for any unexpected complications or additional visits or services beyond those described in Section I of this Agreement will not be the responsibility of County. Contractor should arrange directly with the Client for payment in the event of any such unexpected complications, additional visits or additional services. Unexpected complications include, but are not limited to, bleeding problems at the incision site or internally, infection on or near the suture of incision site, problems related to the use of anesthesia, and allergic reactions to drugs. D. The total cost of this Agreement shall not exceed $8,125 absent an amendment to this agreement signed by both parties. E. For reimbursement Contractor must submit invoices by the fifth business day of each month. Invoices shall include a description of services performed for each Client during the previous month. If County is not satisfied with the completeness of a submitted invoice, County may request Contractor to either revise the invoice or provide additional information. Fees will be paid within thirty (30) days of receipt of a proper and accurate invoice from Contractor for Contractor's Services. Billings for services provided through June 30, 2012 must be submitted by July 6, 2012, in order to be eligible for reimbursement. All invoices must be mailed or delivered in-person to the following address to ensure proper payment. Invoices sent by fax or email will not be accepted. Eagle County Health & Human Services Business Office 550 Broadway P.O. Box 660 Eagle, CO 81631 F. If, prior to payment of compensation, but after submission to County of a request therefore by Contractor, County reasonably determines that payment as requested would be improper because the services were not performed as prescribed by the provisions of this Agreement, the County shall have no obligation to make such payment. If, at any time after or during the Term or after termination of this Agreement as hereinafter provided or expiration of this Agreement, County reasonably determines that any payment theretofore paid by County to Contractor was improper because the services for which payment was made were not performed as prescribed by the provisions of this Agreement, then upon written notice of such determination and request for reimbursement from County, Contractor shall forthwith return such payment to County. Upon termination of this Agreement as hereinafter provided or expiration of the Term, any unexpended funds advanced by County to Contractor shall forthwith be returned to County. IV: PROHIBITIONS ON PUBLIC CONTRACT FOR SERVICES If Contractor has any employees or subcontractors, Contractor shall comply with C.R.S. § 8- 17.5-101, et seq., regarding Illegal Aliens — Public Contracts for Services, and this Contract. By execution of this Contract, Contractor certifies that it does not knowingly employ or contract with an illegal alien who will perform under this Contract and that Contractor will participate in the E -verify Program or other Department of Labor and Employment program ("Department Program") in order to confirm the eligibility of all employees who are newly hired for employment to perform work under this Contract. A. Contractor shall not: (i) Knowingly employ or contract with an illegal alien to perform work under this contract for services; or (ii) Enter into a contract with a subcontractor that fails to certify to the Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under the public contract for services. B. Contractor has confirmed the employment eligibility of all employees who are newly hired for employment to perform work under this Contract through participation in the E -verify Program or Department Program, as administered by the United States Department of Homeland Security. Information on applying for the E -verify program can be found at: http://www.dhs.lzov/xprevprot/programs/Rc 1185221678150.shtm C. The Contractor shall not use either the E -verify program or other Department Program procedures to undertake pre-employment screening of job applicants while the public contract for services is being performed. D. If the Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an illegal alien, the Contractor shall be required to: (i) Notify the subcontractor and the County within three days that the Contractor has actual knowledge that the subcontractor is employing or contracting with an illegal alien; and (ii) Terminate the subcontract with the subcontractor if within three days of receiving the notice required pursuant to subparagraph (i) of the paragraph (D) the subcontractor does not stop employing or contracting with the illegal alien; except that the Contractor shall not terminate the contract with the subcontractor if during such three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. E. The Contractor shall comply with any reasonable request by the Department of Labor and Employment made in the course of an investigation that the department is undertaking pursuant to its authority established in C.R.S. § 8- 17.5-102(5). F. If a Contractor violates these prohibitions, the County may terminate the contract for a breach of the contract. If the contract is so terminated specifically for a breach of this provision of this Contract, the Contractor shall be liable for actual and consequential damages to the County as required by law. G. The County will notify the office of the Colorado Secretary of State if Contractor violates this provision of this Contract and the County terminates the Contract for such breach. V. TERMINATION County may terminate this Agreement at any time and for any reason or no reason upon written notice to Contractor specifying the date of termination, which date shall be not less than ten (10) days from the date of the notice. In the event Contractor files for bankruptcy or is declared bankrupt or dissolves, County may declare in writing that this Agreement is terminated, and all rights of Contractor and obligations of County, except for payment of accrued but unpaid fees and expenses, shall terminate immediately. VI. CONTRACTOR'S DUTIES A. All funds received by Contractor under this Agreement shall be or have been expended solely for the purpose for which granted, and any funds not so expended, including funds lost or diverted for other purposes, shall be returned to County. B. Contractor shall maintain, for a minimum of 3 years, adequate financial and programmatic records for reporting to County on performance of its responsibilities hereunder. Contractor shall be subject to financial audit by federal, state or county auditors or their designees. Contractor authorizes County to perform audits or to make inspections during normal business hours, upon 48 hours notice to Contractor, for the purpose of evaluating performance under this Agreement. Contractor shall cooperate fully with authorized Public Health representatives in the observation and evaluation of the program and records. Contractor shall have the right to dispute any claims of misuse of funds and seek an amicable resolution with County. C. Contractor shall comply with all applicable federal, state and local rules, regulations and laws governing services of the kind provided by Contractor under this Agreement. D. Contractor shall assure that the service described herein is provided to the County at a cost not greater than that charged to other persons in the same community. E. Contractor shall safeguard information and confidentiality of all clients in accordance with rules of Eagle County Public Health, and the Health Information Privacy and Accountability Act. F. Contractor shall provide the County with a monthly report of services that includes: • Name of client • Client's date of birth Dates of service and service provided If client decided to cancel the procedure VII. NOTICE Any notice required under this Agreement shall be given in writing by registered or certified mail; return receipt requested which shall be addressed as follows: COUNTY: Eagle County Public Health Director PO Box 660 Eagle, CO 81631 (970) 328-8819 CONTRACTOR: Mountain Family Health Centers 1905 Blake Ave., Suite 101 Glenwood Springs, CO 81601 970-945-2840 Notice shall be deemed given three (3) days after the date of deposit in a regular depository of the United States Postal Service. VIII. ASSIGNMENT Contractor shall not assign any of its rights or duties under this Agreement to a third party without the prior written consent of County. County shall terminate this Agreement in the event of any assignment without its prior written consent of County. IX. MODIFICATION Any revision, amendment or modification of this Agreement shall be valid only if in writing and signed by all parties. X. INSURANCE Insurance Tyne • Workers' Compensation • Employers Liability, including Occupational Disease • Comprehensive General Liability, including • Professional Liability Insurance Coverage Minimums Statutory $500,000 $1,000,000 per occurrence, $2,000,0000 aggregate $1,000,000 per occurrence Contractor shall purchase and maintain such insurance as required above and shall provide certificates of insurance in a form acceptable to County upon execution of this Agreement. XI. MISCELLANEOUS A. The relationship of Contractor to County is that of independent contractor. No agent, employee or volunteer of Contractor shall be deemed to be an agent, employee or volunteer of County. B. In the event of litigation in connection with this Agreement, the prevailing party shall be entitled to recover all reasonable costs incurred, including attorney fees, costs, staff time and other claim related expense. C. Invalidity or unenforceability of any provision of this Agreement shall not affect the other provisions hereof, and this Agreement shall be construed as if such invalid or unenforceable provision was omitted. D. Contractor shall indemnify and hold harmless County, its Board of Commissioners, and the individual members thereof, its agencies, departments, officers, agents, employees, servants and its successors from any and all demands, losses, liabilities, claims or judgments, together with all costs and expenses incident thereto which may accrue against, be charged to or be recoverable from County, its Board of Commissioners, and the individual members thereof, its agencies, departments, officers, agents, employees, servants and its successors, as a result of the acts or omissions of Contractor, its employees or agents, in or in part pursuant to this Agreement or arising directly or indirectly out of Contractor's exercise of its privileges or performance of its obligations under this Agreement. E. Contractor shall comply at all times and in all respects with all applicable federal, state and local laws, resolutions, and codes. F. Notwithstanding anything to the contrary contained in this Agreement, County shall have no obligations under this Agreement after, nor shall any payments be made to Contractor in respect of any period after, August 31 st of the calendar year of the Term of this Agreement, without an appropriation therefore by County in accordance with a budget adopted by the Board of County Commissioners in compliance with the provisions of Article 25, Title 30 of the Colorado Revised Statutes, the Local Government Budget Law (C.R.S. §§ 29-1-101 et seq.) and the TABOR Amendment (Colorado Constitution, Article X, Sec. 20). G. This Agreement shall be governed by the laws of the State of Colorado. Jurisdiction and venue for any suit, right or cause of action arising under, or in connection with this Agreement shall be exclusive in Eagle County, Colorado. H. This Agreement supersedes all previous communications, negotiations and/or agreements between the respective parties hereto, either verbal or written, and the same not expressly contained herein are hereby withdrawn and annulled. This is an integrated agreement and there are no representations about any of the subject matter hereof except as expressly set forth in this Agreement. I. This Agreement does not, and shall not be deemed or construed to, confer upon or grant to any third party or parties any right to claim damages or to bring any suit, action or other proceeding against either Contractor or County because of any breach hereof or because of any of the terms, covenants, agreements and conditions herein. J. Contractor certifies that it has read the Agreement, understands each and every term and the requirements set forth herein, and agrees to comply with the same. // SIGNATURE PAGE TO FOLLOW // In Witness Whereof, County and Contractor have executed this Agreement in triplicate on the date set forth above. Two counterparts have been delivered to County and one to Contractor. COUNTY OF EAGLE, STATE OF COLORADO, By and through the Eagle County Manager Montag, Eagle County MOUNYAlWAMILY HEALTH CENTERS By:�a r� i Title: STATE OF COLORADO ) ) ss County of ) The fiqiFgoing was acknowledged before me this /V/kday of 20 I/ by v+� Witness my hand and official seal. 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Lalr lappa regnsedaa= IdiLgn mmreammml- dmlAlb an aalgim acoatmdo y gm eWd ro atl m emcees de am.doaegdtbettdtbprepmmrmdourn®pdocsladol mtI bdmmeL A s mepr adrm y m penoaa qs sure emetaVada las a b mmrw2tedmdeeb ilvdm mo rmmI I 'I If lleaYnlB. 9aldnano- roo.11eerlo y tlncpi3 sadomatel domtde amnm sella reataaaf m emmaml a slamsde3adladmptasde`lsfmana1qusapelw NwAaFbnmdo (�rawdmlmdopewla 6metf�ddaPawaas®.ttdloem pesb2gw speeerpa ms awfmaelaoAeamt tmxafpdtlela Qa rosepsgta► (1) Han tonommtldo per b auras 3o AN; sane w te.ita m m qua a pmama@MedaFanaadetcramu mleftydwrierstoquasrwrot Is aromas V li La opewolM paw w MINIU adM s Meso a almae All 30 dNR pea ataas de 72 cos, dwptme As at facia M et qm le pwm= Grata r Ferala de Imam undam damm aIn SU l� r mala epropleda y aearoat m9m ft): ❑ PeropwaaBM Fed* pod= ds Wit ❑ Clrupwaudommlde+apmltia{E1saf>mmdWoulmick": Fr—&t—o*o Amw rma.pm.rmmm s 10 EXHIBIT B PROOF OF INSURANCE (Certificate of insurance to be inserted as Exhibit B) 11 OP ID: DM ACORO' ��- CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDMYYY) 10/03/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 303-771-1800 f 2=f Omnivest Insurance Group303-290-0884 dba Peliton Insurance 4600 S. Ulster St. #1400 Denver, CO 80237 Eric H. Mohr, Inc. Override a�"E ac No: EMAIL PRODUCER cus D#• MOUNT08 INSURERS AFFORDING COVERAGE NAIC # EACH OCCURRENCE $ 1,000,00 INSURED Mountain Family Health Centers INSURERA: Hartford Insurance Co 22357 dba Columbine Family Health INSURER 13: Pinnacol Assurance 41190 Center Attn: Ms. Annette Franta, CFO. 1905 Blake Avenue #101 INSURER C: INSURER D: $ Glenwood Springs, CO 81601 INSURER E: LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS INSURER F CnVF0Af1_PC CERTIFICATE NI IMRFR- REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN B POLICY NUMBER MMI�� EFF MMIDD/ EXP LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 71 OCCUR `' 1 34SBAVT9917 10/03/11 10/03/12 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 300,00 MED EXP (Any one person) $ 10,00 PERSONAL &ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN.L AGGREGATE UMIT APPLIES PER: PRO LOC POLICY 7 JECT PRODUCTS -COMP/OPAGG $ 2,000,00 $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 34SBAVT9917 10/03/11 10/03/12 COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Peraccident) $ $ $ UMBRELLA LIAB EXCESS UAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION S $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILrrY ANY PROPRIETORIPARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N yes, describe under DESCRIPTION OF OPERATIONS below N I A 1461272 06/01/11 06/01/12 WC STA�UMTU- OTH- TS E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE -EA EMPLOYEE $ 500,00 E.L. DISEASE -POLICY LIMIT $ 500,00 A A Building BPP SSAVT9917 SBAVT9917 10/03/11 10/03111 10/03/12 10/03/12 $250 Ded see notin $250 Ded see note DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) CFRTIFICATF 14CAl r1RR CANCFI 1 ATIAN ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26 (2009/09) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Eagle County HHS POB 660 REPRESENyTATIVE AUTHORIZED � Eagle, CO 81631 `' 1 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26 (2009/09) The ACORD name and logo are registered marks of ACORD