HomeMy WebLinkAboutC12-390 Community Health Services Agreement AGREEMENT BETWEEN EAGLE COUNTY
AND COMMUNITY HEALTH SERVICES
FOR THE PROVISION OF PRENATAL HEALTH CARE SERVICES
This Agreement ( "Agreement ") dated as of this day of 20 f v, is
between the County of Eagle, State of Colorado, a body corporate and politic, by and through
its Board of County Commissioners ( "County "), with a mailing address of 500 Broadway,
Post Office Box 850, Eagle, CO 81631 and Community Health Services, Inc., a private non-
profit Colorado corporation with a mailing address of 0405 Castle Creek Road, Suite 6,
Aspen, CO 81611 ( "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, among the services County assures, in order to promote such health, safety and
welfare are prenatal health care services; 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.
AGREEMENT
NOW, THEREFORE, in consideration of the foregoing premises and the following promises,
County and Contractor enter into this Agreement.
I: SCOPE
A. Contractor shall provide timely prenatal health -care services, in accordance with
current ACOG medical standards, to low- income Eagle County residents from the Roaring
Fork Valley, with incomes at or below 185% of the federal poverty level who have been
referred to Contractor by County and agree to receive services from Contractor ( "Clients ").
These dollars shall be used solely to defray the cost of Contractor's provision of prenatal
services for to those Clients. County is responsible for the eligibility of each Client for
services, initializing the Medicaid application enrollment, and for maintaining files regarding
eligibility under the scope of this Agreement. Contractor shall provide services for 53
Clients, who are currently pregnant and have been referred by the County under this
Agreement. Contractor shall submit quarterly reports with numbers served and
demographics (See Section VI.F below), in addition to quarterly invoices for payment.
II: TERM
This Agreement shall commence on January 1, 2013, and shall terminate on December 31,
2013.
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III: COMPENSATION
A. During the term of this Agreement, Eagle County will pay to Contractor $550 for
each Client served by Contractor. County will reimburse Contractor on a quarterly basis for
Clients served during the previous quarter upon receipt of properly submitted invoices by
Contractor. The Contractor shall utilize these funds to offset the costs of the prenatal care
and care coordination services provided by the Contractor. Contractor shall be reimbursed
for services provided to Clients only after they have been deemed eligible by County.
County will not reimburse Contractor for services provided to Contractor's patients before
they are deemed eligible Clients by County. The total cost of this Agreement shall not
exceed $29,150, absent an amendment to this agreement signed by both parties.
B. For reimbursement Contractor must submit invoices by the fifth business day of each
quarter. Invoices shall include a description of services performed for each Client during the
previous quarter. 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 December 31,
2013 must be submitted by January 10, 2014, 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 Public Health
550 Broadway
P.O. Box 660
Eagle, CO 81631
C. 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.
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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.gov /xprevprot/programs /gc 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-
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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.
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F. Contractor shall provide the County with a quarterly report of services that includes:
• Name of client
• Client's date of birth
• Date of first service
• Due date
• Week of pregnancy at first visit as Client
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: CONTRACTOR:
Jennie Wahrer, Eagle County Public Health Contact: Liz Stark
PO Box 660 Community Health Services, Inc.
Eagle, CO 81631 0405 Castle Creek Road, Suite 6
(970) 328 -8819 Aspen, Colorado 81611
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.
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 Type Coverage Minimums
• Workers' Compensation Statutory
• Employers Liability, including $500,000
Occupational Disease
• Comprehensive General Liability, including $600,000 per occurrence or as specified
in
Broad Form Property Damage the Colorado Governmental Immunity
Act, whichever is greater
• Professional Liability Insurance $1,000,000 per occurrence
5
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 attorney fees, 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, December 31st 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.
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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.
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 ITS BOARD OF COUNTY
COMMISSIONERS
Peter F. Runyon, Chairman
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. ACORD,.. ,
CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDP YYY)
03/29/2012
PRODUCER - - - --
Pinnacol Assurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
7501 E Lowry Blvd AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Denver, CO 80230 -7006 CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
•
INSURERS AFFORDING COVERAGE NAIC#
INSURED INSURER A: Pinnacol Assurance 41190
Community Health Services, Inc.
0405 Castle Creek Road #6 INSURER B:
- Aspen, CO 81611 INSURER C:
INSURER a
INSURER E.
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDNG
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMMENT 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 ADD'L 1 I 1 POLICY EFFECTIVE POLICY EXPIRATION
LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM /OD/YYYY) DATE(MM/DD/YYYY) LIMITS
GENERAL LIABILITY EACH OCCURRENCE _
I COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED
CLAIMS MADE OCCUR PREMISES
MED EXP(Any one person)
PERSONAL 8 ADV INJURY
GEN'L AGGREGATE LIMIT APPLIERS PER: GENERAL AGGREGATE
•
POLICY n PROJECT n LOC PRODUCTS - COMP /OP AGG it
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
•
. ANY AUTO (Ea Accident)
1 ALL OWNED AUTOS - BODILY INJURY
SCHEDULED AUTOS (Per person)
. HIRED AUTOS BODILY INJURY
. NON -OWNED AUTOS (Per accident)
. PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY AUTO ONLY • EA ACCIDENT
. ANY AUTO OTHER THAN EA ACC
AUTO ONLY: AGG
EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE
. OCCUR _ CLAIMS MADE AGGREGATE
. DEDUCTIBLE •
RETENTION $
WORKERS COMPENSATION AND x WC STATU- OTHER
A EMPLOYER'S LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE 2190342 04/01/2012 04/01/2013 TORY LIMITS
OFFICER/MEMBER EXCLUDED? EL EACH ACCIDENT $100,000
E.L DISEASE- EA EMPLOYEE $100,000
If yes, pleasedescribe under SPECIAL PROVISIONS below
OTHER _ EL DISEASE - POLICY LIMIT $500,000
DESCRIPTION OF OPERATIONS /LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT /SPECIAL PROVISIONS
CERTIFICATE HOLDER CANCELLATION
1373746 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE COLORADO DEPARTMENT OF PUBLIC HEALTH AND THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
ENVIRONMENT MAIL 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE
4300 SOUTH CHERRY CREEK DRIVE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
Denver, CO 80246 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Ryan Roginson
ACORD 25(2001/08) Underwriter ACORD CORPORATION 1988
Print Date: 3/24/2012
HEALTHCARE PROVIDERS SERVICE
CNA ORGANIZATION PURCHASING GROUP
Certificate of iii itrance onso
nurses service organization"
OCCURENCE POLICY FORM
Producer Branch Prefix Policy Number Policy Period
018098 970 HPG 0265850879 from 04/29/12 to 04/29/13 at 12:01 AM Standard Time
Named Insured and Address: Program Administered by:
Community Health Services, Inc. Nurses Service Organization
405 Castle Creek Rd Ste 6 159 E. County Line Road
Aspen, CO 81611 -3125 Hatboro, PA 19040 -1218
1- 888 - 288 -3534
www.nso.com
Medical Specialty: Code: Insurance is provided by:
Nurse Practitioner Firm 80965 American Casualty Company of Reading, Pennsylvania
333 S. Wabash Avenue, Chicago, IL 60604
Excludes Cosmetic Procedures
Professional Liability $1,000,000 each claim $ 6,000,000 aggregate
Your professional liability limits shown above include the following:
* Good Samaritan Liability * Malplacement Liability * Personal Injury Liability
* Sexual Misconduct Included in the PL limit shown above subject to $ 25,000 aggregate sublimit
Coverage Extensions
License Protection $ 25,000 per proceeding $ 25,000 aggregate
Defendant Expense Benefit $ 1,000 per day limit $ 25,000 aggregate
Deposition Representation $ 10,000 per deposition $ 10,000 aggregate
Assault $ 25,000 per incident $ 25,000 aggregate
Includes Workplace Violence Counseling
Medical Payments $ 25,000 per person $ 100,000 aggregate
First Aid $ 10,000 per incident $ 10,000 aggregate
Damage to Property of Others $ 10,000 per incident $ 10,000 aggregate
Information Privacy (HIPAA) Fines and Penalties $ 25,000 per incident $ 25,000 aggregate
Workplace Liability
Workplace Liability Included in Professional Liability Limit shown above
Fire & Water Legal Liability Included in the PL limit shown above subject to $150,000 aggregate sublimit
Total: $ 4,323.00
Base Premium $4,323.00
Policy Forms & Endorsements(Please see attached list for a general description of many common policy forms and
endorsements.)
G- 121500 -D G- 121503 -C G- 121501 -C G- 145184 -A G- 147292 -A GSL15563
GSL15564 GSL15565 GSL17101 GSL13424 GSL13425 G- 123846 -0O5
GSL3886 GSL3908 GSL 5589 GSL19904
Keep this document in a safe place.lt
°I.eter‘4,4k4 ^ p and proof of payment are your proof of
� tiil• �JJ' "`! coverage. There is no coverage in force
unless the premium is paid in full.ln ordE
Chairman of the Board Secretary to activate your coverage, please remit
premium in full by the effective date of
this Certificate of Insurance.
Master Policy # 188711433
c_1A1od1 -1=2 mz»n1■ Coveraae Chanae Date: Endorsement Chance Date: 4/29/2012
• .
® DATE!MM,'DD'YYYY)
A� ° CERTIFICATE OF LIABILITY INSURANCE 04 -11 -2012
THIS CERTIFICATE'S 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 ADDITIONALINSURED, the policylies) must be endorsed. If SUBROGATIONIS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
HUB INTERNATIONAL INS SVCS INC /PHS PHONE FAX
IA NoExt): ( 866) 467 -8730 (AC,No): (877) 905 -0457
340887 P: (866)467 -8730 F: (877)905 -0457 E -MAIL '
PO BOX 33015 PRODUCER
SAN ANTONIO TX 78265 CUSTOMER ID k:
INSURER(S) AFFORDING COVERAGE NAIC k
INSURED INSURER A : Hartford Casualty Ins Co
INSURER B :
COMMUNITY HEALTH SERVICES
0405 CASTLE CREEK RD STE 6 INSURER C :
ASPEN CO 81611 INSURER D :
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS
INSR. • 4 LI •e I Y X• LIMITS
LTR - TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DDYYYY) (MM!DDNYYY)
GENERAL LIABILITY EACH OCCURRENCE $ 1, 0 0 0, 0 0 0
DAMAGE TO REN ID 5 3 0 0 0 0 0
COMMERCIAL GENERAL LIABILITY - PREMISES (Ea occurrence) ,
A CLAIMS -MADE X OCCUR MED EXP )Any one person) i$10,000
X ' General Liab X 34 SBA PA6360 04/23/2012 04/23/2013 PERSONAL & ADV INJURY $ 1, 000, 000
GENERAL AGGREGATE $ 2, 0 Q 0, 000
GEN'L AGGREGATE LIMIT APPLIES PER: ', PRODUCTS - COMP OP AGG $ 2 , 000 , 000
POLICY PE0T II. X LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
I--- (Ea accidents $ 1, 0 0 0, 0 0 0
ANY AUTO
BODILY INJURY Per person) ; $
ALL OWNED AUTOS
BODILY INJURY Per accident), $
SCHEDULED AUTOS
PROPERTY DAMAGE
A '',X' HIRED AUTOS 34 SBA PA6360 04 04/23/2013 $
!Per accident)
X, NON -OWNED AUTOS $
UMBRELLA LIAB - OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS -MADE AGGREGATE ; $
'_. DEDUCTIBLE $
RETENTION $ ' $
WORKERS COMPENSATION WC STATU OTH-
I AND EMPLOYERS' LIABILITY TORY LIMITS ER
Y'N
1 ANY PROPRIETOR PARTNER 'EXECUTIVE I N / A E.L. EACH ACCIDENT $
OFFICER :MEMBER EXCLUDED?
(Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $
If yes, describe under
DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Those usual to the Insured's Operations. State of Colorado is listed as
additional insured per the Business Liability Coverage Form SS0008. A
Business Liability Waiver of Subrogation applies to the certificate holder per
form SS0008, Waiver of Subrogation, attached to this policy.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
Colorado Department of Public Health BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
and Environment DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
4300 CHERRY CREEK DR S AUTHORIZREPRESENTATIVE t
DENVER, CO 80248 / /l ^i\--
1988 -2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
