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Home My WebLink AboutC14-114 Bright Future Foundation of Eagle County AGREEMENT BETWEEN EAGLE COUNTY AND BRIGHT FUTURE FOUNDATION OF EAGLE COUNTY This Agreement ("Agreement") is effective as of the. day of March and is between the County of Eagle, State of Colorado, a body corporate and politic,by and through its County Manager ("County"), and Bright Future Foundation of Eagle County, a Colorado non-profit corporation with a mailing address of PO Box 2558, Avon, CO 81620 ("Contractor"). WHEREAS, the County, through its Department of Health and Human Services ("HHS"), works to promote the health, safety and welfare of County residents of all ages; and WHEREAS, County provides various services to Eagle County residents in order to promote health, safety and welfare; and WHEREAS, the use of outside providers enhances the ability of County to promote such health, safety and welfare; and WHEREAS, County wishes to hire Contractor to perform the services outlined in Section 1.1 hereunder; and WHEREAS, County and Contractor intend by this Agreement to set forth the scope of the responsibilities of the Contractor in connection with the services and related terms and conditions to govern the relationship between Contractor and County in connection with the services. AGREEMENT NOW THEREFORE,based upon the representations by Contractor set forth in the foregoing recitals, for good and valuable consideration, including the promises set forth herein, the parties agree to the following: 1. Scope of Services: 1.1 The Contractor will provide the services more particularly set forth in the attached Exhibit "A" labeled Scope of Services (hereinafter called "Contractor's Services" or "Services") incorporated herein by reference. The Contractor's Services are generally described as providing individual and family counseling for Child Welfare clients to prevent unnecessary placement of children and youth in out-of-home care, support family preservation, and assist in family reunification. 1.2 Any revision, amendment or modification of this Agreement shall be valid only if in writing and signed by all parties. Except as may be expressly altered by the amendment, all terms and conditions of this Agreement shall control. To the extent the terms and conditions of this Agreement may conflict with Exhibit "A" or any future exhibits or amendments, the terms and conditions of this Agreement shall control. 1.3 The Contractor agrees that Contractor will not knowingly enter into any arrangenpent with third parties that will conflict in any manner with this Agreement. 1.4 Contractor has given the County a proposal for performing the Services and represented that it has the expertise and personnel necessary to properly and timely perform the Services. 2. Term of Agreement: 2.1 This Agreement shall commence on the agreement date first above written and, subject to the provisions of Section 2.2 hereof, shall continue in full force and effect until May 31, 2015. 2F2 This Agreement may be terminated by either party for any reason with 15 days written notice, with or without cause, and without penalty. In the event the 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 payment of accrued but unpaid fees set forth in Section 2.3 hereof, shall terminate immediately. 2�3 In the event of any termination of this Agreement, Contractor shall be compensated for all hours of work then satisfactorily completed. 3. Independent.Contractor: 3.1 With respect to the provision of the Contractor's Services hereunder, Contractor acknowledges that Contractor is an independent contractor providing Contractor's services to the County. Nothing in this Agreement shall be deemed to make Contractor an agent, employee, partner o�r representative of County. 32 The Contractor shall not have the authority to, and will not make any commitments or enter into any agreement with any party on behalf of County without the written consent of the Board of County Commissioners. 3,3 The Contractor and its employees are not entitled to workers' compensation benefits through the County. The Contractor is solely responsible for necessary and adequate workers' compensation insurance and shall be responsible for withholding and paying all federal and state taxes. The Contractor and its employees are not entitled to unemployment insurance benefits unless unemployment compensation coverage is provided by an entity other than the County. The Contractor hereby acknowledges full and complete liability for and timely payment of all local, state and federal taxes imposed including, without limitation, tax on self-employment income, unemployment taxes and income taxes. 4. Compensation: 4.1 For the Contractor's Services provided hereunder, County shall pay to the Contractor a fee as set forth in the attached Exhibit "A." Contractor will not be entitled to bill at overtime,and/or double time rates for work done outside normal business hours unless 2 • specifically authorized to do so by County. In no event shall fees or compensation under this Agreement exceed fifteen thousand dollars ($15,000). Fees for any additional services will be as set forth in an executed addendum between the parties. 4.2 For reimbursement Contractor must submit invoices by the fifth business day of each month. Invoices shall include a description of services performed. 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 to explain the insufficiency of the invoice. Fees will be paid within thirty (30) days of receipt of a proper and accurate invoice from Contractor for Contractor's Services. 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 4.3 If, prior to payment of compensation or reimbursement for services 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 set forth herein or expiration of the Term, any unexpended funds advanced by County to Contractor shall forthwith be returned to County. 4.4 Notwithstanding anything to the contrary contained in this Agreement, no charges shall be made to the County nor shall any payment be made to the Contractor in excess of the amount for any work done in respect of any period after December 31st of the calendar year of the Term of this Agreement, without the written approval 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). 5. Indemnification: The Contractor shall indemnify and hold harmless County and any of its officers, agents and employees against any losses, claims, damages or liabilities for which County or any of its officers, agents, or employees may become subject to, insofar as any such losses, claims, damages or liabilities arise out of, directly or indirectly, this Agreement, or are based upon any 3 performance or nonperformance by Contractor or any of its subcontractors hereunder; and Contractor shall reimburse County for any and all attorney fees and costs, legal and other expenses incurred by County in connection with investigating or defending any such loss, claim, damage, liability or action. This indemnification shall not apply to claims by third parties against a County to the extent that the County is liable to such third party for such claims without egard to the involvement of the Contractor. 6. Contractor's Professional Level of Care and Additional Duties: 6.1 In rendering its services hereunder, Contractor shall comply with the highest standards of customer service to the public. Contractor shall provide appropriate supervision of its employees to ensure the maintenance of these high standards of customer service and professionalism, the performance of such obligation to be determined at the sole discretion of County. In the event that County finds these standards of customer service are not being met by Contractor, County may terminate this Agreement, in whole or in part, upon ten (10) days notice to the Contractor. 6.2 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. Contractor shall provide the County with progress reports upon County's request; or Contractor shall furnish progress reports as more specifically set forth in the attached Exhibit "A". 63 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 HHS 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. 6,4 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. Contractor shall be solely responsible for ensuring proper licensing and credentitling of those providing services under this Agreement. 6,5 Contractor shall comply with the requirements of the Civil Rights Act of 1964 and Section 504, Rehabilitation Act of 1973, concerning discrimination on the basis of race, color, sei, age, religion, political beliefs, national origin, or handicap. 7. 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: 4 COUNTY: CONTRACTOR: Eagle County Health & Human Services Bright Future Foundation Toni Rozanski Casey Wolfington, Psy.D. P.O. Box 660 PO Box 2558 Eagle, CO 81631 Avon, CO 81620 970-328-8852 970-949-7097 casey@mybrightfuture.org 8. Insurance: 8.1 At all times during the term of this Agreement Contractor shall maintain in full force and effect the following insurance: Insurance Type Coverage Minimums • Workers' Compensation Statutory • Employers Liability, including $1,000,000 Occupational Disease • Comprehensive General Liability, including $1,000,000 per occurrence or as specified in Broad Form Property Damage the Colorado Governmental Immunity Act, whichever is greater. This policy shall be endorsed to include coverage of physical/sexual abuse and molestation. • Professional Liability Insurance $1,000,000 per occurrence • Third party fidelity/crime coverage The policy shall name Eagle County and including coverage for theft and Eagle County's clients as loss payee as their mysterious disappearance. Interests may appear. 8.2 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. Contractor shall name Eagle County, is elected officials and employees as an additional insured under the general liability policy. A certificate reflecting the foregoing insurance shall be attached hereto and incorporated herein as Exhibit C. 9. Non-Assignment and Subcontractors: Contractor shall not assign this Agreement or employ any subcontractor without the prior written approval of the County Representative, who is designated in Section 7 of this Agreement. The Contractor shall be responsible for the acts and omissions of its agents, employees and sub- contractors. The Contractor shall bind each subcontractor to the terms of this Agreement. The County may terminate this Agreement, if the Contractor assigns or subcontracts this Agreement 5 without the prior written consent from the County, and any such assignment or subcontracting shall be a.material breach of this Agreement. 10. Jirisdiction and Confidentiality: 10.1 This Agreement shall be interpreted in accordance with the laws of the State of Colorado and the parties hereby agree to submit to the jurisdiction of the courts thereof. Venue shall be in the Fifth Judicial District for the State of Colorado. 10.2 The Contractor and County acknowledge that,during the term of this Agreement and in the course of the Contractor rendering the Contractor's Services,the Contractor and County may acquire knowledge of the business operations of the other party not generally known and deemed confidential. The parties shall not disclose,use,publish or otherwise reveal,either directly or through another,tp any person,firm or corporation,any such confidential knowledge or information and shall retain all knowledge and information which he has acquired as the result of this Agreement in trust in a fiduciary capacity for the sole benefit of the other party during the term of this Agreement,and for a period of five(5)years following termination of this Agreement. Any such information must be marked as confidential. The parties recognize that the County is subject to the Colorado Open Records Act and nothing herein shall preclude a release of information that is subject to the same. 11. Miscellaneous: 11.1 This Agreement constitutes the entire Agreement between the parties related to its subject matter. It supersedes all prior proposals, agreements and understandings, either verbal or written. 11.2 This Agreement does not and shall not be deemed to confer upon or grant to any third party any right enforceable at law or equity arising out of any term, covenant, or condition herein or the breach hereof. 11.3 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. 12. Prohibitions on Public Contract for Services: Iff 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 illlegal 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 6 (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 (3) 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 (3) days of receiving the notice required pursuant to subparagraph (i) of 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. II SIGNATURE PAGE TO FOLLOW// 7 IN WITNESS WHEREOF, the parties hereto have executed this Agreement the day and year first above written. COUNTY OF EAGLE, STATE OF COLORADO By and through its County Manager By: _ Montag, County Manager CONTRACTOR: Bright Future Foundation of Eagle County, a Colorado non-profit corporation By: AL , Casey Wolfington, Psy40., Clinical Director Bright Future Foundat . 8 EXHIBIT A SCOPE OF SERVICES, PAYMENT& FEE SCHEDULE Description of Services: Provide individual and family counseling for child welfare clients to prevent unnecessary placement of children and youth in out-of-home care, support family preservation, and assist in family reunification. Services will include bilingual intensive family therapy services, bilingual parent education and support services, bilingual recreational/ therapeutic therapy for children, bilingual sexual abuse treatment services and bilingual domestic violence treatment services. Additional Provisions: 1. Assessments and Planning. Contractor shall provide the County with an assessment and plan within thirty (30) days of enrollment or participation in services by a family or child. This plan shall include the treatment plan for the child's family, including specific objectives and target dates for accomplishment. Such plan shall be subject to review and approval by County. Thereafter, at monthly intervals, Contractor shall submit reports that include progress and barriers in achieving the goals and provisions of the treatment plan. Reimbursement for services relating to the plan is subject to the timely receipt of written assessment, plan, and reports. 2. Eligibility. County is responsible for determining the eligibility of each individual family for services under this agreement. County shall advise Contractor in writing of the authorized service plan within three (3) working days of receipt of the certification and service plan (Exhibit B). There shall be no payment for services provided without prior authorization for such services by the County. Such authorization shall include the level of services to be provided,the nature and type of services provided and the time frames in which these services are to be provided. 3. Mandatory Reporting. Contractor shall notify HHS immediately of all reports of suspected child abuse or neglect involving Contractor, including, but not limited to, employees, volunteers and clients. HHS contractors are considered to be mandatory reporters for suspected child abuse and neglect and are to make those reports directly to the Eagle County Child Abuse and Neglect Hotline, 970-328-7720. Payment and Fee Schedule: County will compensate Contractor for performance of services as follows: (1) Face to face contact with clients for individual and family counseling-$75 per hour for In Office services, $85 per hour for In Office specialized/bilingual Services; (2) Face to face contact with clients for parenting education and support services-$75 per hour for In Office parent coaching services, $85 per hour for In Office bilingual parenting coaching services; -$45 9 per hour{for In Office parenting life skills services, $55 per hour for In Office bilingual parenting life skillsiservices; (3) Face to face contact with clients for behavioral coaching-$75 per hour for In Office services, $85 per hour for In Office bilingual services; $45 per hour for In Office life skills for youth services, $55 per hour for In Office bilingual life skills for youth services; (4) Face to face contact with clients for sexual abuse treatment services-$80 per hour for In Office individual and family counseling services, $90 per hour for In Office bilingual individual and family counseling services, $45 per hour for In Office group counseling services, $55 per hour for In Office bilingual group counseling services; (5) Face to face contact for domestic violence treatment services-$75 per hour for In Office individual and family counseling services, $85 per hour for In Office bilingual individual and family counseling services, $45 per hour for In Office group counseling services, $55 per hour for In Office bilingual group counseling services. (6) Case management services-$35 per hour including travel to and from a client family home to perform services or participating in case conferences. The maximum contract amount is not to exceed $15,000. 10 Exhibit B Eagle County Health&Human Services Authorization for Services Household#: 19- Case Name: Service Provider: Telephone#: Family's Mailing Address: Dates of Service: / Family's Physical Address: Start End Family Information Father Mother Child Child Child Child Child Family Members Date of Birth Household Suffix 01 02 03 04 05 06 07 State ID# Social Security# Types of Services Requested Please Check[4]Which Family Members Will Receive Services Indicated Suffix 01 02 03 04 05 06 07 Family Communication Individual Parenting Skills Intensive Family/Individual Therapy Group Services Substance Abuse Evaluation Substance Abuse Treatment (Specified) Sexual Abuse Treatment Day Treatment Psychological Evaluation Psychiatric Evaluation Parent-Child Interact ional Other (Specified) Comments Total Number of Units Approved(1 unit=1 hour): Payment Method EHS Core TANF Child Welfare CWMH Core:Human Service Other Progress Reports Required Monthly Not Required Case Manager: Telephone#: Date Manager: Telephone#: Date Bills must be submitted by the 5th of the month.Mail to HHS,P.O.Box 660,Eagle,CO 81631 HHS Business Office Total Obligation: Date Entered: Service Dates Service Amounts Date Paid Obligation Balance 11 EXHIBIT C INSURANCE CERTIFICATE (Certificate of insurance to be inserted as Exhibit C) 12 This Declarations Page is attached to and forms part of evidence provisions(Form LMA 3031 01/03/06) Allied Health Professional and Supplemental Liability Policy for Specified Members of the National Professional Purchasing Group Association,Inc. CLAIMS MADE DECLARATIONS NOTICE: COVERAGE A.-PROFESSIONAL LIABILITY APPLIES ON A CLAIMS MADE BASIS. COVERAGE A.APPLIES TO THOSE CLAIMS FIRST MADE AGAINST AN INSURED AND REPORTED TO US DURING THE POLICY TERM OR ANY EXTENDED REPORTING PERIOD. AMOUNTS INCURRED FOR LEGAL DEFENSE SHALL REDUCE THE LIMIT OF LIABILITY AVAILABLE TO PAY. JUDGEMENTS OR SETTLEMENTS UNDER COVERGE A. Certificate Number: 120-1006538 Issued by: Certain Underwriter's at Lloyd's,London Authority Ref.No.: GLOPR1000702 Named Insured Member and Address: Policy Term: Jennifer Richert Effective Date: 07/22/2013 P.O.Box 1072 Expiration Date: 07/22/2014 Edwards,CO 81632 12:01 AM Standard Time at the address of the Named Insured Professional Liability Retroactive Date: 07/22/2013 Coverage provided through master Certificate issued to: National Professional Purchasing Group Association,Inc. Business Entity: N/A Lockton Risk Services,Inc. Professional Services: NBCC Mental Health Counselor 333 W.Wacker Dr. #300 Affiliation: National Board of Certified Counselors Chicago,Il 60606 NOTE: THIS IS A CLAIMS MADE POLICY FOR COVERAGE A. PLEASE READ YOUR POLICY CAREFULLY COVERAGE LIMITS PREMIUM Coverage A.: Professional Liability and . $250,000 Each Professional $500,000 Aggregate Personal and Advertising Injury Incident or Offense Coverage B.: Supplemental Liability $250,000 Each Occurrence $500,000 Aggregate General Liability (Included) Host Liquor Liability (Included) Fire/Water Damage Legal $ 100,000 Each Occurrence Liability (Included) Coverage C.: Medical Expenses Coverage $ 2,000 Each Person $ 50,000 Aggregate Coverage D.Additional Payments: Defendants Reimbursement $ 10,000 Each Professional $ 500 Each Day Incident,Offense or Occurrence Deposition Fees and Expenses $ 5,000 Each Deposition $ 25,000 Aggregate Damage to Property of Others $ 500 Each Occurrence $ 5,000 Aggregate Deductible: $2,500 per claim Total Annual Policy Premium $ 34.00 35%minimum earned premium applies In the event of a claim,notice should be sent to: Lockton Companies, Inc. P.O.Box 410679 Kansas City,MO 64114-0679 Forms and Endorsements Attached at Certificate Issuance: AIF 26101L(06/05),LMA 3031 (01/03/06),AIF2610(06-05),LSW1135B (06/03),AIF 2610 B(07/03),LMA 5020(14/09/2005),NMA 1256(3-17-60), NMA 1477,NMA 464,AlF2657(10/05),NMA 2962(06/02/03),AIF 2610 0 (01/08),AIF 2610 Q(09-04),AIF 2610 R(09/04),CG2173010,IL0985010 - AIF 2610-IL Dec(06/05) Authorized Signature Psychologists Professional Liability ACE American Insurance Company Claims Made Insurance Policy Declarations PRODUCER NUMBER 273865 DATE OF ISSUE July 31,2013 PSYCHOLOGISTS' PROFESSIONAL LIABILITY CLAIMS MADE INSURANCE POLICY THIS POLICY/CERTIFICATE IS ISSUED IN ASSOCIATION WITH THE PSYCHOLOGISTS PURCHASING GROUP ASSOCIATION Item POLICY/CERTIFICATE NUMBER: 58G2275631A Named Insured: Casey Wolfington 1. Address: Po Box 757 City, State &Zip Code: Edwards, CO 81632 0757 2. Policy Period: From: 09/20/2013 To: 09/20/2014 12:01 A.M.local time at the address shown in Item 1. 3. COVERAGE LIMITS OF LIABILITY PREMIUM Professional Liability $1,000,000 Each Incident $3,000,000 Aggregate Wrongful Employment $5,000 Aggregate $1,165.00 Practices REIMBURSEMENTS Licensing Board Defense $5,000 per Proceeding Other Governmental Regulatory $5,000 per Proceeding Body Defense Deposition Expense $5,000 per Insured Premises Medical Payment $2,500 per Person $75,000 Aggregate Assault and/or Battery $1,000 Aggregate Loss of Earnings $500 per Day, per Insured $15,000 Aggregate Per Incident Surcharge(s) Total Premium $1,165.00 4. Retroactive Date 09/20/2008 5. This policy is made and accepted subject to the printed conditions in this policy together with the provisions, stipulations and agreements contained in the following form(s)or endorsement(s). PF15215a, PF33748, PF15217a(05/07), CC-1K11g(01/11), PF15245a, PF15224a,ALL22368 , PF15742a, PF17914(02/05), 6 Notice of claim should be sent to: All other correspondence should be sent to: Trust Risk Management Services,Inc. Trust Risk Management Services, Inc. 181 W Madison St Ste 2900 1791 Paysphere Circle Chicago, IL 60602 Chicago, IL 60674 7. REPRESENTATIVE: Agent or broker: Trust Risk Management Services,Inc. doing business in CO as Potomac Risk Management Services,Inc. Office address: 1791 Paysphere Circle City, State,Zip Chicago, IL 60674 Website: www.apait.org Phone: 1.877.637.9700 - PF-15215a(04/07) ©2007 The Trust • ��...,N BRIGFUT-01 GROW A`.°RE CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) 10/10/2013 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 CONTACT NAME: Colorado Nonprofit Insurance Agency PHONE lac,Nei:(303)894-0161 789 Sherman Street, (ac,No,E,u:(303)894-0298 Suite 260 E-MAIL Denver,CO 80203 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL If INSURER A:Alliance of Nonprofits for Ins INSURED INSURER B:Pinnacol Assurance Bright Future Foundation for Eagle County INSURER C:North American Elite PO Box 2558 INSURER D: Avon,CO 81620 INSURER E: _INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR )MID POLICY NUMBER 1MM/DD/YYYYLJMM/DDIYYYYL LIMITS GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 A X COMMERCIAL GENERAL LIABILITY X 2013-09907 9/20/2013 9/20/2014 DAMAGE TO RENTED PREMISES(Ea oaurtence) s 500,000 CLAIMS-MADE (X �OCCUR MED EXP(Any one person) _ $ 20,000 ---- PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG_ S 2,000,000 POLICY PRO" I ILO LIQUOR LIABILIT $ 1,000,000 JECT C AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) S A _ ANY AUTO 2013-09907-LIMB 9/20/2013 9/20/2014 BODILY INJURY(Per person) S ALL OWNED —SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) S HIRED AUTOS N�OgWNED PROPERTY DAMAGE $ — (Per accident) S X UMBRELLA UAB X OCCUR EACH OCCURRENCE S 1,000,000 A EXCESS LIAB CLAIMS-MADE 2013-09907-LIMB 9/20/2013 9/20/2014 AGGREGATE _ S DED X RETENTIONS 10,000 _ S WORKERS COMPENSATION I WC STATU- I0TH- AND EMPLOYERS'LIABILITY TORY LIMITS ER B ANY PROPRIETOR/PARTNER/EXECUTIVEY/N 3061556 10/1/2013 10/1/2014 EL EACH ACCIDENT S 100,000 OFFICER/MEMBER EXCLUDED? f j N I A (Mandatory In NH) E L DISEASE-EA EMPLOYEE S 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT S 500,000 C Commercial Property CWB0000024-12 9/20/2013 9/20/2014 BPP @ Loc 3-Avon,CO 45,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Addttlenal Remarks Schedule,If more apace Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Eagle County Health&Human Services THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Bob Morris ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 660 Eagle,CO 81631 AUTHORIZED REPRESENTATIVE 1tiZ.r. L' ®1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD • Certificate of Insurance (Proof of Coverage) Date Issued: 08/02/2013 THIS IS A CLAIMS MADE POLICY. NOTICE:A LOWER LIMIT OF LIABILITY APPLIES TO JUDGEMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS OF SEXUAL MISCONDUCT(SEE POLICY FOR DETAILS). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND,OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Insured Name and Mailing Address* Program Administrator Sheri Mintz Underwritten By: PO Box 4217 NASW Risk Retention Group,Inc Edwards,CO 81632 Administrative office:50 Citizen's Way,Suite 304 Frederick,MD 21701 Administered By: *Additional insured locations are often requested by individual business owners who CPH and Associates have more than one office. Your coverage is portable,meaning that you are covered at 711 S.Dearborn,Suite 205 any location for practice under the occupation(s)listed on your policy. Chicago,IL 60605 P.312-987-9823 F.312-987-0902 sw @cphins.com Coverage Policy#:SW-ES23908 Effective Date:08/02/2013 Expiration Date:08/02/2014 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits of Liability Coverage Part PER CLAIM(Per Individual claim) AGGREGATE(Total amount per policy year) $2,000,000.00 $4,000,000.00 Professional Liability $2,000,000.00 $4,000,000.00 Supplemental Liability $5,000 per Deposition $35,000 Per Policy Period Deposition Expense Coverage $35,000 $35,000 State Licensing Board Investigation Defense $15,000 $15,000 Emergency First Aid $25,000 $25,000 Health Information-HIPAA $15,000 $15,000 First Party Assault $5,000 per incident $50,000 Medical Payments $1,000 per day $35,000 per policy period Wage Loss and Expense Description/Special Provisions:The NASW Risk Retention Group supports this policy with its full faith,credit,and assets,and this Insurance policy Is reinsured with Lloyd's,London.THIS POLICY IS ISSUED BY YOUR RISK RETENTION GROUP.YOUR RISK RETENTION GROUP MAY NOT BE SUBJECT TO ALL OF THE INSURANCE LAWS AND REGULATIONS OF YOUR STATE.STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE FOR YOUR RISK RETENTION GROUP. Certificate Holder Cancellation Proof of Coverage Should any of the above described policies be cancelled before the expiration date thereof,notice will be delivered in accordance with the policy provisions. Holder has also been added to the policy as an additional Authorized Representative insured:** Yes/X No **If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed.A statement on this certificate does not confer rights (+ 9114 to the certificate holder in lieu of such endorsement(s). C.Philip Hodson,President DISCLAIMER:The Certificate of Insurance does not constitute a contract between the issuing insurer(s),authorized representative or producer,and the certificate holder,nor does It affirmatively or negatively amend,extend,or alter the coverage afforded by the policies listed thereon.