HomeMy WebLinkAboutC15-074 Colorado Mountain Medical, P.C. AGREEMENT BETWEEN EAGLE COUNTY,COLORADO AND COLORADO MOUNTAIN MEDICAL,P.C. FOR MEDICAL DIRECTOR SERVICES THIS AGREEMENT("Agreement")executed this,6 day of January,2015 and effective as of January 1, 2015,by and between Colorado Mountain Medical,P.C.,a Colorado corporation(hereinafter "Contractor")and Eagle County,Colorado,a body corporate and politic(hereinafter"County"). RECITALS WHEREAS,the County,through its Department of Public Health and Environment("PH")works to promote the health, safety and welfare of County residents of all ages;and WHEREAS,the County uses outside providers and professionals to enhance the ability of County to promote such health,safety and welfare;and WHEREAS,Contractor employs a team of primary care physicians,specialists and other practitioners with offices in Vail,Eagle and Edwards,Colorado;and WHEREAS,Contractor employs Kent Petrie,M.D.who is licensed to practice medicine in the State of Colorado, is a resident of Eagle County and has the time,skill,expertise,and experience necessary to provide the Services; and WHEREAS,County desires to appoint Dr.Kent Petrie as Eagle County Public Health Medical Director to perform the Services defined below in paragraph 3;and WHEREAS,this Agreement shall govern the relationship between Contractor and County in connection with the Services. AGREEMENT NOW, THEREFORE, in consideration of the foregoing and the following promises Contractor and County agree as follows: 1. Appointment. Until further order of the Board, County hereby appoints Kent Petrie,M.D. as Eagle County Public Health Medical Director to provide the services required of Contractor hereunder. In the event that Dr. Petrie is unavailable to provide Medical Director Services as requested by County, County may either (a) approve of another Physician employed or retained by Contractor to render such services; or (b) elect to contract for the services of a Physician not employed or retained by Contractor. In the former event, such Physician must be specifically approved in writing by County prior to the rendering of such services. The County may revoke its approval of a Physician at any time by written notice of such revocation to Contractor. • The term "Physician" as used herein shall mean any physician employed or otherwise retained by Contractor and approved by County to furnish services pursuant to this Agreement. County may revoke its approval of a Physician at any time by written notice of such revocation to Contractor. The services of a Physician hereunder may be requested and activated by the Board of County Commissioners, County Manager,Public Health Director,Environmental Health Director,or Human Services Director. 2. Licensure and Staff Membership. Contractor warrants that any Physician performing services for County under this Agreement shall (a) at all times hold a currently valid and unlimited license to practice medicine in the State of Colorado; and(b)apply for,be awarded and maintain in good standing membership on the medical staff of Contractor with appropriate and unrestricted privileges, or receive and maintain temporary privileges,all in accordance with Contractor's policies. Per Colorado State Board of Nursing requirements, collaborative agreements will be put into place to designate prescriptive authority relationships between all of County's Advance Practice Nurses and Dr.Petrie. 3. Physician Responsibilities/Services.Contractor shall ensure that the Physician provides the following services upon request: (a)Medical consultation on topics including,but not limited to,communicable disease control, immunizations,indigent health care,screening programs and any other health service provided by the County; (b)Communication with and dissemination of information regarding health care needs and issues to private health care providers in coordination with Public Health through the County's Health Alert Network; (c)Consultation with Environmental Health Department,including evaluation of sanitary standards and abatement of nuisances,and approving cease and desist orders; (d)Consultation with the Public Health Director on issues that impact the public's health,as well as both preparedness and response for public health emergencies; (e)Consultation to the Board of County Commissioners,Emergency Management,Environmental Health,and Human Services,including participation in Board of Health meetings; (f)Provision of written reports and recommendations regarding public health issues,upon reasonable request; 2 Eagle County HHS Prof Sery Final 5/14 (g)Participation in training in the areas of emergency management,public health services and regulations,and child abuse and neglect reporting; (h)Oversight of County's Advance Practice Nurses with regard to the prescriptive authority provided them for program areas such as tuberculosis treatment,STD treatments,fluoride varnish,and other program areas identified by the parties; (i)Oversight of Eagle County's Title X Family Planning program to include: (a)Medical consultation on family-planning health services provided by the County; (b)Clinical supervision of the Title X Program and Title X Program staff; (c)Medical oversight of County's Advance Practice Nurses with regard to the prescriptive authority provided them for program,and other program areas identified by the parties; (d)Familiarity with the Family Planning Title X medical guidelines as outlined in the Family Planning Title X Nursing Manual and agrees to follow them; (e)Review and approval(via signature)of appropriate Colorado Department of Public Health and Environment(CDHPE)Family Planning Program policies and protocols which have been written and approved by the Medical Policy advisory Committee (MedPAC); (f)Review and co-sign ten percent(10%)of Family Planning client charts for the purpose of quality assurance. (j)Represent public health on identified community work groups or committees;and The parties anticipate that the time required of the Physician in the provision of such services under this Agreement will not exceed a total of one hundred thirty two(132)hours per calendar year.The services shall be performed in accordance with the provisions and conditions of this Agreement. 4. Requirements. In the provision of services hereunder,Contractor and Physician shall do the following: 3 Eagle County HHS Prof Sery Final 5/14 (a)Safeguard protected health information of individuals and the confidentiality of situations for which Physician's consultation is requested,in accordance with the rules of Public Health and the Health Information Portability and Accountability Act. (b)Abide by the applicable provisions of County Media Policy;all media contacts to Physician in the role of Medical Director for the County are to be reported to the Public Health Director,who will coordinate with the County Administrator,the County Attorney and the County Communications Director in providing appropriate responses to such media contacts. (c)Comply with appropriate standards of customer service to the public and provide appropriate consultation in the development and implementation of Public Health protocols to promote the maintenance of high standards of customer service and professionalism. (d)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,sex,age,religion,national origin, or handicap. (e)Notify immediately Human Services,at(970)328-8840,of all reports of suspected child or adult abuse or neglect made to or observed by or otherwise coming to the attention of Physician. Comply with all applicable laws,resolutions,and codes of County, State of Colorado,or the (f) p Y �P � tY, , federal government. 5. County's Representative. The Public Health Department's designee shall be Contractor's contact with respect to this Agreement and performance of the Services. 6. Term of the Agreement. This Agreement shall commence upon January 1,2015,and subject to the provisions of paragraph 14 hereof,shall continue in full force and effect until further order of the Board. However, in no case shall the term of this Agreement extend beyond December 31,2015. 7. Extension or Modification. This Agreement may not be amended or supplemented,nor may any obligations hereunder be waived,except by agreement signed by both parties. No additional services or work performed by Contractor shall be the basis for additional compensation unless and until Contractor has obtained written authorization and acknowledgement by County for such additional services in accordance with County's internal policies. Accordingly,no course of conduct or dealings between the parties,nor verbal change orders,express or implied acceptance of alterations or additions to the Services, and no claim that County has been unjustly enriched by any additional services,whether or not there is in fact any such unjust enrichment, shall be the basis of any increase in the compensation payable hereunder. In the event that written authorization and acknowledgment by County for such additional services is not 4 Eagle County HHS Prof Sery Final 5/14 • timely executed and issued in strict accordance with this Agreement,Contractor's rights with respect to such additional services shall be deemed waived and such failure shall result in non-payment for such additional services or work performed. 8. Compensation. As the sole source of compensation to the Contractor hereunder, County shall pay Contractor the flat rate of$1,000.00 per month ($12,000.00 per year). The total cost to the County for Medical Director Services shall not exceed $12,000.00, absent an amendment to this agreement signed by both parties. a. For reimbursement Contractor must submit invoices monthly. 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. Payment will be made for Services satisfactorily performed within thirty(30)days of receipt of a proper and accurate invoice. All invoices shall include detail regarding the hours spent,tasks performed,who performed each task and such other detail as County may request. All invoices may be mailed or delivered in-person to the following address to ensure proper payment. Invoices may also be securely emailed to hhsaccountspavable @eaglecountv.us. Eagle County Public Health 551 Broadway P.O.Box 660 Eagle,CO 81631 b. Any out-of-pocket expenses to be incurred by Contractor and reimbursed by County shall be identified on Exhibit A. Out-of-pocket expenses will be reimbursed without any additional mark-up thereon and are included in the not to exceed contract amount set forth above. Out-of-pocket expenses shall not include any payment of salaries,bonuses or other compensation to personnel of Contractor. Contractor shall not be reimbursed for expenses that are not set forth on Exhibit A unless specifically approved in writing by County. c. 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 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 set forth in this Agreement,then upon written notice of such determination and request for reimbursement from County,Contractor shall forthwith return such payment(s)to County. Upon termination or expiration of this Agreement,unexpended funds advanced by County, if any, shall forthwith be returned to County. d. 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 5 Eagle County HHS Prof Sery Final 5/14 • upon County's request;or Contractor shall furnish progress reports as more specifically set forth in the attached Exhibit A. e. County will not withhold any taxes from monies paid to the Contractor hereunder and Contractor agrees to be solely responsible for the accurate reporting and payment of any taxes related to payments made pursuant to the terms of this Agreement. 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 31 of any year,without an appropriation therefor by County in accordance with a budget adopted by the Board of County Commissioners in compliance with 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). 9. Subcontractors. Contractor acknowledges that County has entered into this Agreement in reliance upon the particular reputation and expertise of Contractor. Contractor shall not enter into any subcontractor agreements for the performance of any of the Services or additional services without County's prior written consent,which may be withheld in County's sole discretion. County shall have the right in its reasonable discretion to approve all personnel assigned to the subject project during the performance of this Agreement and no personnel to whom County has an objection, in its reasonable discretion, shall be assigned to the project. Contractor shall require each subcontractor,as approved by County and to the extent of the Services to be performed by the subcontractor,to be bound to Contractor by the terms of this Agreement, and to assume toward Contractor all the obligations and responsibilities which Contractor,by this Agreement, assumes toward County.County shall have the right(but not the obligation)to enforce the provisions of this Agreement against any subcontractor hired by Contractor and Contractor shall cooperate in such process. The Contractor shall be responsible for the acts and omissions of its agents,employees and sub-consultants or subcontractors. 10. Insurance. Contractor agrees to provide and maintain at Contractor's sole cost and expense,the following insurance coverage with limits of liability not less than those stated below: a. Types of Insurance. i. Workers' Compensation insurance as required by law. ii. Auto coverage with limits of liability not less than$1,000,000 each accident combined bodily injury and property damage liability insurance,including coverage for owned,hired,and non-owned vehicles. iii. Commercial General Liability coverage to include premises and operations, personal/advertising injury,products/completed operations,broad form property damage with limits of liability not less than$1,000,000 per occurrence and$2,000,000 aggregate limits. 6 Eagle County HHS Prof Sery Final 5/14 iv. Professional liability insurance with prior acts coverage for all Services required hereunder, in a form and with an insurer or insurers satisfactory to County,with limits of liability of not less than$1,000,000 per claim and$2,000,000 in the aggregate. In the event the professional liability insurance is on a claims-made basis,Contractor warrants that any retroactive date under the policy shall precede the effective date of this Agreement. Continuous coverage will be maintained during any applicable statute of limitations for the Services. b. Other Requirements. i. The automobile and commercial general liability coverage and such other coverage as indicated above shall be endorsed to include Eagle County, its associated or affiliated entities, its successors and assigns,elected officials,employees,agents and volunteers as additional insureds. ii. Contractor's certificates of insurance shall include subcontractors as additional insureds under its policies or Contractor shall furnish to County separate certificates and endorsements for each subcontractor. All coverage(s)for subcontractors shall be subject to the same minimum requirements identified above. Contractor and subcontractors, if any, shall maintain the foregoing coverage in effect until the Services are completed. In addition,all such policies shall be kept in force by Contractor and its subcontractors until the applicable statute of limitations for the Services has expired. iii. Insurance shall be placed with insurers duly licensed or authorized to do business in the State of Colorado and with an"A.M.Best"rating of not less than A-VII. iv. Contractor's insurance coverage shall be primary and non-contributory with respect to all other available sources. Contractor's policy shall contain a waiver of subrogation against Eagle County. v. All policies must contain an endorsement affording an unqualified thirty(30) days notice of cancellation to County in the event of cancellation of coverage. vi. All insurers must be licensed or approved to do business within the State of Colorado and all policies must be written on a per occurrence basis unless otherwise provided herein. vii. Contractor's certificate of insurance evidencing all required coverage(s)is attached hereto as Exhibit B. Upon request,Contractor shall provide a copy of the actual insurance policy and/or required endorsements required under this Agreement within five(5)business days of a written request from County,and hereby authorizes Contractor's broker,without further notice and authorization by Contractor,to immediately comply with any written request of County for a complete copy of the policy. viii. Contractor shall advise County in the event the general aggregate or other aggregate limits are reduced below the required per occurrence limit. Contractor,at its own expense,will 7 Eagle County HHS Prof Sery Final 5/14 • reinstate the aggregate limits to comply with the minimum limits and shall furnish County a new certificate of insurance showing such coverage. ix. If Contractor fails to secure and maintain the insurance required by this Agreement and provide satisfactory evidence thereof to County,County shall be entitled to immediately terminate this Agreement. x. The insurance provisions of this Agreement shall survive expiration or termination hereof. xi. The parties hereto understand and agree that the County is relying on,and does not waive or intend to waive by any provision of this Agreement,the monetary limitations or rights, immunities and protections provided by the Colorado Governmental Immunity Act,as from time to time amended,or otherwise available to County, its affiliated entities, successors or assigns, its elected officials, employees,agents and volunteers. xii. Contractor is not entitled to workers' compensation benefits except as provided by the Contractor,nor to unemployment insurance benefits unless unemployment compensation coverage is provided by Contractor or some other entity. The Contractor is obligated to pay all federal and state income tax on any moneys paid pursuant to this Agreement. 11. 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 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 performance or nonperformance by Contractor or any of its subcontractors hereunder including claims for bodily injury or personal injury including death,or loss or damage to tangible or intangible property;and Contractor shall reimburse County for reasonable 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 the County to the extent that County is liable to such third party for such claims without regard to the involvement of the Contractor. This paragraph shall survive expiration or termination hereof. 12. Ownership of Documents. All documents prepared by Contractor in connection with the Services shall become property of County. Contractor shall execute written assignments to County of all rights (including common law, statutory,and other rights, including copyrights)to the same as County shall from time to time request. For purposes of this paragraph,the term"documents"shall mean and include all reports,plans,studies,tape or other electronic recordings,drawings, sketches,estimates,data sheets, maps and work sheets produced,or prepared by or for Contractor(including any employee or subcontractor in connection with the performance of the Services and additional services under this Agreement). 13. Notice. Any notice required by this Agreement shall be deemed properly delivered when(i) personally delivered,or(ii)when mailed in the United States mail,first class postage prepaid,or(iii) 8 Eagle County HHS Prof Sent Final 5/14 when delivered by FedEx or other comparable courier service,charges prepaid,to the parties at their respective addresses listed below,or(iv)when sent via facsimile so long as the sending party can provide facsimile machine or other confirmation showing the date,time and receiving facsimile number for the transmission,or(v)when transmitted via e-mail with confirmation of receipt. Either party may change its address for purposes of this paragraph by giving five(5)days prior written notice of such change to the other party. COUNTY: Eagle County Public Health P.O.Box 660 Eagle,CO 81631 Attention: Jennifer Ludwig,Public Health Director With a copy to: Eagle County Attorney Post Office Box 850 Eagle,Co 81631 CONTRACTOR: Colorado Mountain Medical,P.C. P.O.Box 5850 Eagle,CO 81631 Attention: Brooks Bock,M.D. 14. Termination. County may terminate this Agreement,in whole or in part,at any time and for any reason,with or without cause,and without penalty therefor with seven(7)calendar days' prior written notice to the Contractor. Upon termination of this Agreement,Contractor shall immediately provide County with all documents as defined in paragraph 12 hereof, in such format as County shall direct and shall return all County owned materials and documents. County shall pay Contractor for Services satisfactorily performed to the date of termination. 15. Venue,Jurisdiction and Applicable Law. Any and all claims,disputes or controversies related to this Agreement,or breach thereof, shall be litigated in the District Court for Eagle County,Colorado, which shall be the sole and exclusive forum for such litigation. This Agreement shall be construed and interpreted under and shall be governed by the laws of the State of Colorado. 16. Execution by Counterparts:Electronic Signatures. This Agreement may be executed in two or more counterparts,each of which shall be deemed an original,but all of which shall constitute one and the same instrument. The parties approve the use of electronic signatures for execution of this Agreement. Only the following two forms of electronic signatures shall be permitted to bind the parties to this Agreement: (i) Electronic or facsimile delivery of a fully executed copy of the signature page; (ii) the image of the signature of an authorized signer inserted onto PDF format documents. All documents must be properly notarized,if applicable. All use of electronic signatures shall be governed by the Uniform Electronic Transactions Act,C.R.S. 24-71.3-101 to 121. 9 Eagle County HHS Prof Sery Final 5/14 • 17. Other Contract Requirements. a. In rendering the 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 are maintained. The performance of such obligation shall be determined at the sole discretion of County.In the event County finds these standards of customer service are not being met by Contractor,County may terminate this Agreement, in whole or in part,upon seven(7)days' notice to Contractor. b. Contractor shall be responsible for the completeness and accuracy of the Services, including all supporting data or other documents prepared or compiled in performance of the Services, and shall correct,at its sole expense,all significant errors and omissions therein. The fact that the County has accepted or approved the Services shall not relieve Contractor of any of its responsibilities. Contractor shall perform the Services in a skillful,professional and competent manner and in accordance with the standard of care, skill and diligence applicable to Contractors performing similar services. This paragraph shall survive termination of this Agreement. c. Contractor represents and warrants that it has the expertise and personnel necessary to properly perform the Services and covenants that its professional personnel are duly licensed to perform the Services within Colorado. d. Contractor agrees to work in an expeditious manner,within the sound exercise of its �' Pe judgment and professional standards, in the performance of this Agreement. Time is of the essence with respect to this Agreement. e. This Agreement constitutes an agreement for performance of the Services by Contractor and Physician as an independent contractor and not as an employee of County. The Physician providing services under this Agreement shall not be deemed,for any purpose,to be an employee or agent of the County,but while providing services under this Agreement, shall at all times remain in the employ of the Contractor. Nothing contained in this Agreement shall be deemed to create a relationship of employer- employee,master-servant,partnership,joint venture or any other relationship between County and Contractor or Physician except that of independent contractor.Contractor shall have no authority to bind County. f. Contractor represents and warrants that at all times in the performance of the Services, Contractor shall comply with any and all applicable federal and state laws,codes,rules and regulations. g. Contractor shall comply with the Civil Rights Act of 1964 and Section 504, Rehabilitation Act of 1973,concerning discrimination on the basis of race,color, sex,age,religion, political beliefs,national origin or handicap. io Eagle County HHS Prof Sery Final 5/14 • h. This Agreement contains the entire agreement between the parties with respect to the subject matter hereof and supersedes all other agreements or understanding between the parties with respect thereto. i. Contractor shall not assign any portion of this Agreement without the prior written consent of the County. Any attempt to assign this Agreement without such consent shall be void. j. This Agreement shall be binding upon and shall inure to the benefit of the parties hereto and their respective permitted assigns and successors in interest.Enforcement of this Agreement and all rights and obligations hereunder are reserved solely for the parties,and not to any third party. k. No failure or delay by either party in the exercise of any right hereunder shall constitute a waiver thereof. No waiver of any breach shall be deemed a waiver of any preceding or succeeding breach. 1. The invalidity, illegality or unenforceability of any provision of this Agreement shall not affect the validity or enforceability of any other provision hereof. m. Contractor shall maintain for a minimum of three years,adequate financial and other records for reporting to County. Contractor shall be subject to financial audit by federal, state or county auditors or their designees. Contractor authorizes such audits and inspections of records during normal business hours,upon 48 hours' notice to Contractor.Contractor shall fully cooperate during such audit or inspections. n. The signatories to this Agreement aver to their knowledge,no employee of the County has any personal or beneficial interest whatsoever in the Services or Property described in this Agreement.The Contractor has no beneficial interest,direct or indirect,that would conflict in any manner or degree with the performance of the Services and Contractor shall not employ any person having such known interests. o. The Contractor, if a natural person eighteen(18)years of age or older,hereby swears and affirms under penalty of perjury that he or she(i)is a citizen or otherwise lawfully present in the United States pursuant to federal law,(ii)to the extent applicable shall comply with C.R.S.24-76.5-103 prior to the effective date of this Agreement. 18. Prohibitions on Government Contracts. As used in this Section 15,the term undocumented individual will refer to those individuals from foreign countries not legally within the United States as set forth in C.R.S. 8-17.5-101,et. seq.If Contractor has any employees or subcontractors,Contractor shall comply with C.R.S. 8-17.5-101,et. seq.,and this Agreement. By execution of this Agreement,Contractor certifies that it does not knowingly employ or contract with an undocumented individual who will perform under this Agreement 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 Services under this Agreement. 11 Eagle County HHS Prof Sery Final 5/14 a. Contractor shall not: i. Knowingly employ or contract with an undocumented individual to perform Services under this Agreement;or ii. Enter into a subcontract that fails to certify to Contractor that the subcontractor shall not knowingly employ or contract with an undocumented individual 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 Services under this Agreement 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://wtivw.dhs.gov/xprevprot/programs/gc 1185221678150.shtm c. 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 Contractor obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an undocumented individual, Contractor shall be required to: i. Notify the subcontractor and County within three (3) days that Contractor has actual knowledge that the subcontractor is employing or contracting with an undocumented individual; 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 undocumented individual; except that Contractor shall not terminate the contract with the subcontractor if during such three(3)days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an undocumented individual. e. 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 Contractor violates these prohibitions, County may terminate the Agreement for breach of contract. If the Agreement is so terminated specifically for breach of this provision of this Agreement, Contractor shall be liable for actual and consequential damages to County as required by law. g. County will notify the Colorado Secretary of State if Contractor violates this provision of this Agreement and County terminates the Agreement for such breach. 12 Eagle County HHS Prof Sent Final 5/14 IN WITNESS WHEREOF,the parties have executed this Agreement the day and year first set forth above. COUNTY OF EAGLE, STATE OF COLORADO, By and Through Its COUNTY MANAGER By: � v 1 Lid Rachel Oys,Acting Si ounty Manager COLORADO MOUNTAIN MEDICAL,P.C. By: Brooks F. ock,MD,FACEP Title: Chief Executive Officer 13 Eagle County HHS Prof Sery Final 5/14 4 EXHIBIT A 14 Eagle County HHS Prof Sery Final 5/14 EXHIBIT B Insurance Certificate 15 Eagle County HHS Prof Sery Final 5/14 COLOMOU-01 JKLEIN ,4coRO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `-.--,-' 2/5/2015 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: COPIC Financial Service Group PHONE 720 FAX 858-6281 7351 East Lowry Blvd,Suite 400 (A/C,No,Ext):( )858-6280 (A/C,No): (720) Denver,CO 80230 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Travelers Insurance Company 19046 INSURED INSURER B: Colorado Mountain Medical PC. INSURER C: PO Box 5850 INSURER D: Eagle,CO 81631 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 '1ADDL,SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY �', EACH OCCURRENCE $ 2,000,000 I DAMAGE TO RENTED---- CLAIMS-MADE j X !� OCCUR X 1680-7D931424-142 11/15/2014 11/15/2015 pREMISES(Eaoccurrence) $ 300,000 MED EXP(Any one person) $ 5,000 ,, PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY- PEA LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 2,000,000 ANY AUTO X 680-7D931424-14-42 11/15/2014 BODILYINJ A 11/15/2015 BODILY INJURY(Per person) $ ALL OWNED —I SCHEDULED ' BODILY INJURY(Per accident) $ AUTOS AUTOS X , NON-OWNED PROPERTY DAMAGE $ - - - -- - - HIRED AUTOS AUTOS Jer accidentZ__ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE i AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION PER I OTH- jAND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A ------ --- - -- (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(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Eagle County,its associated or affiliated entities,its successors and assigns,elected officials,employees,agents and volunteers are Additional Insureds under the commercial general liability and automobile liability policies of insurance,ATIMA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Eagle County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 500 Broadway PO Box 850 Eagle,CO 81631 AUTHORIZED REPRESENTATIVE I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ILCOPIC Better Medicine• Better Lives CERTIFICATE OF PROFESSIONAL LIABILITY INSURANCE CERTIFICATE HOLDER INSURED Eagle County Kent A.Petrie,M.D. PO Box 850 PO Box 1749 Eagle,CO 81631-0850 Edwards, CO 81632-1749 Group Name: Colorado Mountain Medical P.C. This certificate is issued as a matter of information only and confers no rights upon the holder. By its issuance,the company does not alter, change,modify or extend the provisions of said policy and does not waive any of its rights thereunder. POLICY NUMBER: PCC0003985 RETRO DATE: 12/17/1987 POLICY TERM: 12/17/2014 to: 12/17/2015 LIMITS OF LIABILITY: Per Medical Incident/Peer Review Incident: $ 1,000,000 Annual Aggregate: $ 3,000,000 SPECIALTY:FP/GP-Office/Ambulatory Dated at: Denver, Colorado Date: February 13,2015 Countersigned by Authorized Representative CO-COI 09/01/2010 Post Office Box 17540 Denver,Colorado 80217-0540(720)858-6000 1-800-421-1834 FAX(720)858-6004