HomeMy WebLinkAboutC15-091 Natalie Hewitt, RD AGREEMENT FOR PROFESSIONAL SERVICES
BETWEEN
EAGLE COUNTY,COLORADO
AND NATALIE HEWITT,RD r
THIS AGREEMENT for Professional Services("Agreement")is effective as of f 4'10 ,2015 by
and between Natalie Hewitt,RD(hereinafter"Contractor")and Eagle County,Colorado a body corporate
and politic(hereinafter"County").
RECITALS
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,the County uses outside providers and professionals to enhance the ability of County to
promote such health, safety and welfare; and
WHEREAS,County desires to hire the Contractor to perform the Services defined below in paragraph 1;
and
WHEREAS,Contractor is authorized to do business in the State of Colorado and has the time, skill,
expertise,and experience necessary to provide the Services;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. Services. Contractor agrees to diligently provide all services,labor,personnel and materials
necessary to perform and complete the Early Head Start Program nutrition services described in Exhibit A
("Services")which is attached hereto and incorporated herein by reference.The Services shall be
performed in accordance with the provisions and conditions of this Agreement.
a. Contractor agrees to furnish the Services in accordance with the schedule established in
Exhibit A. If no completion date is specified in Exhibit A,then Contractor agrees to furnish the Services
in a timely and expeditious manner consistent with the applicable standard of care. By signing below
Contractor represents that it has the expertise and personnel necessary to properly and timely perform the
Services.
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b. In the event of any conflict or inconsistency between the terms and conditions set forth in
Exhibit A and the terms and conditions set forth in this Agreement,the terms and conditions set forth in
this Agreement shall prevail.
c. Contractor agrees that it will not enter into any consulting or other arrangements with
third parties that will conflict in any manner with the Services.
2. County's Representative. The HHS Department's designee shall be Contractor's contact with
respect to this Agreement and performance of the Services.
3. Term of the Agreement. This Agreement shall commence upon the date first written above,and
subject to the provisions of paragraph 11 hereof, shall continue in full force and effect through the 31st
day of December, 2015.
4. 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
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.
5. Compensation. County shall compensate Contractor for the performance of the Services in a sum
computed and payable as set forth in Exhibit A. The performance of the Services under this Agreement
shall not exceed$1,350.00. Contractor shall not be entitled to bill at overtime and/or double time rates
for work done outside of normal business hours unless specifically authorized in writing by County.
a. Contractor shall submit an invoice or other documentation as may be required by County
on a monthly basis for the preceding month. All invoices shall include detail regarding the hours spent,
tasks performed,who performed each task and such other detail as County may request. 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 must be mailed or delivered in-person to the following address to ensure proper
payment. Invoices sent by fax or e-mail will not be accepted.
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Eagle County Health and Human Services
Business Office
550 Broadway
Post Office 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
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).
6. 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
subcontract agreements for the performance of any of the Services or additional services without
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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 subcontractors.
7. 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 as required by law.
iii. Intentionally Omitted.
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$5,000,000 in the aggregate. In the event the professional liability
insurance is on a claims-made basis,Consultant 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 provided that the coverage is commercially available at a
reasonable premium. Contractor shall provide thirty(30)days' notice to County prior to cancelling such
insurance during the applicable statute of limitations period.
v. Intentionally Omitted.
b. Other Requirements.
i. Intentionally omitted.
ii. Intentionally omitted.
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.
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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
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.
8. 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
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of its sub-Contractors 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.
9. 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).
10. 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)
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,Colorado
Attention: Toni Rozanski
551 Broadway
Post Office Box 660
Eagle,CO 81631
Telephone: 970-328-8852
Facsimile: 970-328-8829
E-mail: toni.rozanski @eaglecounty.us
With a copy to:
Eagle County Attorney
500 Broadway
Post Office Box 850
Eagle,Co 81631
Telephone: 970-328-8685
Facsimile: 970-328-8699
E-Mail: atty @,eaglecounty.us
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CONTRACTOR:
Contractor:
Natalie Hewitt,RD
510 Brush Creek Terrace#E1
Eagle CO 81631
Phone: 970-376-7622
E-mail: natalie @thesitteragency.com
11. 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 9 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.
12. 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.
13. 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.
14. 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
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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
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
as an independent contractor and not as an employee of County. 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 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.
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.
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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.
15. Prohibitions on Government Contracts.
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 Agreement. By execution of this
Agreement,Contractor certifies that it does not knowingly employ or contract with an illegal alien 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.
a. Contractor shall not:
i. Knowingly employ or contract with an illegal alien 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 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 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://www.dhs.gov/xprevprot/programs/gc 1 1 8522 1 678 1 5 0.shtm
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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 illegal alien, 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 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 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 illegal alien.
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.
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 id COUNTY MANAGER
Y
B : it/,
_
Rachel Oys,Acting Co—wl Manager
10
CONTRACTOR:
W
Print Name: (Ak l ui It
Title: I'1l 'A elltd i Lof
11
EXHIBIT A
SCOPE OF SERVICES,PAYMENT&FEE SCHEDULE
Description of Services: The Contractor will provide monitoring and consultative services for the Eagle
County Early Heart Start Program. The Contractor will provide the following services:
• Provide documentation and maintain qualifications as a Registered Dietitian.
• Maintain up to date liability insurance.
• Maintain confidentiality of any information regarding enrolled children and families.
• Upon referral to the Contractor,review,revise and recommend a Treatment Plan for Overweight
(non-WIC enrolled)Early Head Start children with a Body Mass Index(BMI)between the 85th-
95th%tile based on the Centers for Disease Control (CDC)BMI Calculator and/or the CDC
Weight for Length Growth Charts.
• Provide Nutrition Counseling to families of(non-WIC)enrolled Early Head Start children with
BMI's/Growth indicators>95th%tile or<5th%tile within 90 days of at-risk identification.
• Remain available for questions,recommendations and referrals for home visitors as needed
regarding the nutritional health of Early Head Start enrolled children at-risk due to food allergies,
intolerances and/or other special dietary needs.
• Provide Nutrition Counseling to pregnant moms(non-WIC-enrolled)enrolled in Early Head
Start Program as needed
• Upon referral to the Contractor,review high nutritional-risk WIC program plans and policies to
assure consistency,efficiency and best practice between programs and dual enrolled clients.
• The Contractor will prioritize services according to the Early Head Start Integrated Service Plan.
The Eagle County Early Head Start Program agrees to:
• Calculate and provide BMI/Growth indicators for consultation purposes and refer to
Contractor in a timely manner.
• Provide translation services for consultations with families as needed.
• Provide timely information regarding email communication,meetings,deadlines,resources
and materials.
• Evaluate the implementation of the Treatment Plan for Overweight(non-WIC enrolled)Early
Head Start children with a BMI/growth indicator between the 85th-95tl%tile through a
quarterly meeting with Home Visitors and/or the Health Coordinator.
• Participate in the Self-Assessment of the Nutrition Program.
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• Review and make recommendations for menus for site-based programs,group socializations
and other family meetings to assure nutrient density,high quality,and safe,affordable,
culturally appropriate,family-friendly,visually appealing and easily prepared foods.
• Provide a brief report for the Health Service Advisory Committee at each meeting(3 times a
year)regarding strengths and opportunities for improvement of the Early Head Start nutrition
program.
• Assure nutritional information distributed to parents is evidenced based or current best-
practice.
• Provide or recommend training to Early Head Start Program staff as the need arises.
• Review nutrition and meal service practices at the Family Learning Center and Basalt
Campus Kids through and annual site visit.
• Review and make recommendations for policies,procedures and service plan(s)in the area
of nutrition,including nutritional assessment tools for pregnant women.
Payment and Fee Schedule: The County will compensate the Contractor for performance of services
described under"Description of Services"above at a rate of$60.00/hour for a maximum of 22.5 hours in
2015. Compensation under this Agreement shall not exceed$1,350.00.
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EXHIBIT B
Insurance Certificate
14
IMPORTANT - IDENTIFICATION CARDS MUTL VOL
FOLD TOP AND BOTTOM OF CARD ON PERFORATION STATE FARM® FOLD TOP AND BOTTOM OF CARD ON PERFORATION
StateFarr COLORADO MtutesFarn? COLORADO
INSURANCE CARD A INSURANCE CARD
INSURED HEWITT,CHARLES MUTL INSURED HEWITT,CHARLES MUTL
VOL VOL
POLICY NUMBER 1525757•A07-06H EFFECTIVE POLICY NUMBER 1525757•A07-06H EFFECTIVE
YR 2012 MAKE TOYOTA JAN 07 2015 TO JUL 07 2015 YR 2012 MAKE TOYOTA JAN 07 2015 TO JUL 07 2015
MODEL TACOMA VIN 8TMMU4FN2CM040S20 MODEL TACOMA VIN STMMU4FN2CM040520
AGENT COMERFORD INS AGENCY ODIC AGENT COMERFORD INS AGENCY INC
PHONE (970)828.4000 NAIC 25178 PHONE (970)828-0000 NAIC 25178
THE COVERAGE PROVIDED BY THE POUCY MEETS THE THE COVERAGE PROVIDED BY THE POUCY MEETS THE
A�ODIIUREPAEBBI . A�ODYA � PTD AE BY BI
BLYNJURY/PPO PRESCRIBED DAMAGE LIABILITY ILINJURY/P INJURY/PROPERTY MG UABILTY
C MEDICAL PAYMENTS C MEDICAL PAYMENTS
D 250 DEDUCT COMPREHENSIVE D 250 DEDUCT COMPREHENSIVE
0 500 DEDUCT COLLISION G 500 DEDUCT COLLISION
H,8 H,S
SEE REVERSE SIDE FOR ADDITIONAL COVERAGE INFORMATION SEE REVERSE SIDE FOR ADDITIONAL COVERAGE INFORMATION
KEEP A CARD IN YOUR CAR.
THIS CARD IS INVALID IF THE POLICY FOR WHICH IT WAS ISSUED LAPSES OR IS TERMINATED.
6094/06094 KEEP YOUR CURRENT CARD UNTIL THE EFFECTIVE DATE OF THIS CARD. M Sy$Ponds
140995.1 15-09-2012(u1pcco1bl
nnrnoa
Registered Registered Commission
61
Dietitian RAN Dietitian on Dietetic
Nutritionist' Registration
CDR certifies that thecredentialingagencyfor dr
Natalie R Hewitt Academy of Nutrition
and Dietetics
has successfully completed
requirements for dietetic registration.
NtlC1(4;1 U
4{, Registered Dietitian"(RD')
Signature
Registered Dietitian
Registration ID.Number Nutritionist'(RDN^)
1011433 � /, L
Registration Payment Period j.,i/�I t W �//l
09/01/2014-08/31/2015 Chair,Commission on Dietetic Registration
Client#436239
MEMORANDUM OF INSURANCE Date Issued 09/22/2014
Producer This memorandum is issued as a matter of information
only and confers no rights upon the holder. This
Mercer Consumer, a service of memorandum does not amend, extend or alter—4140—
Mercer Health& Benefits Administration LLC coverages afforded by the Certificate listed below.
P.O. Box 14576
Des Moines, IA 50306-3576
1-800-503-9230 Company Affording Coverage
Insured Liberty Insurance Underwriters Inc
Natalie Hewitt
510 Brush Creek Terrace #E1
Eagle CO 81631
This is to certify that the Certificate listed below has been issued to the insured named above for the policy period indicated,
not withstanding any requirement, term or condition of any contract or other document with respect to which this
memorandum may be issued or may pertain, the insurance afforded by the Certificate described herein is subject to all the
terms,exclusions and conditions of such Certificate.The limits shown may have been reduced by paid claims.
Type of Insurance Certificate Number Effective Date Expiration Date Limits
Professional Liability AHY-724547002 10/29/2014 10/29/2015 Per Incident/ $1,000,000
DietetnNutr SE Occurrence
Dietitian
Annual Aggregate $5,000,000
PROOF OF INSURANCE
Memorandum Holder: Should the above describe Certificate be cancelled
PROOF OF COVERAGE ONLY before the expiration date thereof,the issuing company
will endeavor to mail 30 days written notice to the
Memorandum Holder named to the left, but failure to
mail such notice shall impose no obligation or liability
of any kind upon the company, its agents or
representatives.
Authorized Representative
Mark Brostowitz
Mercer Consumer,a service of Mercer Health&Benefits Administration LLC. In CA d/b/a Mercer Health&Benefits Insurance Services LLC.CA Lic.#0G39709
