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HomeMy WebLinkAboutC15-119 Community Health Services, Inc. AGREEMENT FOR PROFESSIONAL SERVICES BETWEEN EAGLE COUNTY, COLORADO AND COMMUNITY HEALTH SERVICES, INC. THIS AGREEMENT("Agreement") is effective as of the ( -3' day of ka. ti , 2015 by and between Community Health Services, Inc., a nonprofit Colorado corporation located in Pitkin County (hereinafter"Consultant"or"Contractor")and Eagle County, Colorado, a body corporate and politic (hereinafter"County"). RECITALS WHEREAS,the County, through its Department of Public Health(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, County desires to hire the Consultant to perform the Services defined below in paragraph 1; and WHEREAS, Consultant 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 Consultant and County in connection with the Services. AGREEMENT NOW, THEREFORE, in consideration of the foregoing and the following promises Consultant and County agree as follows: 1. Services. Consultant agrees to diligently provide all services, labor, personnel and materials necessary to perform and complete the 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. Consultant agrees to furnish the Services by December 31, 2015 and in accordance with the schedule established in Exhibit A. If no completion date is specified in Exhibit A, then Consultant agrees to furnish the Services in a timely and expeditious manner consistent with the applicable standard of care. By signing below Consultant represents that it has the expertise and personnel necessary to properly and timely perform the Services. 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. Consultant 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 Public Health Department's designee shall be Consultant'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 Consultant shall be the basis for additional compensation unless and until Consultant 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, Consultant'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 Consultant 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 $30,158. 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. 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 must be mailed or emailed to the following address to ensure proper payment. Eagle County Public Health Jennifer Ludwig 551 Broadway 2 Eagle County HHS Prof Sery Final 5/14 Post Office Box 660 Eagle, CO 81631 Email: Jennifer.ludwig @eaglecounty.us b. Intentionally omitted 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, Consultant 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 Consultant hereunder and Consultant 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 Consultant 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. Sub-consultants. Consultant acknowledges that County has entered into this Agreement in reliance upon the particular reputation and expertise of Consultant. Consultant shall not enter into any sub-consultant 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. Consultant shall require each sub-consultant,as approved by County and to the extent of the Services to be performed by the sub-consultant,to be bound to Consultant by the terms of this Agreement, and to assume toward Consultant all the obligations and responsibilities 3 Eagle County HHS Prof Sery Final 5/14 which Consultant, by this Agreement, assumes toward County. County shall have the right(but not the obligation)to enforce the provisions of this Agreement against any sub-consultant hired by Consultant and Consultant shall cooperate in such process. The Contractor shall be responsible for the acts and omissions of its agents, employees and sub-consultants or sub-contractors. 7. Insurance. Consultant agrees to provide and maintain at Consultant'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. 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, 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. v. Intentially omitted 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. Consultant's certificates of insurance shall include sub-consultants as additional insureds under its policies or Consultant shall furnish to County separate certificates and endorsements for each sub-consultant. All coverage(s) for sub-consultants shall be subject to the same minimum requirements identified above. Consultant and sub-consultants, 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 Consultant and its sub-consultants 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. 4 Eagle County HHS Prof Sery Final 5/14 • iv. Consultant's insurance coverage shall be primary and non-contributory with respect to all other available sources. Consultant'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. Consultant's certificate of insurance evidencing all required coverage(s)is attached hereto as Exhibit B. Upon request, Consultant 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 Consultant's broker, without further notice and authorization by Consultant, to immediately comply with any written request of County for a complete copy of the policy. viii. Consultant shall advise County in the event the general aggregate or other aggregate limits are reduced below the required per occurrence limit. Consultant,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 Consultant 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. Consultant is not entitled to workers' compensation benefits except as provided by the Consultant, nor to unemployment insurance benefits unless unemployment compensation coverage is provided by Consultant or some other entity. The Consultant is obligated to pay all federal and state income tax on any moneys paid pursuant to this Agreement. 8. Indemnification. The Consultant 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 5 Eagle County HHS Prof Sery Final 5/14 indirectly, this Agreement, or are based upon any performance or nonperformance by Consultant or any of its sub-consultants hereunder including claims for bodily injury or personal injury including death, or loss or damage to tangible or intangible property; and Consultant 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 Consultant. This paragraph shall survive expiration or termination hereof. 9. Ownership of Documents. All documents prepared by Consultant in connection with the Services shall become property of County. Consultant 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 Consultant(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: Jennifer Ludwig, Public Health Director 551 Broadway Post Office Box 660 Eagle, CO 81631 Telephone: 970-328-8819 Facsimile: 855-848-8829 E-Mail: Jennifer.ludwig @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 6 Eagle County HHS Prof Sery Final 5/14 E-Mail: atty @eaglecounty.us CONSULTANT: Liz Stark Pitkin County Public Health Director Community Health Services,Inc. 0405 Castle Creek Road,Suite 6 Aspen,CO 81611 Telephone:970-920-5420 Facsimile: 970-920-5419 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 Consultant. Upon termination of this Agreement, Consultant 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 Consultant 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. Consultant 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 7 Eagle County HHS Prof Sery Final 5/14 has accepted or approved the Services shall not relieve Consultant of any of its responsibilities. Consultant shall perform the Services in a skillful, professional and competent manner and in accordance with the standard of care, skill and diligence applicable to Consultants performing similar services. This paragraph shall survive termination of this Agreement. c. Consultant 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. Consultant 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 Consultant 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 Consultant except that of independent contractor. Consultant shall have no authority to bind County. f. Consultant represents and warrants that at all times in the performance of the Services, Consultant 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. Consultant 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. 8 Eagle County HHS Prof Sery Final 5/14 m. Consultant shall maintain for a minimum of three years, adequate financial and other records for reporting to County. Consultant shall be subject to financial audit by federal, state or county auditors or their designees. Consultant authorizes such audits and inspections of records during normal business hours, upon 48 hours' notice to Consultant. Consultant 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 Consultant has no beneficial interest, direct or indirect,that would conflict in any manner or degree with the performance of the Services and Consultant shall not employ any person having such known interests. o. The Consultant, 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. 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 Consultant has any employees or subcontractors, Consultant shall comply with C.R.S. 8-17.5-101, et. seq.,and this Agreement. By execution of this Agreement, Consultant certifies that it does not knowingly employ or contract with an undocumented individual who will perform under this Agreement and that Consultant 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. Consultant 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 Consultant that the subcontractor shall not knowingly employ or contract with an undocumented individual to perform work under the public contract for services. b. Consultant 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 1185221678150.shtm 9 Eagle County HHS Prof Sery Final 5/14 c. Consultant 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 Consultant obtains actual knowledge that a subcontractor performing work under the public contract for services knowingly employs or contracts with an undocumented individual, Consultant shall be required to: i. Notify the subcontractor and County within three (3) days that Consultant 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 Consultant 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. Consultant 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 Consultant 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, Consultant shall be liable for actual and consequential damages to County as required by law. g. County will notify the Colorado Secretary of State if Consultant 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 Its BOARD OF COUNTY COMMISSIO ERS 004 By: • et dn.% Kathy Ct ndler-Henry, Chairman if Attest: * * • By: 19,F. 4; Teak J. Simonton, Clerk to the Board 10 Eagle County HHS Prof Sery Final 5/14 CONSULTANT: COMMUNITYI7,AL H S '.?_VICES, INC. By: „ Print Name: 0-Ar Title: U (A) 11 Eagle County HHS Prof Sery Final 5/14 EXHIBIT A SCOPE OF SERVICES, SCHEDULE, FEES Duties and Responsibilities: 1. Provides leadership for Mid-Valley Planning Team and subcommittees. This includes coordinating and facilitating bi-annual meetings of full planning team; fostering the development of subcommittees and assisting with strategic planning; recruiting and retaining partnerships of the planning team; and maintaining the planning team's web page. 2. Develops and fosters partnerships with Roaring Fork Valley non-profit organizations and government entities. 3. Represents the Roaring Fork Valley at various community meetings and coalitions, such as but not limited to: West Mountain Regional Healthcare Coalition, Cradle to Career Initiative, LiveWell Garfield County, Healthy Communities Coalition, Senior Collaboratives,Mental Health and Substance Abuse Alliances. 4. Strategically links public health initiatives between Pitkin, Eagle, and Garfield counties. Accountability: Contractor will report to Pitkin County's Public Health Director. Monthly phone calls, or as needed, will be scheduled with Eagle County's Public Health Director to provide updates and to discuss accomplishments, challenges, and barriers. Accommodations: Eagle County will provide office share space in its El Jebel office. A schedule will be determined by contractor and Eagle County Public Health Director. Contractor will provide own laptop computer and cell phone. Landline phone at office space may be used by contractor when in the office. Compensation: Contractor will send a monthly invoice to Eagle County in the amount of$2,513.17, not to exceed$30,158 for a 12-month period ending December 31, 2015. Invoices are to be emailed to Jennifer Ludwig, Public Health Director,at Jennifer.ludwig @eaglecounty.us. 12 Eagle County HHS Prof Sery Final 5/14 EXHIBIT B Insurance Certificate 13 Eagle County HHS Prof Sery Final 5/14 P1 N ACOL 7501 E Lowry Blvd ASSURANCE Denver, CO 80230-7006 303-361-4000/800-873-7242 __._.__ �.__._.____ www..pinnacol coin April 1, 2014 Policy#:2190342 ITEM 1, INSURED Community Health Services, Inc. 0405 Castle Creek Road#6 Aspen, CO 81611 PR/.00 ITEM 2. POLICY PERIOD: FROM: 04/01/2014 TO 04/01/2015 12:01 A.M. MOUNTAIN STANDARD TIME ITEM 3, A. Workers`Compensation Insurance: Part One of the policy applies to the workers'compensation law of the states listed here: COLORADO B, Employers Inability Insurance: Part Two of the policy applies to work in each state listed in Item 3 A. The limits of our liability under part two are: BODILY INJURY BY ACCIDENT $100,000 EACH ACCIDENT BODILY INJURY BY DISEASE 5100.000 EACH EMPLOYEE BODILY INJURY BY DISEASE 5500.000 POLICY LIMIT C Other States Insurance Part Three of the policy applies to the states, if any listed here NONE (Please contact Pinnacol Assurance for information on coverage outside the state of Colorado) D This policy includes the attached endorsements and schedules 511 Other State Endorsement CATO9 Catastrophe(Other than Certified Acts of Terrorism) TER09 Terrorism Risk Insurance Program Reauthorization Act ITEM 4 We will determine the premium for this policy by our manuals of rules classifications rates and rating plans. All information required below is subject to verification and change by audit The statements of estimated advanced premium are also a part of this policy. 7501 E Lowry Blvd Denver,CO 80230-7006 Page 2 of 6 P UB408- 04/012014 19 55 13 2190342 40970250 P4ALL `` `°", CERTIFICATE OF LIABILITY INSURANCE Rog i�15%20 THIS CERTIFICATEIS 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 SUBROGATIONIS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT HUB INTERNATIONAL INS SVCS INC/PHS r4.E,4: (866) 467-8730 JFVIO.No): (888) 443-6112 340887 P: (866) 467-8730 F: (888) 443-6112 : PO BOX 33015 INSURER(S)AFFORDING COVERAGE MAIL SAN ANTONIO TX 78265 INSURER Hartford Casualty Ins Co wsuREo INSURER B INSURER C COMMUNITY HEALTH SERVICES INSURER O. 0405 CASTLE CREEK RD STE 6 INSURER E: ASPEN CO 81611 INSURER, 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. DM TYPE OF INSURANCE AMU SURE POULC'NlMSEIt POLICY EPF - roLCYEXP LIMITS LTR WSJ PM) (fTIM/WNTY171 GOMILYFrni COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 - Ia./on-mix 11 OCCUR . ' PREMISE 3T(Ea KTEertca) s300,000 A X General Liab X 34 SBA PA6360 09/23/2014 04/23/2015 MEDEXP(Anyoneperwn) s10,000 I PERSONAL it ADVINJURY S1,000, 000— GEN1.AGGREGATE UNIT APPLIES PER. 1 GENERAL AGGREGATE 4,000,000 POLICY JECaT © LOC PRODUCTS-COMP/OP AG° s2,000,000 OTHER: s AUTOMOBILE LJABIl11'Y • COMBINED SINGLE UNIT (Eaacddsld) s1, 000,000 _ ANY AUTO BODILY INJURY(Par parson) s A A ED OSULED 34 SBA PA6360 04/23/2014 04/23/2015 BODILY INJURY(Pa aoddsnt) s X HIRED AUTOS X NON• WN£D PROPERTY DAMAGE AUTOS (Par aeddenf) A UMBRELLA LAB OCCUR • EACH OCCURRENCE EXCESS UAB CLAIMS-MADE AGGREGATE s DEDI IRETEMIOrr a S NDUELT CCMP&1$4 ION PER AND EMPLGIE/S'LLOULTT 'STATUTE I IER ANY PROPRIETGR/PARTNERLEXECUTNE YIN E.L.EACH ACCIDENT I OFFICER/MEMEER EXCLUDED? _ (Mandatory NH)la N/A i El.DISEASE.EA EMPLOYEE S If yes,describe under E.L.DISEASE-POLICY MMIT S DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS ILOCAnONS I VEHICLES(ACORD Mt.AMINlenal Remarks Sehedple,may be attached R more space Is required) Those usual to the Insured's Operations. Certificate Holder is an Additional Insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Eagle County BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL Be DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 850 AUTHORIZED REPRESENTATIVE 500 BROADWAY "`J�� �^7Qa _EAGLE, CO, 81631 / ` 01988.2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD • Print Date: 3/29/2014 HEALTHCARE PROVIDERS SERVICE CNAORGANIZATION PURCHASING GROUP /II Certificate of 3Sn5tirante nurses service organization- OCCURENCE POLICY FORM Producer Branch Prefix Policy Number Policy Period 018098 970 HPG 0265850879 from 04/29/14 to 04/29/15at 12:01 AM Standard Time Named insured and Address: Program Administered by: Community Health Services, inc. Nurses Service Organization 405 Castle Creek Rd Ste 6 159 E.County Line Road Aspen, CO 61611-3125 Hatboro, PA 19040-1218 1-888-288-3534 www.nso.com Medical Specialty: Code: Insurance is provided by: Nurse Practitioner Firm 80965 American Casualty Company of Reading,Pennsylvania 333 S.Wabash Avenue, Chicago, IL 60604 Excludes Cosmetic Procedures Professional Liability $1,000,000 each claim $6,000,000 aggregate Your professional liability limits shown above include the following: • Good Samaritan Liability Malplacement Liability • Personal Injury Liability • Sexual Misconduct Included in the PL limit shown above subject to$25,000 aggregate sublimit Coverage Extensions , License Protection $25,000 per proceeding S 25,000 aggregate Defendant Expense Benefit ,. S 1,000 per day limit $25,000 aggregate Deposition Representation $ 10,000 per deposition $10,000 aggregate Assault $25,000 per incident $25,000 aggregate Includes Workplace Violence Counseling Medical Payments $25,000 per person $100,000 aggregate First Aid $ 10,000 per incident $10,000 aggregate Damage to Property of Others $10,000 per incident $10,000 aggregate Information Privacy(HIPAA)Fines and Penalties $25,000 per incident $25,000 aggregate Workplace Liability , Workplace Liability included in Professional Liability Limit shown above Fire &Water Legal Liability Included in the PL limit shown above subject to $150,000 aggregate sublimit Total:$7,697.00 Base Premium $7,697.00 Policy Forms &Endorsements(Please see attached list for a general description of many common policy forms and endorsements.) , R G-121500-D G-121503-C G-121501-C G-145184-A G-147292-A GSL15563 GSL15564 GSL15565 GSL17101 GSL13424 GSL13425 G-123846-005 GSL3886 GSL3908 GSL 5589 GSL-6076 GSL19904 Keep this document in a safe place.R Qtterm.Asid f'� 1140 .4..41. 7A/44 . and proof of payment are your proof of c coverage. There is no coverage in force unless the premium is paid in full In order Chairman of the Board Secretary to activate your coverage,please remit premium in full by the effective date of this Certificate of Insurance. Master Policy#188711433 G-141241-B(03/2010) Coverage Change Date: Endorsement Change Date: