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HomeMy WebLinkAboutC15-183 Mary Ezequelle, LCSW PC First Amendment FIRST AMENDMENT TO AGREEMENT BETWEEN EAGLE COUNTY, COLORADO AND MARY EZEQUELLE, LCSW,PC THIS FIRST AMENDMENT ("First Amendment")is effective as of the` day of , 2015 by and between Mary Ezequelle,LCSW, PC, a Colorado professional corpo ation(hereinafter"Consultant" or"Contractor") and Eagle County, Colorado, a body corporate and politic (hereinafter"County"). RECITALS WHEREAS, County and Consultant entered into an agreement dated the 9th day of April, 2014, for certain Services (the "Original Agreement"); and WHEREAS,the term of the Original Agreement expires on the 31st day of May, 2015 and the parties desire to extend the term of the Original Agreement for an additional year on the same terms and conditions as set forth in the Original Agreement. FIRST AMENDMENT NOW THEREFORE, in consideration of the foregoing and the mutual rights and obligations as set forth below, the parties agree as follows: 1. The Original Agreement shall be amended to extend the term to the 31st day of May, 2016. 2. Capitalized terms in this First Amendment will have the same meaning as in the Original Agreement. To the extent that the terms and provisions of the First Amendment conflict with, modify or supplement portions of the Original Agreement, the terms and provisions contained in this First Amendment shall govern and control the rights and obligations of the parties. 3. Except as expressly altered, modified and changed in this First Amendment, all terms and provisions of the Original Agreement shall remain in full force and effect, and are hereby ratified and confirmed in all respects as of the date hereof. 4. This First Amendment shall be binding on the parties hereto, their heirs, executors, successors, and assigns. [Rest of Page Intentionally Left Blank] IN WITNESS WHEREOF, the parties hereto have executed this First Amendment to the Original Agreement the day and year first above written. COUNTY OF EAGLE, STATE OF COLORADO, By and Throu_r Its COUNTY MANAGER By: / A'- 4 Brent McFall, C o unty Manager CONSULTANT: MARY EZEQUELLE, LCSW,PC By: Mahn E-1/527#14•41 Print Name: (\ta.ry t=Z2 w k t Title: © t,,t.7 - The foregoing instrument has been subscribed and affirmed, sworn to before me in the county of of Colorado, this ELENA GI-I- EBOS �j j osga/�fy ti NOTARY STATE OF COLORADO NOTARY ID 20144035509 , real,and commission expiration) MY COMMISSION EXPIRES SEPTEMBER 10,2018 2 Eagle County Amendment Ext Term Final 5/14 • Certificate of Insurance (Proof of Coverage) Date Issued: 5/5/2014 THIS IS A CLAIMS MADE POLICY. NOTICE:A LOWER LIMIT OF LIABILITY APPLIES TO JUDGEMENTS OR SETTLEMENTS WHEN THERE ARE ALLEGATIONS OF SEXUAL MISCONDUCT(SEE POLICY FOR DETAILS). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND,OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Insured Name and Mailing Address* Program Administrator Underwritten By: NASW Risk Retention Group,Inc Mary B Ezequelle,LCSW,PC Administrative office:50 Citizen's Way,Suite 304 PO Box 4066 Frederick,MD 21701 262 Cedar Dr Administered By: Gypsum,CO 81637 CPH and Associates 711 S.Dearborn,Suite 205 Chicago,IL 60605 P)312-987-9823 F)312-987-0902 E)SW @cphins.com *Additional insured locations are often requested by individual business owners who have more than one office. Your coverage is portable,meaning that you are covered at any location for practice under the occupation(s)listed on your policy. Coverage Policy#: SW-S03839 'Effective Date: 06/01/2014 'Expiration Date: 06/01/2015 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits of Liability Coverage Part PER CLAIM AGGREGATE (Per individual claim) (Total amount per policy year) $1 million $3 million Professional Liability $1 million $3 million Supplemental Liability $5,000 per Deposition $35,000 Per Policy Period Deposition Expense Coverage $35,000 $35,000 State Licensing Board Investigation Defense $15,000 $15,000 Emergency First Aid $25,000 $25,000 Health Information-HIPAA $15,000 $15,000 First Party Assault $5,000 per incident $50,000 Medical Payments $1,000 per day $35,000 per policy period Wage Loss and Expense Description/Special Provisions:The NASW Risk Retention Group supports this policy with its full faith,credit,and assets,and this insurance policy is reinsured with Lloyd's,London.THIS POLICY IS ISSUED BY YOUR RISK RETENTION GROUP.YOUR RISK RETENTION GROUP MAY NOT BE SUBJECT TO ALL OF THE INSURANCE LAWS AND REGULATIONS OF YOUR STATE.STATE INSURANCE INSOLVENCY GUARANTY FUNDS ARE NOT AVAILABLE FOR YOUR RISK RETENTION GROUP. Certificate Holder Cancellation • Eagle County,its associated SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED and affiliated entities, BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE successor or assigns,its DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. elected officials,employees, agents and volunteers PO Box 660 Eagle,CO 81631 Holder has also been added to the policy as an additional insured:** Authorized Representative: Yes/_No 1� **If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). C.Philip Hodson,President DISCLAIMER: The Certificate of Insurance does not constitute a contract between the issuing insurer(s),authorized representative or producer,and the certificate holder,nor does it affirmatively or negatively amend,extend,or alter the coverage afforded by the policies listed thereon. 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CO), 00 r.r, - •-• NO■ Q) r.• - = ,,,) • *ti Lir ...< .s5 z_ 0 • 7, 1 -' '.. . co .2• •S c -14 mu -2 2o c Z :Sj g Z \ i ' / --'I..•-..) 711 S.Dearborn,Suite 205,Chicago,IL 60605 Fax: 312-987-0902 Phone: 888-278-0038 E-mail: sw @cphins.com Website:www.naswins.com Certificate of Insurance abmp, ` OCCURRENCE COVERAGE ABMP In-Dues Liability Program ABMP MAILING ADDRESS: MASTER POLICY HOLDER Associated Bodywork&Massage Professionals Allied Professionals Insurance RPG 25188 Genesee Trail Road Suite 200 AGENT/BROKER Golden,CO 80401 Allied Professionals Insurance Services ISSUED BY: POLICY#: API-ABMP-14 Allied Professionals Insurance Company,A Risk Retention Group, Inc. LIABILITY LIMITS (per member) ANNUAL AGGREGATE $6,000,000 COMMERCIAL GENERAL LIABILITY PER OCCURRENCE LIMIT $2,000,000 PRODUCTS-COMP/OP Included PROFESSIONAL LIABILITY Included GENERAL LIABILITY Included FIRE LIABILITY LIMIT $100,000 To verify information,contact ABMP. Tel: 303-674-8478 Fax: 303-674-0859 This Policy is issued by your risk retention group. Your risk retention group may not be subject to all of the insurance laws and regulations of your State. State insurance insolvency guaranty funds are not available for your risk retention group. Coverage is afforded to person(s)named herein as Named Insureds according to the terms and conditions of the Policy to which this Certificate refers. No other rights or conditions,except as specifically stated herein,are granted or inferred. COVERAGES THIS IS TO CERTIFY THAT THE POLICY OF INSURANCE LISTED ABOVE HAS BEEN ISSUED TO ADDITIONAL INSURED: THE INSURED NAMED BELOW.THE INSURED ACTIVE DATE LISTED BELOW APPLIES ONLY TO ELEMENTS OF COVERAGE CONTINUOUSLY IN PLACE SINCE THE INCEPTION OF THE NAMED (with inception date) INSURED'S POLICY. CHANGES TO COVERAGE ARE EFFECTIVE RETROACTIVELY ONLY TO THE DATE THE CHANGE WAS MADE.REPORT IN WRITING WITHIN 48 HOURS ANY$ALL CLAIMS, OR INCIDENTS THAT YOU BELIEVE MAY RESULT IN A CLAIM,EVEN IF GROUNDLESS- This Certificate,along with the Policy to which it refers,is valid evidence of coverage extended to the Eagle County Department of Human Sep 05 2014 Certificate Holder listed below. Services I, Oralia Archideque Sep 05,2014 CERTIFICATE HOLDER (Active Registered Members are on file with the ABMP Membership Director) Member/Named Insured: Mary Ezequelle Membership I.D.#: 1049157 Member/Policy Term Active: Sep-05-2014 Member/Policy Term Expires: Sep-04-2015 Total Member Cost: $ 199 (ABMP Membership,including Member Liability Coverage) pg2c A Authorized Representative CANCELLATION:The Company shall provide the Named Insured 90 days notice of its intent Coverage is extended subject to all terms and conditions of the Policy. to cancel this policy for any reason other than failure to pay amounts when due. Should the Named Insured fail to pay amounts when due,the Policy shall be immediately and automatically cancelled without further notice.