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HomeMy WebLinkAboutC15-203 Mountain Family Health CentersAGREEMENT FOR PROFESSIONAL SERVICES BETWEEN EAGLE COUNTY, COLORADO AND MOUNTAIN FAMILY HEALTH CENTERS FOR THE PROVISION OF PRENATAL HEALTH CARE SERVICES This Agreement ("Agreement") is effective as of the day of , 20 �5 , and between Mountain Family Health Centers ("MFHC"), a nonprofit Colorado corporation with a mailing address of 1905 Blake Ave., Suite 101, Glenwood Springs, CO 81601 ("Contractor) ("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 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 shall provide timely prenatal health-care services, in accordance with current ACOG medical standards, to low-income Eagle County residents, with incomes at or below 195% of the federal poverty level who have been referred to Contractor by County and agree to receive services from Contractor ("Clients"). These dollars shall be used solely to defray the cost of Contractor's provision of prenatal services to those Clients. County is responsible for the eligibility of each Client for services, initializing the Medicaid application enrollment, and for maintaining files regarding eligibility under the scope of this Agreement. Contractor shall provide services for up to 128 Clients that are referred by the County during the term of this Agreement. Contractor shall submit quarterly reports with numbers served and demographics, in addition to quarterly invoices for payment (See paragraph 5(a) below). G16-dD�3 a. Contractor agrees to furnish the Services no later than December 31, 2015. The 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. 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. Count's Representative. The Public Health 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 December 31, 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. During the term of this Agreement, Eagle County will pay to Contractor $550.00 for each Client served by Contractor. County will reimburse Contractor on a quarterly basis for Clients served during the previous quarter upon receipt of properly submitted invoices by Contractor. The Contractor shall utilize these funds to offset the costs of the prenatal care and care coordination services provided by the Contractor. Contractor shall be reimbursed for services provided to Clients only after they have been deemed eligible by County. County will not reimburse Contractor for services provided to Contractor's patients before they are deemed eligible Clients by County. The total cost of this Agreement shall not exceed $70,400.00, absent an amendment to this agreement signed by both parties. a. For reimbursement Contractor must submit invoices quarterly. 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. 2 Eagle County HHS Prof Sery Final 5/14 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 hhsaccourltspayableCcaulecounty.Lis. Eagle County Health and Human Services Business Office 550 Broadway Post Office Box 660 Eagle, CO 81631 Contractor shall not be reimbursed for any out of pocket expenses. 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). 3 Eagle County HHS Prof Sery Final 5/14 6. Sub -contractors. 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 sub -Contractor 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 sub -Contractor, as approved by County and to the extent of the Services to be performed by the sub -Contractor, 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 sub -Contractor 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 -Contractors or sub -contractors. 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. 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. This policy shall be endorsed to include coverage for physical/sexual abuse and molestation. 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. 4 Eagle County HHS Prof Sery Final 5/14 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. 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. 5 Eagle County HHS Prof Sery Final 5/14 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 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, in terms of the quarterly reports with numbers served and demographics to be submitted to the County, 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:Jennie Wahrer 551 Broadway Post Office Box 660 Eagle, CO 81631 Telephone: 970-328-2604 6 Eagle County HHS Prof Sery Final 5/14 Facsimile: 855-848-8829 E -Mail: jennie.wahrer@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 CONTRACTOR: Ross Brooks, Executive Director Mountain Family Health Centers 1905 Blake Ave., Suite 101 Glenwood Springs Colorado, 81601 Telephone: 970-945-2840 E -Mail: rbrooks@mountainfamily.org 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. Eagle County HHS Prof Sery Final 5/14 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 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. s Eagle County HHS Prof Sery Final 5/14 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. 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 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. a. Contractor shall not: i. Knowingly employ or contract with an undocumented individual to perform Services under this Agreement; or 9 Eagle County HHS Prof Sery Final 5/14 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://www.dhs.gov/xprevprot/programs/gc—1 185221678150.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. 10 Eagle County HHS Prof Sery 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 BOARD OF COUNTY y: B 1 �%l C� � '"3iBiatr- ,Chairman Attest: f�Ll�? `1-t�•N'1 By; V.V. . VI "% Teak J. Simonton, Clerk to the Board CONTT2ACT : By; Ross Brooks Mountain Family Health Centers, Chief Executive Officer 11 Eagle County HHS FW Secy Fina( 5114 EXHIBIT A SCOPE OF SERVICES, SCHEDULE, FEES 1. Services: Contractor shall provide timely prenatal health-care services, in accordance with current ACOG medical standards, to low-income Eagle County residents, with incomes at or below 195% of the federal poverty level who have been referred to Contractor by County and agree to receive services from Contractor ("Clients"). These dollars shall be used solely to defray the cost of Contractor's provision of prenatal services to those Clients. County is responsible for the eligibility of each Client for services, initializing the Medicaid application enrollment, and for maintaining files regarding eligibility under the scope of this Agreement. Contractor shall provide services for up to 128 Clients that are referred by the County during the term of this Agreement. Contractor shall submit quarterly reports with numbers served and demographics, in addition to quarterly invoices for payment. Schedule: This contract will be effective January 1, 2015 to December 31, 2015. 3. Compensation. During the term of this Agreement, Eagle County will pay to Contractor $550.00 for each Client served by Contractor. County will reimburse Contractor on a quarterly basis for Clients served during the previous quarter upon receipt of properly submitted invoices by Contractor. The Contractor shall utilize these funds to offset the costs of the prenatal care and care coordination services provided by the Contractor. Contractor shall be reimbursed for services provided to Clients only after they have been deemed eligible by County. County will not reimburse Contractor for services provided to Contractor's patients before they are deemed eligible Clients by County. The total cost of this Agreement shall not exceed $70,400.00, absent an amendment to this agreement signed by both parties. 12 Eagle County HHS Prof Sery Final 5/14 EXHIBIT B Insurance Certificate 13 Eagle County HHS Prof Sery Final 5/14 ��. MOUNFAM-01 LFISCHE �.,_.,...-- CERTIFICATE OF LIABILITY INSURANCE TE(MWDD 4/17!20! 5 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 poticy(les) 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 endorsementfsl. Insurance Ulster Street #1400 CO 80237 INSURER A : LIDerty Mutual INSURED INSURER B : Pinnacol Assurance -41190 MountainFamNy Health Center Attn: Ms. Annette Franca, CFO INsuRERc: 1905 Blake Avenue #101 INSURERO Glenwood Springs, CO 81601 INSURER E : INSURERF COVERAGES r_FRTII:I1'ATC - - KCvI01U1N vumt3ER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTOTHE INSURED NAMEDABOVE FOR THE POLICYPERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF.SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRPJJUL A TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY IVSD WOR fAfVD POLICYNUMBERMID M!D LIMITS CLAIMS -MADE EkI OCCUR S(15)56117851. 06101/2014 06/01/2015 EACH OCCURRENCE $ 1,000,000 PREMISES E F-moccuni_ $ 1,000„000 MED EXP (Any one person) $ 15,000 PERSONAL &ADV INJJRY $ 1,000,000 GEN'L AGGREGATE L IM IT APPLIES PER: POLICY O � LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS- COMP/Op AGG $ 2,000,000 $ A AUTOMOBILE x LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIREDAUTOS X NON -OWNED. AUTOS S(15)56117851 06/01!2014 06/01/2015 COM IN D S GL L I Ea ae ident 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ Peracaderd $ $ A B A X LLALIAB SLIAB ;DED X OCCUR CLAIMS -MADE NIA SO(15)561`17851 461272 SZS(15)56117851 06%01/2014 06/01/2014 06/01/2014 06/01!2015 06/0!/201,5 06/01/2015 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,OOQ X RETENTION$ 10.000 WORKERS COMPENSATION--- AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN ORRCERIMEMSEREXCLUDED? (Mari, describe If yes, desmbe under and DESCRIPTION OF OPERATIONS below Bldg & Contents BLKT F $ X STATUTE ,X ER E.L. EACH ACCIDENT $ 500,000 E.L.DISEASE- EA EMPLOYEE $ 500 000 , E.L. DISEASE - POLICY :LIMIT $ -500,000 $500 4,599,766 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 101, Additlonal 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 r•eoTrerrwTr ung r.rs Eagle County POB 660 Eagle, CO 81631 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2014 ACORD CORPORATION. All rights reserved: ­_- — 11 1 ne s+vuw name ana logo are registered marks of ACORD riSSUE DATE: 6/19/2014 2a. FTCA DEEMING NOTICE NO.: 1-F00000109-14-01 2b. Supersedes: [I 3. COVERAGE PERIOD: FROM: 1/1/2015 THROUGH: 12/31/2015 DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES AND SERVICES 4. NOTICE TYPE: Renewal ADMINISTRATION 4e y . 5a. ENTITY NAME AND ADDRESS: Mountain Family Health Center POST OFFICE BOX 9 NEDERLAND, CO 80466-0009 NOTICE OF DEEMING ACTION FEDERAL TORT CLAIMS ACT AUTHORIZATION: Federally Supported Health Centers Assistance Act 6. ENTITY TYPE: Grantee (FSHCAA), as amended, Sections 224(g) -(n) of the Public Health Service (PHS) 7. EXECUTIVE DIRECTOR: Act, 42 U.S.G. § 233(g) -(n) Brooks Ross 8a. GRANTEE ORGANIZATION: Mountain Family Health Center 8b. GRANT NUMBER: H80CS00830 9. THIS ACTION IS BASED ON THE INFORMATION SUBMITTED TO, AND AS APPROVED BY HRSA, AS REQUIRED UNDER 42 U.S.C. § 233(h) FOR THE ABOVE TITLED ENTITY AND IS SUBJECT TO THE TERMS AND CONDITIONS INCORPORATED EITHER DIRECTLY OR BY REFERENCE IN THE FOLLOWING: a. The authorizing program legislation cited above. b. The program regulation cited above, and; c. HRSA's FTCA-related policies and procedures_ In the event there are conflicting or otherwise inconsistent policies applicable to the program, the above order of precedence shall prevail. 10. Remarks: The check box [xj in the supersedes field indicates that this notice supersedes any and all active NDAs and rescinds any and all future NDAs issued prior to this notice. Electronically signed by Jim Macrae, Associate Administrator for Primary Health Care on: 6/19/2014 9:47:35 AM FTCA DEEMING NOTICE NO.: GRANT NUMBER: , 1-F00000109-14-01 H80CS00830 Mountain Family Health Center POST OFFICE BOX 9 NEDERLAND, C080466-0009 Dear Brooks Ross: The Health Resources and Services Administration (HRSA), in accordance with the Federally Supported Health Centers Assistance Act (FSHCAA), as amended, sections 224(g) -(n) of the Public Health Service (PHS) Act, 42 U.S.C. §§ 233(g) -(n), deems Mountain Family Health Center to be an employee of the PHS, for the purposes of section 224, effective 1/1/2015 through 12/31/2015. Section 224(a) of the PHS Act provides liability protection under the Federal Tort Claims Act (FTCA), 28 U.S.C. §§ 1346(b), 2672, or by alternative benefits provided by the United States where the availability of such benefits precludes a remedy under the FTCA, for damage for personal injury, including death, resulting from the performance of medical, surgical, dental, or related functions by PHS employees while acting within the scope of such employment. This protection is exclusive of any other civil action or proceeding_ Coverage extends to deemed entities and their (1) officers; (2) governing board members; (3) full- and part-time employees; and (4) contractors who are licensed or certified individual health care practitioners providing full-time services (i.e., on average at least 32%2 hours per week for the entity for the period of the contract), or, if providing an average of less than 32%2 hours per week of such service, are licensed or certified providers in the fields of family practice, general internal medicine, general pediatrics, or obstetrics/gynecology. Volunteers are neither employees nor contractors and therefore are not eligible for FTCA coverage under FSHCAA. This Notice of Deeming Action (NDA) is also confirmation of medical malpractice coverage for both Mountain Family Health Center and its covered individuals as described above. This NDA; along with documentation confirming employment or contractor status with the deemed entity, may be used to show liability coverage for damage for personal injury, including death, resulting from the performance of medical, surgical, dental, or related functions by PHS employees while acting within the scope of such employment, In addition, FTCA coverage is comparable to an "occurrence" policy without a monetary cap. Therefore, any coverage limits that may be mandated by other organizations are met. This action is based on the information provided in your FTCA deeming application, as required under 42 U.S.C. § 233(h), with regard to your entity's: (1) implementation of appropriate policies and procedures to reduce the risk of malpractice and litigation; (2) review and verification of professional credentials and privileges, references, claims history; fitness, professional review organization findings, and licensure status of health professionals, (3) cooperation with the Department of Justice (DOJ) in the defense of claims and actions to prevent claims in the future; and (4) cooperation with DOJ in providing information related to previous malpractice claims history. Deemed health centers must continue to receive funding under Section 330 of the PHS Act, 42 U.S.C. § 254b, in order to maintain coverage as a deemed PHS employee. If the deemed entity loses its Section 330 funding, such coverage will end immediately upon termination of the grant. In addition to the relevant statutory and regulatory requirements, every deemed health center is expected to follow HRSA's FTCA-related policies and procedures, which may be found online at http:/Iwww.bphc_hrsa.gov. For further information, please contact your HRSA Project Officer as listed on your Notice of Grant Award or the Bureau of Primary Health Care (BPHC) Help Line at 1-877-974-2742 or bphchelpline@hrsa.gov.