HomeMy WebLinkAboutC15-459 Colorado Mountain MedicalAGREEMENT FOR PROFESSIONAL SERVICES
BETWEEN EAGLE COUNTY. COLORADO
AND
COLORADO MOLNTAIN MEDICAL, P.C.
FOR MEDICAL DIRECTOR SERVICES
THIS AGREEMENT ("Agreement") is effective as of the !!-Aay of Po,tfut&2015 by and
between Colorado Mountain Medical, P.C. a Colorado corporation (hereinafter'oContractor" or
"Contractor") and Eagle County, Colorado, a body corporate and politic (hereinafter "County").
RECITALS
WHEREAS, the County, through its Department of Public Health and Environment ("PH") works to
promote the health, safety and welfare of County residents of all ages; and
WI{EREAS, the County uses outside providers and professionals to enhance the ability of County to
promote such health, safety and welfare; and
WHEREAS, Contractor employs a team of primary care physicians, specialists and other practitioners
with offices in Vail, Eagle and Edwards, Colorado; and
WHEREAS, Contractor employs Kent Petrie, M.D. who is licensed to practice medicine in the State of
Colorado, is a resident of Eagle County and has the time, skill, expertise, and experience necessary to
provide the Services; and
WHEREAS, County desires to appoint Dr. Kent Peffie as Eagle County Public Health Medical Director
to perform the Services defined below in paragraph 3; and
WHEREAS, this Agreement shall govern the relationship between Contractor and County in connection
with the Services.
AGREEMENT
NOW, THEREFORE, in consideration of the foregoing and the following promises Contractor and
County agree as follows:
1. Appointment. Until further order of the Boar4 County hereby appoints Kent Petrie, M.D. as Eagle
County Fublic Health Medical Director to provide the services required of Contactor hereunder. In the event
that Dr. Petrie is unavailable to provide Medical Director Services as requested by County, County may
either (a) approve of another Physician employed or retained by Conffactor to render such services; or (b)
elect to contract for the services of a Physician not employed or retained by Conhactor. In the former even!
such Physician must be specifically approved in writing by County prior to the rendering of such services.
The County may revoke its approval of a Physician at any time by written notice of such revocation to
Contractor.
Eagie County Commissloners' OfficeC15-459
The term "Physician" as used herein shall mean any physician employed or otherwise retained by
Contractor and approved by County to fumish services pursuant to this Agreement. County may revoke its
approval of a Physician at any time by written notice of such revocation to Contractor. The services of a
Physician hereunder may be requested and activated by the Board of County Commissioners, County
Managero Public Health Director, Environmental Health Director, or Human Services Director.
2. Licensure and Staff Membership. Contractor warrants that any Physician performing services for
County under this Agreement shall (a) at all times hold a currently valid and unlimited license to practice
medicine in the State of Colorado; and (b) apply for, be awarded and maintain in good standing membership
on the medical staff of Confractor with appropriate and unresfficted privileges, or receive and maintain
temporary privileges, all in accordance with Contractor's policies.
Per Colorado State Board of Nursing requirements, collaborative agreements will be put into
place to designate prescriptive authority relationships between all of County's Advance Practice Nurses
and Dr. Petrie.
3. Physician Responsibilities/Services. Contractor shall ensure that the Physician provides the
following services upon request:
(a) Medical consultation on topics including, but not limited to, communicable disease control,
immunizations, indigent health care, screening programs and any other health service provided by
the County;
(b) Communication with and dissemination of information regarding health care needs and issues to
private health care providers in coordination with Public Health through the County's Health Alert
Network;
(c) Consultation with Environmental Health Departrnent including evaluation of sanitary standards
and abatement ofnuisances, and approving cease and desist orders;
(d) Consultation with the Public Health Director on issues that impact the public's health, as well as
both preparedness and response for public health emergencies;
(e) Consultation to the Board of County Commissioners, Emergency Managemen! Environmental
Health, and Human Services, including participation in Board of Health meetings;
(f) Provision of written reports and recommendations regarding public health issues, upon reasonable
request
(g) Participation in training in the areas of emergency management, public health services and
regulations, and child abuse and neglect reporting;
(h) Oversight of County's Advance Practice Nurses with regard to ttre prescriptive authority provided
them for program areas such as tuberculosis heafinent, STD treatments, fluoride varnish, and other
program areas identified by the parties;
(i) Oversight of Eagle County's Title X Family Planning program to include:
(a) Medical consultation on family-planning health services provided by the County;
(b) Clinical supervision of the Title X Program and Title X Program staff;
2
Eagle County HHS ProfServ Final 5/14
(c) Medical oversight of County's Advance Practice Nurses with regard to the
prescriptive authority provided them for program, and other program areas identified by
the parties;
(d) Familiarity with the Family Planning Title X medical guidelines as outlined in the
Family Planning Title X Nursing Manual and agrees to follow them;
(e) Review and approval (via signature) of appropriate Colorado Department of Public
Health and Environment (CDHPE) Family Planning Program policies and protocols
which have been written and approved by the Medical Policy advisory Committee
(MedPAC);
(f) Review and co-sign ten percent (10%) of Family Planning client charts for the purpose
of quality assurance.
O Represent public health on identified community work groups or committees; and
The parties anticipate that the time required of the Physician in the provision of such services under this
Agreement will not exceed a total of one hundred thirty trvo (132) hours per calendar year. The services shall
be performed in accordance with the provisions and conditions of this Agreement.
4. Requirements. In the provision of services hereunder, Contractor and Physician shall do the
following:
(a) Safeguard protected health information of individuals and the confidentiality of situations for
which Physician's consultation is requested, in accordance with the rules of Public Health and the
Health Information Portability and Accountability Act.
(b) Abide by the applicable provisions of County Media Policy; all media contacts to Physician in
the role of Medical Director forthe County are to be reported to the Public ltrealth Director, who will
coordinate with the County Administrator, the County Attomey and the County Communications
Director in providing appropriate responses to such media contacts.
(c) Comply with appropriate standards of customer service to the public and provide appropriate
consultation in the development and implementation of Public Health protocols to promote the
maintenance of high standards of customer service and professionalism.
(d) Comply with the requirements of the Civil Rights Act of 1964 and Section 504, Rehabilitation
Act of 1973 conceming discrimination on the basis of raceo color, sex, age, religion, national origin,
or handicap.
(e) Notifr immediately Human Services, at (970) 328-8840, of all reports of suspected child or adult
abuse or neglect made to or observed by or otherwise coming to the attention of Physician.
(f) Comply with all applicable laws, resolutions, and codes of County, the State of Colorado, orthe
federal government.
5. County's Representative. The Public Health Department's designee shall be Contractor's contact
with respect to this Agreement and performance of the Services.
3
Eagle County HHS ProfServ Final 5/14
6. Term of the Agreement. This Agreement shall commence upon the date frst written aboveo and
subject to the provisions of paragraph 14 hereof, shall continue in full force and effect through the 31"
day of December,2016.
7. Extension or Modification. This Agreement may be extended for up to three additional one year
terms upon written agreement of the parties. Any amendments or modifications shall be in writing 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 ofconduct 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.
8. Compensation. County shall compensate Contractor for the performance of the Services in the
amount of $1,000.00 per month ($12,000.00 per year). The performance of the Services under this
Agreement shall not exceed $121000.00. 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. 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 perfiormed 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 delivered in-person to the following address to ensure proper
payment. Invoices may also be securely emailed to hhsaccountspayable@eaglecounty.us.
Eagle County Public Health
551 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 in this Agreement. 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.
4
Eagle County HHS ProfServ Final 5/14
Contractor shall not be reimbursed for expenses that are not set forth explicitly in this Agreement 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 tlerefore 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 Countv.
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.
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-l-l0l et. seq.) and the
TABOR Amendment (Colorado Constitution, Article X, Sec. 20).
9. 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 ofthe 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.
5
Eagle County HHS ProfSew Final 5/14
10. Insurance. Contractor agrees to provide and maintain at Contractoros sole cost and expense, the
following insurance coverage with limits of liability not less than those stated below:
Types oflnsurance.
Workers' Compensation insurance as required by law.
ll. 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,
personaVadvertising injury, productVcompleted 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
hereundero in a form and with an insurer or insurers satisfactory to County, with limits of liability of not
less than S1,000,000 per claim and $2,000,000 in the aggregate. ln 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.
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 offrcials, employees, agents and volunteers as additional insureds.
ii. Contractor's certificates of insurance shall include sub-Contractors as additional
insureds under its policies or Contractor shall furnish to County separate certificates and endorsements for
each sub-Contractor. All coverage(s) for sub-Contractors shall be subject to the same minimum
requirements identified above. Contractor and sub-Contractors, if any, shall maintain the foregoing
coverage in effect until the Services are completed. In addition, all such policies shall be kept in force by
Contractor and its sub-Contractors 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'oA.M. Best" rating of not less than A-V[.
lv. Contractor's insurance coverage shall be primary and non-contributory with
respect to all other available sources. Conkactor's policy shall contain a waiver of subrogation against
Eagle County.
v. All policies must contain an endorsement affording an unqualified thirly (30)
days notice of cancellation to County in the event of cancellation of coverage.
6
Eagle County HHS ProfServ Final 5/14
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 A. 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.
termination hereof.
The insurance provisions of this Agreement shall survive expiration or
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. Conffactor is not entitled to workers' compensation benefits except as
provided by the Contractor, nor to unemployment insurance benefits unless unemployment compensation
coverage is provided by Contractor or some other entity. The Contractor is obligated to pay all federal
and state income tax on any moneys paid pursuant to this Agreement.
11. Indemnification. The Contractor shall indemnif' and hold harmless County, and any of its
ofTicers, 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 nonperfoflnance by Contractor or any
of its sub-Contractors hereunder including claims for bodily rqiury or personal injury including death, or
loss or damage to tangible or intangible properly; 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
7
Eagle County HHS Prof Serv Final 5/14
without regard to the involvement of the Contractor. This paragraph shall survive expiration or
termination hereof.
T2. Ownership of Documents. All documents prepared by Contractor in connection with the Services
shall become property of County. Contractor shall execute written assignments to County of all rights
(including common law, statutory, and other rights, including copyrights) to the same as County shall
from time to time request. For purposes of this paragraph, the term "documents" shall mean and include
all reports, plans, studies, tape or other electronic recordings, drawings, sketches, estimates, data sheets,
maps and work sheets produced, or prepared by or for Contractor (including any employee or
subcontractor in connection with the performance of the Services and additional services under this
Agreement).
13. Notice. Any notice required by this Agreement shall be deemed properly delivered when (i)
personally delivered, or (ii) when mailed in the United States mail, first class postage prepaid, or (iii)
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 parly may change its
address for purposes of this paragraph by giving five (5) days prior written notice of such change to the
other par{y.
COUNTY:
Eagle County Public Health
Attention: Jennifer Ludwig, Public Health Director
Post Office Box 660
Eagle, CO 81631
Telephone : 97 0 -328 -8840
With a copy to:
Eagle County Attorney
500 Broadway
Post Office Box 850
Eagle, Co 81631
Telephone: 970-328-8685
Facsimile: 97 0-328-8699
E-Mail : atty@eaglecounty.us
CONTRACTOR:
Colorado Mountain Medical, P.C.
P.O. Box 5850
Eagle, CO 81631
Attention: Brooks Bock, M.D.
8
Eagle County FIHS ProfServ Final 5/14
14. Terminatiol. County may terminate this Agreement, in whole or in par! atany time and for any
reason, with or without cause, and without penalty therefor with seven (7) calendar days' prior written
notice to the Contractor. Upon termination of this Agreement, Contractor shall immediately provide
County with all documents as defined in paragraph 12 hereof in such format as County shall direct and
shall return all County owned materials and documents. County shall pay Contractor for Services
satisfactorily performed to the date of termination.
15. Venue. Jurisdiction 4nd Applicable Law. Any and all claims, disputes or controversies related to
this Agreement, or breach thereof, shall be litigated in the District Court for Eagle County, Colorado,
which shall be the sole and exclusive forum for such litigation. This Agreement shall be construed and
interpreted under and shall be governed by the laws of the state of colorado.
16. Execution by Counterparts: Electronic Signatures. This Agreement may be executed in two or
more counterparts, each of which shall be deemed an original, but all of which shall constitute one and the
same instrument. The parties approve the use of electronic signatures for execution of this Agreement.
Only the following two forms of elechonic signatures shall be permitted to bind the parties to this
Agreement: (i) Elechonic or facsimile delivery of a fully executed copy ofthe 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.
17. Other Contract Requirements.
a. In rendering the Services hereunder, Contractor shall comply with the highest standards
of customer service to the public. Contractor shall provide appropriate supervision of its employees to
ensure the maintenance of these high standards of customer service and professionalism are maintained.
The performance of such obligation shall be determined at the sole discretion of County. In the event
County finds these standards of customer service are not being met by Contractor, County may terminate
this Agreement, in whole or in par! 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 Serviceso
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.
9
Eagle County HHS ProfServ Final 5/14
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 Countv.
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 parly 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.
l. 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 houts, 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 Properly described in this
Agreement. The Contractor has no beneficial interest, direct or indirect, that would conflict in any manner
10
Eagle County HHS Prof Serv Final 5/14
or degree with the performance of the Services and Contractor shall not employ any person having such
known interests.
o. The Contractor, ifa natural person eighteen (18) years ofage or older, hereby swears and
affirms under penalty of perjury that he or she (i) is a citizen or otherwise lawfully present in the United
States pursuant to federal law, (ii) to the extent applicable shall comply with C.R.S. 24-76.5-103 prior to
the effective date of this Agreement.
18. Prohibitions on Government Contracts.
As used in this Section 15, the term undocumented individual will refer to those individuals from foreign
countries not legally within the United States as set forth in C.R.S. 8-17.5-101, et. seq. If Contractor has
any employees or subcontractors, Contractor shall comply with C.R.S. 8-17.5-101, et. seq., and this
Agreement. By execution of this Agreement, Contractor certifies that it does not knowingly employ or
contract with an undocumented individual who will perform under this Agreement and that Contractor
will participate in the E-verifu 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.
Contractor shall not:
i. Knowingly employ or contract with an undocumented individual to perform
Services under this Agreement; or
ii. Enter into a subcontract that fails to certifr to Contractor that the subcontractor
shall not knowingly employ or conffact 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-Veri$'
Program or Department Program, as administered by the United States Department of Homeland
Security. Information on applying forthe E-veriff progmm can be found at:
http:l/wr,vw.dh s. gov/xprevprot/pro grams/gc_ I 1 8 522 1 67 8 I 5 0. shtm
c. Contractor shall not use either the E-verifu program or otler Department Program
procedures to undertake pre-employment screening ofjob 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. Noti$, the subcontractor and County within
actual knowledge that the subcontractor is employing or contracting
and
three (3) days that Contractor has
with an undocumented individual:
11
Eagle County HHS ProfServ Final 5/14
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- I 7.5 - 1 02(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 notiff the Colorado Secretary of State if Contractor violates this provision of
this Agreement and County terminates the Agreement for such breach.
IREST OF qAGE INTENTIONALLr LEFT BI!/,NK]
L2
Eagle County HHS ProfServ Final 5/14
IN WITNESS WHEREOF, the parties have executed this Agreement the day and year frst set forth
above.
COLINTY OF EAGLE, STATE OF COLORADO,
By and Through Its COTINTY MANAGER
By:
COLORADO MOUNTAIN MEDICAL. P.C.:
Print Name:
Title:
Wa.ciES, €. @C;&, n,S
13
Eagle County HHS Prof Serv Final 5/14
t4
Eagle County HHS ProfServ Final 5/14
CERTIFICATE OF LIABILITY INSURANCE DATE (raviDD/YYYY)
11t24t2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTTFICATE HOLDER, THIS
CERTIFICATE DOES NOT AFFIRI'ATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER TI{E COVERAGE AFFORDED BYTHEPOLICIES
BELOW. TH|S CERTIFTCATE OF TNSURANCE DOES NOT CONSTTTUTE A CONTRACT BETWEEN THE |SSUTNG TNSURER(S), AUTHORTZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLOER"
IMPORTANT: lf the certificate holder isanADD|TIONALINSURED,thepolicy(ies)mustbeendorsed. lf SUBROGATIONlSWAIVED,subjectto
the terms and conditions of the policy, certain policles may requlre an endorsement. A statoment on this csrllficato doos not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
COPIG Financhl Servic,e Group
7351 Eaat Lowry Blvd, Suite 400
Denvar, GO E0230
ffi--Tffi;iirot858:628rF.rllrT -
tguig**-*
ta{gu.REk€} AFFoRDT{G covERAGE I ltatc I
lxsgpEx 1 r Trdv€lens Insurance 9046
INSURED
Colorado Mountain Medical PC.
PO Box 5850
Eagle, CO 81631
l!!gB-Ea"e.__,
IilSURER C :
INSURER D:
MCBC!-Ei_*"
INSURER F:
COVERAGES
coLoMou-o1 JROMERO
REVISION NUMBER:CERTIFICATE NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOWHAVEBEENISSUEDTOTHEINSUREDMMEDABOVEFORTHEPOLICYPERIOD
INDICATED" NOTWITHSTANDING ANY REOUIREMENT, 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 HEREINISSUBJECTTOALLTHETERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.re;= l.*glffil"-_;;-*"* -T;'mffiIlgHBffiffi ;;-
A COMUERCIAL GENERAL L]ABILITY* t r--"1
_- | CLATMS-MADE L J OCCUR x $80-7D931 42,f-1 5-42 11t15nu5 11t15t2016
EACH OCCURRENCE
bATffiCFIgFEtr'EU**-
.AFFusgglEecsmcrsel-*
MED EXP (Any one peFon)
$ **3,990",.09
300,00(!
s 5,00(
PERSOML & ADV INJURY J 2,000,00(
GEI
"o.'." f] ffi l-1.o"
GENEML AGGREGATE $4,000,0|x
PROOUCTS. COMP/OP AGG $4,000,001
A
AUl OI'OBILE LIABILITY
ANYAUTO
ALL OWNED
AUTOS
HIRED AUTOS
l"'-"1 scHEDUrEo
ftll$1"***"
x t80-7D931 424-1 5.42 11115t2015 11t15t20',t6
uvmotrcg -II9LG LtMt IlE r.dddnl $ 2.000.00(
BODILY IIUURY (Per p3Bon)$
BOOILY INJURY (Per accident)D
rnvr(st r vns$E
tP€. ocdd€{rl}$
s
urrBRELt-A UAB | _ .l occun
ExcEssL|AB I lCwrr,rS_UeOe
EACH OCCURRENCE $
AGGREGATE $
DED I I RETENTION$$
IT'ORKERS COTPEI{SATIONaNDEI|PLOYERS'LIAB|L|TY YrN
ANY PROPRIETOR.,PARTNER/EXECUTIVE t-OFFICER/MEMBEREXCLUOEO? I(llandeiort in NH)
lf yes, desqibe under
DESCRIPTION OF OPERATIONS bdN
N'A
trEK I lvtn-
__IsI^IllLE_.l __[ ER
E.L, EACH ACCIDENT $
E,L, DISEASE - EA EMPLOYEI
E,L. DISEASE . POLICY LIMIT s
DESCRIPTIONOFOPERATIONSTLOCATIONSTVEHICLES (ACORDl0l,AddltlonalRomrrl3Schcdulo,mlyboittrchedlfmorolps€lsrsqulrod)
Eagle County, its assoclated or afflllated enffUes, lts successors and asslgns, elected ofllcials, employees, agents and volunteers are Additional Insureds
under the commerclal general llablllty and automoblle llablllty pollcies of lnsurance, ATIMA.
SHOULD ANY OF THE ABOVE DESCRIBEO POLICIES BE CANCELLED BEFORE
THE EXPIRATION OATE THEREOF, NOTICE W1LL BE DELIVERED IN
ACCORDANCE WITH THE FOLICY PROVISONS.
ACORD 2512014t011 The ACORD name and logo are reglstercd marks of ACORD
ITGSCOPIC'
Better Medicine. Better Lives
CERTIFICATE HOLDER
Eagle County Public Health & Environment
PO Box 850
Eagle, CO 81631-0850
CERTIFICATE OF PROFESSIONAL LIABILITY INSURANCE
INSURED
Colorado Mountain Medical P.C.
PO Box 1749
Edwards. CO 81632-l'7 49
Group Name: Colorado Mountain Medical P.C.
This Certificate is issued as a matter of information only and confers no rights upon the holder. By its
issuance the company does not alter, change, modifu or extend the provisions of said policy and does
not waive any of its rights thereunder. COPIC extends blanket coverage to an employee or authorized
volunteer worker (an "insured") of the named insured while working under the direct supervision of the
named insured and within the scope of their assigned duties. However, "employee" or "volunteer
worker" does not include:
Acupuncturists
Advanced Practice Nurses
Aestheticians
Anesthesiologist Assistants
Child Health Associates
Clinical Nurse-Specialists
CRNAAIuTse Anesthetists
Cytotechnologists
Electroloeists
Emergency Medical Techs
Endermologists
Laser Technicians
Microdermabrasionists
Nurse Clinicians
Nurse Midwives
Nurse Practitioners
Pharmacists
Physician Assistants
Physicists
Physiologists
Psychologists
Psychotherapists
Radiology Practitioner Assistants
Optometrists Surgical Assistants
Orthopaedic PhysicianAssistants Surgical Technicians
or any other allied health professional performing highly-skilled health care services or procedures even if
they are employees unless the individual or the position is listed on the declaration page(s) and in that
event, an employee or volunteer listed on the declaration page(s) shall be treated as an "insured" for
coverage purposes. Each "Insured" shall share limits with others, as provided in the Policy. Because we
cover certain t5zpes of "Insureds" on an automatic and blanket basis, we are unable to veriff coverage for
an individual who is not in one of the allied health specialties identified above.
POLICYNUMBER: PCC0003985
POLICY TERM: l2ll7 12015 to: l2ll7 12016
LIMITS OF LIABILITY:
RETRO DATE: l2ll7/1987
Per Medical Incident/Peer Review Incidentg 1,000,000
spECIALTy: Entity/Corp Specialty
Annual Aggregate$ 3'000',000
Dated at: Denver. Colorado
co-cor 09t0v20r0
Post Office Box 17540 Denver, Colorado 80217-0540 (720) 858-6000 l-800-421-1834 FAX (720) 858-6004
Date: November 23, 2015
Countersigned by Authorized Representative
