HomeMy WebLinkAboutC14-115 Alpine Springs Counseling AgreementAGREEMENT BETWEEN EAGLE COUNTY
AND
ALPINE SPRINGS COUNSELING, P.C.
This Agreement ("Agreement") is effective as of the -day of March, 2014 and is between the
County of Eagle, State of Colorado, a body corporate and politic, by and through its County
Manager ("County"), and Alpine Springs Counseling, P.C. a Colorado professional corporation,
with a mailing address of PO Box 1983, Glenwood Springs, CO 81602 ("Contractor").
WHEREAS, the County, through its Department of Health and Human Services
("HHS"), works to promote the health, safety and welfare of County residents of all ages; and
WHEREAS, County provides various services to Eagle County residents in order to
promote health, safety and welfare; and
WHEREAS, the use of outside providers enhances the ability of County to promote such
health, safety and welfare; and
WHEREAS, County wishes to hire Contractor to perform the services outlined in Section
1.1 hereunder; and
WHEREAS, County and Contractor intend by this Agreement to set forth the scope of
the responsibilities of the Contractor in connection with the services and related terms and
conditions to govern the relationship between Contractor and County in connection with the
services.
AGREEMENT
NOW THEREFORE, based upon the representations by Contractor set forth in the
foregoing recitals, for good and valuable consideration, including the promises set forth herein,
the parties agree to the following:
1. Scope of Services:
1.1 The Contractor will provide the services more particularly set forth in the attached
Exhibit "A" labeled Scope of Services (hereinafter called "Contractor's Services" or "Services")
incorporated herein by reference. The Contractor's Services are generally described as providing
substance abuse treatment and monitoring services and domestic violence treatment services for
Child Welfare clients to prevent unnecessary placement of children and youth in out -of -home
care, support family preservation, and assist in family reunification.
1.2 Any revision, amendment or modification of this Agreement shall be valid only if
in writing and signed by all parties. Except as may be expressly altered by the amendment, all
terms and conditions of this Agreement shall control. To the extent the terms and conditions of
this Agreement may conflict with Exhibit "A" or any future exhibits or amendments, the terms
and conditions of this Agreement shall control.
1.3 The Contractor agrees that Contractor will not knowingly enter into any
arrangement with third parties that will conflict in any manner with this Agreement.
1.4 Contractor has given the County a proposal for performing the Services and
represented that it has the expertise and personnel necessary to properly and timely perform the
Services.
2. Term of Agreement:
2.1 This Agreement shall commence on the agreement date first above written and,
subject to the provisions of Section 2.2 hereof, shall continue in full force and effect until May
31, 2015.
2.2 This Agreement may be terminated by either party for any reason with 15 days
written notice, with or without cause, and without penalty. In the event the Contractor files for
bankruptcy or is declared bankrupt or dissolves, County may declare in writing that this
Agreement is terminated, and all rights of Contractor and obligations of County, except payment
of accrued but unpaid fees set forth in Section 2.3 hereof, shall terminate immediately.
2.3 In the event of any termination of this Agreement, Contractor shall be
compensated for all hours of work then satisfactorily completed.
3. Independent Contractor:
3.1 With respect to the provision of the Contractor's Services hereunder, Contractor
acknowledges that Contractor is an independent contractor providing Contractor's services to the
County. Nothing in this Agreement shall be deemed to make Contractor an agent, employee,
partner or representative of County.
3.2 The Contractor shall not have the authority to, and will not make any
commitments or enter into any agreement with any party on behalf of County without the written
consent of the Board of County Commissioners.
3.3 The Contractor and its employees are not entitled to workers' compensation
benefits through the County. The Contractor is solely responsible for necessary and adequate
workers' compensation insurance and shall be responsible for withholding and paying all federal
and state taxes. The Contractor and its employees are not entitled to unemployment insurance
benefits unless unemployment compensation coverage is provided by an entity other than the
County. The Contractor hereby acknowledges full and complete liability for and timely payment
of all local, state and federal taxes imposed including, without limitation, tax on self-employment
income, unemployment taxes and income taxes.
4. Compensation:
4.1 For the Contractor's Services provided hereunder, County shall pay to the
Contractor a fee as set forth in the attached Exhibit "A." Contractor will not be entitled to bill at
overtime and/or double time rates for work done outside normal business hours unless
2
specifically authorized to do so by County. In no event shall fees or compensation under this
Agreement exceed ten thousand dollars ($10,000). Fees for any additional services will be as set
forth in an executed addendum between the parties.
4.2 For reimbursement Contractor must submit invoices by the fifth business day of
each month. 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 to explain the insufficiency of the invoice.
Fees will be paid within thirty (30) days of receipt of a proper and accurate invoice from
Contractor for Contractor's Services.
All invoices must be mailed or delivered in-person to the following address to ensure
proper payment. Invoices sent by fax or email will not be accepted.
Eagle County Health & Human Services
Business Office
550 Broadway
P.O. Box 660
Eagle, CO 81631
4.3 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 of this Agreement as hereinafter
provided 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 prescribed by the provisions of this Agreement, then upon
written notice of such determination and request for reimbursement from County, Contractor
shall forthwith return such payment to County. Upon termination of this Agreement as set forth
herein or expiration of the Term, any unexpended funds advanced by County to Contractor shall
forthwith be returned to County.
4.4 Notwithstanding anything to the contrary contained in this Agreement, no charges
shall be made to the County nor shall any payment be made to the Contractor in excess of the
amount for any work done in respect of any period after December 31st of the calendar year of
the Term of this Agreement, without the written approval in accordance with a budget adopted
by the Board of County Commissioners in compliance with the provisions of 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).
5. 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 or any of its
officers, agents, or employees 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 subcontractors hereunder; and
Contractor shall reimburse County for any and all 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 the County is liable to such third party for such claims
without regard to the involvement of the Contractor.
6. Contractor's Professional Level of Care and Additional Duties:
6.1 In rendering its 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, the performance of such obligation to be determined at the sole discretion of
County. In the event that County finds these standards of customer service are not being met by
Contractor, County may terminate this Agreement, in whole or in part, upon ten (10) days notice
to the Contractor.
6.2 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".
6.3 Contractor shall maintain, for a minimum of 3 years, adequate financial and
programmatic records for reporting to County on performance of its responsibilities hereunder.
Contractor shall be subject to financial audit by federal, state or county auditors or their
designees. Contractor authorizes County to perform audits or to make inspections during normal
business hours, upon 48 hours notice to Contractor, for the purpose of evaluating performance
under this Agreement. Contractor shall cooperate fully with authorized HHS representatives in
the observation and evaluation of the program and records. Contractor shall have the right to
dispute any claims of misuse of funds and seek an amicable resolution with County.
6.4 Contractor shall comply with all applicable federal, state and local rules,
regulations and laws governing services of the kind provided by Contractor under this
Agreement. Contractor shall be solely responsible for ensuring proper licensing and
credentialing of those providing services under this Agreement.
6.5 Contractor shall comply with the requirements of 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.
7. Notice:
Any notice required under this Agreement shall be given in writing by registered or certified
mail; return receipt requested which shall be addressed as follows:
4
COUNTY:
Eagle County Health & Human Services
Toni Rozanski
P.O. Box 660
Eagle, CO 81631
970-328-8852
8. Insurance:
CONTRACTOR:
Alpine Springs Counseling, P.C.
Robert Stark Ph. D., CAC III
PO Box 1983
Glenwood Springs, CO 81602
970-945-7858
8.1 At all times during the term of this Agreement Contractor shall maintain in full
force and effect the following insurance:
Insurance Type Coverage Minimums
• Workers' Compensation Statutory
• Employers Liability, including $1,000,000
Occupational Disease
• Comprehensive General Liability, including $1,000,000 per occurrence or as specified in
Broad Form Property Damage
the Colorado Governmental Immunity Act,
whichever is greater. This policy shall be
endorsed to include coverage of
physical/sexual abuse and molestation.
• Professional Liability Insurance
$1,000,000 per occurrence
• Third party fidelity/crime coverage
The policy shall name Eagle County and
including coverage for theft and
Eagle County's clients as loss payee as their
mysterious disappearance.
Interests may appear.
8.2 Contractor shall purchase and maintain such insurance as required above and shall
provide certificates of insurance in a form acceptable to County upon execution of this
Agreement. Contractor shall name Eagle County, is elected officials and employees as an
additional insured under the general liability policy. A certificate reflecting the foregoing
insurance shall be attached hereto and incorporated herein as Exhibit C.
9. Non -Assignment and Subcontractors:
Contractor shall not assign this Agreement or employ any subcontractor without the prior
written approval of the County Representative, who is designated in Section 7 of this Agreement.
The Contractor shall be responsible for the acts and omissions of its agents, employees and sub-
contractors. The Contractor shall bind each subcontractor to the terms of this Agreement. The
County may terminate this Agreement, if the Contractor assigns or subcontracts this Agreement
without the prior written consent from the County, and any such assignment or subcontracting
shall be a material breach of this Agreement.
10. Jurisdiction and Confidentiality:
10.1 This Agreement shall be interpreted in accordance with the laws of the State of
Colorado and the parties hereby agree to submit to the jurisdiction of the courts thereof. Venue shall
be in the Fifth Judicial District for the State of Colorado.
10.2 The Contractor and County acknowledge that, during the term of this Agreement and
in the course of the Contractor rendering the Contractor's Services, the Contractor and County may
acquire knowledge of the business operations of the other parry not generally known and deemed
confidential. The parties shall not disclose, use, publish or otherwise reveal, either directly or through
another, to any person, firm or corporation, any such confidential knowledge or information and shall
retain all knowledge and information which he has acquired as the result of this Agreement in trust in a
fiduciary capacity for the sole benefit of the other party during the term of this Agreement, and for a
period of five (5) years following termination of this Agreement. Any such information must be
marked as confidential. The parties recognize that the County is subject to the Colorado Open
Records Act and nothing herein shall preclude a release of information that is subject to the
same.
11. Miscellaneous:
11.1 This Agreement constitutes the entire Agreement between the parties related to its
subject matter. It supersedes all prior proposals, agreements and understandings, either verbal or
written.
11.2 This Agreement does not and shall not be deemed to confer upon or grant to any
third party any right enforceable at law or equity arising out of any term, covenant, or condition
herein or the breach hereof.
11.3 Invalidity or unenforceability of any provision of this Agreement shall not affect
the other provisions hereof, and this Agreement shall be construed as if such invalid or
unenforceable provision was omitted.
12. Prohibitions on Public Contract for Services:
If Contractor has any employees or subcontractors, Contractor shall comply with C.R.S. §
8-17.5-101, et seq., regarding Illegal Aliens — Public Contracts for Services, and this Contract.
By execution of this Contract, Contractor certifies that it does not knowingly employ or contract
with an illegal alien who will perform under this Contract 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 work under this Contract.
(a) Contractor shall not:
(i) Knowingly employ or contract with an illegal alien to perform
work under this contract for services; or
(ii) Enter into a contract with a subcontractor that fails to certify to the
Contractor that the subcontractor shall not knowingly employ or
contract with an illegal alien to perform work under the public
contract for services.
(b) Contractor has confirmed the employment eligibility of all employees who
are newly hired for employment to perform work under this Contract
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
(c) The 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 the Contractor obtains actual knowledge that a subcontractor performing
work under the public contract for services knowingly employs or
contracts with an illegal alien, the Contractor shall be required to:
(i) Notify the subcontractor and the County within three (3) days that
the Contractor has actual knowledge that the subcontractor is
employing or contracting with an illegal alien; and
(ii) Terminate the subcontract with the subcontractor if within three
(3) days of receiving the notice required pursuant to subparagraph
(i) of paragraph (d) the subcontractor does not stop employing or
contracting with the illegal alien; except that the Contractor shall
not terminate the contract with the subcontractor if during such
three days the subcontractor provides information to establish that
the subcontractor has not knowingly employed or contracted with
an illegal alien.
(e) The 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 a Contractor violates these prohibitions, the County may terminate the
contract for a breach of the contract. If the contract is so terminated
specifically for a breach of this provision of this Contract, the Contractor
shall be liable for actual and consequential damages to the County as
required by law.
(g) The County will notify the office of the Colorado Secretary of State if
Contractor violates this provision of this Contract and the County
terminates the Contract for such breach.
11 SIGNATURE PAGE TO FOLLOW //
IN WITNESS WHEREOF, the parties hereto have executed this Agreement the day and
year first above written.
COUNTY OF EAGLE, STATE OF COLORADO
By and through its County Manager
B•
eith Montag, County Manager
CONTRACTOR:
ALPINE SPRINGS COUNSELING, P.C.
By:
Robert Stark, Ph.D., CAC III, President
Alpine Springs Counseling, P.C.
EXHIBIT A
SCOPE OF SERVICES, PAYMENT & FEE SCHEDULE
Description of Services: Provide substance abuse treatment and monitoring services and
domestic violence treatment services for child welfare clients to prevent unnecessary
placement of children and youth in out -of -home care, support family preservation, and assist in
family reunification. Services will include individual and group substance abuse outpatient
treatment services, detox services, substance abuse monitoring through urine analysis or
Breathalyzer tests, and individual and group domestic violence treatment services
Additional Provisions:
1. Assessments and Planning. Contractor shall provide the County with an assessment and
plan within thirty (30) days of enrollment or participation in services by a family or child. This
plan shall include the treatment plan for the child's family, including specific objectives and
target dates for accomplishment. Such plan shall be subject to review and approval by County.
Thereafter, at monthly intervals, Contractor shall submit reports that include progress and
barriers in achieving the goals and provisions of the treatment plan. Reimbursement for
services relating to the plan is subject to the timely receipt of written assessment, plan, and
reports.
2. Eligibility. County is responsible for determining the eligibility of each individual family
for services under this agreement. County shall advise Contractor in writing of the authorized
service plan within three (3) working days of receipt of the certification and service plan (Exhibit
B). There shall be no payment for services provided without prior authorization for such
services by the County. Such authorization shall include the level of services to be provided, the
nature and type of services provided and the time frames in which these services are to be
provided.
3. Mandatory Reporting. Contractor shall notify HHS immediately of all reports of
suspected child abuse or neglect involving Contractor, including, but not limited to, employees,
volunteers and clients. HHS contractors are considered to be mandatory reporters for
suspected child abuse and neglect and are to make those reports directly to the Eagle County
Child Abuse and Neglect Hotline, 970-328-7720.
Payment and Fee Schedule: County will compensate Contractor for performance of substance
abuse treatment services as follows: (1) Face to face contact with clients for individual
outpatient services -$80 per hour for In Office services, $90 per hour for In Office bilingual
services, $90 per hour for In Home/ Off Site services, $95 per hour for In Home/ Off Site
bilingual services; (2) Face to face contact with clients for group outpatient services -$45 per
hour for In Office services, $55 per hour for In Office bilingual services, $55 per hour for In
Home/ Off Site services, $60 per hour for In Home/ Off Site bilingual services; (3) Detox services
$140 per day for In Office services, $150 per day for In Office bilingual services; (4) Substance
abuse monitoring services -$10 per episode for Breathalyzer testing, $20 per episode for urine
analysis testing, $35 per episode for ETG analysis. County will compensate Contractor for
performance of domestic violence treatment services as follows: (1) Face to face contact for
domestic violence treatment services -$75 per hour for In Office services, $85 per hour for In
Office bilingual services, $85 per hour for In Home/ Off Site services, $90 per hour for In Home/
Off Site bilingual services; (2) Face to face contact for group domestic violence services- $45 per
hour for In Office group counseling services, $55 per hour for In Office bilingual group
counseling services. (6) Case management services -$35 per hour including travel to and from a
client family home to perform services or participating in case conferences. The maximum
contract amount is not to exceed $10,000.
10
Household #: 19 -
Telephone #:
Dates of Service: /
Start End
Exhibit B
Eagle County Health & Human Services
Authorization for Services
Case Name:
Family's Mailing Address:
Family's Physical Address:
Service Provider:
Family Information
r..+k_ ne„+h.,. /`hies !'hilrl (:hilrl (:hilri (;him
Family
Members
Date of Birth
Household Suffix 01 02 03 04 05 06 07
State I D #
Social Security #
Types of Services Requested
Pleasa Check r,ll Which Family Members Will Receive Services Indicated
Suffix 01 02 03 04 05 06 07
Family Communication
Individual Parenting Skills
Intensive Family/ Individual Therapy
Group Services
Substance Abuse Evaluation
Substance Abuse Treatment
(Specified)
Sexual Abuse Treatment
Day Treatment
Psychological Evaluation
Psychiatric Evaluation
Parent -Child Interact ional
Other
(Specified)
Comments
Total Number of Units Approved (1 unit =1 hour):
Payment Method
EHS Core TANF Child Welfare
Progress Reports
Required Monthly Not Required
CWMH Core: Human Service Other
Case Manager: Telephone #:
Date
Manager: Telephone #:
Date
Bills must be submitted by the 51h of the month. Mail to HHS, P.O. Box 660, Eagle, CO 81631
HHS Business Office
Total Obligation: Date Entered:
Service Dates Service Amounts Date Paid Obligation Balance
11
EXHIBIT C
INSURANCE CERTIFICATE
(Certificate of insurance to be inserted as Exhibit C)
12
Account Number: CO STAR 1980 Date: 11/18/13 Initials: JA
CERTIFICATE OF INSURANCE
DARWIN NATIONAL ASSURANCE COMPANY
C/O: American Professional Agency, Inc.
95 Broadway, Amityville, NY 11701
800-421-6694
This is to certify that the insurance policies specified below have been issued by the company indicated
above to the insured named herein and that, subject to their provisions and conditions, such policies afford
the coverages indicated insofar as such coverages apply to the occupation or business of the Named insured(s)
as stated.
THIS CERTIFICATE OF INSURANCE NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR
ALTERS THE COVERAGE(S) AFFORDED BY THE POLICY(IES) LISTED ON THIS CERTIFICATE.
Name and Address of Insured:
ROBERT S. STARK, PH.D.
PO BOX 1983
GLENWOOD SPGS CO 81602
Type of Work Covered: PROFESSIONAL PSYCHOLOGIST
Location of Operations: N/A
(If different than address listed above)
Claim History:
Do+- i— ,— A7 i-- ; a 1 0 /(11 /7 flfld
Additional Named Insureds:
Coverages
Policy
Number
Effective
Date
Expiration
Date
Limits of
Liability
PROFESSIONAL/
LIABILITY
5010-6392
12/01/13
12/01/14
1,000,000
3,000,000
NOTICE OF CANCELLATION WILL ONLY BE GIVEN TO THE FIRST NAMED INSURED ON THIS
POLICY AND HE OR SHE SHALL ACT ON BEHALF OF ALL INSUREDS WITH RESPECT TO GIVING
OR RECEIVING NOTICE OF CANCELLATION.
Comments: COLORADO DEPARTMENT OF CORRECTIONS IS LISTED AS AN
ADDITIONAL INSURED ON THE ABOVE REFERENCED POLICY.
This Certificate Issued to:
Name: ROBERT S. STARK, PH.D.
PO BOX 1983
Address:
GLENWOOD SPGS CO 81602
APA 00049 00 (05/2012)
Autgorized Representative
ALSPR-4 OP ID: ML
CERTIFICATE OF LIABILITY INSURANCE
DAT02107D1YYYYy
auo7na
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 policy(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 endorsement(s).
PRODUCER Phone: 970-945-9161
GIA Group/Glenwood Ins. Agency
P o Box 1270 Fax: 970-945-6027
Glenwood Springs, CO 81602-1270
Christy Franke
NAME: Melissa Anderson
MCI,. EIB: 970-384.5311 A� Ne : 970-945-6027
E-MAIL
melissas lenwoodins.com
INSURER(S) AFFORDING COVERAGE NAIC
INSURER A: Great American Insurance Co.
INSURED Alpine Springs Counseling P.C.
P.O. Box 1983
Glenwood Springs, CO 81602
INSURER B: Pinnacol Assurance
INSURER C
INSURER 0:
INSURER E :
INSURER F :
COVERAGES CERTIFICATE NUMBER: REVlclnlu wlllu129M&
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.
INSR
LTR
TYPE OF INSURANCEAULJL
POLICY NUMBER
MM1DD
POLICY EXP
MMIDDIYYYY
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ - 1,000,00
A
X COMMERCIAL GENERAL LIABILITY
CLAIMSMADE OCCUR
X
PAC0630001
1110413
11/04/14
DAMAGETO RENTED
PREMISES Ea occurrence $ 100,0
MED EXP (Any one person) $ 10,000
PERSONAL &ADV INJURY $ 1,000,00
GENERAL AGGREGATE $ 3,000,00
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS- COMPIOP AGG $ 3,000,00
POLICY F1PRO LOC
$
AUTOMOBILE
LIABILITY
Ea aBINEDcide tSINGLE LIMIT $
BODILY INJURY (Per person) $
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY Per accident $
( )
NON -OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAG
Per accident $
UMBRELLA LIAR
HCLAIMS-MADE
OCCUR
EACH OCCURRENCE $
EXCESS LIAS
AGGREGATE $
DED I I RETENTION $
1 $
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNERIEXECUTIVE YIN
OFFICERIMEMBER EXCLUDED?
N 1 A
027610
04/01/13
04/01/14
X WC STATU- OTH-
I TOBY LIMITS ER
E.L. EACH ACCIDENT $ 100,00
E.L. DISEASE- EA EMPLOYEE $ 100,00
If yes, describe under oryin
(Mandatory d and
DESCRIPTION OF OPERATIONS below
E.L. DISEASE- POLICY LIMIT $ 500,00
A
Property Section
PAC0630001
1110413
11/04/14
DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more apace is required)
Certificate holder is listed as Addiotnal Insured in regad tothe Insured's
ongoing operatons as resepcts the GeneraLiability Policy.
Peer Assistance Services
2170 S Parker Rd Ste229
Denver, CO 80231
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
01988-2010 ACORD CORPORATION- All rights reserved
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
