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HomeMy WebLinkAboutC17-381 Community Health ServicesTHIRD AMENDMENT TO AGREEMENT BETWEEN
EAGLE COUNTY, COLORADO
AND
COMMUNITY HEALTH SERVICES, INC.
FOR THE PROVISION OF PRENATAL HEALTH CARE SERVICES
THIS THIRD AMENDMENT ("Third Amendment") is effective as of 11/16/2017
by and between Community Health Services, Inc., a Colorado nonprofit corporation (hereinafter
"Consultant" or "Contractor") and Eagle County, Colorado, a body corporate and politic
(hereinafter "County")
RECITALS
WHEREAS, County and Consultant entered into an agreement dated the 10'h day of February,
2015, for certain Services (the "Original Agreement") (C15-051); and
WHEREAS, by a First Amendment dated the 15`i' day of December, 2015, the parties extended
the term of the Original Agreement to December 31, 2016; and
WHEREAS, by a Second Amendment dated the 14'h day of November, 2016, the parties
extended the term of the Original Agreement to December 31, 2017; and
WHEREAS, the term of the Original Agreement expires on the 31' day of December, 2017 and
the parties desire to extend the term of the Original Agreement for an additional year on the same
terms and conditions as set forth in the Original Agreement.
. : R - ►► ►I1 ►►I
NOW THEREFORE, in consideration of the foregoing and the mutual rights and obligations as
set forth below, the parties agree as follows:
1. The Original Agreement shall be amended to extend the term to the 31$' day of
December, 2018.
2. Capitalized terms in this Third Amendment will have the same meaning as in the
Original Agreement. To the extent that the terms and provisions of the Third
Amendment conflict with, modify or supplement portions of the Original Agreement,
the terms and provisions contained in this Third Amendment shall govern and control
the rights and obligations of the parties.
3. Except as expressly altered, modified and changed in this Third Amendment, all
terms and provisions of the Original Agreement shall remain in full force and effect,
and are hereby ratified and confirmed in all respects as of the date hereof.
4. This Third Amendment shall be binding on the parties hereto, their heirs, executors,
successors, and assigns.
C17-381
IN WITNESS WHEREOF, the parties hereto have executed this Third Amendment to the
Original Agreement the day and year first above written.
COUNTY OF EAGLE, STATE OF COLORADO,
By and Through Its COUNTY MANAGER
Bryan Treu, Interim County Manager
COMMUNITY HEALTH SERVICES, INC.
Print Name:
Liz Stark
Title: Executive Director
2
Eagle County Amendment Ext Term Final 5/14
CERTIFICATE OF LIABILITY INSURANCE
DA C F. (MbN"MrY I
3/25/2017
THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONIFERS 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 pollry(ias) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATIDN 15 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).
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HUB INTERNATIONAL INS SVCS INC/PHS
340B87 P: (866) 467-8730 F.- (888) 443-5112
PO BOX 33015
SAN ANTONIO TX 78265
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COMMUNITY HEALTH SERVICES
0405 CASTLE CREEK RD STE 6
,ASPEN CO 81611
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COVERAGES CERTIFICATE NUMBER: REVISIUN riUIr IUt:K:
THIS 13 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED 13ELOW 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 SE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUB.iECT TO ALL THE
TERMS,EXCLUSIDNS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
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rmvTpe,Ai une nGea CONCFI_ULTION
ACORD 25 (2016103)
Q 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and [one are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORE THE EXPIRATION DA'T'E THEREOF, NOTICE WILL BE
DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
"'""ORJZEDRE)P'ESENT"T11W -
Eagle County
PO BOX 850
EAGLE, CO 81631
ACORD 25 (2016103)
Q 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and [one are registered marks of ACORD
04/03/2017 12:03:43 PM -0600 FAXCOM PAGE 2 OF 3
ACORD. CERTIFICATE OF LIABILITY INSURANCE DATEIMLVDDiYYYY]
aRCOUCER
6a A 3x2017
Pinnacol Assurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY
75D1 E LowryStvd AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
Denver, CO 80230.7006 CERTIFICATE DOES NOT AMEND. EXTEND OR ALTER THE
COVERAGE AFFORDED BY THE POLICIES BELOW.
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Community Health Services, Inc.
0405 Castle Creek Road Ste 201
Aspen. 00 81611
COVERACE6
INSURERS AFFORDING COVERAGE
INWRERA Pinnacol Assurance
INIVRER B
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41190
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMMENT 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
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CERTIFICATE HOLDER
COmmunityHealth services
0405 Castle Creek Rd
Suite 201
Aspen. CC 81611
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CANCELLATION
SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE; THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO
NOTIFY 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO
THE LEFT, BUT FAILURE TO NOTIFY SUCH NOTICE SHALL IMPOSE NO
OBLIGATION OR LIABILITY OFANY KIND UPON THE COMPANY, ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Jeff Bunn
ACORD 2312001108} Undelwrier ACORD CORPORATION 151118
312412017 11:54:04 AM
Fax5erver Fa rver003 Page 4
CNAORGANIZATION
HEALTHCARE PROVIDERS SERVI6
PURCHASING GROUP
Certificate of nIA T�l mnso
nurses i
OCCURRENCE POLICY FORM Print Date: 3/24/2017
Producer Branch Prefix
Policy Number Policy Period
018098 970 HPG
0265550879 from 04/29/17 to 04/29/18 at 12:01 AAA Standard Time
Named Insured and Address:
Program Administered by:
Community Health Services, Inc.
Nurses Service Organization
405 Castle Creek Rd Ste B
158 E. County Line Roar!
Aspen, CO 81611-3125
Hatboro, PA 19040-1218
1-888-288-3534
www.nso.com
Medical Specialty:
Code: Insurance is provided by:
Nurse Practitioner Firm
80965 American Casualty Company of Reading, Pennsylvani
Excludes Cosmetic Procedures
333 S. Wabash Avenue, Chicago, IL 80604
Professional Liability
$1,000,000 each claim $6,000,000 aggregate
Your professional liability limits shown above include the following:
Good Samaritan Liability
" Malplacement Liability Personal Injury Liability
Sexual Misconduct Included in the PL limit shown above subject to $ 25.000 aggregate sublimit
Coverage Extensions
License Protection
$ 25,000 per proceeding S 25. DOD aggregate
Defendant Expense Benefit
$ 1,000 per day limit S 25 DOD aggregate
Deposition Representation
$ 10,0110 per deposition S10-000 aggregate
Assault
S25,000 per incident S 25. DOD aggregate
Includes Workplace Violence Counseling
Medical Payments
$ 25,0110 per person S100,000 aggregate
First Ald
$ 10,000 per Incident 510,000 aggregate
Damage to Property of Others
$10,000 per incident S-10'.000 aggregate
Enterprise Privacy Protection - Claims Made $ 25,000 per incident S 25,000 aggregate
Retroactive Date: 4/29/2016
(Defense inside limits)
Workplace Liability
Workplace Liability Included in Professional Liability Limit shown above
Fire & Water Legal Liability Included in the PL limit shown above subject to $150,000 aggregate sublim t
Total: $ 8,740.00
Base Premium $8,740.0
Policy Forms & Endo rsements(Please see attached list for a general description of many common policy forms and
endorsements.)
G -121500-D G-1 21503-C G -121501-C G -145184-A G-1 47292-A GSL15564 GSL15565
GSL17101 GSL13424 GSL13425 CNAB0052 G-123846-CO5 CNA81753 CNA81758
CNA82011 CNA79575 CNA79516 GSL 5589 GSL -6076
Chairman of th Board
G -141241-l3 (0312010)
Keep this document in a sate place. ft
and proof or payment are your proof of
coverage. There is no coverage in fora
unless the premium is pain' in fLW-In ord.
Secretary to activate your coverage, please reraft
premium in fid by the effective date of
this Cerfirrcate of Insurance.
Master Policy # 188711433
Coverage Change Date: Endorsement Change Date,