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Home My WebLink About2012-153 Aging - Linda Cole, RN Zo12..i�a [Departmental Use Only] TITLE Fit Feet-Cole FY 2012-13 ORANGE COUNTY CONTRACT UNDER$10,000.00 NORTH CAROLINA THIS AGREEMENT, made and entered into this 1st day of July, 2012, ("Effective Date") by and between Orange County, North Carolina, a body politic and corporate organized under the laws of the State of North Carolina, (the "County"), party of the first part; and Linda Cole, R.N. (the "Provider"), party of the second part; WITNESSETH: For the purpose and subject to the terms and conditions hereinafter set forth, the County hereby contracts for the services of the Provider, and the Provider agrees to provide the following services to the County in accordance with the terms of this Agreement,time being of the essence: The services and/or materials (hereinafter referred to collectively as "Services") to be furnished under this Agreement are as follows: staffing the weekly Fit Feet Clinics at the Central Orange and Seymour Senior Centers,which includes screening clients for feet problems, providing basic trimming of the nails and education on appropriate foot care,and referring clients for medical evaluation and/or intervention as needed. The term of this agreement rendered shall be from July 1,2012 to June 30, 2013. Provider represents and agrees that Provider is qualified to perform and fully capable of performing and providing the services required or necessary under this Agreement in a fully competent, professional and timely manner to the satisfaction of the County. Provider shall be responsible for all errors or omissions, in the performance of the Agreement. Provider shall correct any and all errors, omissions, discrepancies, ambiguities, mistakes or conflicts at no additional cost to the County. Provider agrees that Provider shall not sub-contract any of the services to be provided in this Agreement, nor shall Provider assign any right or responsibility granted or required by this Agreement,without the prior written approval of the County. SPECIFIC TERMS 1. Payment: The County agrees to pay at the rates specified for Services satisfactorily performed in accord with this Agreement. The amount to be paid by the County shall not exceed $3,000.00, ($20.00/hr). Payment shall be made within thirty (30) days of an invoice properly submitted to County. Should Provider fail to perform its duties under the terms of this Agreement, County°may, without fault or penalty, withhold any payment associated with the work to be performed until such time as said work is completed. 2. Non—waiver: Failure by County at any time to require the performance by Provider of any of the provisions hereof shall in no way waive or affect the County's right hereunder to enforce the same, nor shall any waiver by the County of any breach be held to be a waiver of any succeeding breach or a waiver of this Non-Waiver Clause. 3. Independent Contractor: The Provider shall operate as an independent Provider, and the County shall not be responsible for any of the Provider's acts or omissions. The Provider shall not be treated as an employee with respect to the Services performed hereunder for federal or state tax, unemployment or workers' compensation purposes. The Provider understands that neither federal, nor state, nor payroll tax of any kind shall be withheld or paid by the County on behalf of the Provider or the employees of the Provider. 4. Insurance: The Provider shall obtain, at its sole expense, all insurance needed to adequately insure itself during the performance of these services as required by the County's Risk Management Policy. Revised July 2010 1 . h 5. Indemnity: The Provider agrees to defend, indemnify, and hold harmless Orange County from all losses, liabilities, claims, demands, suits, costs, damages or expenses (including reasonable attorney's fees) arising from bodily injury, including death, to any person or persons or damage to or destruction of any property caused in whole or in part by any negligent or intentional act or omission on the part of the Provider. 6. Termination: This Agreement may be terminated at any time by mutual written agreement of the parties or by the County upon written notice to the Provider. 7. Entire Agreement: The parties have read this Agreement and agree to be bound by all of its terms, and further agree that it constitutes the complete and exclusive statement of the Agreement between the parties unless and until modified in writing and signed by the parties. Modifications may be evidenced by telefacsimile signature. 8. Governing Law:aw: Both parties agree that this Agreement shall be governed by the laws of the State of North Carolina. Should either party initiate litigation to settle any dispute involving the terms of this Agreement such litigation shall be initiated in the General Court of Justice of North Carolina seated in Orange County, North Carolina. 9. Non Appropriation: Provider acknowledges that County is a governmental entity, and the validity of this Agreement is based upon the availability of public funding under the authority of its statutory mandate. In the event that public funds are unavailable and not appropriated for the performance of County's obligations under this Agreement, then this Agreement shall automatically expire without penalty to County immediately upon written notice to Provider of the unavailability and non-appropriation of public funds. IN WITNESS WHEREOF,Orange County and the Provider have signed this Agreement, effective as of the day first written above. ORANGE COUNT PROVIDER �G . By: '-(3 By:ic �� Co Mana Title: r` 200 S. Camero t. 201A Davie Road P.O. Box 818 Carrboro,NC 27510 Hillsborough,NC 27278 Vendor#60120 This instrument has been approved as to technical content. Ja toler,Departm4nt Director This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Contr 1 Act. h V,0—f (a.w ✓�• Office of the Finance Director This i ment has been approved as to form and legal sufficiency. Office of th Co ty Attorney Revised July 2010 2 Print Date: 7/27/2012 CNA HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP Certificate of �fiY�nr�iltce mnso nurses service organtzatwn•- OCCURENCE POLICY FORM Producer Branch Prefix Policy Number Policy Period 018098 970 HPG 0423623038 from 07/06/12 to 07/06/13 at 12:01 AM Standard Time Named Insured and Address: Program Administered by: Linda D Cole Nurses Service Organization 201 Davie Rd Apt A 159 E. County Line Road Carrboro, NC 27510-1670 Hatboro, PA 19040-1218 1-800-247-1500 www.nso.com Medical Specialty: Code: Insurance is provided by: Registered Nurse 80964 American Casualty Company of Reading, Pennsylvania Excludes Cosmetic Procedures 333 S. Wabash Avenue, Chicago, IL 60604 Professional Liability $ 500,000 each claim $2,500,000 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 $25,000 aggregate Defendant Expense Benefit $ 1,000 per day limit $25,000 aggregate Deposition Representation $ 10,000 per deposition $ 10,000 aggregate Assault $25,000 per incident $25,000 aggregate Includes Workplace Violence Counseling Medical Payments $25,000 per person $100,000 aggregate First Aid $ 10,000 per incident $ 10,000 aggregate Damage to Property of Others $ 10,000 per incident $10,000 aggregate Information Privacy(HIPAA)Fines and Penalties $25,000 per incident $25,000 aggregate 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 subiimit Personal Liability $500,000 aggregate Total: $ 143.00 Base Premium $143.00 Premium reflects Self Employed , Part Time Policy Forms&Endorsements(Please see attached list for a general description of many common policy forms and endorsements.) G-121500-D GSL10546NC G-121503-C G-121501-C G-145184-A G-147292-A GSLI5563 GSL15564 GSL15565 GSL17101 GSL13424 G-123846-C32 GSL3886 GSL3908 GSL19904 Keep this document in a safe piece.It /. i � � p `I _ and proof of payment are your proof of oT[ � ll'„U C1�-,r(!-^�- coverage. There is no coverage in force ' unless the premium is paid in full.In order Chairman of the Board Secretary to activate your coverage,please remit premium in full by the effective date of this Certificate of Insurance. Master Policy#188711433 G-141241-B(03/2010) Coverage Change Date: Endorsement Change Date: POLICY FORMS&ENDORSEMENTS The list below contains general descriptions of the policy forms and endorsements that may or may not apply to your professional liability insurance policy. Please refer to your Certificate of Insurance for the policy forms& endorsements specific to your state and your policy period.Coverages, rates and limits may differ or may not be available in all states.All products and services are subject to change without notice. Think Green—expanded definitions and copies of these policy forms and endorsements are available online at www.nso.com/policyforms COMMON POLICY FORMS&ENDORSEMENTS FORM# DESCRIPTION G-121500-D Common Policy Conditions GSL10546NC North Carolina Amendatory Endorsement G-121503-C Workplace Liability Form G-121501-C Occurrence Policy Form G-145184-A Policyholder Notice-OFAC Compliance Notice G-147292-A Policyholder Notice-Silica,Mold&Asbestos Disclosure GSL15563 Information Privacy Coverage Endorsement HIPAA Fines, Penalties&Notification Costs GSL15564 Sexual Misconduct Sublimits of Liability Professional Liability&Sexual Misconduct Exclusion GSL15565 Healthcare Providers Professional Liability Assault Coverage GSL17101 Exclusion of Specified Activities Reuse of Parenteral Devices and Supplies GSL13424 Services to Animals G-123846-C32 North Carolina Cancellation and Non-Renewal GSL3886 Coverage &Cap on Losses from Certified Acts Terrorism GSL3908 Notice-Offer of Terrorism Coverage&Disclosure of Premium GSL19904 Exclusion of Cosmetic Procedures PLEASE REFER TO YOUR CERTIFICATE OF INSURANCE FOR THE POLICY FORMS&ENDORSEMENTS SPECIFIC TO YOUR STATE AND YOUR POLICY PERIOD. For NJ residents: The PLIGA surcharge shown on the Certificate of Insurance is the NJ Property&Liability Insurance Guaranty Association. For KY residents: The surcharge shown on the Certificate of Insurance is the KY Firefighters and Law Enforcement i Foundation Program Fund and the Local Tax is the KY Local Government Premium Tax. For WV residents: The surcharge shown on the Certificate of Insurance is the WV Premium Surcharge. For FL residents: The FIGA Assessment shown on the Certificate of Insurance is the FL Insurance Guaranty Association. Form#:G-1 41241-B(03/2010) Named Insured:Linda D Cole Master Policy#:188711433 Policy#:0423623038 I ; Print Date: 7/27/2012 HEALTHCARE PROVIDERS SERVICE CNAORGANIZATION PURCHASING GROUP ®n V O (Certificate of '1115m ance nurses service organization" OCCURENCE POLICY FORM Producer Branch Prefix Policy Number Policy Period 018098 970 HPG 0423623038 from 07/06/12 to 07/06/13 at 12:01 AM Standard Time Named Insured and Address: Program Administered by: Linda D Cole Nurses Service Organization 201 Davie Rd Apt A 159 E. County Line Road Carrboro, NC 27510-1670 Hatboro, PA 19040-1218 1-800-247-1500 www.nso.com Medical Specialty: Code: Insurance is provided by: Registered Nurse 80964 American Casualty Company of Reading, Pennsylvania Excludes Cosmetic Procedures 333 S.Wabash Avenue, Chicago, IL 60604 Professional Liability $ 500,000 each claim $2,500,000 aggregate Your professional liability limits shown above include the following: i • 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 $25,000 aggregate Defendant Expense Benefit $ 1,000 per day limit $25,000 aggregate Deposition Representation $ 10,000 per deposition $10,000 aggregate Assault $25,000 per incident $25,000 aggregate Includes Workplace Violence Counseling Medical Payments $25,000 per person $100,000 aggregate First Aid $ 10,000 per incident $10,000 aggregate Damage to Property of Others $ 10,000 per Incident $10,000 aggregate Information Privacy(HIPAA)Fines and Penalties $25,000 per incident $25,000 aggregate 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 sublimit Personal Liability $500,000 aggregate Total:$ 143.00 Base Premium $143.00 Premium reflects Self Employed , Part Time Policy Forms&Endorsements(Please see attached list for a general description of many common policy forms and endorsements.) G-121500-D GSL10546NC G-121503-C G-121501-C G-145184-A G-147292-A GSL15563 GSL15564 GSL15565 GSL17101 GSL13424 G-123846-C32 GSL3886 GSL3908 GSL19904 Keep this document in a safe place.It �� and proof of payment are your proof of .TI i coverage. There is no coverage in force un less the premium is paid in full.In order Chairman of the Board Secretary to activate your coverage,please remit premium in full by the effective date of i this Certificate of Insurance. Master Policy#188711433 G-141241-B(03/2010) Coverage Change Date: Endorsement Change Date: i POLICY FORMS&ENDORSEMENTS The list below contains general descriptions of the policy forms and endorsements that may or may not apply to your professional liability insurance policy. Please refer to your Certificate of Insurance for the policy forms& endorsements specific to your state and your policy period.Coverages, rates and limits may differ or may not be available in all states.All products and services are subject to change without notice. Think Green—expanded definitions and copies of these policy forms and endorsements are available online at www.nso.com/policyforms COMMON POLICY FORMS& ENDORSEMENTS FORM# DESCRIPTION G-121500-D Common Policy Conditions GSL10546NC North Carolina Amendatory Endorsement G-121503-C Workplace Liability Form G-121501-C Occurrence Policy Form G-145184-A Policyholder Notice-OFAC Compliance Notice G-147292-A Policyholder Notice-Silica, Mold&Asbestos Disclosure GSL15563 Information Privacy Coverage Endorsement HIPAA Fines, Penalties&Notification Costs GSL15564 Sexual Misconduct Sublimits of Liability Professional Liability&Sexual Misconduct Exclusion GSL15565 Healthcare Providers Professional Liability Assault Coverage i GSL17101 Exclusion of Specified Activities Reuse of Parenteral Devices and Supplies GSL13424 Services to Animals G-123846-C32 North Carolina Cancellation and Non-Renewal GSL3886 Coverage&Cap on Losses from Certified Acts Terrorism GSL3908 Notice-Offer of Terrorism Coverage&Disclosure of Premium GSL19904 Exclusion of Cosmetic Procedures PLEASE REFER TO YOUR CERTIFICATE OF INSURANCE FOR THE POLICY FORMS&ENDORSEMENTS SPECIFIC TO YOUR STATE AND YOUR POLICY PERIOD. For NJ residents: The PLIGA surcharge shown on the Certificate of Insurance is the NJ Property&Liability Insurance Guaranty Association. For KY residents: The surcharge shown on the Certificate of Insurance is the KY Firefighters and Law Enforcement Foundation Program Fund and the Local Tax is the KY Local Government Premium Tax. For WV residents: The surcharge shown on the Certificate of Insurance is the WV Premium Surcharge. For FL residents: The FIGA Assessment shown on the Certificate of Insurance Is the FL Insurance Guaranty Association. Form#:G-141241-B(03/2010) Named Insured:Linda D Cole Master Policy#:188711433 Policy#:0423623038