Loading...
HomeMy WebLinkAbout2014-456 Health - Piedmont Health Services for services to PHS with respect to 20 hrs. per week services of a NC licensed Registered Dietitian $30,500 NORTH CAROLINA REGISTERED DIETITIAN SERVICES AGREEMENT ORANGE COUNTY This Services Agreement (hereinafter "Agreement"), made and entered into this 1St day of July, 2014, ("Effective Date") by and between Orange County,North Carolina a body politic and corporate of the State of North Carolina (hereinafter, the "County") through their Department of Health(hereinafter,the"OCHD") and Piedmont Health Services, Inc, (hereinafter,the "PHS"). WITNESSETH• That the County and PHS, for the consideration herein named, do hereby agree as follows: 1. Services a. Scope of Work. i) This Agreement is for services to be rendered by the County to PHS with respect to: Twenty hours (20) per week services of a North Carolina licensed Registered Dietitian ("RD"), as provided in Exhibit 1, PHS Job Description and Section 3 below, Basic Services. ii) By executing this Agreement, the County represents and agrees that OCHD 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. iii) Time is of the essence with respect to this Agreement. iv) The services to be performed under this Agreement consist of Basic Services, as described and designated in Section 3 hereof and as provided in Exhibit 1, PHS Job Description. Compensation to the County for Basic Services under this Agreement shall be as set forth herein. 2. Responsibilities of PHS a. Services to be provided. The County shall provide PHS with all services required in Section 3 to satisfactorily complete the Project within the time limitations set forth herein and in accordance with the highest professional standards. b. Standard of Care. i) The County shall exercise reasonable care and diligence in performing services under this Agreement in accordance with the highest generally accepted standards of this type of practice throughout the United States and in accordance with applicable federal, state and local laws and regulations applicable to the performance of these services. County is solely responsible for the professional quality, accuracy and timely completion and/or submission of all work related to the Basic Services. Revised April 2010 1 ii) The County shall be responsible for all errors or omissions, in the performance of the Agreement. The County shall correct any and all errors, omissions, discrepancies, ambiguities,mistakes or conflicts at no additional cost to the PHS. iii) The County shall not, except as otherwise provided for in this Agreement, subcontract the performance of any work under this Agreement without prior written permission of PHS. No permission for subcontracting shall create, between the PHS and the subcontractor, any contract or any other relationship. iv) The County is an independent contractor of PHS. Any and all employees of the County engaged by the County in the performance of any work or services required of the County under this Agreement, shall be considered employees or agents of the County only and not of PHS, and any and all claims that may or might arise under any workers compensation or other law or contract on behalf of said employees while so engaged shall be the sole obligation and responsibility of the County. v) The County agrees that its employees, agents and its subcontractors, if any, shall be required to comply with all federal, state and local antidiscrimination laws, regulations and policies that relate to the performance of County's services under this Agreement. vi) If activities related to the performance of this Agreement require specific licenses, certifications, or related credentials County represents that it and/or its employees, agents and subcontractors engaged in such activities possess such licenses, certifications, or credentials and that such licenses certifications, or credentials are current, active, and not in a state of suspension or revocation. 3. Basic Services a. Basic Services. The Services to be rendered pursuant to this Agreement are as follows (fully describe services to be provided): Twenty hours per week services of a Registered Dietitian as provided in accordance with Exhibit 1 PHS Job Description and this Section of the Agreement as provided below: i) Hiring Responsibility: (a) OCHD will conduct the recruitment process; however, the PHS shall review and contribute to the job posting; (b) All job applications must follow the Orange County and OCHD hiring and recruitment policies; (c) The position will be posted on the Orange County job vacancy website. PHS may create a link to the Orange County vacancy website to advertise the position; (d) PHS will collaborate with OCHD in the selection process by helping to develop interview questions and serving on the interview and selection panel. Revised April 2010 2 ii) Job Description: The person in the position will follow the duties described within the Orange County job description when working with OCHD. While working at PHS, the person will follow the job duties as described in the PHS job description for MNT Dietitian (Exhibit 1). Job duties will be consistent with the scope of practice for dietitians registered and licensed to practice in North Carolina. iii) Supervision: OCHD Nutrition Program Manager is the primary supervisor of the RD. However, PHS will provide on-site supervision of the dietitian for the 20 hours per week the person works at PHS. PHS will report any practice infractions to OCHD within twenty-four hours. PHS will work with OCHD to create WPPR performance measures and consult with OCHD on the annual performance review. Supervisors will communicate monthly. iv) Orientation/Training: The RD must attend any County, OCHD and PHS required orientation and training. OCHD and PHS will discuss training needs and requirements and develop a mutually agreed upon schedule to meet the requirements. Training and Orientation may cause the normal work schedule to vary. v) Probationary Period: OCHD has a statutorily required 24 month probationary period to assess if the employee can perform proficiently. During this period of time, the Orange County Health Director has the right to terminate the employment due to unsatisfactory performance. Since this employee will be employed by OCHD, this would supersede the 90-day probationary period normally applied to PHS employees. Termination of the RD employment will terminate this Agreement. vi) Any revenue generated by the RD at PHS while providing the twenty hours of service shall be the property of PHS. vii) PHS assumes responsibility for setting fees, billing, collections and dispute resolutions for RD services provided at the PHS site. 4. Duration of Services a. Term. The term of this Agreement shall be from July 1, 2014 to June 30, 2015. b. Scheduling of Services. i) Regular Schedule. The RD shall work at OCHD on Tuesday and Thursday (all day) and Friday mornings. The RD shall work at PHS on Mondays (8am to 8pm) and Wednesdays (8am to 5pm), any changes to regular schedule or location of the RD will be made by the PHS Supervisor and the OCHD Nutrition Program Manager. Schedule or location changes must be mutually agreed upon by both parties in writing. ii) Excess Time Worked. Any time worked over the twenty hours per week required under this Agreement shall be paid by PHS. Revised April 2010 3 iii)Holiday Schedule. The RD will follow the holiday schedule adopted by the Orange County Board of County Commissioners for County employees. If PHS requires the RD to work during a scheduled holiday, PHS will be responsible for any overtime or holiday pay. iv)Leave. The RD will be provided with vacation and sick leave as an Orange County employee. When the employee is on scheduled leave from Orange County and PHS, PHS will be required to pay for services when the RD is on approved leave. The OCHD Nutrition Program Manager will consult with the PHS Supervisor prior to approving employee requests for vacation and sick leave. v) The Commencement Date for Basic Services shall be July 1, 2014. 5. Compensation a. Compensation for Basic Services. Compensation for Basic Services shall include all compensation due to the County from PHS for all services under this Agreement. The maximum amount payable for Basic Services shall not exceed a total of Thirty Thousand Five Hundred Dollars ($30,500) exclusive of any overtime or holiday pay and mileage reimbursement @ a maximum of 350 miles per/month at a rate of.50cents per mile up to a total of Two thousand One Hundred ($2,100) dollars. Payment for Basic Services shall become due and payable within thirty (30) days of the County properly invoicing PHS. The County shall invoice PHS monthly. Payment shall be subject to provisions of Section 5(b). Payment will begin only after the employee has been hired to the position and has begun receiving compensation from the County. b. Disputes. In the event the amount stated on an invoice is disputed by the PHS, PHS may withhold payment of all or a portion of the amount stated on an invoice until the parties resolve the dispute. Should the County fail to perform its duties under the terms of this Agreement, PHS may, without fault or penalty, withhold any payment associated with the work to be performed until such time as said work is completed. c. Additional Services. PHS shall not be responsible for costs related to any services in addition to the Basic Services performed by County unless County requests such additional services in writing and such additional services are evidenced by a written amendment to this Agreement. 6. Responsibilities of the County a. Cooperation and Coordination. The County has designated Renee Kemske to act as the County's representative with respect to Agreement and shall have the authority to render decisions within guidelines established by the Health Director and/or the County Board of Health and shall be available during working hours as often as may be reasonably required to render decisions and to furnish information. 7. Insurance Revised April 2010 4 a. General Requirements. PHS shall purchase and maintain and shall cause each of his subcontractors to purchase and maintain, during the period of performance of this Agreement: i) Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury, including bodily injury, sickness, disease or death of any of the PHS's employees or any other person and to real and personal property including loss of use resulting thereof in the amount of at least $ 1,000,000 for each occurrence and $2,000,00 in the aggregate; b. Additional Insured. All insurance policies required under this Agreement shall name the County as an additional insured party. Evidence of such insurance shall be furnished to the County, together with evidence that each policy provides the County with not less than thirty (30) days prior written notice of any cancellation, non-renewal or reduction of coverage. 8. Indemnity a. Indemnity. PHS agrees to defend, indemnify and hold harmless the County from all loss, liability, claims or expense, including attorney's fees, arising out of or related to the Agreement and arising from bodily injury including death or property damage to any person or persons caused in whole or in part by the negligence or misconduct of PHS except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this provision to require the PHS to indemnify the County to the fullest extent permitted under North Carolina law. 9. Amendments to the Agreement a. Changes in Basic Services. Changes in the Basic Services and entitlement to additional compensation or a change in duration of this Agreement shall be made by a written Amendment to this Agreement executed by the County and the PHS. The County shall proceed to perform the Services required by the Amendment only after receiving a fully executed Amendment from PHS. 10. Termination a. Termination for Convenience of the County. This Agreement may be terminated without cause by the County and for its convenience upon seven (7) days' prior written notice to the PHS. b. Other Termination. PHS may terminate this Agreement based upon the County's material breach of this Agreement provided the County has not taken all reasonable actions to remedy the breach. PHS shall give the County thirty (30) days' prior written notice of its intent to terminate this Agreement for cause. c. Compensation After Termination. i) In the event of termination, the County shall be paid that portion of the fees and expenses that the employee has earned to the date of termination. Revised April 2010 5 ii) Should this Agreement be terminated, the County shall deliver to PHS within thirty (30) days, at no additional cost, all deliverables including any electronic data or files relating to this Agreement. d. Waiver. The continuation of services by the County under this Agreement or the failure of the County to require compliance by the PHS with any provisions of this Agreement or the waiver by the County of any breach of this Agreement shall not constitute a waiver of any claim for damages by the County for any breach of this Agreement or a waiver of any other required compliance with this Agreement. 11. Additional Provisions a. Limitation and Assignment. The County and the PHS each bind themselves, their successors, assigns and legal representatives to the terms of this Agreement. Neither the County nor the PHS shall assign or transfer its interest in this Agreement without the written consent of the other. b. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. Consultant shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all anti- discrimination laws. Pursuant to the terms of North Carolina General Statute 153A- 449(b) no county may enter into a contract with a contractor unless the contractor and the contractor's subcontractors comply with the requirements of Article 2 of Chapter 64 of the North Carolina General Statutes. Where applicable, failure to maintain compliance with the requirements of Article 2 of Chapter 64 of the General Statutes constitutes Consultant's breach of this Agreement. By executing this Agreement Consultant affirms Consultant is in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. c. Dispute Resolution. Any and all suits or actions to enforce, interpret or seek damages with respect to any provision of, or the performance or non-performance of, this Agreement shall be brought in the General Court of Justice of North Carolina sitting in Orange County,North Carolina. It is agreed by the parties that no other court shall have jurisdiction or venue with respect to such suits or actions. The Parties may agree to nonbinding mediation of any dispute prior to the bringing of such suit or action. d. Entire Agreement. This Agreement represents the entire and integrated agreement between the County and the PHS and supersedes all prior negotiations, representations or agreements, either written or oral. This Agreement may be amended only by written instrument signed by both parties. Modifications may be evidenced by facsimile signatures. e. Severabilily. If any provision of this Agreement is held as a matter of law to be unenforceable, the remainder of this Agreement shall be valid and binding upon the Parties. Revised April 2010 6 f. Non-Appropriation. PHS 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 PHS of the unavailability and non-appropriation of public funds. It is expressly agreed that County shall not activate this non-appropriation provision for its convenience or to circumvent the requirements of this Agreement, but only as an emergency fiscal measure during a substantial fiscal crisis. In the event of a change in the County's statutory authority, mandate and/or mandated functions, by state and/or federal legislative or regulatory action, which adversely affects County's authority to continue its obligations under this Agreement, then this Agreement shall automatically terminate without penalty to County upon written notice to PHS of such limitation or change in County's legal authority. g. Notices. Any notice required by this Agreement shall be in writing and delivered by certified or registered mail, return receipt requested to the following: Orange County Piedmont Health Services, Inc. Attention: Health Director Attention: Brian Toomey P.O. Box 8181 299 Lloyd Street Hillsborough,NC 27278 Carrboro,NC 27510 h. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11 A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF, the Parties, by and through their authorized agents, have hereunder set their hands and seal, all as of the day and year first above written. ORANGE COUNTY: PHS: By: By: Bonnie Hammersley , Count(M ger Brian Toomey, Ex utive Director Federal Tax ID #: � This instrument has been approved as to technical content. LL L/z2& 11 Colleen Bridger, MPH, PhD, H th Director Revised April 2010 7 This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act. 061Z,_e_� ,ICJ Clarence G. Grier, Asst. County Manager/CFO This ' trum has been approved as to form and legal sufficiency. Ann tte M. M re, Offic of the County Attorney Revised April 2010 8 ° CD a) E c a) � N > c N 0 0 .Q ccuu Q- oU c i N 0 ° .Q O cn a) N Q c U) E - > ,o a) o co E cu FU a �—LD c � . cn L cu Q O N a) N U O L >+ L — CU q L L a) CL w c- CO) Cl-U •Q Z O i E - L = "' C °U E h h O cu cu H O CO ctl ° Q U w o � " °' > U U 'a > O � W U = N Ca CO) Z Z U }. Q � co Z cu cu Q cu U c ZO U a) -= O ° Y o cn z _ a) = X m C3 c a) a o o c LJJ O � (D a z tF � U W Q V o � a ° a) cu L L I� L J fs =n //„'ww►VV o z .`—° a � Q u, vim, o a) a) - E cu U .� a) > co c rn a) 'in cn V) p .L C ` 0 cu o aa)i 0 � S p c a) a- ^ U Q U U a) = L� •�CD O U �L �� a) 0) N O p .L �co Q T co O L (C u� O a) cu a) � UX N a) C O_ �, _O f6 O Q (B O O C jOPj O U Q 0 � C +-- O cu Q C (O a) N L •cn a) L Q� C"v 0) � j O � � wry CD W ° � c0 0 0 cu cc m cn a) O O U E c N a ,a U = U c ca ,a) "o u CU =3 cu O i>Z U m � p cu cu 'o = a) cu U N 0 a); '> cu Co N U 5 O COD cu J m 4) '— 'O X a) 0 Lp N Z U- WUW W Ws c Orf suoi�s;oadx3 spaaox3 suoi�m:)odx3 spaw juawmidwi SPOON PRIPuIns modes co C O U ai O .n cu a� m N OCo U O CD- Q = C L C O c0 O L N to N I- 6 7 O "N a 5 N N W 2 U C (Q N D U O_ -ffi � > O O O O cu E O Q cu -0 O U O N C N O N "d O U O- '> C N U to N O 2 Q cn CO CD cu co 0 C- 0 0 Q> Q cf) O N Q- M a. .0 CL O U U) C O 3:: C -O W a C CL .—L = U cu — cn E (O cu C N C O cu C U) N N U > C L O cu " " O U C O U- C 2 O O -0"a ,— Q O O N O 0)-D O U 'O cu r E O ?. O p C to Y ❑ O L O N L � O CO O O C- O - N fA C - O � 5 � O O N �� U cu OL U C N I CO O O �. cts ca U) (O cu 70 cu co N > C CD N C _ L N N�Q a O O N� O O v to = L U U Q- 8 �_ cu w IL N O C d C 0) U -6 O N N p Q E > C E E E U D cL E a m U � m U U suoi moadn sPOOOx3 suoi�moodn sjaaw iuowanoidwl SPOON Piepuins Mo1aB � M N � V3 -O L v W O (a U A U Q Q cn C L Z ca O o Q ca. O N W O CD ❑ Q L ❑ � ci ca ca E m U C O N O V O Z _O M O � M ca cu C CL N E W is s U) o ❑ w -❑ O _0 :3.._ LU (n Q L O ca co U S N O N O Q Q U N O ca Q C ❑ N _ ❑ E C C=� (a (A U � C- N Ci C N N O N C o cu a>o o O +� ❑r O U --O? CL O O L O O_ p O c "a �O O O O :> N CD El N N O = O O � O a � (a O Q vi O N cu O "O O O o C N 'a ca E a O� C cn a)U ca U _0 o o M U ca U " (D ca N _ .� ca m � O Q N E ca = C Q O CD CY cu °D � 4; c n ° m d N a. C O a) - v m c Q o E 0 c Q E Q c 0 E E n O N O O U) O ca o °' cO -a cn N ri Q a m w o o s w ¢ v suoi 1e13 odx3 SPOOOx3 suo.Iel:)Odx3 Spew ;uowoAoidwl SPOON PJepue)S M01813 U _O C s U () C W -0 C/) E cu cu c O L H W Z H � Z L 0 (Q cu O y w co 0 0 Q cn C cm w >' ❑ ❑ � U E J 0 C L N a cu O M Z = O ch N a a Cl El O c ❑ ui is ca 3 ° Q v> (D aa) CD-0 = N E N co ❑ o� E ❑ E co U c L CU co C U) u) �C L a) (D Cl)O � 'v E = c w O ❑ O Ln a) d U c O > E W ca V N U � C a) O O ca 0 W a) a) > 0 C-) a.. i. E 'a LO 0 y N d — LO t/) V (u O. v O L V 0 cm a N N t6 � a Q _C C C U v d � V U �ti Q ca Q U V suoi;e;3odx3 spaa3x3 suolp,psdx3 s;aaw ;uoweAoidwi SPOON paepue;g M01013 0 CL N co o � N "a o Y c Q U ca Cl) cn ca O Q co =3 0 N (D C a) L ca L ca L O O ca > O L U 0 a) Q > cn c cn O () a) O N N ca "O a) E O cm cu U) h 0_ T :a a) =3 U N O cn ca C i p u U Q �� a O N p N c 0O Z o 30 U a) E c v N a) ca C C�- N N N (a a) a) c Q N O N U N L O T E L!J C =3 O) 0 O (� C O .0 O a) O_ U Z O) N N O cm E O) U cc ca cn p CM ca .-. O ,c U ca i ca O a) E a)cn s. �' - c N .E cu O L Z a w M t O7 N a) O N �, �_ > Y O) ui G. ��. p Q- Y i M 3 "O N N _ _ ca N M J p O cu C (a p > ❑ O O = -0 (a ❑CD LL' 0 N m N = 0 ca a) o o L N L LJJ i "O c (a N E N O L _ O CD Z_ K _' L p L N +_ a) Q co U LU N N Q LO 0 ❑ 0 m L N co> m m m N -� in 2 Q-� N v, -• ca E ❑ cn Q L + p O to > C O E O at C- cn 0 Co t/ L d rn_ N o o E c ca ° ° Q N c `- � U 'tn C .� O O O x CD- a) U � > m Q- � E ? 3 U m m c a� L � a� m L o (a o E N CAN O - L 0 CL.4) U U O O N N L N Q CD LD N °� c o v m o -0 ca E CD cc a) O = N a) p N ._ .]C Y Q (a C ._ E ° - c a ° a) j o `o ' `o °' o ca > a) - > o >, 3 c 'c E Q a) >,E CD N q? cn cu Co 0 V N (a O cn ♦+ O 1 cB ca O 0 w N O L .N C' N E O Q E N N N �n Q) co O E E '� o C N O N O O o � N (a N in suoplloOdx3 SPOOOx3 suoi RL loodn s;OOw luewoAoidwl SPOON PiOPuels M01813 c 0 a� c cu (D a) � C O c > 0_ ca 0 m 0 aD C � _c cu co cn ai vi =3 U NQ U N N Q � Z cu C C (� N 0 ` cn CO) U Q (B V N a) cu U a)q cn Z to Q 'O O "0 cn O U � D El cn cu cn E � N Q L LL � _ O ca "O d O _ O N Co M 0 J cn- ❑ Q O C (1) U) Cl) ` U Q C : _ LLJ V C i � C O Z ca O E N i U) �.., _ '� C E C to c0 fn O a) Q (� _ E c' O C "0 C p L (O 0 OU =3 O U C 2 CL C •.. 0_ C V i E � 4) O) (B O a) O) = Co OU Y C a) U C ca C =3 C O ID _c 0 -0 >, a) -0 cn U E cu Q U a) L 00 -0 a) CD 0 c C cc 0 O 0 •y 0 C '� -0 .� U (6 U 0 C C a) N a) O) Q N O_ O fa > R O .Q? C)- C a) L cB U .— > d O U co 0 (n a) O_ C w cn cn c C ° c a) cn ca E Fu A2 4 Z L' .2- 0 0 E E ao —5- ti Q O Q 2 U U suopepodx3 sPOOOx3 suorge;oedx3 Spew luowoAoidwl SPOON PaePuBIS MOIOB N O c6 U Q U Q _O 5 N O N .-- � — C O ca O Q E N — U N E CU O Q (C C) in � c c cn N _ ca O O (a .: LO - U E ° a. O a� to v� CD U) — ca cn Q O N N E c N N Co Z cn O- o co C L =3 U Q co >+ O Q O N N LU co cn C >+ N cr V L N c' (a C) L �O Z E n v 3 c et Q > L ❑ U N 0 0L ❑ Ca O U c O N O U) :E O a� :- ca E > N c LL U > CD Y = O cn U cu O C W N ca ca M O i = cu O M .0 E cn > Q v N U NO fa > Co El vj L . U U to 'j (La fn X N C >+ fn O_ �- L Lu U ca = s CDL Z E > O_Y N N 0) U -� `� Q N E to O O cn 0 U ca > � c � •— � L N C L O C O O c c 0 0 E N C Q OU ca «�cn ca N U U 0 0 >+ d >' O , O cc: ca -2 > E -� C E Q E L E 'a > O O c cn U 0 0 0 O N O C Q 3r 8 O `O ca V5 cl O O C cu R O N ca v c C 'a"a cu a) — cn O _ 0 _ 0 Q >> Cl' ci O a ' d `•- 0 O "O U Q � co :5 Q O N T `iE N N O '— c � •� CD C CY cu O O cLa C w L O O 0 C � LJ I O N N _0 N N d d � N +�' N a�i '� cca m CL E o �- o Ln o E L > c E E E c of U aL_ � C/) (1)� (1)0 ° CU of 0 0 0 U k k � / 2 k 0 k E § D \ � � \ o � f k / % k x k © g a 2 cu co 0- / > E § & o m E U CL q e 0 0 cu cu a) ® CD ® x E U >1 q f ) k o 2 2 y k k k k 0 0 Mn ca C S ! / (D 2 � a) � / . E o / ca < § E o ■ 0)4 § 7 a x% o w 2 E $ CL R § o � ■ @ E w ■ z o (D u � � " t CD CD � O z 3 a� m c a� E a� a� L cu cu cu O a) E 2 cm cu co U cn L CD cu N cu E N o V� co >1 N °—� 0- 0 0 O aa) a� L N O cu O E cr- CD CD ca � C a E (B O N O Q C > co cu � � N cu N 2 cu cu L 'i a a) L fn = L w+ � .1�- cc L RS cv -0 cB ° o C"O> CM N i . co L L p p >, O m o D CD Z CD- CL c>a Q- Q- c>u QE U a) lJJ W W co s co U W PIEDM17 OP ID: KB CERTIFICATE OF LIABILITY INSURANCE DATE 10/141204/20 4 14 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(ies) 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 NAME: Dick Dickens,CIC Senn Dunn-High Point PHONE 336-899-2406 a/c No 1400 Eastchester Drive,St 200 A/C No Ext High Point,NC 27265 E-MAIL ddickens@senndunn.com M.Bryan Beasley,CIC ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Co of Amer 12572 INSURED Piedmont Health Services Inc. INSURER B:Selective Insurance Companies 12572 299 Lloyd St. Carrboro,NC 27510 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 TYPE OF INSURANCE DDL UBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 B X COMMERCIAL GENERAL LIABILITY S1971482 02/01/2014 02/01/2015 DAMA 100,000 PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 B X BusinessOwners 51971481 02/01/2014 02101/2015 PERSONAL&ADV INJURY $ 1,000,00 GENERALAGGREGATE $ 3,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3,000,000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ B X ANY AUTO S1971482 02/0112014 02/01/2015 BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS (PEP ACCIDENT) $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 B EXCESS LIAR CLAIMS-MADE S1971482 0210112014 02/01/2015 AGGREGATE $ 3,000,000 DED I X I RETENTION$ -0- $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY T CRY LIMIT ER YIN A ANY PROPRIETOR/PARTNER/EXECUTIVE WC 7977892 02/0112014 02/0112015 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION ORANGOV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Orange County Government ACCORDANCE WITH THE POLICY PROVISIONS. 200 S Cameron Street Hillsborough,NC 27278 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD