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Home My WebLink About2015-226-E Aging - Jennifer Sugg, R.N. for fit feet nurse $980DocuSign Envelope ID: 1F60EHA- F8313-41 CE-BF1 1-1 370E9736968 [Departmental Use Only] TITLE Wellness Contract FY 2014 -15 ORANGE COUNTY CONTRACT UNDER $1,000.00 NORTH CAROLINA THIS AGREEMENT, made and entered into this 18"' day of May, 2015, ( "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 Jennifer Sugg, 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 and /or construction (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 May 20 to June 30, 2015. 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. Pam: 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 $980.00, ($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 contractor, 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. Revised 10/14 DocuSign Envelope ID: 1F60EHA- F8313-41 CE-BF1 1-1 370E9736968 4. Insurance: Provider shall obtain, at its sole expense, Commercial General Liability Insurance, Automobile Insurance, Workers' Compensation Insurance, and any additional insurance as may be required by Owner's Risk Manager as such insurance requirements are described in the Orange County Risk Transfer Policy and Orange County Minimum Insurance Coverage Requirements (each document is incorporated herein by reference and may be viewed at htlp: / /oran eg counlync .gov/purchasing /contracts.asp). If Owner's Risk Manager determines additional insurance coverage is required such additional insurance shall be designated here professional liability (if no additional insurance required mark N/A as being not applicable). Provider shall not commence work until such insurance is in effect and certification thereof has been received by the Owner's Risk Manager. 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 in carrying out Provider's duties and obligations related to the Services to be provided in this Agreement. 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 and Signatures: 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. 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 I IA and Article 40 of North Carolina General Statute Chapter 66. 8. Governing Law and Priority Both parties agree that this Agreement shall be governed by the laws of the State of North Carolina. In determining the basic services to be provided, should any documents be referenced in or attached to this Agreement, the terms herein shall have priority in any conflict between the terms of referenced documents and the terms of this Agreement. 9. Dispute Resolution: Neither party may initiate binding arbitration. Any disputes shall be resolved by nonbinding mediation. 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. 10. 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. [SIGNATURE PAGE TO FOLLOW] Revised 10/14 2 DocuSign Envelope ID: 1F60EHA- F8313-41 CE-BF1 1-1 370E9736968 IN WITNESS WHEREOF, Orange County and the Provider have signed this Agreement, effective as of the day first written above. ORANGE COUNTY By. [—DocuSigned by: ,� U— - yt'r a71 i�IYIOTPector 200 S. Cameron St. P.O. Box 8181 Hillsborough, NC 27278 Revised 10/14 PROVIDER DocuSigned by: By: ' -- s Title. 76E4BF656C824A4... Jennifer Sugg P O Box 272 Bynum, NC 27228 DocuSign Envelope ID: 1F60E2EA- F83B -41 CE-BF1 1-1 370E9736968 HEALTHCARE PROVIDERS SERVICE ORGANIZATION PURCHASING GROUP CNA certificate of kfsurance ns' nurses service organization OCCURRENCE POLICY FORM PRODUCER BRANCH PREFIX POLICY NUMBER Policy Period: 018098 970 HPG 0617869543 -8 From 04/22/15 to 04/22/16 at 12:01 AM Standard Time Named Insured Program Administered by: Nurses Service Organization Jennifer Sugg 159 E. County Line Road PO Box 272 Hatboro, PA 19040 -1218 Bynum, NC 27228 -0272 1- 800 - 247 -1500 www.nso.com Medical Specialty Code Insurance is provided by: Registered Nurse 80964 American Casualty Company of Reading, Pennsylvania 333 South Wabash Avenue Chicago, Illinois 60604 Professional Liability $1,000,000 each claim $6,000,000 aggregate Your prc`.essiond 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 & Penalties $ 25,000 per incident $ 25,000 aggregate Workplace Liability Workplace Liability Included in Professional Liability Limit shown above Fire and Water Legal Liability Included in the PL limit above subject to $150,000 aggregate sublimit Personal Liability $1,000,000 aggregate Total: $53.00 Premium reflects employed, full -time rate with recent graduate discount. Policy Forms & Endorsements (Please see attached list for a general description of many common policy forms and endorsements.) G- 121500 -D G- 121501 -C G- 121503 -C G- 145184 -A G- 147292 -A GSL3886 GSL3908 GSL13424 GSL15563 GSL15564 GSL15565 GSL17101 CNA80052 CNA80051 G- 123846 -C32 GSL10546NC K O v�ra� 4r "'al ice- v y�11'ii 4—% Chairman of the Board Secretary Keep this Certificate of Insurance in a safe place. This Certificate of Insurance and proof of payment are your proof of coverage. There is no coverage in force unless the premium is paid in full. In order to activate your coverage, please remit premium in full by the effective date of this Certificate of Insurance. Form #: G- 141241 -B (3/2010) Master Policy: 188711433