HomeMy WebLinkAbout2015-302-E DSS - Bethesda Care, LLC dba Keston Care for RN services $10,000 DocuSign Envelope ID: 10E673C3-E710-42EA-A3C9-4B338A28EADF
[Departmental Use Only]
TITLE Bethesda Care
FY 2014-15
ORANGE COUNTY
CONTRACT UNDER $15,000.00
NORTH CAROLINA
THIS AGREEMENT, made and entered into this 30tb day of March, 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 Bethesda Care, L.L.C. dba Keston Care
(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: The Provider will provide a Registered Nurse to make home visits for
the purpose of conducting RN assessments of beneficiaries of the Community Alternatives Program for
Disabled Adults (CAP/DA) in Orange County and entering the required data in e-CAP. Assessments will be
scheduled by the CAP/DA case managers in the Adult Services Unit of OCDSS.
The Registered Nurse will attend OCDSS approved training prior to performing any such
assessments, and attend any new training as necessary. .
The term of this agreement rendered shall be from March 30, 2015 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. 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 Ten
Thousand Dollars and 001100, ($10,000). The Provider will be paid at a rate of$30/per hour. Provider shall
also be reimbursed at a rate of Zero Cents (¢0) per/mile for mileage costs. 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
Revised 7114 1
DocuSign Envelope ID: 10E673C3-E710-42EA-A3C9-4B338A28EADF
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: 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 ht :/loran ecount c. ov/ urchasin contracts.as ).
If Owner's Risk Manager determines additional insurance coverage is required such additional insurance
shall consist of General Liability Professional that includes coverage for abuse or sexual misconduct and
employee theft (if no additional insurance required mark NIA 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. Indemnitv: 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 and Si natures: 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. 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. Priori : In determining the basic services to be provided, should any documents be
referenced in this Agreement, the terms herein shall have priority in any conflict between the terms of
referenced documents and the terms of this Agreement.
9. Governing Law: Both Both p arties 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. Provider 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 Provider's
breach of this Agreement. By executing this Agreement Provider affirms Provider is in compliance with
Article 2 of Chapter 64 of the North Carolina General Statutes.
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.
Revised 7114 7
DocuSign Envelope ID: 10E673C3-E710-42EA-A3C9-4B338A28EADF
IN WITNESS WHEREOF,Orange County and the Provider have signed this Agreement, effective
as of the day first written above.
Oad,NTY PRORsigned by:
jOV�,Vt tf �AaM1Mt,V'S 30/2015 p �OAIn l�t, SS�t /9/2015
By.t7 4835SE4��... Dy. A419EAGAE43741A
Bonnie Hammersley, County Manager
200 S. Cameron St. Roxanne Kessler
P.O. Box 8181 11312 US 15-501, Chatham Crossing Suite 400
Hillsborough,NC 27278 Chapel Hill, NC 27517
Revised 7114 3
DocuSign Envelope ID: 10E673C3-E710-42EA-A3C9-4B338A28EADF
First
,.Y . . .
Eft
klsurance Cmp(yrly
I South Wacker Drive, Suite 238,0:
Chicago, IL 60606
312-715-3010
MULTIPLE PERIL POLICY
DECLARATIONS
f7oliGy Number:,Ni'P1006082 00 Producer:Insurance,service Canter of F ayettevilla,
Named Insured: Bethesda Care LLC,:
Keston Care
M601ing Addrm 1:1:312 Hwy 15.501 Norlb
Obatham Crossing.Ste 400
Chapel.Hill NC 27514
Term of CoverW. Frarrt 10/5/2014 To 10/612015 12:01'a.m.Loral Tilte at,Your
Mailin Address,Si own Above
Rost Anrtu'2'd Premium: �1
Cwnragee Provided
In return for your payment of the f"uir0d.Pfsmlum,we provide the covera;tge.described irr"tht PoIIGy*"
Section In
A. General Conditions
Property lnsuranc43,yes
8.. Terms&Conditions—All Propeny`and ReWed Coverages .
Option Coverages ,
C. General Property
D, income Protection&a~)dra Expense
E. Sect Pera4nal PrOp"
F.. Garrtpu4ers ® :El G. Grime
Prirrrary l_iaVd1ty lrlUrances
H. Terms 8r<Conditions—.Primary i_iability Coverages
�, t�pticu181 Ccrve�ageffi
1 $0011y fniury and Property Dacnsge 1 iability � I
J1 Sexual Abuse Liat lhty
K. Social Work.:FosWCare and Counseling Liability 0 13
4_ Mcaf Lability
.M. Personal and Advertising Injury,Liability �
N. Non-Owned and:Ffired i to Liability .
C. Medical Payments
P. Employee Benefits Administration Liability E3 Is
Additional fonds applicable to this policy:
Cate: 1 DM014 by:
W
-
First Rona`ofit In su1 eh' GA ! ',
Authorized.Rapressni�ve
:-� 0412f!O PKG 1000 Page 1 bf"5
DocuSign Envelope ID: 10E673C3-E710-42EA-A3C9-4B338A28EADF
PRIMARY LIABILITY DECLARATIONS
LIMITS OF C VERAGE
Combined Policy Year Annual Aggregate Limit—Applicable to
Sections I.,J., K. and L. $ 3.00D G 0
Section L
Bodily Injuryy and Property Damage Liability
Each Occurrence Limit - $ $1,W0,000
Section J.
Sexual Abuse Liability
Each Sexual Abuse Occurrence Limit $ 1,000;000
Section K.
Social Work, Foster Care and Counseling Liability
Each Social Work Occurrence Limit $ 1,000,000
Section L.
Medical Liability
Each Medical Incident Limit $ 1,0D0,000`
Section M.
Personal and Advertising Injury Liability
Policy Year Annual Aggregate Limit $ 1,0()0,
Section N.
Non-Owned and Hired Auto Liability
Each.Aocident Limit $ 1.000,000
Section 0.
Medical Payments $ 5,000 per Person
$ 251000 per Occurrence
$ 75.OW Policy Year
Annual Aggregate
Section P.
Employee Benefit Administration Liability $ NOT PROVIDED each Clain
NOTPROVIDED Policy Year
Annual Aggregate
Page 5 of 5
0412010 P.G 1000
DocuSign Envelope ID: 10E673C3-E710-42EA-A3C9-4B338A28EADF
k?$V cr?M cmpany
1 South Wacker DriVe, Suite 2380
Chicago, IL 60606
312-715-3010
UMBRELLAUABILITYPOUCY
C 5NERAl..DECLARATIONS
Policy Number.: NAm sioo=3 oo Producer i f Fy ,t a ce nr.
'Renewal of Policy Nufhber.: Now
1. Named Insured: Ewthesda care LLc
1.1312 Hwy 15-501 North
Main t th ix s: Cheaham Crossing Ste 400
Chapel Hilt N0,27514
2. Policy Penod: From: I(YW2o14 To: tat ols
12:01 a.m. Local Time at Mailing.Address Above
3. Annual Pren ium-
4. Limits of Insurance and Retention:
a. 1.170000 Each' occurrence Limit
b. 1,00o,00o General Aggregate Limit
C' - � Retained Limit
Underlying Policies and Limits:
Coverage Limits Insurer T.
�,aoo,a�o Grcc+i�eRCa B iota naxee- 1q;�r�sta
General
Liability t06JTfPi 5
NPP1006= 3;a00000 1Gener Ay®reyaae
Employees
. SQp.ifUi) .AtaefiACCidaiit. Stmsswaoq 7!i}12E7t4 ,
Liability
W0100-009512 5£30.000 f0i®eese Po y L !
Other.Liability 500.000 Uwase Ewh EffOoyee
Additional Farms Applicable To This Policy At Issuance:
8 '
Date:1"M14 Br_
Authorit0d Representative
Fi t lit rofit i,rraure lr r p€tny
DocuSign Envelope ID: 10E673C3-E710-42EA-A3C9-4B338A28EADF
HEALTHCARE PROVIDERS SERVICE
CNAORGANIZATION PURCHASING GROUP mnso
(Certificate of 31110urance nurses service orpnizatimr
OCCURENCE POLICY FORM Print Date: 2109!2015
Producer Branch Prefix Policy Number Policy Period
018098 970 HPG 0428064583 from 02118/15 to 02118116 at 12:01 AM Standard Time
Named Insured and Address: Program Administered by:
Colleen Black Semelka Nurses Service Organization
265 Severin St 159 E. County Line Road
Chapel Hill, NC 27516-1511 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
333 S.Wabash Avenue, Chicago, IL 60604
Professional Liability $1,000,000 each claim $3,000,000 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 $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 $1,000,000 aggregate
Total: $ 102.00
Base Premium $102.00
Premium reflects 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
Keep this document in a safe place.It
and proof of payment are your proof of
I coverage. There is no coverage in force
Cf. unless the premium is paid in full.In order
to activate your coverage,please remit
Chairman of the Board Secretary premium in full by the effective date of
this Certificate of Insurance.
Master Policy# 188711433
G-141241-13(0312010) Coverage Change Date: Endorsement Change Date: